Identification of a deep intronic POLR3A variant causing inclusion of a pseudoexon derived from an Alu element in Pol III-related leukodystrophy

J Hum Genet. 2020 Oct;65(10):921-925. doi: 10.1038/s10038-020-0786-y. Epub 2020 Jun 1.

Abstract

Pseudoexon inclusion caused by deep intronic variants is an important genetic cause for various disorders. Here, we present a case of a hypomyelinating leukodystrophy with developmental delay, intellectual disability, autism spectrum disorder, and hypodontia, which are consistent with autosomal recessive POLR3-related leukodystrophy. Whole-exome sequencing identified only a heterozygous missense variant (c.1451G>A) in POLR3A. To explore possible involvement of a deep intronic variant in another allele, we performed whole-genome sequencing of the patient with variant annotation by SpliceAI, a deep-learning-based splicing prediction tool. A deep intronic variant (c.645 + 312C>T) in POLR3A, which was predicted to cause inclusion of a pseudoexon derived from an Alu element, was identified and confirmed by mRNA analysis. These results clearly showed that whole-genome sequencing, in combination with deep-learning-based annotation tools such as SpliceAI, will bring us further benefits in detecting and evaluating possible pathogenic variants in deep intronic regions.

Publication types

  • Case Reports
  • Comparative Study

MeSH terms

  • Agenesis of Corpus Callosum / diagnostic imaging
  • Agenesis of Corpus Callosum / genetics
  • Alu Elements / genetics*
  • Amino Acid Sequence
  • Atrophy
  • Autism Spectrum Disorder / genetics*
  • Cerebellum / diagnostic imaging
  • Cerebellum / pathology
  • Deep Learning
  • Exome Sequencing
  • Genes, Recessive
  • Hereditary Central Nervous System Demyelinating Diseases / diagnostic imaging
  • Hereditary Central Nervous System Demyelinating Diseases / genetics*
  • Humans
  • Infant, Newborn
  • Introns / genetics*
  • Laryngomalacia / congenital
  • Laryngomalacia / genetics
  • Male
  • Muscle Hypotonia / genetics*
  • Mutation, Missense*
  • Protein Isoforms / genetics*
  • Pseudogenes / genetics*
  • RNA Polymerase III / genetics*
  • RNA, Messenger / genetics
  • Sequence Alignment
  • Sequence Homology, Amino Acid
  • Whole Genome Sequencing

Substances

  • Protein Isoforms
  • RNA, Messenger
  • POLR3A protein, human
  • RNA Polymerase III