학술논문
Exome sequencing in routine diagnostics: a generic test for 254 patients with primary immunodeficiencies
Document Type
article
Author
Peer Arts; Annet Simons; Mofareh S. AlZahrani; Elanur Yilmaz; Eman AlIdrissi; Koen J. van Aerde; Njood Alenezi; Hamza A. AlGhamdi; Hadeel A. AlJubab; Abdulrahman A. Al-Hussaini; Fahad AlManjomi; Alaa B. Alsaad; Badr Alsaleem; Abdulrahman A. Andijani; Ali Asery; Walid Ballourah; Chantal P. Bleeker-Rovers; Marcel van Deuren; Michiel van der Flier; Erica H. Gerkes; Christian Gilissen; Murad K. Habazi; Jayne Y. Hehir-Kwa; Stefanie S. Henriet; Esther P. Hoppenreijs; Sarah Hortillosa; Chantal H. Kerkhofs; Riikka Keski-Filppula; Stefan H. Lelieveld; Khurram Lone; Marius A. MacKenzie; Arjen R. Mensenkamp; Jukka Moilanen; Marcel Nelen; Jaap ten Oever; Judith Potjewijd; Pieter van Paassen; Janneke H. M. Schuurs-Hoeijmakers; Anna Simon; Tomasz Stokowy; Maartje van de Vorst; Maaike Vreeburg; Anja Wagner; Gijs T. J. van Well; Dimitra Zafeiropoulou; Evelien Zonneveld-Huijssoon; Joris A. Veltman; Wendy A. G. van Zelst-Stams; Eissa A. Faqeih; Frank L. van de Veerdonk; Mihai G. Netea; Alexander Hoischen
Source
Genome Medicine, Vol 11, Iss 1, Pp 1-15 (2019)
Subject
Language
English
ISSN
1756-994X
Abstract
Abstract Background Diagnosis of primary immunodeficiencies (PIDs) is complex and cumbersome yet important for the clinical management of the disease. Exome sequencing may provide a genetic diagnosis in a significant number of patients in a single genetic test. Methods In May 2013, we implemented exome sequencing in routine diagnostics for patients suffering from PIDs. This study reports the clinical utility and diagnostic yield for a heterogeneous group of 254 consecutively referred PID patients from 249 families. For the majority of patients, the clinical diagnosis was based on clinical criteria including rare and/or unusual severe bacterial, viral, or fungal infections, sometimes accompanied by autoimmune manifestations. Functional immune defects were interpreted in the context of aberrant immune cell populations, aberrant antibody levels, or combinations of these factors. Results For 62 patients (24%), exome sequencing identified pathogenic variants in well-established PID genes. An exome-wide analysis diagnosed 10 additional patients (4%), providing diagnoses for 72 patients (28%) from 68 families altogether. The genetic diagnosis directly indicated novel treatment options for 25 patients that received a diagnosis (34%). Conclusion Exome sequencing as a first-tier test for PIDs granted a diagnosis for 28% of patients. Importantly, molecularly defined diagnoses indicated altered therapeutic options in 34% of cases. In addition, exome sequencing harbors advantages over gene panels as a truly generic test for all genetic diseases, including in silico extension of existing gene lists and re-analysis of existing data.