Lethal neonatal respiratory failure due to biallelic variants in BBS1 and monoallelic variant in TTC21B

Abstract

Background: Bardet-Biedl syndrome (BBS) is a rare, autosomal recessive ciliopathy characterized by early onset retinal dystrophy, renal anomalies, postaxial polydactyly, and cognitive impairment with considerable phenotypic heterogeneity. BBS results from biallelic pathogenic variants in over 20 genes that encode key proteins required for the assembly or primary ciliary functions of the BBSome, a heterooctameric protein complex critical for homeostasis of primary cilia. While variants in BBS1 are most frequently identified in affected individuals, the renal and pulmonary phenotypes associated with BBS1 variants are reportedly less severe than those seen in affected individuals with pathogenic variants in the other BBS-associated genes.

Case-diagnosis: We report an infant with severe renal dysplasia and lethal pulmonary hypoplasia who was homozygous for the most common BBS1 pathogenic variant (c.1169 T > G; p.M390R) and also carried a predicted pathogenic variant in TTC21B (c.1846C > T; p.R616C), a genetic modifier of disease severity of ciliopathies associated with renal dysplasia and pulmonary hypoplasia.

Conclusions: This report expands the phenotypic spectrum of BBS with the first infant with lethal neonatal respiratory failure associated with biallelic, pathogenic variants in BBS1 and a monoallelic, predicted pathogenic variant in TTC21B. BBS should be considered among the ciliopathies in the differential diagnosis of neonates with renal dysplasia and severe respiratory failure.

Keywords: BBS1; Bardet-Biedl syndrome; Neonatal respiratory failure.

Fig. 1

a Lung histology shows immature parenchyma with alveolar septal widening and hypoplasia with decreased number of alveoli between terminal bronchiole and pleura as indicated by dotted line (right lower lobe, H&E, 20X , arrow indicates thickened alveolar septa). b Renal histology shows numerous cystically dilated tubules lined by immature primitive appearing cuboidal epithelium and surrounded by collarettes (as indicated by arrows) of condensed mesenchyme with stromal hyperplasia characteristic of renal dysplasia. An immature glomerulus is present at the periphery of the lobule (*) (H&E, 20X)