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Biallelic variants in DNA2 cause poikiloderma with congenital cataracts and severe growth failure reminiscent of Rothmund-Thomson syndrome
  1. Ricardo Di Lazzaro Filho1,2,
  2. Guilherme Lopes Yamamoto2,3,
  3. Tiago J Silva4,
  4. Leticia A Rocha1,
  5. Bianca D W Linnenkamp3,
  6. Matheus Augusto Araújo Castro3,
  7. Deborah Bartholdi5,
  8. André Schaller5,
  9. Tosso Leeb6,
  10. Samantha Kelmann3,
  11. Claudia Y Utagawa7,
  12. Carlos E Steiner8,
  13. Leandra Steinmetz3,
  14. Rachel Sayuri Honjo3,
  15. Chong Ae Kim3,
  16. Lisa Wang9,
  17. Raphaël Abourjaili-Bilodeau10,
  18. Philippe M Campeau11,
  19. Matthew Warman12,13,
  20. Maria Rita Passos-Bueno1,
  21. Nicolas C Hoch4,
  22. Debora Romeo Bertola1,3
  1. 1 Departamento de Genética e Biologia Evolutiva do Instituto de Biociências, Universidade de São Paulo, Sao Paulo, Brazil
  2. 2 Genômica/Genera, Diagnósticos da América SA, Barueri, Brazil
  3. 3 Departamento de Pediatria do Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
  4. 4 Departamento de Bioquímica do Instituto de Química, Universidade de Sao Paulo, Sao Paulo, Brazil
  5. 5 Department of Human Genetics, University of Bern, Bern, Switzerland
  6. 6 Institute of Genetics, University of Bern, Bern, Switzerland
  7. 7 Centro Universitário de Volta Redonda, Volta Redonda, Brazil
  8. 8 Hospital das Clínicas, UNICAMP, Campinas, Brazil
  9. 9 9Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
  10. 10 University of Montreal, Montreal, Québec, Canada
  11. 11 CHU Sainte-Justine Research Center, University of Montreal, Montreal, Québec, Canada
  12. 12 Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts, USA
  13. 13 Genetics, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Debora Romeo Bertola, Instituto de Biociências, Universidade de São Paulo, Sao Paulo, SP, Brazil; debora.bertola{at}


Rothmund-Thomson syndrome (RTS) is a rare, heterogeneous autosomal recessive genodermatosis, with poikiloderma as its hallmark. It is classified into two types: type I, with biallelic variants in ANAPC1 and juvenile cataracts, and type II, with biallelic variants in RECQL4, increased cancer risk and no cataracts. We report on six Brazilian probands and two siblings of Swiss/Portuguese ancestry presenting with severe short stature, widespread poikiloderma and congenital ocular anomalies. Genomic and functional analysis revealed compound heterozygosis for a deep intronic splicing variant in trans with loss of function variants in DNA2, with reduction of the protein levels and impaired DNA double-strand break repair. The intronic variant is shared by all patients, as well as the Portuguese father of the European siblings, indicating a probable founder effect. Biallelic variants in DNA2 were previously associated with microcephalic osteodysplastic primordial dwarfism. Although the individuals reported here present a similar growth pattern, the presence of poikiloderma and ocular anomalies is unique. Thus, we have broadened the phenotypical spectrum of DNA2 mutations, incorporating clinical characteristics of RTS. Although a clear genotype–phenotype correlation cannot be definitively established at this moment, we speculate that the residual activity of the splicing variant allele could be responsible for the distinct manifestations of DNA2-related syndromes.

  • Genetics, Medical
  • Genetics
  • DNA Repair
  • Congenital, Hereditary, and Neonatal Diseases and Abnormalities
  • Founder Effect

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  • Contributors RDLF, GLY and DRB designed the study. LW, PC and ML-W discussed the clinical and molecular results. GLY, RDLF, DRB and TL analysed the genomic data. GLY, LAR, RDLF and AS performed molecular sequencing. MAAC, TJS and NCH conducted protein functional and in silico studies. DRB, GLY, BDWL, DB, CYU, SK, CES, LS and RSH contributed to the acquisition of the clinical data. GLY, RDLF, DRB, TJS and NCH prepared the manuscript. CAK, MRP-B and PC wrote and edited the manuscript.

  • Funding This study was supported by FAPESP/CEPID (2013/08028-1) (DRB) and CNPq (303375/2019) (DRB), as well as FAPESP 2018/18007-5 and 2019/06039-2 (NCH). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.