<p>The array-based form of comparative genomic hybridization (array-CGH) is a new methodology that has shown to be of significant importance. This thesis focuses on the development of array-CGH with the aim to define candidate regions/genes on chromosome 22 in a wide spectrum of cancer-related conditions. In <b>paper I</b>, we developed and applied the first comprehensive genomic microarray, representing human chromosome 22, for analysis of DNA copy number. Using this array-based approach, we identified gene copy number alterations, including heterozygous/homozygous deletions, amplifications, IGLV/IGLC locus instability and the breakpoints of imbalanced translocation, in several 22q-associated disorders. In <b>paper II</b>, we applied the same array to perform DNA copy number profiling of a series of ovarian carcinoma. cDNA arrays were also used in this study to correlate gene expression levels with DNA-copy number. In the course of this analysis, we determined a small 3.5 Mb candidate 22q telomeric region and suggested a number of specific candidate genes. <b>Paper III</b> described the comprehensive and high-resolution analysis of chromosome 22 in a large set of various stage breast cancers. Multiple distinct patterns of genetic aberrations were observed. The smallest identified candidate locus was 220 kb in size and mapped to a gene-rich region in the vicinity of telomere of 22q. Intriguing result of this study was the detection of high frequency (26.6%) of intra-tumoral clonal variation in gene copy number profiles, which should be viewed as a high number, considering that we study in detail only a single human chromosome. In <b>paper IV</b>, we profiled a series of 28 Wilms tumor samples using 22q-array in order to assess specific regions affected with DNA dosage-alterations. The distribution of aberrations defined a complex amplifier genotype and delimited two tumor suppressor/oncogene candidate loci. These results open up for several avenues for continued research of these tumor forms. These findings also demonstrate the power of array-CGH in the precise determination of minute DNA copy number alterations and strengthen the notion that further studies, preferentially in the context of the entire human genome, are needed.</p>

<p>Neurofibromatosis type 2 (NF2) is an autosomal dominant disorder with the clinical hallmark of bilateral vestibular schwannomas (VS). Patients affected by a severe NF2 phenotype also presents with peripheral schwannomas, meningiomas and ependymomas. The closely related disorder schwannomatosis also displays multiple schwannomas, but never VS. Mutation screening of the <i>NF2</i> gene in the above mentioned tumors did not identify mutations in numerous of cases. We analyzed the DNA sequence covering the <i>NF2</i> locus in order to identify evolutionarily conserved non-genic sequences (CNGs) with unknown regulatory function (paper I). The aim was to analyze CNGs for mutations in DNA derived from patients affected by NF2 associated tumors. During mutation analysis of the coding part of <i>NF2</i> and within the CNGs defined in paper I, were mutations detected in 39% of sporadic meningiomas (paper II). Two candidate regions were identified on 22q using array-CGH. Methylation profiling did not identify methylation of the <i>NF2</i> promoter in these tumors. Sporadic schwannomas were profiled for CNV using a 22q genomic array in the search for putative gene(s) that in addition to <i>NF2</i> could be involved in the development of schwannoma and/or schwannomatosis (paper III). The predominant aberration identified was monosomy 22. Terminal and interstitial deletions encompassing the <i>NF2</i> gene were detected in tumor DNA and eight loci affected by CNV in constitutional DNA. Some of these CNVs are unlikely to be phenotypically neutral, considering their size and gene content. Two schwannomatosis candidate regions were identified on 22q using array-CGH (paper IV). These regions were further characterized by a PCR-product based array with higher resolution. Rearrangements of the immunoglobulin lambda (<i>IGL</i>) locus detected were restricted to schwannomatosis patients. In the second candidate region spanning <i>GSTT1</i> and <i>CABIN1</i> genes, was frequent copy number polymorphism at the <i>GSTT1</i> locus identified. We further describe missense mutations in the <i>CABIN1 </i>gene, making this gene a plausible candidate which may contribute to the pathogenesis of these disorders. </p>

