Wolf-Hirschhorn Syndrome Research Articles

Prenatal diagnosis of 18p deletion and 8p trisomy syndrome: literature review and report of a novel case

18p deletion syndrome constitutes one of the most frequent autosomal terminal deletion syndromes, affecting one in 50,000 live births. The syndrome has un-specific clinical features which vary significantly between patients and may overlap with other genetic conditions. Its prenatal description is extremely rare as the fetal phenotype is often not present during pregnancy. Trisomy 8p Syndrome is characterized by heterogenous phenotype, with the most frequent components to be cardiac malformation, developmental and intellectual delay. Its prenatal diagnosis is very rare due to the unspecific sonographic features of the affected fetuses. We present a very rare case of a fetus with multiple anomalies diagnosed during the second trimester whose genomic analysis revealed a 18p Deletion and 8p trisomy Syndrome. This is the first case where this combination of DNA mutations has been described prenatally and the second case in general. The presentation of this case, as well as the detailed review of all described cases, aim to expand the existing knowledge regarding this rare condition facilitating its diagnosis in the future.

Evaluation of the Sleep Profile in Children With Cri du Chat Syndrome: A Pilot Study

Evaluation of the Sleep Profile in Children With Cri du Chat Syndrome: A Pilot Study

Epilepsy and congenital cerebral palsy: Parallels between the location of genome anomalies and clinical manifestations

Progress in molecular genetics is gradually leading to a radical revision of the understanding of the nature of not only recognized genetically determined diseases, but also those whose genetic nature has only been assumed. More and more information is emerging about polygenic and/or multifactorial diseases. The authors P.L. Sokolov and N.V. Chebanenko in 2022 proposed the concept of a neurotropic genome and the classification of genes, according to their “areas of responsibility” – points of application of determinant activity. There is a growing number of scientific works on the dependence of the pathological phenotype on the nature of the mutation and its localization along the gene.In this article, using the example of Wolf–Hirschhorn syndrome, variants of the dependence of the phenotype on the location of the genome abnormality are considered. A case of a disease from the authors’ practice, in which epilepsy and cerebral palsy predominate, is presented; the phenotype is analyzed with the nature and location of the identified genetic anomaly. The authors make assumption about the connection between the nature and location of the genome anomaly and the characteristics of the phenotype.

Analysis of genetic etiology in a patient with 1p36 deletion syndrome in conjunct with Snijders Blok-Campeau syndrome

To explore the genetic basis for a patient with unexplained developmental delay and special facial features. A male patient admitted to the Maternal and Child Health Care Hospital of Gansu Province on May 27, 2021 due to infertility was selected as the study subject. Clinical data of the patient was collected, and genomic DNA was extracted from peripheral blood samples from the patient and his parents. Whole exome sequencing (WES) was carried out, and candidate variant was verified by Sanger sequencing. The patient was found to harbor a 2.54 Mb deletion in 1p36.33p36.32 and a heterozygous c.1123G>C (p.E375Q) variant of the CHD3 gene, neither of which was detected in his parents. The patient was diagnosed with Snijders Blok-Campeau syndrome in conjunct with 1p36 deletion syndrome, which has enabled genetic counseling for his family.

A focused surgical case report: Managing scoliosis in Wolf–Hirschhorn syndrome

IntroductionWolf–Hirschhorn syndrome (WHS) is a genetic disorder from a chromosomal deletion on chromosome 4, leading to systemic pathologies including spinal deformities like scoliosis.AimThe objective of this publication is to present a case of scoliosis treatment in a patient with WHS, where the primary goal was to halt the progression of the curvature and achieve the most effective correction of the deformity, despite the guardians' refusal to extend the stabilization system to the pelvis.Case studyPreoperative radiographs revealed a single-curve scoliosis of 64°, as measured by the Cobb method between Th11 and L5. Prior to the scheduled procedure, a magnetic resonance imaging examination of the spinal column was conducted to potentially visualize any spinal cord pathology. A corrective procedure, posterior spinal fusion, was performed using cobalt-chrome rods. A postoperative posturographic control examination was conducted, and follow-up outpatient visits were recommended.Results and discussionDespite not implementing the stabilization system to the pelvis, a reduction in deformation by 22° was achieved, resulting in 42° measured between Th11 and L5. In a follow-up examination 18 months post-operation, the degree of deformity remained stable, maintaining the curvature angle of 42° measured between Th11 and L5.ConclusionsTreating scoliosis in patients with WHS requires a tailored approach, considering the specifics of their condition and utilizing optimal spinal stabilization methods. A multidisciplinary approach, integrating various therapeutic modalities, is crucial for enhancing the quality of life of WHS patients.

