Abstract
BackgroundMutations in the SLC26A4 gene are associated with Pendred syndrome and autosomal recessive non-syndromic deafness (DFNB4). Both disorders have similar audiologic characteristics: bilateral hearing loss, often severe or profound, which may be associated with abnormalities of the inner ear, such as dilatation of the vestibular aqueduct or Mondini dysplasia. But, in Pendred syndrome (OMIM #274600), with autosomal recessive inheritance, besides congenital sensorineural deafness, goiter or thyroid dysfunctions are frequently present. The aim of this study was to determine whether mutations in SLC26A4 are a frequent cause of hereditary deafness in Brazilian patients.MethodsMicrosatellite haplotypes linked to SLC26A4 were investigated in 68 families presenting autosomal recessive non-syndromic deafness. In the probands of the 16 families presenting segregation consistent with linkage to SLC26A4, Sanger sequencing of the 20 coding exons was performed. In an additional sample of 15 individuals with suspected Pendred syndrome, because of the presence of hypothyroidism or cochleovestibular malformations, the SLC26A4 gene coding region was also sequenced.ResultsIn two of the 16 families with indication of linkage to SLC26A4, the probands were found to be compound heterozygotes for probably pathogenic different mutations: three novel (c.1003 T > G (p. F335 V), c.1553G > A (p.W518X), c.2235 + 2 T > C (IVS19 + 2 T > C), and one already described, c.84C > A (p.S28R). Two of the 15 individuals with suspected Pendred syndrome because of hypothyreoidism or cochleovestibular malformations were monoallelic for likely pathogenic mutations: a splice mutation (IVS7 + 2 T > C) and the previously described c.1246A > C (p.T416P). Pathogenic copy number variations were excluded in the monoallelic cases and in those with normal results after Sanger sequencing. Additional mutations in the SLC26A4 gene or other definite molecular cause for deafness were not identified in the monoallelic patients, after exome sequencing.ConclusionsBiallelic pathogenic mutations in SLC26A4 explained ~ 3% of cases selected because of autosomal recessive deafness. Monoallelic mutations were present in ~ 13% of isolated cases of deafness with cochleovestibular malformations or suspected Pendred syndrome. These data reinforce the importance of mutation screening of SLC26A4 in Brazilian subjects and highlight the elevated frequency of monoallelic patients.
Highlights
Mutations in the SLC26A4 gene are associated with Pendred syndrome and autosomal recessive non-syndromic deafness (DFNB4)
Patients A total of 31 unrelated patients were selected to the molecular study of the SLC26A4 gene by Sanger sequencing, divided into two groups, based on clinical and genetic findings, as follows: (A) A sample of 68 pedigrees with hearing loss with presumed autosomal recessive inheritance was considered eligible to haplotype analysis with microsatellite (STR) markers linked to the Autosomal Recessive Deafness Locus number4 (DFNB4)
16 probands from the remaining pedigrees with haplotype segregation compatible with DFNB4 were selected to sequencing of the SLC26A4 gene. (B) 15 patients suspected of Pendred syndrome, because of the presence of hearing loss associated with thyroid dysfunction, or because of the presence of hearing loss with enlarged vestibular aqueduct (EVA) or presenting hearing loss associated to other cochlear/vestibular malformation
Summary
Mutations in the SLC26A4 gene are associated with Pendred syndrome and autosomal recessive non-syndromic deafness (DFNB4). Both disorders have similar audiologic characteristics: bilateral hearing loss, often severe or profound, which may be associated with abnormalities of the inner ear, such as dilatation of the vestibular aqueduct or Mondini dysplasia. In Pendred syndrome (OMIM #274600), with autosomal recessive inheritance, besides congenital sensorineural deafness, goiter or thyroid dysfunctions are frequently present. Mutations in the SLC26A4 gene (NM_000441) were found to be causative of two autosomal recessive disorders, Pendred syndrome (OMIM # 274600) and one of the forms of non-syndromic autosomal recessive hearing loss (DFNB4; #600791) [4]. Because of the variable expressivity and overlap of the clinical features, the two conditions may be considered as subsets of the spectrum of clinical manifestations of one single genetic entity [5]
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