L’hypertension artérielle essentielle (HTA) est une pathologie complexe, multifactorielle et à forte composante génétique. L’impact de la variabilité dans le nombre de copies sur l’HTA est encore peu connu. Nous envisagions que des variants dans le nombre de copies (CNVs) communs pourraient augmenter ou diminuer le risque pour l’HTA. Nous avons exploré cette hypothèse en réalisant des associations pangénomiques de CNVs avec l’HTA et avec l’HTA et le diabète de type 2 (DT2), chez 21 familles du Saguenay-Lac-St-Jean (SLSJ) caractérisées par un développement précoce de l’HTA et de la dyslipidémie. Pour la réplication, nous disposions, d’une part, de 3349 sujets diabétiques de la cohorte ADVANCE sélectionnés pour des complications vasculaires. D’autre part, de 187 sujets de la cohorte Tchèque Post-MONICA (CTPM), choisis selon la présence/absence d’albuminurie et/ou de syndrome métabolique. Finalement, 134 sujets de la cohorte CARTaGENE ont été analysés pour la validation fonctionnelle. Nous avons détecté deux nouveaux loci, régions de CNVs (CNVRs) à effets quantitatifs sur 17q21.31, associés à l’hypertension et au DT2 chez les sujets SLSJ et associés à l’hypertension chez les diabétiques ADVANCE. Un modèle statistique incluant les deux variants a permis de souligner le rôle essentiel du locus CNVR1 sur l’insulino-résistance, la précocité et la durée du diabète, ainsi que sur le risque cardiovasculaire. CNVR1 régule l’expression du pseudogène LOC644172 dont le dosage est associé à la prévalence de l’HTA, du DT2 et plus particulièrement au risque cardiovasculaire et à l’âge vasculaire (P<2×10-16). Nos résultats suggèrent que les porteurs de la duplication au locus CNVR1 développent précocement une anomalie de la fonction bêta pancréatique et de l’insulino-résistance, dues à un dosage élevé de LOC644172 qui perturberait, en retour, la régulation du gène paralogue fonctionnel, MAPK8IP1. Nous avons également avons identifié six CNVRs hautement hérités et associés à l'HTA chez les sujets SLSJ. Le score des effets combinés de ces CNVRs est apparu positivement et étroitement relié à la prévalence de l’HTA (P=2×10-10) et à l’âge de diagnostic de l’HTA. Dans la population SLSJ, le score des effets combinés présente une statistique C, pour l’HTA, de 0.71 et apparaît aussi performant que le score de risque Framingham pour la prédiction de l’HTA chez les moins de 25 ans. Un seul nouveau locus de CNVR sur 19q13.12, où la délétion est associée à un risque pour l’HTA, a été confirmé chez les Caucasiens CTPM. Ce CNVR englobe le gène FFAR3. Chez la souris, il a été démontré que l’action hypotensive du propionate est en partie médiée par Ffar3, à travers une interférence entre la flore intestinale et les systèmes cardiovasculaire et rénal. Les CNVRs identifiées dans cette étude, affectent des gènes ou sont localisées dans des QTLs reliés majoritairement aux réponses inflammatoires et immunitaires, au système rénal ainsi qu’aux lésions/réparations rénales ou à la spéciation. Cette étude suggère que l’étiologie de l’HTA ou de l’HTA associée au DT2 est affectée par des effets additifs ou interactifs de CNVRs. / Essential hypertension (HT) is a multifactorial complex disease with a strong genetic component. However, little is known about the effects of copy number variance on HT. We hypothesized common Copy Number Variants (CNVs) could increase or decrease the risk for HT. We performed GWAS of CNVs with HT and, with HT and Type 2 Diabetes (T2D), in 21 families of the Saguenay-Lac-St-Jean region of Quebec (FC) affected by early-onset hypertension and dyslipidemia. Replication was tested in a cohort of 3349 unrelated diabetic subjects of Caucasian origin from the ADVANCE trial. Replication was also tested in 187 individuals from the Czech Post-Monica (CPM) cross-sectional survey, ascertained by the presence/absence of albuminuria and/or metabolic syndrome. We performed locus-specific transcriptional analyses in 134 subjects from the CARTaGENE population cohort. We identified two CNV Regions (CNVRs), at 17q21.31, associated with HT and T2D in FC and associated with hypertension in ADVANCE diabetics. A statistical model of association including both CNVRs underlined the main effect size of CNVR1 on insulin resistance, T2D early onset and duration, and risk for cardiovascular diseases (CVD). CNVR1 appeared to influence LOC644172 expression, whose transcript abundance was associated with the prevalence of HT and T2D, and strongly with the risk of CVD and vascular age (P<2×10-16). Our results suggest carriers of copy-number gain at these 17q21.31 loci, principally at the CNVR1 locus, undergo premature β-cell functional deregulation and insulin resistance, due to increase dosage of the LOC644172 pseudogene, which might in turn affect the regulation of expression of its functional paralog, MAPK8IP1. We also report six different CNVR loci, highly heritable and contributing to the risk of hypertension, in French Canadians. The combined CNV risk score appeared robustly related to prevalence of hypertension (p=2×10-10) and age at diagnosis of hypertension. In FC, this combined CNV risk score model showed a C-statistic of 0.71 for HT and appeared as powerful as Framingham HT risk score in predicting hypertension in individuals aged less than 25. We validated the association of a new locus, 19q13.12 deletion-CNVR, with hypertension, in CPM. FFAR3 surrounds this 19q13.12 deletion-CNVR. It has been demonstrated that in mice, a portion of propionate hypotensive effect is mediated by Ffar3, and involves a cross-talk between the gut microbiota and the renal-cardiovascular system. The identified CNVRs appear to influence genes and QTLs mainly related to immune and inflammatory responses and renal damaged and repair. Some CNVRs are exclusive to primates. This study suggests that additive and interactive actions of multiple copy-number variants are involved in the etiology of hypertension or of hypertension associated with T2D.

