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  • Heterozygous variants that ...
    Snijders Blok, Lot; Vino, Arianna; den Hoed, Joery; Underhill, Hunter R; Monteil, Danielle; Li, Hong; Reynoso Santos, Francis Jeshira; Chung, Wendy K; Amaral, Michelle D; Schnur, Rhonda E; Santiago-Sim, Teresa; Si, Yue; Brunner, Han G; Kleefstra, Tjitske; Fisher, Simon E

    Genetics in medicine, 03/2021, Volume: 23, Issue: 3
    Journal Article

    Heterozygous pathogenic variants in various FOXP genes cause specific developmental disorders. The phenotype associated with heterozygous variants in FOXP4 has not been previously described. We assembled a cohort of eight individuals with heterozygous and mostly de novo variants in FOXP4: seven individuals with six different missense variants and one individual with a frameshift variant. We collected clinical data to delineate the phenotypic spectrum, and used in silico analyses and functional cell-based assays to assess pathogenicity of the variants. We collected clinical data for six individuals: five individuals with a missense variant in the forkhead box DNA-binding domain of FOXP4, and one individual with a truncating variant. Overlapping features included speech and language delays, growth abnormalities, congenital diaphragmatic hernia, cervical spine abnormalities, and ptosis. Luciferase assays showed loss-of-function effects for all these variants, and aberrant subcellular localization patterns were seen in a subset. The remaining two missense variants were located outside the functional domains of FOXP4, and showed transcriptional repressor capacities and localization patterns similar to the wild-type protein. Collectively, our findings show that heterozygous loss-of-function variants in FOXP4 are associated with an autosomal dominant neurodevelopmental disorder with speech/language delays, growth defects, and variable congenital abnormalities.