Neurofibromatosis type-2 (NF2) is an autosomal dominant disorder with the clinical hallmark of bilateral eighth cranial nerve schwannomas. However, the diagnostic criterion is complicated by the presence of a variable phenotype, with the severe form presenting with additional tumors such as peripheral schwannoma, meningioma and ependymoma. We constructed a microarray spanning 11Mb of 22q, encompassing the NF2 gene, to detect deletions in schwannoma. Forty seven patients were analyzed and heterozygous deletions were detected in 45% of tumors. Using this array-based approach, we also detected genetic heterogeneity in a number of samples studied. Despite the high sensitivity and the comprehensive series of studied schwannomas, no homozygous deletions affecting the NF2 gene were detected <b>(paper I)</b>. In order to detect more subtle deletions within the NF2 locus, a higher-resolution gene-specific array was developed, for the detection of disease-causing<b> </b>deletions using a PCR-based non-redundant strategy. This novel approach for array construction significantly increased the reliability and resolution of deletion-detection within the NF2 locus <b>(paper II)</b>. To further expand the coverage of the 11 Mb microarray, we constructed the first comprehensive microarray representing a human chromosome for analysis of DNA copy number. This 22q array covers 34.7 Mb, representing 1.1% of the genome, with an average resolution of 75 kb <b>(paper III)</b>. Using this array, we analyzed sporadic and familial schwannomatosis samples, which revealed two commonly deleted regions within the immunoglobulin lambda locus and the GSTT1/CABIN1 locus. These regions were further characterized using higher-resolution non-redundant arrays, bioinformatic tools, positional cloning and mutational screening. Missense mutations were detected in the CABIN1 gene, which may contribute to the pathogenesis of schwannomatosis and therefore requires further study <b>(paper IV)</b>. Meningioma is the second most common NF2-associated tumor and loss of 1p has been previously established as a major genetic factor for disease initiation/progression and also correlates with increased morbidity. We analyzed 82 meningiomas using a chromosome 1 tiling-path genomic microarray. The distribution of aberrations detected supports the existence of at least four regions on chromosome 1, which are important for meningioma tumorigenesis <b>(paper V)</b>.

Microarray-based comparative genomic hybridization (array-CGH) has emerged as a versatile platform with a wide range of applications in molecular genetics. This thesis focuses on the development of array-CGH with a specific aim to approach disease-related questions through improved strategies in array construction and enhanced resolution of analysis. In <b>paper I</b>, we applied an array covering 11 Mb of 22q, encompassing the NF2 locus, for deletion detection in sporadic schwannoma. Hemizygous deletions and tumor heterogeneity were identified. Array-CGH was established as a reliable platform for detection of DNA dosage alterations. <b>Paper II</b> described the construction of the NF2 gene-specific microarray for high-resolution scanning of deletions in the NF2 locus. We report a novel PCR-based non-redundant strategy for microarray fabrication, which considerably improved the sensitivity and reliability of deletion detection. <b>Paper III</b> reported the first tiling-path array comprehensively covering a human chromosome. The usefulness of the 22q-array was demonstrated by applying it to detect DNA dosage-alterations in 22q-associated disorders. In <b>paper IV</b>, we optimized array-CGH protocols for deletion detection in 22q11 deletion-syndrome. We showed that genomic and cDNA clones are not optimal for analysis of 22q11 locus and that PCR-based non-redundant strategy is reliable for deletion detection in such regions. In <b>paper V</b>, we utilized the 22q-array for understanding the genetic basis of schwannomatosis. Two commonly deleted regions were identified within the IGL and the GSTT1/CABIN1 loci. Further investigations using high-resolution arrays, bioinformatic analysis and mutational screening were performed. Missense mutations, specific to the schwannomatosis- and NF2 samples, were identified in the CABIN1 gene. <b>Paper VI</b> described the first array-CGH study for comprehensive and high-resolution profiling of deletions spanning the 17q11 locus. Both typical and atypical deletions were identified in NF1 samples. Bioinformatic analysis revealed novel segmental duplications, which can potentially mediate 17q11 deletions.

