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Yıl:2020; Cilt: 57; Sayı: 3>> Özet
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Nöropsikiyatri Arşivi; 2020;57(3):177-191
Açıklanamayan Gelişimsel Geriliği ve Zihinsel Yetersizliği Olan Türk Hastalarda Kromozomal Mikroarray Analizi
H Gürkan, Eİ Atlı , E Atlı, L Bozatlı , MA Altay, S Yalçıntepe, Y Özen , D Eker, Ç Akurut, S Demir, I Görker
Trakya Üniversitesi, Edirne
Amaç: Aneuploidiler, kopya numarası varyasyonları (CNV’ler) ve spesifik genlerdeki tek nükleotid varyantları, gelişim geriliği (GG) ve entellektüel yetersizliğin (EY) ana genetik nedenleridir. Bu genetik değişiklikler, kromozom analizi, kromozomal mikro dizin (KMD) ve yeni nesil DNA dizilim teknikleri kullanılarak tespit edilebilir. Bu nedenle; bu çalışmada, 123 hastada açıklanamayan GG ve EY’in genomik etiyolojisinin belirlenmesinde KMA’nın önemini anlamayı amaçladık. Yöntem: 123 hastaya kromozom analizi, DNA fragment analizi ve kromozomal mikro dizin analizi yapıldı. Periferik kandan konvansiyonel G-bant, karyotip analizi, ilk tarama testlerinin bir parçası olarak yapıldı. FMR1 gen CGG tekrar sayısı ve metilasyon analizi, Fragjil X sendromunu dışlamak için yapıldı. Bulgular: Normal karyotipe sahip ve frajil X taraması normal olan 123 açıklanamayan EY/GG hastasında KMD analizi yapıldı. Kırk dört CNV, 39 (39/123=%31,7) hastada tespit edildi. On iki CNV önemi bilinmeyen varyant (VUS) (%9,75) hasta ve 7 CNV benign (%5,69) hasta rapor edildi. Altı hastada, bir veya daha fazla patojenik CNV belirlendi. Bu nedenle, KMD’nin tanısal etkinliği %31,7 olarak bulundu (39/123). Sonuç: Günümüzde genetik analiz, psikiyatri servislerine başvuran EY hastalarının değerlendirmesinde halen rutinin bir parçası değildir. KMD ile yapılan genetik bir tanı genetik soru işaretlerini ortadan kaldırabilir ve böylece hastaların klinik yönetimini değiştirebilir. Pozitif KMD bulguları olan hastaların yaklaşık üçte birine klinik olarak müdahale edilebilir. Bununla birlikte, CNV’lerin çoklu bozukluklar için önemli risk faktörleri olarak ortaya çıkması, komorbid nörogelişimsel koşullara sahip bireylerin KMD testinin önerildiği yerde önceliklendirilmesi gerekliliğini arttırmaktadır.
Chromosomal Microarray Analysis in Turkish Patients with Unexplained Developmental Delay and Intellectual Developmental Disorders
Introduction: Aneuploids, copy number variations (CNVs), and single nucleotide variants in specific genes are the main genetic causes of developmental delay (DD) and intellectual disability disorder (IDD). These genetic changes can be detected using chromosome analysis, chromosomal microarray (CMA), and next-generation DNA sequencing techniques. Therefore; In this study, we aimed to investigate the importance of CMA in determining the genomic etiology of unexplained DD and IDD in 123 patients. Method: For 123 patients, chromosome analysis, DNA fragment analysis and microarray were performed. Conventional G-band karyotype analysis from peripheral blood was performed as part of the initial screening tests. FMR1 gene CGG repeat number and methylation analysis were carried out to exclude fragile X syndrome. Results: CMA analysis was performed in 123 unexplained IDD/DD patients with normal karyotypes and fragile X screening, which were evaluated by conventional cytogenetics. Forty-four CNVs were detected in 39 (39/123=31.7%) patients. Twelve CNV variant of unknown significance (VUS) (9.75%) patients and 7 CNV benign (5.69%) patients were reported. In 6 patients, one or more pathogenic CNVs were determined. Therefore, the diagnostic efficiency of CMA was found to be 31.7% (39/123). Conclusion: Today, genetic analysis is still not part of the routine in the evaluation of IDD patients who present to psychiatry clinics. A genetic diagnosis from CMA can eliminate genetic question marks and thus alter the clinical management of patients. Approximately one-third of the positive CMA findings are clinically intervenable. However, the emergence of CNVs as important risk factors for multiple disorders increases the need for individuals with comorbid neurodevelopmental conditions to be the priority where the CMA test is recommended

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