Article Text


Original article
Genomic alterations that contribute to the development of isolated and non-isolated congenital diaphragmatic hernia
  1. Margaret J Wat1,
  2. Danielle Veenma2,3,
  3. Jacob Hogue4,
  4. Ashley M Holder5,
  5. Zhiyin Yu1,
  6. Jeanette J Wat6,
  7. Neil Hanchard1,
  8. Oleg A Shchelochkov7,
  9. Caraciolo J Fernandes8,
  10. Anthony Johnson1,9,10,
  11. Kevin P Lally11,
  12. Anne Slavotinek4,
  13. Olivier Danhaive12,
  14. Thomas Schaible13,
  15. Sau Wai Cheung1,
  16. Katherine A Rauen4,
  17. Vijay S Tonk14,
  18. Dick Tibboel3,
  19. Annelies de Klein2,
  20. Daryl A Scott1
  1. 1Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
  2. 2Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, the Netherlands
  3. 3Department of Paediatric Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
  4. 4Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
  5. 5Department of Surgery, Washington University School of Medicine, Saint Louis, Missouri, USA
  6. 6Department of Biochemistry and Cell Biology, Rice University, Houston, Texas, USA
  7. 7Department of Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  8. 8Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
  9. 9Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
  10. 10Department of Pediatric Surgery, Baylor College of Medicine, Houston, Texas, USA
  11. 11Department of Pediatric Surgery, University of Texas Medical School, Houston, Texas, USA
  12. 12Department of Neonatology, Bambino Gesù Children's Hospital, Rome, Italy
  13. 13Department of Pediatrics, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
  14. 14Department of Pediatrics, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, Texas, USA
  1. Correspondence to Daryl A Scott, Baylor College of Medicine, R813, One Baylor Plaza, BCM 227, Houston, Texas 77030, USA; dscott{at}


Background Congenital diaphragmatic hernia (CDH) is a life threatening birth defect. Most of the genetic factors that contribute to the development of CDH remain unidentified.

Objective To identify genomic alterations that contribute to the development of diaphragmatic defects.

Methods A cohort of 45 unrelated patients with CDH or diaphragmatic eventrations was screened for genomic alterations by array comparative genomic hybridisation or single nucleotide polymorphism based copy number analysis.

Results Genomic alterations that were likely to have contributed to the development of CDH were identified in 8 patients. Inherited deletions of ZFPM2 were identified in 2 patients with isolated diaphragmatic defects and a large de novo 8q deletion overlapping the same gene was found in a patient with non-isolated CDH. A de novo microdeletion of chromosome 1q41q42 and two de novo microdeletions on chromosome 16p11.2 were identified in patients with non-isolated CDH. Duplications of distal 11q and proximal 13q were found in a patient with non-isolated CDH and a de novo single gene deletion of FZD2 was identified in a patient with a partial pentalogy of Cantrell phenotype.

Conclusions Haploinsufficiency of ZFPM2 can cause dominantly inherited isolated diaphragmatic defects with incomplete penetrance. These data define a new minimal deleted region for CDH on 1q41q42, provide evidence for the existence of CDH related genes on chromosomes 16p11.2, 11q23-24 and 13q12, and suggest a possible role for FZD2 and Wnt signalling in pentalogy of Cantrell phenotypes. These results demonstrate the clinical utility of screening for genomic alterations in individuals with both isolated and non-isolated diaphragmatic defects.

  • Diaphragmatic hernia
  • ZFPM2
  • microdeletion 1q41q42
  • microdeletion 16p11.2
  • FZD2
  • clinical genetics
  • cytogenetics
  • molecular genetics

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  • Funding This work was supported by National Institutes of Health grants T32-GM007330-33S1 and F30-HL099469-01 (MJW), and KO8-HD050583 and R01-HD065667 (DAS). DV was supported by a Sophia-ErasmusMC grant SSWO 551. This work was also supported by Award Number P30HD024064 from the Eunice Kennedy Shriver National Institute of Child Health & Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health & Human Development or the National Institutes of Health. These funding sources had no direct involvement in the study design, the collection, analysis and interpretation of the data, the writing of this report, and the decision to submit this manuscript for publication.

  • Competing interests None declared.

  • Ethics approval This study was conducted with the approval of the Institutional Review Boards of Baylor College of Medicine, Houston, Texas, USA and Erasmus Medical Center, Rotterdam, the Netherlands.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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