The array-based form of comparative genomic hybridization (array-CGH) is a new methodology that has shown to be of significant importance. This thesis focuses on the development of array-CGH with the aim to define candidate regions/genes on chromosome 22 in a wide spectrum of cancer-related conditions. In <b>paper I</b>, we developed and applied the first comprehensive genomic microarray, representing human chromosome 22, for analysis of DNA copy number. Using this array-based approach, we identified gene copy number alterations, including heterozygous/homozygous deletions, amplifications, IGLV/IGLC locus instability and the breakpoints of imbalanced translocation, in several 22q-associated disorders. In <b>paper II</b>, we applied the same array to perform DNA copy number profiling of a series of ovarian carcinoma. cDNA arrays were also used in this study to correlate gene expression levels with DNA-copy number. In the course of this analysis, we determined a small 3.5 Mb candidate 22q telomeric region and suggested a number of specific candidate genes. <b>Paper III</b> described the comprehensive and high-resolution analysis of chromosome 22 in a large set of various stage breast cancers. Multiple distinct patterns of genetic aberrations were observed. The smallest identified candidate locus was 220 kb in size and mapped to a gene-rich region in the vicinity of telomere of 22q. Intriguing result of this study was the detection of high frequency (26.6%) of intra-tumoral clonal variation in gene copy number profiles, which should be viewed as a high number, considering that we study in detail only a single human chromosome. In <b>paper IV</b>, we profiled a series of 28 Wilms tumor samples using 22q-array in order to assess specific regions affected with DNA dosage-alterations. The distribution of aberrations defined a complex amplifier genotype and delimited two tumor suppressor/oncogene candidate loci. These results open up for several avenues for continued research of these tumor forms. These findings also demonstrate the power of array-CGH in the precise determination of minute DNA copy number alterations and strengthen the notion that further studies, preferentially in the context of the entire human genome, are needed.

Neurofibromatosis type 2 (NF2) is an autosomal dominant disorder with the clinical hallmark of bilateral vestibular schwannomas (VS). Patients affected by a severe NF2 phenotype also presents with peripheral schwannomas, meningiomas and ependymomas. The closely related disorder schwannomatosis also displays multiple schwannomas, but never VS. Mutation screening of the NF2 gene in the above mentioned tumors did not identify mutations in numerous of cases. We analyzed the DNA sequence covering the NF2 locus in order to identify evolutionarily conserved non-genic sequences (CNGs) with unknown regulatory function (paper I). The aim was to analyze CNGs for mutations in DNA derived from patients affected by NF2 associated tumors. During mutation analysis of the coding part of NF2 and within the CNGs defined in paper I, were mutations detected in 39% of sporadic meningiomas (paper II). Two candidate regions were identified on 22q using array-CGH. Methylation profiling did not identify methylation of the NF2 promoter in these tumors. Sporadic schwannomas were profiled for CNV using a 22q genomic array in the search for putative gene(s) that in addition to NF2 could be involved in the development of schwannoma and/or schwannomatosis (paper III). The predominant aberration identified was monosomy 22. Terminal and interstitial deletions encompassing the NF2 gene were detected in tumor DNA and eight loci affected by CNV in constitutional DNA. Some of these CNVs are unlikely to be phenotypically neutral, considering their size and gene content. Two schwannomatosis candidate regions were identified on 22q using array-CGH (paper IV). These regions were further characterized by a PCR-product based array with higher resolution. Rearrangements of the immunoglobulin lambda (IGL) locus detected were restricted to schwannomatosis patients. In the second candidate region spanning GSTT1 and CABIN1 genes, was frequent copy number polymorphism at the GSTT1 locus identified. We further describe missense mutations in the CABIN1 gene, making this gene a plausible candidate which may contribute to the pathogenesis of these disorders.