Obesity is a serious public health crisis and recent estimates of its incidence are the highest in United States history, with 35% and 17% of American adults and children affected, respectively. The clinical definition of adult obesity is operationalized as a body mass index (BMI) greater than 30 kg/m2. Although the prevalence of common obesity has increased dramatically over the past 30 years–largely thought to be due to changes in the environment, such as high calorie diets and sedentary lifestyles—twin and family studies have shown consistently that relative body weight is under considerable genetic influence in both children and adults, with heritability estimates ranging from 40% to 90%. Elucidating the genetic and environmental liability to relative body weight is an important public health endeavor. To further our understanding of the genetics of BMI and common complex obesity, several studies are described that integrate clinical, twin, and genome-wide association (GWAS) methodology in the context of genetic risk scores, clinical risk prediction, development across adolescence into adulthood, and comorbidity with depression symptoms and smoking behavior. First, in two cross-sectional genetic association studies, the utility of genetic risk sum scores (GRSS) were assessed, which summarize the total number of risk alleles, as an alternative form of replication and for potential clinical utility for obesity risk prediction. Next, since there has been only limited research on when during development BMI-associated variants begin influencing BMI, a longitudinal twin study was utilized to assess the effects of adult-validated BMI-SNPs across adolescence into adulthood. In addition, obesity is comorbid with numerous medical conditions including cardiovascular disease, insulin-resistance and some forms of cancer, as well as, various psychiatric disorders including eating disorders, mood disorders, and substance use. The next series of studies aimed to understand phenotypic and genetic associations between BMI/obesity and binge eating disorder (BED), depression symptoms and smoking behavior. Using a clinical sample of overweight and obese women with and without BED, the relationship of BED, food intake and internalizing symptoms of depression and anxiety was examined. Next, twin study methodology was used to investigate if shared genetic and/or environmental liability was responsible for phenotypic associations found between BMI, depression symptoms, and impulsivity. Finally, a genetic association study aimed at investigating whether genetic variants were associated with multiple behaviors, body composition and smoking behavior, or were trait-specific is presented. By utilizing several samples and methodologies and by pursuing methods development, a comprehensive approach is presented that is hoped to represent a more powerful evidence-based strategy to understanding the genetic and environmental determinants of BMI and common complex obesity, along with associated depression symptoms and smoking behavior.

Schizophrenia is a complex disorder affecting 1% of the population and is highly heritable, but the majority of contributing genetic factors has remained elusive. Current risk estimates for clinical practice are primarily determined by family history and associated empirical risk. Copy number variants (CNVs) may hold the key to explaining the missing heritability in schizophrenia research; schizophrenia risk estimates as high as 30% have been found for the most-studied CNV associated with schizophrenia, 22q11. Currently, there are methods to identify CNVs though previously collected data from SNP microarrays that would facilitate these types of studies. To determine if algorithms that call CNVs from microarray data are robust four genomic regions with putative CNVs called by the Wellcome Trust Consortium using Birdseye in Birdsuite with Affymetrix 6.0 array raw SNP intensities, primarily affecting genes CHD1L, COX5B, PAK7, ZFYVE20, were validated using Taqman real-time qPCR assays in 29 samples by research groups at VCU and Dublin. CNVs called from the algorithm were 100% validated at VCU though there were false negatives from the algorithm that were validated. Two samples at loci with putative duplications were not called by the Dublin group, which may be because of differing sensitivities of the Taqman assays to be able to detect a 50% difference in copy number between duplications and diploid controls, or because of another technical or analytical difference between the two sites. Deletion frequency of one common CNV found in the gene ERBB4, was assessed by qPCR in both Irish singleton (ICCSS) and Irish family (IHDSF) samples and compared with Irish control (Trinity Biobank) and North American control populations. The ERBB4 deletion frequency was not significantly different when comparing the Irish controls to the Irish singleton or the Irish family samples though the family samples were different when compared against the North American control population, which suggests population stratification, rather than a true association between ERBB4 and increased schizophrenia risk. Current clinical practice has been improved by knowledge and evaluation of CNV-related disorders that include risk for psychosis and additional phenotypes. Genotyping of individuals with known psychosis has led to improved patient care for non-psychosis-related phenotypes associated with CNVs. Individuals with suspected genomic disorders that are found to have CNVs can be counseled on potential psychosis risk and potential risk to their offspring. Recurrent CNVs may hold promise in future clinical practice in order to individualize risk estimates in the general patient population, and increase the number of individuals able to receive anticipatory treatment to minimize disease severity.

