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Combined mutation screening of NKX2-5, GATA4, and TBX5 in congenital heart disease: multiple heterozygosity and novel mutations.
[holt-oram syndrome]
Background
.
 
Variants
of
several
genes
encoding
transcription
modulators
,
signal
transduction
,
and
structural
proteins
are
known
to
cause
Mendelian
congenital
heart
disease
(
CHD
)
.
NKX
2
-
5
and
GATA
4
were
the
first
CHD-causing
genes
identified
by
linkage
analysis
in
large
affected
families
.
Mutations
of
TBX
5
cause
Holt-
Oram
syndrome
,
which
includes
CHD
as
a
clinical
feature
.
All
three
genes
have
a
well-established
role
in
cardiac
development
.
Design
.
 
In
order
to
investigate
the
possible
role
of
multiple
mutations
in
CHD
,
a
combined
mutation
screening
was
performed
in
NKX
2
-
5
,
GATA
4
,
and
TBX
5
in
the
same
patient
cohort
.
Samples
from
a
cohort
of
331
CHD
patients
were
analyzed
by
polymerase
chain
reaction
,
double
high
-performance
liquid
chromatography
and
sequencing
in
order
to
identify
changes
in
the
NKX
2
-
5
,
GATA
4
,
and
TBX
5
genes
.
Results
.
 
Two
cases
of
multiple
heterozygosity
of
putative
disease-causing
mutations
were
identified
.
One
patient
was
found
with
a
novel
L
122
P
NKX
2
-
5
mutation
in
combination
with
the
private
A
1443
D
mutation
of
MYH
6
.
A
patient
heterozygote
for
a
D
425
N
GATA
4
mutation
carries
also
a
private
mutation
of
the
MYH
6
gene
(
V
700
M
)
.
Conclusions
.
 
In
addition
to
reporting
two
novel
mutations
of
NKX
2
-
5
in
CHD
,
we
describe
families
where
multiple
individual
mutations
seem
to
have
an
additive
effect
over
the
pathogenesis
of
CHD
.
Our
findings
highlight
the
usefulness
of
multiple
gene
mutational
analysis
of
large
CHD
cohorts
.
Diseases
Validation
Diseases presenting
"putative disease-causing mutations"
symptom
holt-oram syndrome
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