Cri Du Chat Syndrome: A Case Study

Cri du Chat syndrome (CdCS) is a chromosomal abnormality resulting from a deletion of variable size at the end of the short arm of chromosome 5 (5p), including a critical region located at p15.2. It is one of the most common chromosomal deletions, with an incidence in the general population of between 1:20,000 and 1:50,000. Clinical features include an acute monochromatic cry, microcephaly, characteristic craniofacial dysmorphia progressing with age and significant mental and psychomotor retardation. The size of the deletion varies, and treatment depends on the various symptoms. Parental chromosomal rearrangement is found in 12% of cases and the majority of deletions responsible for cri-du-chat disease occur de novo. We present an observation of a Cri du Chat syndrome, confirmed by metaphasic karyotype (46, XY,del(5)(p13) de novo). Through this observation we will update the scientific news of this rare syndrome, as well as the place of cytogenetic explorations in the precise diagnosis and genetic counselling of dysmorphic syndromes.

Clinical details of individuals with Rauch-Steindl syndrome due to NSD2 truncating variants.

Rauch-Steindl syndrome (RAUST) is a very rare genetic syndrome caused by a pathogenic variant in NSD2 on chromosome 4p16.3. Although NSD2 was previously thought to be the major gene in Wolf-Hirschhorn syndrome (WHS), a contiguous gene syndrome of chromosome 4p16.3 deletion, RAUST has been found to present different facial and clinical features from WHS. In this study, we report the details of two newly diagnosed individuals with RAUST in order to better understand the molecular and clinical features of RAUST. Whole-genome sequencing was performed on two individuals with psychomotor delay and growth failure. Detailed clinical evaluation of growth parameters, craniofacial features, electroencephalogram (EEG), magnetic resonance imaging of the brain, and developmental assessment were performed. Both individuals had de novo truncating variants in NSD2. One had a novel variant (c.2470C>T, p.Arg824*), and the other had a recurrent variant (c.4028del, p.Pro1343Glnfs*49). Both exhibited characteristic RAUST facial features, growth failure, and mild psychomotor delay. A novel finding of RAUST was seen in individual 2, a Chiari malformation type 1, and both showed delayed bone age. They lacked common WHS features such as congenital heart defects, cleft lip/palate, and seizures (EEG with abnormal findings). We present a novel variant and clinical presentations of RAUST, expand the molecular and clinical diversity of RAUST, and improve our understanding of this rare syndrome, which is distinct from WHS. Further researches are needed on more RAUST cases and on functional analysis of NSD2.

PRDM16 co-operates with LHX2 to shape the human brain.

PRDM16 is a dynamic transcriptional regulator of various stem cell niches, including adipocytic, hematopoietic, cardiac progenitors, and neural stem cells. PRDM16 has been suggested to contribute to 1p36 deletion syndrome, one of the most prevalent subtelomeric microdeletion syndromes. We report a patient with a de novo nonsense mutation in the PRDM16 coding sequence, accompanied by lissencephaly and microcephaly features. Human stem cells were genetically modified to mimic this mutation, generating cortical organoids that exhibited altered cell cycle dynamics. RNA sequencing of cortical organoids at day 32 unveiled changes in cell adhesion and WNT-signaling pathways. ChIP-seq of PRDM16 identified binding sites in postmortem human fetal cortex, indicating the conservation of PRDM16 binding to developmental genes in mice and humans, potentially at enhancer sites. A shared motif between PRDM16 and LHX2 was identified and further examined through comparison with LHX2 ChIP-seq data from mice. These results suggested a collaborative partnership between PRDM16 and LHX2 in regulating a common set of genes and pathways in cortical radial glia cells, possibly via their synergistic involvement in cortical development.