O Transtorno do Espectro Autista (TEA) é uma doença do neurodesenvolvimento. É caracterizado por déficits significativos e persistentes na comunicação e na interação social e por padrões restritos e repetitivos de comportamento, interesses ou atividades. O TEA é considerado uma doença comum, afetando 1 a cada 68 crianças e com uma proporção de 4,2 meninos afetados para cada menina (.A etiologia do autismo apresenta um forte componente genético. Neste contexto, as metodologias genômicas de larga escala (Sequenciamento de nova geração, microarray) contribuíram para o conhecimento sobre a genética do TEA. No entanto, em aproximadamente 70% dos pacientes, o transtorno permanece com etiologia não identificada. Com base nisso, para o presente trabalho, elaborou-se a hipótese de que pequenas CNVs (entre 1 e 50 Kb), que se encontram abaixo da resolução da maioria dos microarrays comerciais, e cuja detecção ainda apresenta limitações para a sua detecção através de sequenciamento de nova geração, poderiam contribuir para o fenótipo em uma proporção significativa dos casos. Como primeira etapa para abordar essa questão, realizou-se a metodologia de aCGH customizado 60K cobrindo um total de 269 genes candidatos ao TEA, a fim de selecionar CNVs potencialmente patogênicas entre 98 pacientes brasileiros com TEA idiopático. Com esta triagem inicial, a prevalência de CNVs potencialmente patogênicas obtida foi de 9%, com 20% delas caracterizadas como pequenas. A análise subsequente foi realizada com a metodologia de aCGH customizado 180K, o qual cobriu um total de 1527 genes candidatos ao TEA. Um total de 63 pacientes com autismo foram analisados com este novo array. A partir destas hibridações, a prevalência de CNVs potencialmente patogênicas obtida foi de 12,7%, com 62,5 % delas classificadas como pequenas. Esta taxa de detecção é bastante expressiva, particularmente se considerarmos que a amostra de pacientes utilizada foi submetida a uma pré-triagem, com a finalidade de excluir os pacientes com as CNVs mais prevalentes no TEA, nas regiões 15q11-q13, 16p11.2 e 22q13.3. A última abordagem utilizada neste trabalho foi comparar a detecção de CNVs pela metodologia de aCGH, referência padrão ouro para detecção de CNVs, com a de sequenciamento de nova geração (NGS). Os dados de 9 pacientes obtidos por NGS foram analisados através dos softwares NextGene e XHMM. Os softwares, no entanto, apresentaram resultados discrepantes entre si e pouca sobreposição com os dados de aCGH 180K, de 38,9% e 50%, considerando o NextGene e o XHMM respectivamente. Os resultados obtidos sugerem que o aCGH customizado é promissor para a detecção de CNVs pequenas e que essas, por sua vez, podem contribuir para o risco de TEA em pelo menos 6,3 %, dos casos / Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder. It is characterized by significant and persistent deficits in communication and social interaction, and by restricted and repetitive patterns of behavior, interests or activities. ASD is considered a common disease, affecting 1 in 68 children and a proportion of 4.2 boys affected for each girl.The etiology of autism has a strong genetic component. In this context, genomic methodologies of high-throughput (new generation sequencing, microarray) contributed to the knowledge about the genetics of ASD. However, in approximately 70% of patients with ASD, the disorder remains with unidentified etiology. Therefore, foi this work, it was hypothesized that small CNVs (between 1 and 50 Kb), which are below the resolution of most commercial microarrays and and whose detection still has limitations for its detection detection through NGS, could contribute to the phenotype in a proportion of cases. As a first step to address this hypothesis, it was performed the methodology of custom aCGH 60K, covering a total of 269 ASD candidate genes, in order to select potentially pathogenic CNVs among 98 Brazilian patients with idiopathic ASD. With this initial screening, the prevalence of potentially pathogenic CNVs obtained was 9%, with 20% of them characterized as small. The subsequent analysis was performed using the 180K custom aCGH methodology, which covered a total of 1527 TEA candidate genes. A total of 63 patients with autism were analyzed with this new array. From these hybridizations, the prevalence of potentially pathogenic CNVs obtained was 12.7%, with 62.5% of them classified as small. This detection rate is quite significant, particularly considering that the sample of patients used was pre-screened, in order to exclude patients with the most prevalent CNVs in ASD in the regions 15q11-q13, 16p11.2 and 22q13.3. The last approach used in this work was to compare the detection of CNVs by the methodology of aCGH, gold standard reference for CNVs detection, with the next generation sequencing (NGS).Data from 9 patients obtained by NGS were analyzed using NextGene and XHMM software. The softwares, however, presented discrepant results among themselves and little overlap with the data of aCGH 180K, of 38.9% and 50%, considering NextGene and XHMM respectively. These results suggest that the customized aCGH represents a promising approach for the detection of small CNVs and that these, in turn, can contribute to the risk of ASD in at least 6,3 % of cases

