A Retrospective Analysis of Clinically Focused Exome Sequencing Results of 372 Infants with Suspected Monogenic Disorders in China

• Published in: Pharmacogenomics and personalized medicine 2023-01, Vol.16, p.81-97
• Main Authors: Jia, An, Lei, Yi, Liu, Dan-Ping, Pan, Lu, Guan, Hui-Zhen, Yang, Bicheng
• Format: Article
• Language: English
• Subjects: Abdomen; Analysis; Anemia; Bioinformatics; Carnitine; Children; Childrens health; clinical exome sequencing; clinical management; Congenital diseases; Diagnosis; diagnostic rate; Disease management; Ethylenediaminetetraacetic acid; Family medical history; Genes; Genetic counseling; Genetic disorders; Genetic screening; Genomes; Health aspects; Homeostasis; Hospitals; Infants; Integument; Intensive care; Mass spectrometry; Maternal & child health; Medical diagnosis; Medical prognosis; Metabolism; Molecular genetics; monogenic diseases; Nervous system; Neutropenia; Original Research; PAH gene; Patients; Pediatrics; phenotypic features; Phenylketonuria; Respiratory distress syndrome; Scientific imaging; Statistical analysis; Systemic primary carnitine deficiency; Thyroid gland
• ISSN: 1178-7066; 1178-7066
• DOI: 10.2147/PGPM.S387767

The context was designed to optimize the diagnostic utility of clinically focused exome sequencing (CFES) and shorten the diagnostic odyssey among pediatric patients suspected of monogenic disorders (MDs). Here, we retrospectively analyzed the clinical notes of 372 patients from different areas in the Jiangxi province that were referred for a diagnostic CFES and analysis from June 2018 to March 2022 with symptoms suggestive of MDs. In our study, preliminary tests using the proband-only clinical exome sequencing as a cost-effective first-tier diagnostic test for pediatric patients with unidentified MDs, supplemented by family segregation studies for targeted variants when indicated. Probands with confirmed diagnostic (CD) or likely diagnostic (LD) genetic influences accounted for 12% of all cases, whereas those with an uncertain diagnosis accounted for 48%. We also found that systemic primary carnitine deficiency (CDSP) ( gene) and phenylketonuria ( gene) were relatively more prevalent, and these patients with CDSP had the most frequent c.1400C > G variant (p.S467C) and c.51C > G variant (p. F17L) in this study. In addition, statistical analysis revealed that the estimates of diagnostic yields varied across certain phenotypic features of patients, and patients with specific phenotypic traits tended to benefit more from CFES. The CFES may be a first-line genetic test for diagnosing young children with suspected genetic conditions, as it validates the identification of molecular genetics alterations and facilitates comprehensive medical management. Moreover, we found that infants exhibiting metabolism/homeostasis abnormalities, craniofacial /otolaryngology/ ophthalmologic abnormalities, and/or the integument were significantly more likely to receive a genetic diagnosis via CFES than infants without such features. However, due to the current study's low diagnostic yield and inherent limitations, high-quality clinical studies with larger sample sizes are still needed to provide more likely results and confirm our findings.