Loss of function in NSD2 causes DNA methylation signature similar to that in Wolf-Hirschhorn syndrome

PurposeWolf-Hirschhorn syndrome (WHS), a contiguous gene syndrome caused by heterozygous deletions of the distal short arm of chromosome 4 that includes NSD2, reportedly causes specific DNA methylation signatures in peripheral blood cells. However, the genomic loci responsible for these signatures have not been elucidated. The present study aims to define the loci underlying WHS-related DNA methylation signatures and explore the role of NSD2 in these signatures. MethodsWe conducted genome-wide methylation analysis of individuals with WHS or NSD2 variants using an array method. We studied genome-edited knockin mice and induced pluripotent stem cells to explore the function of NSD2 variants. ResultsThree undiagnosed cases with NSD2 variants showed WHS-related DNA methylation signatures. In patient-derived induced pluripotent stem cells and genome-edited knockin mice, these variants cause NSD2 loss of function, respectively. The p.Pro905Leu variant caused decreased Nsd2 protein levels and altered histone H3-lysine 36 dimethylation levels similarly to what was observed in Nsd2 knockout mice. Nsd2 knockout and p.Pro905Leu knockin mice exhibited common DNA methylation changes. ConclusionThese results revealed that WHS-related DNA methylation signatures are dependent on NSD2 dysfunction and could be useful in identifying NSD2 variants of uncertain significance.

Esophageal Cancer with Early Onset in a Patient with Cri du Chat Syndrome.

In Cri du Chat (CdC), cancer as comorbidity is extremely rare. In databases from Denmark, Spain, Australia, New Zealand, and Japan, no cancer was reported; in Italy and Germany, four cancers were identified out of 321 CdCs. In a 29-year-old CdC patient, clinical investigations following hematemesis led to the diagnosis of esophageal adenocarcinoma (EAC). A high pain threshold was also observed. Conventional and molecular cytogenetic defined the size of the deletion, and exome analysis on the trio completed the molecular work. Cytogenetic analysis showed a de novo chromosomal alteration: 46,XY,ishdel(5)(p14.3)(D5S28-) and arr[GRCh37] 5p15.33p14.3(1498180_19955760)x1. A quantitative sensory test demonstrated a high heat threshold. A 18f-fluorodeoxyglucose PET/TC scan of the brain failed to detect reduction of metabolism in the somatosensory area or insular cortex. Exome analysis in the trio (patient and parents) failed to identify variants to be interpreted as a likely risk factor for EAC. We conclude that the presence of well-known risk factors (maleness, obesity, gastroesophageal reflux, and Barrett's metaplasia) in a patient with very limited capability of expressing discomfort or referring clinical symptoms have been the main risk factors for developing EAC. At present, based on the available data, there is no evidence of any increased risk of developing cancer in CdC patients.

Wolf-hirschhorn Syndrome in Malaysia

Introduction: Wolf–Hirschhorn syndrome (WHS) is rare but a well-known clinical condition due to partial deletion of the short arm of chromosome 4 (4p). It is distinguished by a distinctive facial appearance known as the “Greek warrior helmet”, impaired growth and development, intellectual incapacity and seizures. The features of WHS vary between individuals based on the size and location of the missing piece of chromosome 4. Methods: Six cases of unsuspected WHS were diagnosed from 2011 to 2020 using conventional cytogenetic and fluorescent in situ hybridization (FISH) with a WHS probe. Result: Four of them had a visible cytogenetic deletion on chromosome 4p whereas the remaining two were evaluated with fluorescent in situ hybridization (FISH) using a WHS probe. Conclusion: Conventional cytogenetic testing may yield normal findings and it does not rule out the syndrome. Targeted FISH with a WHS probe is a better option.

High-resolution PGT-A results in incidental identification of patients with small pathogenic copy number variants

PurposeThis study aimed to evaluate whether a high-throughput high-resolution PGT-A method can detect copy number variants (CNVs) that could have clinical implications for patients and their embryos.MethodsA prospective analysis of PGT-A cases was conducted using a high-resolution SNP microarray platform with over 820,000 probes. Cases where multiple embryos possessed the same segmental imbalance were identified, and preliminary PGT-A reports were issued recommending either parental microarray or conventional karyotyping to identify CNVs or translocations.ResultsAnalysis of 6080 sequential PGT-A cases led to identification of 41 cases in which incidental findings were observed (0.7%) and parental testing was recommended. All cases, in which parental studies were completed, confirmed the original PGT-A incidental findings. In 2 of the cases, parental studies indicated a pathogenic variant with clinical implications for the associated embryos. In one of these cases, the patient was identified as a carrier of a duplication in chromosome 15q11.2:q11.2 (SNRPN + +), which is associated with autism spectrum disorder. In the second case, the patient was heterozygous positive for an interstitial deletion of 3p26.1:p26.3, which is associated with 3p deletion syndrome and had clinical implications for the patient and associated embryos. In each case, parental studies were concordant with PGT-A findings and revealed the presence of an otherwise unknown CNV.ConclusionHigh-throughput high-resolution SNP array–based PGT-A has the ability to detect previously unknown and clinically significant parental deletions, duplications, and translocations. The use of cost-effective SNP array–based PGT-A methods may improve the effectiveness of PGT by identifying and preventing previously unknown pathogenic CNVs in children born to patients seeking in vitro fertilization.