Autism Spectrum Disorder (ASD) is a heterogeneous group of neurodevelopmental disorders that affects about 1% of the worldwide population and has a strong genetic component. Stereotyped behavior and restricted interests, as well as problems of social interaction and communication characterize ASD. Moreover, in 10% of cases, ASD occurs as a secondary condition in addition to a syndrome, such as Phelan-McDermid syndrome (PMS), which is associated with a great clinical variability. Among genetic factors, copy number variations (CNVs) are one of the most important. However, the clinical significance of many CNVs remains nuclear and there is an underrepresentation of small CNVs associated with ASD in the literature. In this context, this project aimed to 1) characterize large and small CNVs in Brazilian patients with ASD using an array-CGH previously customized in our laboratory. 2) Clinically and genetically describe a cohort of Brazilian patients with PMS, as well as to determine the frequency of this syndrome among Brazilian patients with ASD and other neurodevelopmental disorders. In result, we 1) further validated the customized array-CGH, 2) provided additional evidence of association with ASD for 27 candidate genes, 3) described 15 CNVs never reported in the literature in association with this disorder, 4) presented evidence that around 70% of CNVs found in our cohort are not polymorphism of our population and 5) reinforced the idea of shared molecular pathways among different neurodevelopmental disorders. In addition, we described for the first time a Brazilian cohort of patients with PMS and contributed to the molecular and clinical characterization of this syndrome. We also provided additional evidence of genotype-phenotype association with regard to the presence of renal problems and speech status in patients with PMS and estimated the frequency of this syndrome among Brazilian patients with ASD and intellectual disability (syndromic or not). With these results, we hope to contribute to better understand the ASD and PMS etiology, especially in our population / O Transtorno do Espectro Autista (TEA) corresponde ao um grupo heterogêneo de alterações no neurodesenvolvimento que afeta cerca de 1% da população mundial e apresenta um forte componente genético. O TEA é caracterizado pela presença de comportamento estereotipado e interesses restritos, além de problemas de interação social e comunicação. Além disso, em 10% dos casos, o TEA ocorre como uma condição secundária somada a uma síndrome. Um exemplo é a síndrome de Phelan-McDermid (PMS), associada a uma grande variabilidade clínica. Dentre os fatores genéticos, as variações no número de cópias (CNVs) são um dos mais importantes. No entanto, o significado clínico de muitas CNVs permanece incerto, além de haver juma sub-representação de CNVs pequenas associadas ao TEA na literatura. Dentro deste contexto, este projeto teve como objetivos 1) caracterizar CNVs grandes e pequenas em pacientes brasileiros com TEA utilizando uma lâmina de array-CGH previamente customizada no Laboratório de Genética do Desenvolvimento - USP. 2) descrever clínica e geneticamente uma casuística de pacientes brasileiros com PMS, bem como determinar a frequência desta síndrome em pacientes com TEA e com outras alterações de neurodesenvolvimento. Como resultados, nós 1) validamos a lâmina customizada, 2) fornecemos evidencia adicional de associação com o TEA para 27 genes, 3) descrevemos 15 CNVs nunca reportadas em associação com o transtorno 4) apresentamos evidências de que cerca de 70% das CNVs encontradas em nossa coorte não são polimorfismo de nossa população e 5) reforçamos a ideia de vias moleculares compartilhadas entre diferentes alterações do neurodesenvolvimento. Além disso, descrevemos pela primeira vez uma casuística brasileira de pacientes com PMS e contribuímos para a síndrome. Fornecemos evidência adicional de associação genótipo-fenótipo no que diz respeito à presença de problemas renais e status de fala em pacientes com PMS e estimamos a frequência da síndrome entre pacientes brasileiros com TEA e com deficiência intelectual (sindrômica ou não). Com estes resultados, esperamos ter contribuído para o entendimento da etiologia tanto do TEA, quanto da PMS, sobretudo na nossa população

INTRODUÇÃO: Os defeitos cardíacos congênitos (DCC) são um grupo de anormalidades estruturais mais prevalentes ao nascimento e uma das principais causas de morbidade e mortalidade infantil. Os fatores genéticos são importantes na etiologia dos DCC. Estudos têm mostrado a contribuição da variação no número de cópias (CNV) na gênese das malformações cardíacas. A deleção 22q11.2 é a causa mais comum de microdeleção humana e está relacionada com defeito cardíaco (DCC) conotruncal. O MLPA (Multiplex Ligation-dependent Probe Amplification) é um método eficaz para detectar microdeleções/microduplicações em pacientes com DCC. OBJETIVO: Detectar a presença da variação no número de cópias gênicas em pacientes portadores de cardiopatia conotruncal pela técnica de MLPA e associar ao fenótipo do paciente. MÉTODOS: Foram avaliados 39 pacientes (23 do sexo masculino, 16 do sexo feminino) com idade entre 2 dias e 19 anos (mediana de 6 anos), todos com cardiopatia conotruncal, a maioria dos pacientes (56%) apresentavam tetralogia de Fallot. Avaliação clínica e laboratorial foi realizada em todos os pacientes. O cariótipo foi normal em todos pacientes. MLPA foi realizada com os kits P064, P036/P070 e P250. RESULTADOS: Foram detectadas CNVs em sete pacientes: deleção 22q11.2, duplicação 22q11.2, duplicação 15q11.2, duplicação 20p12.2, deleção 19p, duplicação 15q e duplicação 8p23.2 com duplicação 10p12.31. As cardiopatias encontradas nestes pacientes foram: dupla via de saída de ventrículo direito (2), coartação da aorta, tetralogia de Fallot (3) e transposição de grandes artérias. Os achados clínicos extracardíacos encontrados nestes pacientes foram dismorfismo facial, dente neonatal, atrofia e displasia cerebral, atresia duodenal, dificuldade de aprendizado, insuficiência velofaríngea, aplasia de timo, refluxo gastroesofágico, hérnia umbilical, asma, infecções de vias aéreas frequente, déficit de crescimento e somente três apresentavam retardo no desenvolvimento neuropsicomotor (dup 15q11.2, dup 15q, del 22q11.2). As características