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12q15
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12q15

Chromosomes, intricate structures within the nuclei of our cells, contain the blueprint of life—DNA.  Each chromosome carries genes that encode instructions for building and maintaining our bodies, influencing everything from eye color to enzyme production. 

Chromosome testing helps unravel the complexities of genetic information, enabling clinicians and researchers to diagnose and understand a wide range of genetic conditions. 

As the carriers of genetic material, chromosomes play a pivotal role in heredity and disease susceptibility. The proper function of genes—units of heredity composed of DNA—ensures normal development and bodily functions. 

However, mutations occurring by alteration, deletion, or duplication of DNA segments have consequences ranging from benign to life-threatening. 

Chromosome 12q15 microdeletion syndrome is marked by intellectual disability and distinctive facial features, with the specific roles of the deleted genes in these manifestations still not fully understood. 

What is 12q15?

Definition and Chromosomal Location

12q15 refers to a specific region located on the long arm (q arm) of chromosome 12.  The designation "12q15" indicates the precise location of this region on chromosome 12, based on a standardized system of chromosomal mapping. 

Chromosome 12q15 is associated with certain genetic conditions when deleted or mutated. Such deletions in this region can lead to 12q15 microdeletion syndrome, characterized by intellectual disability, dysmorphic facial features, and other structural and functional abnormalities.  [5.] 

The 3 main candidate genes thought to be responsible for 12q15 microdeletion syndrome are CNOT2, KCNMB4, and PTPRB.  [5.] 

Genes Located at 12q15 and Their Functions

The 12q15 region encompasses several genes that play diverse roles in cellular processes and human physiology.  Three important genes to consider in 12q15 microdeletion syndrome are CNOT2, KCNMB4, and PTPRB, although increasingly, alterations in CNOT2 are implicated as a causative factor.  [1.]

CNOT2 Gene and Protein  [3.] 

CNOT2 is integral to the CCR4-NOT complex which regulates various cellular processes such as gene expression, RNA degradation, and protein ubiquitination. 

CNOT2 protein deficiency is linked to a disorder called Intellectual Developmental Disorder with Nasal Speech, Dysmorphic Facies, and Variable Skeletal Anomalies (IDNADFS).  This disorder shares some symptoms with 12q15 microdeletion syndrome, highlighting the important role of CNOT2 in these neurodevelopmental issues. 

So far, fewer than 20 cases have been reported where 12q15 deletions involve the CNOT2 gene, along with a few other specific changes in this gene.  Varied and complex symptoms that can arise from problems with CNOT2, emphasizing the need for more research into how this condition develops and the possible role of other genes in the 12q15 region. 

KCNMB4 Gene and Protein  [2.]

The KCNMB4 gene encodes a beta subunit for MaxiK channels, which are crucial potassium channels that respond to changes in voltage and calcium levels. These channels are key in managing the contraction of smooth muscles and the activity of nerve cells. 

The beta subunit from the KCNMB4 gene modifies the channel's behavior by slowing down its activation, increasing its sensitivity to calcium, and adjusting the voltage needed for activation to lower levels compared to another subunit called beta 1. This helps fine-tune muscle contractions and nerve signaling impulses.

PTPRB Gene and Protein  [4., 6.]

The PTPRB gene encodes a protein belonging to the protein tyrosine phosphatase (PTP) family, which is integral to regulating various cellular activities such as cell growth, differentiation, and the cell division cycle. 

This protein, classified as a receptor-type PTP, interacts with neuronal receptors and cell adhesion molecules like contactin and tenascin C, and may also influence the function of sodium channels through changes in tyrosine phosphorylation. This interaction is crucial for processes like cell adhesion, nerve fiber development, and the specialization of nerve cells. 

Additionally, PTPRB plays a significant role in the remodeling and maintenance of blood vessels, affecting key signaling pathways in endothelial cells that regulate blood vessel size and integrity during development and growth.

Chromosome 12q15 in Health and Disease

Normal Physiological Roles

Genes located at chromosome 12q15 contribute to essential physiological processes that are critical for maintaining health and homeostasis in the human body. These genes may be involved in regulating cell growth, differentiation, and metabolism, among other functions.

12q15 Microdeletion Syndrome

Abnormalities in the 12q15 region have been associated with a variety of health conditions, ranging from developmental disorders to cancer. 

The 12q15 microdeletion syndrome, discovered through array CGH clinical diagnostics, is characterized by deletions along chromosome bands 12q15q21.1. These deletions, about 2.5 Mb in size, encompass a critical region of 1.34 Mb that includes six RefSeq genes. 

Patients with this syndrome typically exhibit a range of symptoms including developmental delays or learning disabilities, nasal speech (due to structural changes in the face and nasal passages), hypotonia, feeding problems, skeletal anomalies, facial dysmorphisms, and hypothyroidism.  [1., 7.]  

This syndrome does not always affect initial blood vessel formation but is crucial for their ongoing remodeling and maintenance.  [7.] 

The genes implicated in 12q15 microdeletion syndrome include CNOT2, KCNMB4, PTPRB; additional genes to consider include PTPRR, TSPAN8, and LGR5.  [7.] 

These genes play various roles in cellular processes like growth, differentiation, and cell signaling. Mutations in these genes can disrupt normal development and function, leading to the clinical manifestations observed in affected individuals.

Genetic testing can be done in many ways.  Testing for genetic alterations in the form of SNPs is increasingly available and can shed light on an individual’s potential for health and disease.  

What is a SNP?

A SNP, or single nucleotide polymorphism, refers to a variation at a single position in a gene along its DNA sequence.  A gene encodes a protein, so an alteration in that gene programs the production of an altered protein.  

