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Extreme Growth Failure is a Common Presentation of Ligase IV Deficiency

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  • Gökhan Yigit
  • Angela L Duker
  • Margriet van Kogelenberg
  • Sara Haghayegh
  • Dagmar Wieczorek
  • Hülya Kayserili
  • Michael H Albert
  • Carol A Wise
  • January Brandon
  • Tjitske Kleefstra
  • Adilia Warris
  • Michiel van der Flier
  • J Steven Bamforth
  • Kurston Doonanco
  • Lesley Adès
  • Alan Ma
  • Michael Field
  • Diana Johnson
  • Fiona Shackley
  • Helen Firth
  • C Geoffrey Woods
  • Peter Nürnberg
  • Richard A Gatti
  • Matthew Hurles
  • Michael B Bober
  • Bernd Wollnik

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    Rights statement: © 2013 The Authors. *Human Mutation published by Wiley Periodicals, Inc. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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    Licence: Creative Commons: Attribution (CC-BY)

Original languageEnglish
JournalHuman Mutation
Publication statusPublished - 10 Oct 2013


Ligase IV syndrome is a rare differential diagnosis for Nijmegen Breakage syndrome owing to a shared predisposition to lympho-reticular malignancies, significant microcephaly and radiation hypersensitivity. Only 16 cases with mutations in LIG4 have been described to date with phenotypes varying from malignancy in developmentally normal individuals, to severe combined immunodeficiency and early mortality. Here we report the identification of biallelic truncating LIG4 mutations in 11 patients with microcephalic primordial dwarfism presenting with restricted prenatal growth and extreme postnatal global growth failure (average OFC -10.1 s.d., height -5.1 s.d.). Subsequently most patients developed thrombocytopenia and leucopenia later in childhood and many were found to have previously unrecognised immunodeficiency following molecular diagnosis. None have yet developed malignancy, though all patients tested had cellular radiosensitivity. A genotype:phenotype correlation was also noted with position of truncating mutations corresponding to disease severity. This work extends the phenotypic spectrum associated with LIG4 mutations, establishing that extreme growth retardation with microcephaly is a common presentation of bilallelic truncating mutations. Such growth failure is therefore sufficient to consider a diagnosis of LIG4 deficiency and early recognition of such cases is important as bone marrow failure, immunodeficiency and sometimes malignancy are long term sequelae of this disorder. This article is protected by copyright. All rights reserved.

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