clínicas foram compatíveis com o relatado na literatura associado com a microdeleção/microduplicação encontrada. Nenhuma destas alterações foram herdadas de seus pais testados em seis casos. CONCLUSÃO: O uso do MLPA possibilitou a detecção de CNVs em pacientes com DCC. O diagnóstico precoce das CNVs em pacientes com DCC auxilia na prevenção de morbidade e diminuição da mortalidade nestes pacientes, contudo em um país com regiões com poucos recursos laboratoriais genéticos uma avaliação clínica minuciosa em todo paciente com DCC é imprescindível para direcionar qual melhor exame deve ser realizado / INTRODUCTION: Congenital heart defects (CHD) are a group of structural abnormalities most prevalent birth and a major cause of infant morbidity and mortality. Genetic factors are important in the etiology of CHD. Studies have shown the contribution of copy number variation (CNV) in the genesis of cardiac malformations. The deleletion 22q11.2 is the most common cause of human microdeletion and is related conotruncal cardiac defect (DCC). The MLPA (Multiplex Ligation-dependent Probe Amplification) is an effective method to detect microdeletions/micoduplications in patients with CHD. PURPOSE: Detect the presence of gene copies number variation in the patients with conotruncal heart defect by MLPA technique and associate the phenotype of the patient. METHODS: 39 patients (23 males, 16 females) aged 2 days old - 19 years old (median= 6 years old) with conotruncal cardiac defect were evaluated. Tetralogy of Fallot was more prevalent heart defect (56%). All patients were evaluated clinical and laboratory. Karyotypes were normal in all pacients. MLPA was performed with the P064, P036/P070 and P250 kits. RESULTS: CNVs were detected in seven patients: 22q11.2 deletion, 22q11.2 duplication, 15q11.2 duplication, 20p12.2 duplication, 19p deletion, 15q duplication and 8p23.2 duplication with 10p12.31 duplication. The congenital heart defect found in these patients were: double outlet right ventricle (2), coarctation of the aorta, tetralogy of Fallot (3) and transposition of the great arteries. Clinical findings in these patients were facial dysmorphism, neonatal tooth, brain atrophy and dysplasia, duodenal atresia, learning disabilities, velopharyngeal insufficiency, thymic aplasia, gastroesophageal reflux, umbilical hernia, asthma, frequent infections of the airways , failure to thrive, and only three had delayed psychomotor development (dup 15q 11.2, dup 15q, del 22q11.2) The clinical features were consistent with those reported in the literature associated with the microdeletion /microduplication found. None of these alterations were inherited from six parents tested. CONCLUSIONS: MLPA was effective to detect CNVs in patients with CHD. Early diagnosis of CNVs in patients with CHD assists in preventing morbidity and decreased mortality in these patients, however, in a country with regions with few genetic laboratory resources a thorough clinical evaluation in all patients with CHD is essential to direct which should be further analyzed performed

O Transtorno de Déficit de Atenção e Hiperatividade (TDAH) é a doença do neurodesenvolvimento mais comum na infância, afetando cerca de 5,8% de crianças e adolescentes no mundo. Muitos estudos vêm tentando investigar a suscetibilidade genética em TDAH, mas sem muito sucesso. Este estudo teve como objetivo analisar variantes raras e comuns contribuindo para a arquitetura genética do TDAH. Foram gerados os primeiros dados de exoma de TDAH de 30 trios brasileiros em que o filho foi diagnosticado com TDAH esporádico. Foram analisados tanto variações de único nucleotídeo (ou SNVs, single-nucleotide variants) quanto variações de número de cópias (ou CNVs, copy-number variants), tanto nesses trios quanto em outros conjuntos de dados, incluindo uma amostra brasileira de 503 crianças/adolescentes controles, bem como resultados previamente publicados em quatro estudos com variação de número de cópias e uma meta-análise de estudos de associação ao longo do genoma. Tanto os trios quanto os controles fazem parte da Coorte de Escolares de Alto Risco para o desenvolvimento de Psicopatologia e Resiliência na Infância do Instituto Nacional de Psiquiatria do Desenvolvimento (INPD). Os resultados de trios brasileiros mostraram três padrões marcantes: casos com variações herdadas e somente SNVs de novo ou CNVs de novo, e casos somente com variações herdadas. Embora o tamanho amostral seja pequeno, pudemos ver que diferentes comorbidades são mais frequentes em casos somente com variações herdadas. Após explorarmos a composição de variações nos probandos brasileiros, foram selecionados genes recorrentes entre amostras do nosso estudo ou em bancos de dados públicos. Além disso, usando somente genes expressos no cérebro (amostras pós-mortem dos projetos Brain Atlas e Genotype-Tissue Expression), construímos uma rede de interação proteína-proteína \"in silico\" com interações físicas confirmadas por pelo menos duas fontes. Análises topológicas e funcionais dos genes da rede mostraram genes relacionados a sinapse, adesão celular, vias glutamatérgicas e serotonérgicas, o que confirma achados de trabalhos independentes na literatura indicando ainda novos genes e variantes genéticas nessas vias. / Attention-Deficit/Hyperactivity Disorder (ADHD) is the most common neuro-developmental disorder in children, affecting 5.8% of children and adolescents in the world. Many studies have attempted to investigate the genetic susceptibility of ADHD without much success. The present study aimed to analyze rare and common variants contributing to the genetic architecture of ADHD. We generated exome data from 30 Brazilian trios where the children were diagnosed with sporadic ADHD. We analyzed both single-nucleotide variants (SNVs) and copy-number