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Next‐generation sequencing for the diagnosis of MYH9‐RD: Predicting pathogenic variants
Authors:Loredana Bury  Karyn Megy  Jonathan C. Stephens  Luigi Grassi  Daniel Greene  Nick Gleadall  Karina Althaus  David Allsup  Tadbir K. Bariana  Mariana Bonduel  Nora V. Butta  Peter Collins  Nicola Curry  Sri V. V. Deevi  Kate Downes  Daniel Duarte  Kim Elliott  Emanuela Falcinelli  Bruce Furie  David Keeling  Michele P. Lambert  Rachel Linger  Sarah Mangles  Rutendo Mapeta  Carolyn M. Millar  Christopher Penkett  David J. Perry  Kathleen E. Stirrups  Ernest Turro  Sarah K. Westbury  John Wu  NIHR BioResource  Keith Gomez  Kathleen Freson  Willem H. Ouwehand  Paolo Gresele  Ilenia Simeoni
Abstract:The heterogeneous manifestations of MYH9‐related disorder (MYH9‐RD), characterized by macrothrombocytopenia, Döhle‐like inclusion bodies in leukocytes, bleeding of variable severity with, in some cases, ear, eye, kidney, and liver involvement, make the diagnosis for these patients still challenging in clinical practice. We collected phenotypic data and analyzed the genetic variants in more than 3,000 patients with a bleeding or platelet disorder. Patients were enrolled in the BRIDGE‐BPD and ThromboGenomics Projects and their samples processed by high throughput sequencing (HTS). We identified 50 patients with a rare variant in MYH9. All patients had macrothrombocytes and all except two had thrombocytopenia. Some degree of bleeding diathesis was reported in 41 of the 50 patients. Eleven patients presented hearing impairment, three renal failure and two elevated liver enzymes. Among the 28 rare variants identified in MYH9, 12 were novel. HTS was instrumental in diagnosing 23 patients (46%). Our results confirm the clinical heterogeneity of MYH9‐RD and show that, in the presence of an unclassified platelet disorder with macrothrombocytes, MYH9‐RD should always be considered. A HTS‐based strategy is a reliable method to reach a conclusive diagnosis of MYH9‐RD in clinical practice.
Keywords:ACMG guidelines  clinical diagnosis  genomics  high throughput sequencing  MYH9‐related disorders  variant classification
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