PT  - JOURNAL ARTICLE
AU  - Cosemans, Nele
AU  - Vandenhove, Laura
AU  - Vogels, Annick
AU  - Devriendt, Koenraad
AU  - Van Esch, Hilde
AU  - Van Buggenhout, Griet
AU  - Olivié, Hilde
AU  - de Ravel, Thomy
AU  - Ortibus, Els
AU  - Legius, Eric
AU  - Aerssens, Peter
AU  - Breckpot, Jeroen
AU  - R. Vermeesch, Joris
AU  - Shen, Sanbing
AU  - Fitzgerald, Jacqueline
AU  - Gallagher, Louise
AU  - Peeters, Hilde
TI  - The clinical relevance of intragenic <em>NRXN1</em> deletions
AID  - 10.1136/jmedgenet-2019-106448
DP  - 2020 May 01
TA  - Journal of Medical Genetics
PG  - 347--355
VI  - 57
IP  - 5
4099  - http://jmg.bmj.com/content/57/5/347.short
4100  - http://jmg.bmj.com/content/57/5/347.full
SO  - J Med Genet2020 May 01; 57
AB  - Background Intragenic NRXN1 deletions are susceptibility variants for neurodevelopmental disorders; however, their clinical interpretation is often unclear. Therefore, a literature study and an analysis of 43 previously unpublished deletions are provided.Methods The literature cohort covered 629 heterozygous NRXN1 deletions: 148 in controls, 341 in probands and 140 in carrier relatives, and was used for clinical hypothesis testing. Exact breakpoint determination was performed for 43 in-house deletions.Results The prevalence of exonic NRXN1 deletions in controls was ~1/3000 as compared with ~1/800 in patients with neurodevelopmental/neuropsychiatric disorders. The differential distribution of deletions across the gene between controls and probands allowed to distinguish distinct areas within the gene. Exon 6–24 deletions appeared only twice in over 100000 control individuals, had an estimated penetrance for neurodevelopmental disorders of 32.43%, a de novo rate of 50% and segregated mainly with intellectual disability (ID) and schizophrenia. In contrast, exon 1–5 deletions appeared in 20 control individuals, had an estimated penetrance of 12.59%, a de novo rate of 32.5% and were reported with a broad range of neurodevelopmental phenotypes. Exact breakpoint determination revealed six recurrent intron 5 deletions.Conclusion Exon 6–24 deletions have a high penetrance and are mainly associated with ID and schizophrenia. In contrast, the actual contribution of exon 1–5 deletions to a neurodevelopmental/neuropsychiatric disorder in an individual patient and family remains very difficult to assess. To enhance the clinical interpretation, this study provides practical considerations for counselling and an interactive table for comparing a deletion of interest with the available literature data.