variants (CNVs) in these trios and across multiple datasets, including a Brazilian sample of 503 children/adolescent controls from the High Risk Cohort Study for the Development of Childhood Psychiatric Disorders, and also previously published results of four CNV studies of ADHD involving children/adolescent Caucasian samples. The results from the Brazilian trios showed 3 major patterns: cases with inherited variations and de novo SNVs or de novo CNVs and cases with only inherited variations. Although the sample size is small, we could see that various comorbidities are more frequent in cases with only inherited variants. After exploring the rare variant composition in our 30 cases we selected genes with variations (SNVs or located in CNV regions) in our trio analysis that are recurrent in the families analyzed or in public data sets. Moreover, using only genes expressed in brain (post-mortem samples from Brain Atlas and The Genotype-Tissue Expression project), we constructed an in silico protein-protein interaction (PPI) network, with physical interactions confirmed by at least two sources. Topological and functional analyses of genes in this network uncovered genes related to synapse, cell adhesion, glutamatergic and serotoninergic pathways, both confirming findings of previous studies and capturing new genes and genetic variants in these pathways.

A perda auditiva é o defeito mais comum ao nascimento e cerca de 70 milhões de pessoas no mundo apresentam algum grau de perda auditiva. Além da alta incidência, as implicações da perda auditiva na linguagem, na cognição e no desenvolvimento emocional e social reforçam sua importância. No entanto, em grande parte dos pacientes, a causa da deficiência auditiva não é esclarecida. Nós usamos hibridação comparativa do genoma baseada em arrays (Array Comparative Genomic Hybridization aCGH) para investigar alterações no número de cópias de segmentos de DNA (Copy Number Variation CNV) em 31 indivíduos que apresentavam deficiência auditiva e sinais clínicos adicionais, mas que não puderam ser classificados em síndrome conhecida. A escolha de indivíduos sindrômicos se baseou no pressuposto de que, em média, apresentam alterações genômicas maiores e, portanto, mais provavelmente detectáveis com o uso de aCGH de 1 Mb, que era a plataforma disponível no início do projeto. CNVs não descrita em bancos de dados de indivíduos normais foram identificadas em oito pacientes, quatro delas ocorreram de novo enquanto as outras quatro foram herdadas de um genitor fenotipicamente normal. As alterações de novo definem segmentos cromossômicos que provavelmente contém genes relacionados à deficiência auditiva e sensíveis a dose, especificamente: 1q23.3-q25.2, 2q22q23, 6p25.3 e 11q13.2-q13.4. As alterações raras identificadas tanto nos pacientes quanto em um genitor normal poderiam ser um evento ao acaso, sem papel na deficiência auditiva; no entanto, a possibilidade de que essas alterações possam funcionar como fatores de predisposição não podem ser descartadas. Se considerarmos apenas as CNVs de novo como causativas dos fenótipos investigados, detectamos quatro pacientes portadores entre os 31 investigados (13%). Se considerarmos também as CNVs herdadas como possivelmente causativas, a taxa de desequilíbrios cromossômicos associados à surdez será de 26%. Esses resultados são provavelmente uma substimativa e esses números seriam possivelmente maiores com o uso de uma das plataformas de alta resolução disponíveis atualmente. Esses resultados, embora limitados, indicam que investigação por aCGH em pacientes com surdez sindrômica idiopática está entre os testes mais eficientes para detectar etiologia dos fenótipos, devendo ser incorporado à rotina no diagnóstico e aconselhamento genético. / Hearing loss is the most common congenital deficiency and about 70 million people worldwide present some degree of hearing impairment. In addition to its high incidence, hearing loss impacts language, cognition and social and emotional development. However, in a large proportion of patients, the cause of the hearing deficiency cannot be elucidated. We screened copy number changes by 1 Mb-array Comparative Genomic Hybridization (aCGH) in 31 individuals with syndromic hearing impairment whose clinical features were untypical for known disorders. The choice of evaluating syndromic rather than non-syndromic individuals was based on the assumption that they are more likely to carry larger genomic alterations which could be more easily detected by the comparatively low resolution 1 Mb aCCG, which was the available platform when this project started. Copy number changes (CNV) not documented in the database of normal individuals were detected in eight patients, four de novo imbalances and four inherited from a normal parent. The de novo alterations define candidate chromosome segments likely to harbor dosage sensitive genes related to hearing impairment, namely 1q23.3-q25.2, 2q22q23, 6p25.3 and 11q13.2- q13.4. The rare imbalances also present in normal parents might be casually associated with hearing impairment, but also have a possible role as a predisposition factor. When only the de novo CNVs were considered causative for the disease phenotypes, our study revealed relevant copy number changes in 4 patients (13%). If we also count the rare CNVs that had been inherited as possibly causative, the frequency of chromosome imbalances associated with syndromic deafness in our sample becomes 26%. These figures are probably underestimates and will probably become larger when high resolution oligoarray platforms are applied. These results indicate that aCGH is an efficient tool for defining the etiology of syndromic deafness and its use in routine diagnosis of hearing impairment and for genetic counseling is highly recommended.