Abstract Breast cancer is the most common cancer among women, and inherited predisposition is one of the major recognized causes of increased breast cancer risk. Only about half of the hereditary cases are explained by mutations in the known susceptibility genes, including the DNA damage response genes BRCA1, BRCA2 and PALB2, leaving the majority still uncovered. Identification of the missing genetic predisposing factors is important for more effective diagnostics and counseling of the risk families, and also for better understanding of the etiology and cellular characteristics of breast cancer. The first aim of this study was to investigate the cancer associations of six rare germline copy number variant (CNV) deletions, which were previously identified in breast cancer patients by a genome-wide microarray approach. The second aim was to identify novel susceptibility alleles, both protein-truncating variants and missense mutations, by next-generation sequencing (NGS) of nearly 800 DNA damage response genes in 189 hereditary breast cancer patients. The cancer-associations of all selected candidate alleles (6 CNVs, 39 protein-truncating variants and 35 missense mutations) were studied by case-control approach using DNA samples from several hundred breast cancer patients and healthy controls. The prevalence of the studied CNVs did not significantly differ between the cases and controls, but when studying the associations with specific clinical parameters, deletion in the CYP2C19 gene showed enrichment in the breast cancer patients with hormonally triple-negative tumors (p=0.021). As CYP2C19 functions in estrogen metabolism, the results indicate that disturbance of hormonal balance due to enzyme defects may predispose specifically to the estrogen receptor-negative subtype of breast cancer. Two protein truncating-variants, TEX15 c.7253dupT and FANCD2 c.2715+1G&gt;A showed significant breast cancer association in the Northern Finnish cohort (p=0.018 and p=0.036, respectively). Similarly, two of the studied missense variants, RECQL p.Ile156Met (p=0.043) and POLG p.Leu392Val (p=0.010), were enriched in the breast cancer cases. Thus, this study provided novel connections between increased breast cancer risk and inherited mutations in TEX15, FANCD2 and POLG genes, and further supported the recently established role of RECQL as a breast cancer susceptibility gene. / Tiivistelmä Rintasyöpä on naisten yleisin syöpä, ja perinnöllinen alttius on yksi merkittävimmistä sairastumisriskiin vaikuttavista tekijöistä. Tunnetuimpia alttiustekijöitä ovat mutaatiot BRCA1-, BRCA2- ja PALB2-DNA-vauriovastegeeneissä, mutta ne yhdessä muiden altistavien geenimutaatioiden kanssa selittävät kuitenkin vain noin puolet perinnöllisistä rintasyöpätapauksista. Uusien alttiusgeenien löytäminen mahdollistaa tehokkaamman diagnostiikan ja korkeassa syöpäriskissä olevien sukujen perinnöllisyysneuvonnan, sekä auttaa ymmärtämään syvemmin rintasyövän etiologiaa ja syntymekanismeja solutasolla. Tämän väitöskirjan ensimmäisenä päämääränä oli tutkia tarkemmin aiemmin genominlaajuisella mikrosirumenetelmällä rintasyöpäpotilailta tunnistettujen harvinaisten perinnöllisten DNA-kopiolukuvariaatioiden (CNV) yhteyttä rintasyöpäriskiin. Toisena tavoitteena oli tunnistaa uusia rintasyöpäalttiusalleeleja, sekä proteiinitrunkaatioita että missense-mutaatioita, hyödyntämällä uuden sukupolven sekvensointitekniikkaa, jonka avulla tutkittiin mutaatioita lähes 800 DNA-vauriovastegeenistä 189 pohjoissuomalaiselta rintasyöpäpotilaalta. Valittujen kandidaattialleelien (6 deleetion aiheuttavaa CNV:tä, 39 proteiinitrunkaatiota ja 35 missense-mutaatiota) yhteyttä rintasyöpään tutkittiin tapaus-verrokkimenetelmällä käyttäen DNA-näytteitä usealta sadalta rintasyöpäpotilaalta ja terveeltä kontrollihenkilöltä. Tutkittujen CNV:iden esiintyvyydessä ei ollut merkitseviä eroja potilaiden ja kontrollien välillä, mutta tarkasteltaessa yhteyttä potilaiden kasvaimista saatuihin kliinisiin parametreihin, deleetio CYP2C19-geenissä oli yleisempi hormonaalisesti kolmoisnegatiivisissa rintatuumoreissa kuin muissa tuumorityypeissä (p=0.021). Koska CYP2C19 on estrogeenimetaboliaan osallistuva entsyymi, sen viallinen toiminta voi mahdollisesti altistaa erityisesti estrogeenireseptorinegatiiviselle rintasyövälle. Kaksi tutkituista proteiinitrunkaatioista, TEX15 c.7253dupT ja FANCD2 c.2715+1G&gt;A, olivat rikastuneet perinnöllisessä rintasyöpäpotilasaineistossa verrattuna kontrolleihin (p=0.018 ja p=0.036). Myös kaksi missense-alleelia, RECQL p.Ile156Met (p=0.043) ja POLG p.Leu392Val (p=0.010), olivat yleisempiä rintasyöpäpotilailla. Tulokset osoittivat uuden yhteyden kohonneen rintasyöpäriskin ja perinnöllisten muutosten TEX15-, FANCD2- ja POLG-geenien välillä, sekä tukivat aiempia tutkimustuloksia, joiden mukaan RECQL on kohtalaisen riskin rintasyöpäalttiusgeeni.

