A novel microdeletion syndrome at 3q13.31 characterised by developmental delay, postnatal overgrowth, hypoplastic male genitals, and characteristic facial features

Abstract

Background: Congenital deletions affecting 3q11q23 have rarely been reported and only five cases have been molecularly characterised. Genotype-phenotype correlation has been hampered by the variable sizes and breakpoints of the deletions. In this study, 14 novel patients with deletions in 3q11q23 were investigated and compared with 13 previously reported patients.

Methods: Clinical data were collected from 14 novel patients that had been investigated by high resolution microarray techniques. Molecular investigation and updated clinical information of one cytogenetically previously reported patient were also included.

Results: The molecular investigation identified deletions in the region 3q12.3q21.3 with different boundaries and variable sizes. The smallest studied deletion was 580 kb, located in 3q13.31. Genotype-phenotype comparison in 24 patients sharing this shortest region of overlapping deletion revealed several common major characteristics including significant developmental delay, muscular hypotonia, a high arched palate, and recognisable facial features including a short philtrum and protruding lips. Abnormal genitalia were found in the majority of males, several having micropenis. Finally, a postnatal growth pattern above the mean was apparent. The 580 kb deleted region includes five RefSeq genes and two of them are strong candidate genes for the developmental delay: DRD3 and ZBTB20.

Conclusion: A newly recognised 3q13.31 microdeletion syndrome is delineated which is of diagnostic and prognostic value. Furthermore, two genes are suggested to be responsible for the main phenotype.

Figure 1

A physical map of the chromosomal region 3q11.2 to 3q23, illustrating the deletions. The deletions identified in novel patients are shown in black, previously reported deletions that have been molecularly characterised are shown in dark grey, and previously reported deletions that have been cytogenetically characterised are shown in light grey. RefSeq genes are indicated in blue. The grey solid box illustrates the shortest region of overlapping deleted region, and a zoomed view shows the five RefSeq genes within this region (bottom panel).

Figure 2

Photographs of cases 1, 2, 4, 5, 6, 7, 9, 10, 12, and 15. Physical characteristics of note are short philtrum, protruding lips with full lower lips and tented upper lips, hypertelorism, and antimongoloid slanted eyes present in several cases.