GNB5 Mutations Cause an Autosomal-Recessive Multisystem Syndrome with Sinus Bradycardia and Cognitive Disability

  • Am J Hum Genet. 2016 Sep 1;99(3):704-710. doi: 10.1016/j.ajhg.2016.06.025.
Elisabeth M Lodder  1 Pasquelena De Nittis  2 Charlotte D Koopman  3 Wojciech Wiszniewski  4 Carolina Fischinger Moura de Souza  5 Najim Lahrouchi  1 Nicolas Guex  6 Valerio Napolioni  7 Federico Tessadori  8 Leander Beekman  1 Eline A Nannenberg  9 Lamiae Boualla  10 Nico A Blom  11 Wim de Graaff  12 Maarten Kamermans  13 Dario Cocciadiferro  14 Natascia Malerba  14 Barbara Mandriani  15 Zeynep Hande Coban Akdemir  4 Richard J Fish  16 Mohammad K Eldomery  4 Ilham Ratbi  10 Arthur A M Wilde  1 Teun de Boer  17 William F Simonds  18 Marguerite Neerman-Arbez  16 V Reid Sutton  19 Fernando Kok  20 James R Lupski  21 Alexandre Reymond  22 Connie R Bezzina  1 Jeroen Bakkers  23 Giuseppe Merla  24
Affiliations
  • 1. Department of Clinical and Experimental Cardiology, Heart Center, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands.
  • 2. Center for Integrative Genomics, University of Lausanne, 1015 Lausanne, Switzerland; Medical Genetics Unit, IRCCS Casa Sollievo della Sofferenza, viale Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
  • 3. Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, 3584 CT Utrecht, the Netherlands; Hubrecht Institute- Royal Netherlands Academy of Arts and Sciences (KNAW), University Medical Centre Utrecht, 3584 CT Utrecht, the Netherlands.
  • 4. Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA.
  • 5. Medical Genetics Service, Hospital de Clinicas de Porto Alegre, 2350 Porto Alegre, Brazil.
  • 6. Center for Integrative Genomics, University of Lausanne, 1015 Lausanne, Switzerland; Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland.
  • 7. Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Palo Alto, CA 94304, USA.
  • 8. Hubrecht Institute- Royal Netherlands Academy of Arts and Sciences (KNAW), University Medical Centre Utrecht, 3584 CT Utrecht, the Netherlands.
  • 9. Department of Clinical Genetics, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands.
  • 10. Centre de Génomique Humaine, Faculté de Médecine et Pharmacie, Mohammed V University of Rabat, 8007, Rabat, Morocco.
  • 11. Department of Pediatric Cardiology, Emma Children's Hospital, Academic Medical Centre, 1105 AZ Amsterdam, the Netherlands.
  • 12. Retinal Signal Processing Lab, Netherlands Institute for Neuroscience, 1105 BA Amsterdam, the Netherlands.
  • 13. Retinal Signal Processing Lab, Netherlands Institute for Neuroscience, 1105 BA Amsterdam, the Netherlands; Department of Genome Analysis, Academic Medical Center, University of Amsterdam, 1105 AZ Amsterdam, the Netherlands.
  • 14. Medical Genetics Unit, IRCCS Casa Sollievo della Sofferenza, viale Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy; PhD Program in Experimental and Regenerative Medicine, Faculty of Medicine, University of Foggia, 71121 Foggia, Italy.
  • 15. Medical Genetics Unit, IRCCS Casa Sollievo della Sofferenza, viale Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy; PhD Program in Molecular Genetics Applied to Medical Sciences, Department of Molecular and Translational Medicine, University of Brescia, 25121 Brescia, Italy.
  • 16. Department of Genetic Medicine and Development, University Medical Centre (CMU), 1211 Geneva, Switzerland.
  • 17. Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, 3584 CT Utrecht, the Netherlands.
  • 18. Metabolic Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, Bethesda, MD 20892-2560, USA.
  • 19. Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Texas Children's Hospital, Houston, TX 77030, USA.
  • 20. Child Neurology Division, Department of Neurology, School of Medicine, University of Sao Paulo, 01246903 Sao Paulo, Brazil.
  • 21. Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA; Texas Children's Hospital, Houston, TX 77030, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX 77030, USA.
  • 22. Center for Integrative Genomics, University of Lausanne, 1015 Lausanne, Switzerland.
  • 23. Department of Medical Physiology, Division of Heart and Lungs, University Medical Center Utrecht, 3584 CT Utrecht, the Netherlands; Hubrecht Institute- Royal Netherlands Academy of Arts and Sciences (KNAW), University Medical Centre Utrecht, 3584 CT Utrecht, the Netherlands. Electronic address: [email protected].
  • 24. Medical Genetics Unit, IRCCS Casa Sollievo della Sofferenza, viale Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy. Electronic address: [email protected].
Abstract

GNB5 encodes the G protein β subunit 5 and is involved in inhibitory G protein signaling. Here, we report mutations in GNB5 that are associated with heart-rate disturbance, eye disease, intellectual disability, gastric problems, hypotonia, and seizures in nine individuals from six families. We observed an association between the nature of the variants and clinical severity; individuals with loss-of-function alleles had more severe symptoms, including substantial developmental delay, speech defects, severe hypotonia, pathological gastro-esophageal reflux, retinal disease, and sinus-node dysfunction, whereas related heterozygotes harboring missense variants presented with a clinically milder phenotype. Zebrafish gnb5 knockouts recapitulated the phenotypic spectrum of affected individuals, including cardiac, neurological, and ophthalmological abnormalities, supporting a direct role of GNB5 in the control of heart rate, hypotonia, and vision.

Keywords
G-protein signaling; heart rate; hypotonia; intellectual disability; parasympathetic system; whole-exome sequencing.