Duplications and deletions are a major source of genomic variation. Duplications, specifically, have a significant impact on gene genesis and dosage, and the malaria parasite P. falciparum has developed resistance to a growing number of anti-malarial drugs via gene duplication. It also contains highly duplicated families of antigenically variable allelic genes. While specific genes and families have been studied, a comprehensive analysis of duplications and deletions within the reference genome and population has not been performed. We analyzed the extent of segmental duplications (SD) in the reference genome for P. falciparum, primarily by a whole genome self alignment. We discovered that while 5% of the genome identified as SD, the distribution within the genome was partition clustered, with the vast majority localized to the subtelomeres. Within the SDs, we found an overrepresentation of genes encoding antigenically diverse proteins exposed to the extracellular membrane, specifically the var, rifin, and stevor gene families. To examine variation of duplications and deletions within the parasite populations, we designed a novel computational methodology to identify copy number variants (CNVs) from high throughput sequencing, using a read depth based approach refined with discordant read pairs. After validating the program against in vitro lab cultures, we analyzed isolates from Senegal for initial tests into clinical isolates. We then expanded our search to a global sample of 610 strains from Africa and South East Asia, identifying 68 CNV regions. Geographically, genic CNV were found on average in less than 10% of the population, indicating that CNV are rare. However, CNVs at high frequency were almost exclusively duplications associated with known drug resistant CNVs. We also identified the novel biallelic duplication of the crt gene – containing both the chloroquine resistant and sensitive allele. The synthesis of our SD and CNV analysis indicates a CNV conservative P. falciparum genome except where drug and human immune pressure select for gene duplication.

INTRODUÇÃO: Os desequilíbrios genômicos constituem causa frequente de abortamento, anomalias congênitas (AC) e atraso de desenvolvimento neuropsicomotor (ADNPM). O aprimoramento de novas técnicas de diagnóstico citogenômico, como por exemplo, a MLPA (Multiplex Ligation-dependent Probe Amplification) e a triagem ampla do DNA utilizando arrays, mostraram que a alteração no número normal de cópias genômicas (CNVs) influencia na patogenicidade dos fenótipos em diversas síndromes. OBJETIVOS: Com isso, os objetivos do presente estudo foram identificar CNVs em pacientes com MC e ADNPM utilizando a técnica de MLPA e, a partir dos resultados alterados, aplicar da técnica de array para a identificação de possíveis rearranjos complexos, além de associar as alterações moleculares encontradas com o fenótipo dos pacientes. MÉTODOS: Participaram do estudo 416 pacientes com MC e ADNPM. As amostras de DNA foram analisadas utilizando a técnica de MLPA com kits comerciais para as principais síndromes de microdeleções (P064) e regiões subteloméricas (P036 e P070). Dois kits de MLPA específicos para as regiões 7q11.23 (P029) e 22q11.2 (P250) também foram utilizados para complementar a identificação de CNVs atípicas. Entre os casos que apresentavam alterações pela técnica de MLPA, 15 pacientes foram submetidos à técnica de array, utilizando três diferentes plataformas: Agilent SurePrint G3 Genoma Humano microarray 180 K, HumanCytoSNP-12 BeadChip, CytoScan(TM) HD array 6.0 Affymetrix®. RESULTADOS: A análise molecular pela técnica de MLPA possibilitou a detecção de microdeleções e/ou microduplicações em 97 pacientes sendo que: em 46 pacientes foi possível encontrar alterações utilizando apenas o kit P064 (microdeleções), em 34 pacientes utilizando apenas os kits P036 e P070 (regiões subteloméricas) e em quatro pacientes só foi possível identificar a alteração utilizando outro kit de MLPA (P250), específico para alterações genômicas em 22q11.2. Rearranjos complexos, envolvendo mais de três cromossomos, foram observados em 10 pacientes. DISCUSSÃO: A MLPA permitiu detectar CNVs em 97/416 pacientes (23,3%), sendo uma técnica ideal para ser aplicada em pacientes com sinais fenotípicos inespecíficos. Algumas alterações genômicas encontradas estão relacionadas também com alterações