Ending A Diagnostic Odyssey: Moving From Exome to Genome to Identify
Cockayne Syndrome
Abstract
Cockayne syndrome is an ultra-rare autosomal recessive disorder
characterized by growth failure and multisystemic degeneration. Excision
repair cross-complementation group 6 (ERCC6) mutations account for most
cases. We report a child with pre- and post-natal growth failure and
progressive neurologic deterioration with multi-system involvement who
has bi-allelic ERCC6 variants, that were discovered by whole genome
sequencing, including a previously unreported intronic variant.
Pathogenicity of these variants was established by demonstrating reduced
levels of ERCC6 mRNA and protein expression, normal unscheduled DNA
synthesis and impaired recovery of RNA synthesis in patient fibroblasts
following UV-irradiation. The study confirms the pathogenicity of a
previously undescribed upstream intronic variant, highlighting the power
of genome sequencing to identify non-coding variants. In addition, this
report provides evidence for the utility of a combination approach of
genome sequencing plus functional studies to provide diagnosis in a
child for whom a lengthy diagnostic odyssey, including exome sequencing,
was previously unrevealing.