As malformações cardíacas congênitas (MCCs) são as malformações mais comuns ao nascimento, representando uma importante causa de morbidade e mortalidade em recém-nascidos. Nos últimos anos, estudos utilizando testes citogenômicos têm permitido elucidar e compreender melhor as causas das MCCs. O objetivo geral desse estudo foi investigar a presença de CNVs em amostras de tecido obtidas post-mortem de portadores de malformações cardíacas congênitas sindrômicas; e os objetivos específicos consistiram em avaliar a frequência das CNVs, destacando as mais relevantes, comparar a presença de CNVs nos diferentes tecidos e realizar a correlação genótipo-fenótipo. Para isso, foram estudados um total de 52 casos de natimortos e recém-nascidos provenientes do Serviço de Verificação de Óbitos - FMUSP. Amostras de DNA extraídas da pele, diafragma e do coração foram avaliadas utilizando o kit AmpFlSTR® MiniFiler(TM) PCR Amplification (Life Technologies(TM), USA) e a técnica de Multiplex Ligation-dependent Probe Amplification (MLPA) com diferentes kits (MCR-Holland, Holanda). A técnica de FISH foi utilizada para a confirmação dos resultados obtidos em um dos casos estudados. Foram encontradas CNVs relevantes em 21 casos, incluindo trissomia do 18 (10 casos), trissomia do 21 (4 casos), trissomia do 13 (2 casos), trissomia do 16 (1 caso), monossomia do X em mosaico (1 caso), dup 4p16 (1 caso), dup 11q25 (1 caso) e del GATA4 éxon 6 (1 caso). A análise genômica se mostrou eficiente na investigação das bases genômicas e na caracterização das diferentes malformações em amostras post-mortem de portadores de MCC sindrômicas / Congenital heart defects (CHDs) are the most common birth defect and represent an important cause of morbidity and mortality in newborns. In recent years, studies using cytogenomic tests have enabled an improved understanding of the causes of CHD. The general objective of this study was to investigate the presence of CNVs in post-mortem tissue samples from patients with congenital syndromic cardiac malformations; and the specific objectives were to evaluate the frequency of CNVs, highlighting the most relevant ones, to compare the presence of CNVs in the different tissues and to perform the genotype-phenotype correlation. For this, a total of 52 stillbirth and newborn cases from the Death Verification Service (SVO), FMUSP were investigated. DNA samples from skin, diaphragm and heart tissues were evaluated using an AmpFlSTR® MiniFiler(TM) PCR Amplification Kit (Life Technologies(TM), California, USA) and Multiplex Ligation-dependent Probe Amplification (MLPA) with different kits (MCRHolland, Amsterdam, The Netherlands). FISH was used to confirm the results of one of the studied cases. The results showed relevant copy number variations (CNVs) in 21 cases, including trisomy 18 (10 cases), trisomy 21 (4 cases), trisomy 13 (2 cases), trisomy 16 (1 case), mosaic monosomy X (1 case), dup 4p16 (1 case), dup 11q25 (1 case) and del GATA4 exon 6 (1 case). Genomic analysis was found to efficiently identify the genomic basis of, and characterize, various malformations found in postmortem samples from syndromic CHD carriers

Os tumores malignos hepáticos são raros nas crianças, sendo o tumor embrionário hepatoblastoma a neoplasia hepática mais comum em crianças abaixo dos 5 anos e, ainda assim, responsável por apenas 1% dos tumores incidentes nessa faixa etária. Devido, entre outros fatores, à sua baixa incidência, o hepatoblastoma é um tumor ainda pouco caracterizado a nível molecular. O presente trabalho contemplou três frentes de análises moleculares em hepatoblastomas: análise de alterações em número de cópias (através da técnica array-CGH), investigação de mutações somáticas em regiões codificadoras (sequenciamento de exoma por next-generation) e delineamento de perfil global de metilação de DNA (beadarrays). Encontramos um baixo número de alterações em número de cópias, na maioria ganhos de grande extensão cromossômica, evidenciando uma baixa instabilidade cromossômica em comparação ao encontrado em outros tumores sólidos de adultos. Uma região em 2q24 previamente associada a um pior prognóstico em hepatoblastomas foi encontrada como ganho de alta amplitude (amplicon). A análise de expressão gênica na área destacou 5 dos 48 genes como super-expressos em nossas amostras de hepatoblastomas (DAPL1, ERMN, GALNT5, SCN1A e SCN3A). Foi observada também uma baixa ocorrência de mutações somáticas não-sinônimas, quando comparada à magnitude de variações encontradas em outros tumores sólidos de adultos. Descrevemos