específicas, como a presença de malformação cardíaca ou convulsões. E em outros casos a alta variabilidade fenotípica pode ser associada a um conjunto de CNVs consideradas patogênicas. Além disso, a inclusão de outra técnica de triagem, com maior cobertura do genoma permitiu detectar rearranjos complexos antes não observados mesmo em síndromes bem descritas como as síndromes de midrodeleções 7q11.23 e 22q11.2. CONCLUSÃO: A MLPA com kits combinados, por possuir maior abrangência de regiões detectadas e menor custo, é uma ferramenta valiosa para ser utilizada como um teste de triagem diagnóstica / INTRODUCTION: Genomic imbalances are the most common cause of miscarriage, congenital anomalies (CA) and mental retardation (MR). With the improvement of new cytogenomics diagnostic techniques, such as the MLPA (Multiplex Ligation-dependent Probe Amplification) and the array techniques, it have been shown that changes in the normal gene copy number influence the pathogenic variability of phenotypes in different syndromes. AIMS: The aims of the present study were to identify CNVs in patients with CM and RM using the MLPA technique and, from the abnormalities results, to apply the array methodology for the identification of complex rearrangements. Furthermore, the study aimed to associate the alterations found by molecular techniques with the phenotype of patients. METHODS: 416 patients with CM and RM participated in the study. The samples were analysed by MLPA technique with commercial kits for the main microdeletion syndromes (P064) and subtelomeric regions (P036 and P070). Two more MLPA kits for specific regions 7q11.23 (P029) and 22q11.2 (P250) were used to confirm the altered results and to complement some results with the identification of atypical abnormalities. From the patients who presented abnormalities by MLPA technique, 15 underwent by microarray-based comparative genomic hybridization (CGH-array) technique, using three different platform: Agilent SurePrint G3 Human Genome microarray 180 kb, HumanCytoSNP -12 BeadChip, CytoScan(TM) HD ® and Affymetrix 6.0. RESULTS: The molecular analysis by MLPA technique allowed the detection of microdeletions and/or microduplications in 97 patients. In 46 patients it was possible to find genomic alteration using only MLPA kit P064 and in 34 patients using only the subtelomeric kits P036 and P070. For four patients it was only possible to identify the genomic abnormalities using another specific MLPA kit (P250), involving the 22q11.2 region. Complex rearrangements involving more than three chromosomes were detected in 10 patients. DISCUSSION: The MLPA technique was capable of detecting CNVs in 97/416 (23,3%) of patients, being an ideal technique to be applied in patients with non-specific signs phenotypic. Some genomic alterations found are, also related to specific changes, such as the presence of cardiac malformation or convulsions. In other cases, the high phenotypic variability may be associated to certain group of pathogenic CNVs. Moreover, the inclusion of additional screening method, with greater coverage, allowed the detection of complex rearrangements not seen before even in syndromes as well described microdeletions syndromes on 7q11.23 and 22q11.2 regions. CONCLUSION: The MLPA technique can be a valuable tool used as a molecular screening test, because it has greater coverage and lower cost of detected regions

A variação no número de cópias gênicas (CNVs) é a alteração estrutural mais prevalente no genoma humano. Estas alterações estão presentes em alta proporção nos subtelômeros, quando comparados com o resto do genoma. Isso ocorre principalmente porque essas regiões são ricas em genes e porque apresentam sequências repetitivas que as tornam suscetíveis a rearranjos genômicos. Na literatura os rearranjos subteloméricos, como deleções, duplicações e translocações estão associados à etiologia da deficiência intelectual (DI), do atraso no desenvolvimento neuropsicomotor (ADNPM) e das malformações congênitas (MC). Estudos prévios com pacientes com DI revelaram taxas de CNVs patogênicas em regiões subteloméricas variando de 2,4% a 4,8%. Os objetivos desse trabalho foram: investigar a presença das CNVs subteloméricas nos pacientes portadores de malformações congênitas e deficiência intelectual, caracteriza-las quanto a extensão e patogenicidade e sugerir os