Abstract
The Smith–Lemli–Opitz syndrome (SLOS [MIM 270400]) is an autosomal recessive malformation syndrome that shows a great variability with regard to severity. SLOS is caused by mutations in the Δ7sterol-reductase gene (DHCR7), which disrupt cholesterol biosynthesis. Phenotypic variability of the disease is already known to be associated with maternal apolipoprotein E (ApoE) genotype. The aim of this study was to detect additional modifiers of the SLOS phenotype. We examined the association of SLOS severity with variants in the genes for ApoC-III, lecithin-cholesterol acyltransferase, cholesteryl-ester transfer protein, ATP-binding cassette transporter A1 (ABCA1), and methylene tetrahydrofolate reductase. Our study group included 59 SLOS patients, their mothers, and 49 of their fathers. In addition, we investigated whether ApoE and ABCA1 genotypes are associated with the viability of severe SLOS cases (n=21) caused by two null mutations in the DHCR7 gene. Maternal ABCA1 genotypes show a highly significant correlation with clinical severity in SLOS patients (P=0.007). The rare maternal p.1587Lys allele in the ABCA1 gene was associated with milder phenotypes. ANOVA analysis demonstrated an association of maternal ABCA1 genotypes with severity scores (logarithmised) of SLOS patients of P=0.004. Maternal ABCA1 explains 15.4% (R2) of severity of SLOS patients. There was no association between maternal ApoE genotype and survival of the SLOS fetus carrying two null mutations. Regarding ABCA1 p.Arg1587Lys in mothers of latter SLOS cases, a significant deviation from Hardy–Weinberg equilibrium (HWE) was observed (P=0.005). ABCA1 is an additional genetic modifier in SLOS. Modifying placental cholesterol transfer pathways may be an approach for prenatal therapy of SLOS.
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Acknowledgements
We thank Hans Dieplinger and Laura Grandner for proofreading regarding the function and transports of lipids in the placenta and English language, respectively. We also thank all doctors who contributed SLOS patients, especially those who contributed two or more (Dr P Clayton, Dr Marisa Giros, Dr D Haas, Dr RI Kelley, and Dr M Krajewska-Walasek) patients in this study.
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Online Mendelian Inheritance in Man (OMIM): http://www.ncbi.nih.gov/omim/ for SLOS [MIM 270400]
DHCR7 Mutation Database: https://grenada.lumc.nl/LOVD2/mendelian_genes/home.php?select_db=DHCR7
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Lanthaler, B., Steichen-Gersdorf, E., Kollerits, B. et al. Maternal ABCA1 genotype is associated with severity of Smith–Lemli–Opitz syndrome and with viability of patients homozygous for null mutations. Eur J Hum Genet 21, 286–293 (2013). https://doi.org/10.1038/ejhg.2012.169
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DOI: https://doi.org/10.1038/ejhg.2012.169
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