Deletion in 1p36.33-p36.32 is associated with pancytopenia: a case report

Background1P36 deletion syndrome is recognized as the most common terminal microdeletion syndrome in humans, characterized by early developmental delay and consequent intellectual disability, seizure disorder, and distinctive facial features. Variable deletion locations may attributed to phenotypic variability. However, the abnormal phenotypes of hematology are rarely reported in 1P36 deletion syndrome patients.Case presentationWe present a case of postnatal intellectual disability accompanied by pancytopenia. Copy number variation analysis revealed a pathogenic deletion in 1p36.331p36.32 with a deletion size of 2.21 Mb. Following successful treatment with glucocorticoids, the patient was diagnosed with immuno-related hemocytopenia (IRH).DiscussionThe patient experienced IRH, an uncommon characteristic of 1p36 deletion syndrome. The deletion fragment of 1p36.33-p36.32, particularly the loss of GNB1 gene, has been associated with the development of pancytopenia. Genotype-phenotype correlations are valuable in identifying the genes responsible for various clinical characteristics of the syndrome by associating phenotypic variation with specific genes located within the chromosome deletion region. Genome sequencing is recommended in cases where clinical manifestations indicate the presence of a genetic disorder but pose diagnostic challenges.

Histone Lysine Methyltransferase MMSET : An Essential Regulator of Human Erythropoiesis.

Erythropoiesis is the process by which hematopoietic stem cells proliferate, differentiate, and eventually form mature erythrocytes. Steady-state erythropoiesis is the result of the coordinated efforts of transcription factors and epigenetic regulators during differentiation. Histone methyltransferases (HMTs) are critical regulators that drive activation and repression of histone marks during erythroid lineage progression. MMSET (multiple myeloma SET domain) protein is aH3K36 methyltransferase (HKMT) required for normal hematopoietic development and essential for B cell differentiation and mature B cell function. Knockout of MMSET induces Wolf-Hirschhorn syndrome, where lymphocytes show abnormal functions, including a deficiency in antibody production. Studies have highlighted that MMSET acts as an oncogenic driver, classically associated with solid tumours, with a special focus on Multiple myeloma. However, the biological role and function of MMSET in human erythropoiesis is untouched and needs to be explored to address its role in the erythroid cascade. To this end, we examined the role of MMSET in human erythropoiesis by studying the genotypic and phenotypic modulatory effects observed upon MMSET knockdown (KD) in erythroid cells. Erythroid cells were generated from human G-CSF mobilized peripheral blood, hematopoietic stem and progenitor cells (HSPCs) as described by (Palii et al.,2011). Cultured cells were transduced with a lentiviral vector (pLKO.1) expressing MMSET andKD was observed after 72 hours of induction. 70-80% KD of MMSET in HSPCs resulted in reduced BFU-Es and CFU-Es in the semi-solid assay (Methocult TM) as compared to the control (pLKO.1 carrying scrambled sequence) (Fig. A), which was co-validated by FACS on days 2 and 4 (Phase I). Taken together, these results indicate that MMSET is required for early erythroid differentiation. Further, to access the role of MMSET during terminal stages of erythroid differentiation, lentiviral-mediated KD of late erythroblasts (days 8-12) (phase II) was done. MMSET KD erythroblasts displayed a block in terminally differentiating (Polychromatic and Orthochromatic) erythroblasts with an increase in Proerythroblasts and Basophilic erythroblasts. Thus, our results indicate that MMSET KD at later stages is associated with disordered terminal erythropoiesis. H3K36 methylation marks are involved in the regulation of DNA replication, recombination, and repair. Specifically, these marks keep DNA replication in check; hence, we noted that loss of MMSET correlates with increased transition of G2M phase cells from S phase cells with respect to control. In lieu of the above context, we noted increased proliferation (via Click-It Edu) in both phases (I and II). Studies have shown that MMSET is associated with DNA damage and repair (Evans et al., 2016). DNA damage and fragmentation mitigates apoptosis as a result of the signalling cascade downstream of effector caspases. We, therefore, observed a significant increase in apoptotic cells (via Annexin/PI staining) in both early and late erythroblasts upon KD of MMSET. To further gain insight, we carried out whole transcriptome analysis upon KD of MMSET and observed differentially expressed erythroid genes at three time points (days 4, 8, and 12) which revealed that GATA1, ALAS2, TAL1, KLF1, and FECH were significantly altered at the specified days (Fig. B). We further observed that erythrocyte development and differentiation, followed by regulation of the G2M transition of the cell cycle, apoptosis (programmed cell death), and cell proliferation, were the most enriched processes. Thus, in the present study, we systematically characterised erythroid impairment developing upon MMSET KD, leading to global downregulation of erythroid-specific genes, which are key players in normal erythroid development. An in-depth assessment of the MMSET -mediated erythroid gene regulatory network needs elucidation for further validation of MMSET as a direct player or mediator in human erythroid development. Our findings uncovered a previously unknown role for MMSET in human erythropoiesis.

