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Gepubliceerd in: Tijdschrift voor Kindergeneeskunde 1/2014

01-01-2014

Exoom-sequencing in de diagnostiek van ontwikkelingsachterstand/verstandelijke beperking

Auteurs: Mw. dr. M.H. Willemsen, mw. dr. T. Kleefstra, mw. dr. H.G. Yntema

Gepubliceerd in: Tijdschrift voor Kindergeneeskunde | Uitgave 1/2014

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Samenvatting

Onverklaarde ontwikkelingsachterstand/verstandelijke beperking (VB) is een van de belangrijkste redenen voor verwijzing naar de kinderarts en/of klinisch geneticus. De meeste ernstige vormen zijn genetisch bepaald. Naar schatting wordt de meerderheid verklaard door de novo genmutaties en chromosoomafwijkingen. Wanneer de patiënt geen klinisch herkenbaar beeld heeft, wordt doorgaans eerst chromosomenonderzoek met array-analyse ingezet. Wanneer er wel een klinisch herkenbaar beeld is, vindt gericht DNA-onderzoek van vaak meerdere genen plaats. Op indicatie vindt screenend metabool onderzoek plaats. Indien bovengenoemde onderzoeken geen diagnose opleveren, komt een deel van de patiënten sinds kort in aanmerking voor exoom-sequencing, waarmee de coderende delen van vrijwel alle genen tegelijkertijd onderzocht worden. De eerste diagnostische studies, bij patiënten zonder klinisch herkenbaar beeld en met een normale uitslag van de array-analyse, laten zien dat de opbrengst van dit onderzoek tussen de 16 en 55% ligt. Naast mutaties in bekende genen, gaat het hierbij ook om mutaties in nieuwe (kandidaat-) genen voor VB. Op korte termijn zal het tevens mogelijk worden om in de data verkregen met exoom-sequencing veranderingen in het aantal kopieën van (gedeelten van) chromosomen betrouwbaar te detecteren, waardoor in de nabije toekomst arrayanalyse als onderzoek van eerste keuze zal komen te vervallen. Het grote voordeel hiervan is dat met één test zowel chromosoomafwijkingen als monogene afwijkingen opgespoord kunnen worden, hoewel men zich wel moet realiseren dat ook met deze test niet alle genetische afwijkingen opgespoord kunnen worden. Het is daarnaast van belang om vóór aanvraag van het onderzoek expliciet de kans op detectie van onbekende varianten of toevalsbevindingen te bespreken.
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Metagegevens
Titel
Exoom-sequencing in de diagnostiek van ontwikkelingsachterstand/verstandelijke beperking
Auteurs
Mw. dr. M.H. Willemsen
mw. dr. T. Kleefstra
mw. dr. H.G. Yntema
Publicatiedatum
01-01-2014
Uitgeverij
Bohn Stafleu van Loghum
Gepubliceerd in
Tijdschrift voor Kindergeneeskunde / Uitgave 1/2014
Print ISSN: 0376-7442
Elektronisch ISSN: 1875-6840
DOI
https://doi.org/10.1007/s12456-014-0005-x