mecanismos produtores dessas alterações. Foram analisadas 105 amostras de DNA de pacientes com DI/ADNPM associada a MC. Utilizamos a técnica de MLPA (Multiplex Ligation-dependent Probe Amplification) com kits específicos para regiões subteloméricas (P036 e P070). Dentre os pacientes que apresentaram alterações pela técnica de MLPA, 7 pacientes foram submetidos à técnica de array, utilizando as plataformas Agilent SurePrint G3 Genoma Humano microarray 180 K e HumanCytoSNP-12 BeadChip Illumina®. O MLPA permitiu identificar alterações subteloméricas em 14,28% dos casos, sendo 7 pacientes com uma deleção isolada, 7 pacientes apresentaram uma deleção concomitante a uma duplicação e um paciente apresentou duas duplicações. A análise por array confirmou as alterações encontradas por MLPA e permitiu a delimitação acurada dos pontos de quebra genômicos. A análise combinada utilizando bioinformática com diferentes ferramentas: DGV (Database of Genomic Variants), DECIPHER (Database of Chromosomal Imbalance and Phenotype in Humans Using Ensembl Resources), UCSC Genome Bioinformatics e DAVID (Database for Annotation, Visualization and Integrated Discovery), revelou um total de 8 genes sugestivos de serem responsáveis por fenótipos clínicos distintos. Dentre eles, o gene DIAPH1 foi relacionado à microcefalia, o gene CTNND2 à DI e o gene OTOS à surdez. O array revelou elementos repetitivos, sequências teloméricas e/ou STRs nas regiões próximas aos pontos de quebra estudados. Também nos permitiu inferir que os pontos de quebra com deleção simples são sugestivos de NHEJ ou MMEJ e os casos que apresentaram rearranjos complexos: FoSTeS ou MMBIR. A estratégia teve sucesso em identificar CNVs subteloméricas e associá-las ao fenótipo dos pacientes e, adicionalmente, possibilitou a sugestão dos mecanismos que as produziram / Copy number variation (CNV) is the most prevalent structural changes in the human genome. These changes are present in a high rate in subtelomere compared with the rest of the genome. This is primarily because these regions are gene rich and because of the presence of repetitive sequences that make them susceptible to genomic rearrangements. Subtelomeric rearrangements, such as deletions, duplications and translocations are associated with the etiology of intellectual disability (ID), the developmental delay (DD) and congenital malformations (CM). Previous studies with patients with ID have revealed rates of pathogenic CNVs in subtelomeric regions ranging from 2.4% to 4.8%. The objectives of this study were to investigate the presence of subtelomeric CNVs in patients with congenital malformations and intellectual disability, characterized them as the extent and pathogenicity and suggest mechanisms of formation. DNA samples from 105 patients with ID/DD associated with CM were analysed. We use the MLPA (Multiplex Ligationdependent Probe Amplification) technique with specific subtelomeric regions (P036 and P070) kits. Among patients with CNVs changes by MLPA, seven were submitted to array technique, using Agilent SurePrint G3 Human Genome microarray HumanCytoSNP or 180 K-12 BeadChip Illumina® platforms. The subtelomeric MLPA analysis identified alterations in 14.28% of cases, 7 patients presented an isolated deletion, 7 patients presented a concomitant deletion and duplication and 1 patient presented two duplications. The array analysis confirmed the alterations found by MLPA and allowed the accurate delineation of the genomic break points. The analysis combined with bioinformatics using different tools: DGV (Database of Genomic Variants), Decipher (Database of Chromosomal Imbalance and Phenotype in Humans Using Ensembl Resources), UCSC Genome Bioinformatics and DAVID (Database for Annotation, Visualization and Integrated Discovery), revealed a total of eight genes that are suggestible responsible for distinct clinical phenotypes. Among them, DIAPH1 gene was related to microcephaly, CTNND2 gene to ID and OTOS gene to deafness. Array revealed repetitive elements, telomeric sequences and / or STR close to breakpoints regions. We propose that the breakpoints with single deletions are suggestive of NHEJ or MMEJ and cases with complex rearrangements: FoSTeS or MMBIR. This strategy could identify subtelomeric CNVs, improve the genotype-phenotype association and also allowed the investigation of mechanisms for formation