A case of deletion 9p syndrome with soft and hard cleft palate

AbstractBackgroundDeletion 9p syndrome is a rare structural chromosomal disorder. Various phenotypes of deletion 9p syndrome have been reported; however, cleft palate has not been reported in many cases.Case presentationWe report the case of a child with deletion 9p syndrome with soft and hard cleft palate, ventricular septal defect, broad and narrow forehead, long philtrum, highly arched eyebrows, binocular dissection, upward‐slanting palpebral fissures, low flat nose, and triangular cranium. Pushback palatoplasty was performed at the age of 1 year and 9 months.ConclusionThis report contributes to the accumulation of reports on the phenotype of deletion 9p syndrome.

Wolf-Hirschhorn syndrome candidate 1 (Whsc1) methyltransferase signals via a Pitx2-miR-23/24 axis to effect tooth development

Wolf-Hirschhorn syndrome (WHS) is a developmental disorder attributed to a partial deletion on the short arm of chromosome 4. WHS patients suffer from oral manifestations including cleft lip and palate, hypodontia, and taurodontism. WHS candidate 1 (WHSC1) gene is a H3K36-specific methyltransferase that is deleted in every reported case of WHS. Mutation in this gene also results in tooth anomalies in patients. However, the correlation between genetic abnormalities and the tooth anomalies has remained controversial. In our study, we aimed to clarify the role of WHSC1 in tooth development. We profiled the Whsc1 expression pattern during mouse incisor and molar development by immunofluorescence staining and found Whsc1 expression is reduced as tooth development proceeds. Using real-time quantitative reverse transcription PCR, Western blot, chromatin immunoprecipitation, and luciferase assays, we determined that Whsc1 and Pitx2, the initial transcription factor involved in tooth development, positively and reciprocally regulate each other through their gene promoters. miRNAs are known to regulate gene expression posttranscriptionally during development. We previously reported miR-23a/b and miR-24-1/2 were highly expressed in the mature tooth germ. Interestingly, we demonstrate here that these two miRs directly target Whsc1 and repress its expression. Additionally, this miR cluster is also negatively regulated by Pitx2. We show the expression of these two miRs and Whsc1 are inversely correlated during mouse mandibular development. Taken together, our results provide new insights into the potential role of Whsc1 in regulating tooth development and a possible molecular mechanism underlying the dental defects in WHS.