As a type of protein with great functionality in human health, alterations in genes for enzymes may confer a difference in function of that enzyme.  The function of that enzyme may be increased or decreased, depending on the altered protein produced.  

SNPs are the most common type of genetic variation in humans and can occur throughout the genome, influencing traits, susceptibility to diseases, and response to medications.

The completion of the Human Genome Project has significantly expanded opportunities for genetic testing by providing a comprehensive map of the human genome that facilitates the identification of genetic variations associated with various health conditions, including identifying SNPs that may cause alterations in protein structure and function.  

Genetic testing for SNPs enables the identification of alterations in genes, shedding light on their implications in health and disease susceptibility.

Laboratory Testing for 12q15

Laboratory testing for 12q15 abnormalities plays a crucial role in diagnosing genetic disorders and assessing disease risk.  There are many methods used for laboratory testing of 12q15.

Overview of Testing Methods

Genetic testing involves various methodologies to analyze DNA and chromosomes for medical and research purposes. Here are the primary types:

Polymerase Chain Reaction (PCR): this technique amplifies small DNA samples to detect or measure specific genes or regions. It's widely used for identifying genetic variants associated with diseases.

DNA Sequencing:

Sanger Sequencing: once the standard for clinical DNA sequencing, this method involves marking DNA nucleotides with fluorescent dyes to read sequences. It's precise but limited to short DNA sections and one sample at a time.

Next-Generation Sequencing (NGS): this includes whole exome and whole genome sequencing, capable of analyzing millions of DNA fragments simultaneously. It's used for comprehensive genetic screening to identify mutations across all protein-coding regions (exome) or the entire genetic makeup (genome).

Cytogenetics:

Karyotyping: this traditional method examines the number and structure of chromosomes under a microscope, identifying abnormalities like extra chromosomes or translocations that can lead to diseases such as Down syndrome or chronic myelogenous leukemia.

Fluorescence In Situ Hybridization (FISH): FISH uses fluorescent probes to illuminate specific gene segments on chromosomes, useful for identifying gene amplifications or deletions.

Microarrays: this technology assesses DNA for duplications, deletions, or large identical DNA stretches using fluorescently labeled DNA samples hybridized on a chip, providing detailed chromosomal information.

Gene Expression Profiling: this test measures which genes are active in cells, using RNA from a tissue sample to determine gene activity. It's particularly used in cancer to guide treatment decisions based on the genes expressed by a tumor.

Each of these technologies plays a crucial role in diagnosing genetic disorders, guiding treatment decisions, and advancing our understanding of genetic diseases.

Sample Types

Samples typically include blood, saliva, or tissue samples containing DNA.  Sample collection can be as simple as performing a cheek swab or collecting saliva.

Interpretation of Test Results

Interpreting test results for 12q15 abnormalities requires expertise and an understanding of genetic principles. A positive result indicating a deletion or duplication in the 12q15 region may suggest an increased risk of certain genetic disorders or predisposition to specific health conditions. 

However, the clinical significance of these findings can vary depending on factors such as the size and location of the genetic alteration, as well as the presence of other genetic or environmental factors. 

Genetic counseling is often recommended to help patients and their families understand the implications of test results and make informed decisions regarding healthcare management and treatment options.

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See References

[1.] Alesi V, Loddo S, Calì F, Orlando V, Genovese S, Ferretti D, Calacci C, Calvieri G, Falasca R, Ulgheri L, Drago F, Dallapiccola B, Baban A, Novelli A. A heterozygous, intragenic deletion of CNOT2 recapitulates the phenotype of 12q15 deletion syndrome. Am J Med Genet A. 2019 Aug;179(8):1615-1621. doi: 10.1002/ajmg.a.61217. Epub 2019 May 30. PMID: 31145527.

[2.] KCNMB4 potassium calcium-activated channel subfamily M regulatory beta subunit 4 [Homo sapiens (human)] - Gene - NCBI. www.ncbi.nlm.nih.gov. Accessed April 26, 2024. https://www.ncbi.nlm.nih.gov/gene/27345 

[3.] Niceta M, Pizzi S, Inzana F, Peron A, Bakhtiari S, Nizon M, Levy J, Mancini C, Cogné B, Radio FC, Agolini E, Cocciadiferro D, Novelli A, Salih MA, Recalcati MP, Arancio R, Besnard M, Tabet AC, Kruer MC, Priolo M, Dallapiccola B, Tartaglia M. Delineation of the clinical profile of CNOT2 haploinsufficiency and overview of the IDNADFS phenotype. Clin Genet. 2023 Feb;103(2):156-166. doi: 10.1111/cge.14247. Epub 2022 Nov 24. PMID: 36224108; PMCID: PMC9939052. 

[4.] PTPRB protein tyrosine phosphatase receptor type B [Homo sapiens (human)] - Gene - NCBI. www.ncbi.nlm.nih.gov. https://www.ncbi.nlm.nih.gov/gene/5787 

[5.] Uehara T, Takenouchi T, Yamaguchi Y, Daimon Y, Suzuki H, Sakaguchi Y, Kosaki K. CNOT2 as the critical gene for phenotypes of 12q15 microdeletion syndrome. Am J Med Genet A. 2019 Apr;179(4):659-662. doi: 10.1002/ajmg.a.61068. Epub 2019 Feb 15. PMID: 30768759.

[6.] UniProt. www.uniprot.org. https://www.uniprot.org/uniprotkb/P23467/entry 

[7.] Vergult, S., Krgovic, D., Loeys, B. et al. Nasal speech and hypothyroidism are common hallmarks of 12q15 microdeletions. Eur J Hum Genet 19, 1032–1037 (2011). https://doi.org/10.1038/ejhg.2011.67 

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