Abstract

We describe a 7-year-old male with high functioning autism spectrum disorder (ASD) and maternally-inherited rare missense variant of Synaptotagmin-like protein 4 (SYTL4) gene (Xq22.1; c.835C>T; p.Arg279Cys) and an unknown missense variant of Transmembrane protein 187 (TMEM187) gene (Xq28; c.708G>T; p. Gln236His). Multiple in-silico predictions described in our study indicate a potentially damaging status for both X-linked genes. Analysis of predicted atomic threading models of the mutant and the native SYTL4 proteins suggest a potential structural change induced by the R279C variant which eliminates the stabilizing Arg279-Asp60 salt bridge in the N-terminal half of the SYTL4, affecting the functionality of the protein’s critical RAB-Binding Domain. In the European (Non-Finnish) population, the allele frequency for this variant is 0.00042. The SYTL4 gene is known to directly interact with several members of the RAB family of genes, such as, RAB27A, RAB27B, RAB8A, and RAB3A which are known autism spectrum disorder genes. The SYTL4 gene also directly interacts with three known autism genes: STX1A, SNAP25 and STXBP1. Through a literature-based analytical approach, we identified three of five (60%) autism-associated serum microRNAs (miRs) with high predictive power among the total of 298 mouse Sytl4 associated/predicted microRNA interactions. Five of 13 (38%) miRs were differentially expressed in serum from ASD individuals which were predicted to interact with the mouse equivalent Sytl4 gene. TMEM187 gene, like SYTL4, is a protein-coding gene that belongs to a group of genes which host microRNA genes in their introns or exons. The novel Q236H amino acid variant in the TMEM187 in our patient is near the terminal end region of the protein which is represented by multiple sequence alignments and hidden Markov models, preventing comparative structural analysis of the variant harboring region. Like SYTL4, the TMEM187 gene is expressed in the brain and interacts with four known ASD genes, namely, HCFC1; TMLHE; MECP2; and GPHN. TMM187 is in linkage with MECP2, which is a well-known determinant of brain structure and size and is a well-known autism gene. Other members of the TMEM gene family, TMEM132E and TMEM132D genes are associated with bipolar and panic disorders, respectively, while TMEM231 is a known syndromic autism gene. Together, TMEM187 and SYTL4 genes directly interact with recognized important ASD genes, and their mRNAs are found in extracellular vesicles in the nervous system and stimulate target cells to translate into active protein. Our evidence shows that both these genes should be considered as candidate genes for autism. Additional biological testing is warranted to further determine the pathogenicity of these gene variants in the causation of autism.

Highlights

  • Whole exome sequencing (WES) and occasionally whole-genome sequencing (WGS) are increasingly used in clinical practice for diagnosis, medical intervention and prognosis [1,2,3]

  • It should be noted that the Synaptotagmin-Like Protein 4 (SYTL4) mRNAs are found in extracellular vesicles and stimulate target cells to translate into active protein [78]

  • Both Q236H Transmembrane protein 187 (TMEM187) and R279C SYTL4 gene variants have been predicted to be damaging or deleterious by SIFT, PolyPhen2, MutationTaster, Provean, and LRT variant calling programs; 3. Both TMEM187 and SYTL4 mRNAs are found in extracellular vesicles and stimulate target cells to translate into active protein [17], and the release and uptake of extracellular vesicles in the nervous system and glial cells provides novel mechanisms of transcellular communication [73]; 4

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Summary

Introduction

Whole exome sequencing (WES) and occasionally whole-genome sequencing (WGS) are increasingly used in clinical practice for diagnosis, medical intervention and prognosis [1,2,3]. High heritability estimates and family studies have supported a definite role of genetics in autism spectrum disorder (ASD). We describe a 7-year-old male with high-functioning autism spectrum disorder presenting for genetic services and whole exome sequencing following a normal microarray analysis, and variants were found in two X-linked genes: SYTL4 and TMEM187. SYTL4 gene, known as Granuphilin/SLP4, encodes a member of the synaptotagmin-like protein family. Members of this family are characterized by an N-terminal RAB27-binding domain and C-terminal tandem C2 domains (Figures 1 and 2). The encoded protein binds to specific small RAB-GTPases involved in intracellular membrane trafficking. This protein binds to RAB27 and may be involved in inhibiting dense core vesicle exocytosis. Alternate splicing results in multiple transcript variants that encode the same protein

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