SAT139 Non-insulinoma Pancreatogenous Hypoglycemia Syndrome In A Patient With 1p36 Deletion Syndrome

Abstract Disclosure: E.D. Auckley: None. M.A. Arosemena: None. L. Philipson: None. Background: 1p36 deletion syndrome comprises a phenotypic presentation that includes central nervous system, cardiac, and craniofacial anomalies. There has been no report of associated hypoglycemia with this syndrome. Nesidioblastosis, also known as non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS), is understood as a rare condition defined by diffuse pancreatic hypertrophy with subsequent hyperinsulinemic hypoglycemia. Diagnosis requires serologic workup consistent with endogenous hyperinsulinemic hypoglycemia, intraarterial calcium stimulation positive for inappropriately elevated insulin secretion, and imaging studies without identified masses. Clinical Case: A 21-year-old female with 1p36 deletion syndrome (seizure disorder, cerebral palsy, vision loss and heart failure) was admitted to the hospital due to persistent falls. On admission vital signs were within normal limits, and physical exam revealed a thin non-verbal patient without significant other findings. During hospitalization and prolonged fasting periods of approximately 14-18 hours related to poor appetite she developed several episodes of hypoglycemia with serum glucose as low as 57 mg/dl. As patient was non-verbal at baseline, symptoms of hypoglycemia such as sweating, lightheadedness or shakiness were not confirmed. Even when she started to eat, hypoglycemic events continued to occur. Dextrose containing fluids (Dextrose 5% and later 10%) were added to try to maintain blood sugars within the normal range. Nevertheless, she continued to develop hypoglycemia. Endocrinology service was consulted and recommended to obtain a critical sample. A critical sample revealed serum glucose of 59 mg/dl, insulin level of 20.6 mcU/mL, proinsulin of 33 pmol/L, and beta-hydroxybutyrate of <0.10 mmol/L. Insulin antibodies was negative. Adrenal insufficiency was unlikely due to a normal 9 am cortisol level of 13.7 ug/dl. Due to the presence of hyperinsulinemic hypoglycemia further workup was conducted. A CT of the abdomen with a pancreatic protocol and 68Ga-DOTATATE PET/CT scan was negative for a pancreatic mass. Endoscopic ultrasound did not reveal a clear pancreatic mass either. This was followed by a calcium stimulation test which showed a two-fold increase in insulin levels in all 3 catheterized pancreatic territories. In the absence of a discrete mass, non-surgical management was recommended. For hypoglycemia management patient was started on octreotide injections with resolution of hypoglycemia. Prior to discharge she was switched to lanreotide and was discharged to continue monthly lanreotide injections. Conclusion: To our knowledge, this is the first case reported of NIPHS in a patient with a mutation in 1p36 deletion. Hyperinsulinism in the setting of diabetes has been reported in this syndrome1 but to our knowledge no cases of hypoglycemia with NIPHS have been reported. Presentation: Saturday, June 17, 2023

WHSC1L1-mediated epigenetic downregulation of VMP1 participates in herpes simplex virus 1 infection-induced mitophagy impairment and neuroinflammation

Microglia are the first-line defenders against invading pathogens in the brain whose activation mediates virus clearance and leads to neurotoxicity as well. This work studies the role of Wolf-Hirschhorn syndrome candidate 1-like 1 (WHSC1L1)/vacuole membrane protein 1 (VMP1) interaction in the activation of microglia and neuroinflammation following herpes simplex virus 1 (HSV-1) infection. Aberrantly expressed genes after HSV-1 infection were screened by analyzing the GSE35943 dataset. C57BL/6J mice and mouse microglia BV2 were infected with HSV-1 for in vivo and in vitro assays. VMP1 was downregulated but WHSC1L1 was upregulated in HSV-1-infected mouse brain tissues as well as in BV2 cells. The VMP1 overexpression enhanced mitophagy activity and suppressed oxidative stress and inflammatory activation of BV2 cells, but these effects were blocked by the autophagy antagonist 3-methyladenine. WHSC1H1 suppressed VMP1 transcription through H3K36me2-recruited DNMT3A. Downregulation of WHSC1H1 similarly enhanced mitophagy in BV2 cells, and it alleviated microglia activation, nerve cell inflammation, and brain tissue damage in HSV-1-infected mice. However, the alleviating roles of WHSC1H1 silencing were negated by further VMP1 silencing. Taken together. this study demonstrates that WHSC1L1 upregulation following HSV-1 infection leads to mitophagy impairment and neuroinflammation through epigenetic suppression of VMP1.

Physiotherapy in Children With Cri Du Chat Syndrome: A Clinical Case

Physiotherapy in Children With Cri Du Chat Syndrome: A Clinical Case

Late Diagnosis of 18p Syndrome with Movement Disorders by Whole Exome Sequencing Read-Depth Based Algorithm.

Late Diagnosis of 18p Syndrome with Movement Disorders by Whole Exome Sequencing Read-Depth Based Algorithm.