uma nova mutação não-sinônima danosa no exon 3 do gene CTNNB1 (beta-catenina), marcador molecular de destaque em hepatoblastomas, que provavelmente desenvolve um papel importante na tumorigênese deste tipo de neoplasia. Dentre a lista de alterações somáticas encontradas, cabe destacar o enriquecimento da via Wnt, via da beta-catenina, já bem estudada em hepatoblastomas e que apresenta correlação tanto com desenvolvimento embrionário como com o processo de carcinogênese. Destacamos uma lista de mutações somáticas não-sinônimas presentes com boa cobertura em nossos experimentos, e ausentes ou presentes em baixa frequência (< 1%) na população. O presente estudo é o pioneiro na análise de alterações globais no padrão de metilação de citosinas em hepatoblastomas, e revelou um padrão incomum de hipometilação global nos tumores, não associado à metilação de regiões repetitivas LINE-1; especificamente, hepatobastomas apresentam um nível intermediário entre o encontrado para os fígados maduros e aquele encontrado para os fígados fetais. Tal achado dá suporte ao modelo no qual a tumorigênese do hepatoblastoma recapitularia fases do desenvolvimento fetal do fígado. Foram destacados 11 genes que apresentaram padrão de metilação de DNA diferencial em seus promotores. Em suma, nossos achados revelam que o tumor embrionário hepatoblastoma apresenta relativa estabilidade genética, com uma frequência menor de alterações (alterações em número de cópias e mutações somáticas em regiões codificadoras) que tumores sólidos de adultos. Simultaneamente, foi detectado um padrão marcante de hipometilação global de DNA associado ao tumor, evidenciando a importância de aspectos epigenéticos em sua tumorigênese / Hepatic malignant tumors are rare in children, the embryonal tumor hepatoblastoma is the most common liver cancer in children under 5 years old but, in spite of that, accounts for only 1% of incident tumors in this age group. Due to its low incidence, among other factors, hepatoblastoma is a tumor poorly characterized at molecular level. This study included three approaches of molecular analyzes in hepatoblastomas: examination of copy number alterations (through array-CGH technique), investigation of somatic mutations in coding regions (next-generation exome sequencing) and determination of the global DNA methylation profile (bead arrays). We found a low frequency of copy number alterations, mostly consisting of large extent chromosomal gains, reflecting lower chromosomal instability than other solid adult tumors. A region at 2q24, previously associated with worse prognosis in hepatoblastomas, was found amplified in high amplitude (amplicon). Gene expression analysis of the 48 genes comprised in the amplicon segment highlighted five genes as overexpressed (DAPL1, ERMN, GALNT5, SCN1A and SCN3A). We also observed a low frequency of non-synonymous somatic mutations in our hepatoblastomas samples compared to the amount of variation found in other adult solid tumors. We described a predicted harmful non-synonymous mutation in exon 3 of CTNNB1 gene (beta-catenin), the best characterized molecular marker in hepatoblastomas. The list of somatic alterations points to a remarkable enrichment of genes from the Wnt pathway, which is well-studied in hepatoblastomas and is associated both with embryonic development and with the process of carcinogenesis. We highlighted a list of non-synonymous somatic mutations that presented high coverage in our experiments, and were absent or present at low frequency (<1%) in the general population. This study is the first to analyze global changes in cytosine methylation in hepatoblastomas, and revealed an unusual pattern of global hypomethylation in these tumors, not associated with LINE-1 repetitive regions; specifically, hepatobastomas exhibited an intermediate level of methylation, in between the patterns of mature and fetal livers. This finding supports the model in which the oncogenesis of hepatoblastoma recapitulates stages of fetal liver development. We highlighted 11 genes that showed differential pattern of DNA methylation in their promoters compared to differentiated liver. In summary, our findings show that the embryonal tumor hepatoblastoma are relatively genetically stable with lower frequency of alterations (changes in copy number and somatic mutations in coding regions) than most solid adult tumors. Simultaneously, a clear pattern of global hypomethylation of non-repetitive DNA was associated with the tumor, indicating the importance of epigenetic aspects in its tumorigenesis