Comprehensive Growth Disorders / Skeletal Dysplasias and Disorders Panel

Last modified: Jun 12, 2018

Summary

  • Is a 332 gene panel that includes assessment of non-coding variants
  • This panel covers the majority of the genes listed in the Nosology 2015 (PMID: 26394607) and all genes in our Malformation category that cause growth retardation, short stature or skeletal dysplasia and is therefore a powerful diagnostic tool. It is ideal for patients suspected to have a syndromic or an isolated growth disorder or a skeletal dysplasia.

Analysis methods

  • PLUS
  • SEQ
  • DEL/DUP

Availability

4 weeks

Number of genes

332

Test code

MA4301

Panel size

Large

CPT codes

SEQ 81405
SEQ 81406
SEQ 81408
DEL/DUP 81479

Summary

The Blueprint Genetics Comprehensive Growth Disorders / Skeletal Dysplasias and Disorders Panel (test code MA4301):

  • Is a 332 gene panel that includes assessment of selected non-coding disease-causing variants
  • Is available as PLUS analysis (sequencing analysis and deletion/duplication analysis), sequencing analysis only or deletion/duplication analysis only

Sample Requirements

  • EDTA blood, min. 1 ml
  • Purified DNA, min. 3μg
  • Saliva (Oragene DNA OG-500 kit)

Label the sample tube with your patient’s name, date of birth and the date of sample collection.

Note that we do not accept DNA samples isolated from formalin-fixed paraffin-embedded (FFPE) tissue.

Subpanel description

This comprehensive panel includes the following panels: 3-M Syndrome / Primordial Dwarfism Panel, Seckel Syndrome Panel, Comprehensive Short Stature Syndrome Panel, Limb Malformations Panel, Brachydactyly / Syndactyly Panel, Comprehensive Skeletal Dysplasias and Disorders Panel, Chondrodysplasia Punctata Panel, Meier-Gorlin Syndrome Panel, Metaphyseal Dysplasia Panel, Micromelic Dysplasia Panel, Osteogenesis Imperfecta Panel, Osteopetrosis and Dense Bone Dysplasia Panel, Short Rib Dysplasia / Asphyxiating Thoracic Dysplasia Panel, Skeletal Dysplasia with Abnormal Mineralization Panel, Skeletal Dysplasias Core Panel and Spondylometaphyseal / Spondyloepi-(meta)-physeal Dysplasia Panel.

This panel covers a broad spectrum of diseases associated with growth retardation, short stature or skeletal dysplasia. Many of these conditions have overlapping features which can make clinical diagnosis a challenge. Genetic diagnostics is therefore the most efficient way to subtype the diseases and enable individualized treatment and management decisions. Moreover, detection of causative mutations establishes the mode of inheritance in the family which is essential for informed genetic counseling. For additional information regarding the conditions tested on this panel, please refer to the National Organization for Rare Disorders and / or GeneReviews.

Genes in the Comprehensive Growth Disorders / Skeletal Dysplasias and Disorders Panel and their clinical significance

Gene Associated phenotypes Inheritance ClinVar HGMD
ACAN# Spondyloepimetaphyseal dysplasia, aggrecan type, Spondyloepiphyseal dysplasia, Kimberley type, Osteochondritis dissecans, short stature, and early-onset osteoarthritis AD/AR 18 30
ACP5 Spondyloenchondrodysplasia with immune dysregulation AR 11 26
ACTB* Baraitser-Winter syndrome AD 46 54
ACTG1* Deafness, Baraitser-Winter syndrome AD 25 43
ACVR1 Fibrodysplasia ossificans progressiva AD 14 19
ADAMTS10 Weill-Marchesani syndrome AR 8 13
ADAMTS17 Weill-Marchesani-like syndrome AR 6 7
ADAMTSL2*,# Geleophysic dysplasia AR 8 28
AGPS Rhizomelic chondrodysplasia punctata type 3 AR 4 8
AIFM1 Deafness, Combined oxidative phosphorylation deficiency 6, Cowchock syndrome XL 27 29
AKT1 Proteus syndrome, Cowden syndrome AD 5 6
ALPL Odontohypophosphatasia, Hypophosphatasia perinatal lethal, infantile, juvenile and adult forms AD/AR 61 290
ALX3 Frontonasal dysplasia type 1 AR 7 7
ALX4 Frontonasal dysplasia type 2, Parietal foramina AD/AR 15 23
AMER1 Osteopathia striata with cranial sclerosis XL 14 38
ANKH Calcium pyrophosphate deposition disease (familial chondrocalcinosis type 2), Craniometaphyseal dysplasia autosomal dominant type AD 12 20
ANKRD11* KBG syndrome AD 119 122
ANO5 Gnathodiaphyseal dysplasia, LGMD2L and distal MMD3 muscular dystrophies AD/AR 60 115
ARHGAP31 Adams-Oliver syndrome AD 2 4
ARSB Mucopolysaccharidosis (Maroteaux-Lamy) AR 27 199
ARSE* Chondrodysplasia punctata X-linked recessive, brachytelephalangic type (CDPX1) XL 21 46
ATP6V0A2 Cutis laxa, Wrinkly skin syndrome AR 16 54
ATR Cutaneous telangiectasia and cancer syndrome, Seckel syndrome AD/AR 8 18
B3GALT6 Spondyloepimetaphyseal dysplasia with joint laxity, Ehlers-Danlos syndrome AR 17 26
B3GAT3* Multiple joint dislocations, short stature, craniofacial dysmorphism, and congenital heart defects AR 5 13
B4GALT7 Ehlers-Danlos syndrome, progeroid form AR 9 9
BCS1L Bjornstad syndrome, GRACILE syndrome, Leigh syndrome, Mitochondrial complex III deficiency, nuclear type 1 AR 33 37
BGN Spondyloepimetaphyseal dysplasia, X-linked, Meester-Loeys syndrome XL 8 7
BHLHA9 Syndactyly Malik-Percin type, mesoaxial synostotic, with phalangeal reduction, Split hand-foot malformation with long bone deficiency (SHFLD3), Gollop-Wolfgang AR 4 37
BMP1 Osteogenesis imperfecta AR 7 15
BMP2 Brachydactyly type A2 AD 5 28
BMPER Diaphanospondylodysostosis AR 5 17
BMPR1B Acromesomelic dysplasia, Demirhan, Brachydactyly C/Symphalangism-like pheno, Brachydactyly type A2 AD/AR 12 16
BRAF* LEOPARD syndrome, Noonan syndrome, Cardiofaciocutaneous syndrome AD 135 65
BRCA2 Fanconi anemia, Medulloblastoma, Glioma susceptibility, Pancreatic cancer, Wilms tumor, Breast-ovarian cancer, familial AD/AR 2959 2364
BRIP1 Fanconi anemia, Breast cancer AD/AR 182 166
CA2 Osteopetrosis, with renal tubular acidosis AR 9 31
CANT1 Desbuquois dysplasia AR 20 28
CASR Hypocalcemia, Neonatal hyperparathyroidism, Familial Hypocalciuric hypercalcemia with transient Neonatal hyperparathyroidism AD/AR 103 393
CBL Noonan syndrome-like disorder with or without juvenile myelomonocytic leukemia AD 23 38
CCDC8 Three M syndrome 3 AR 2 3
CDC6 Meier-Gorlin syndrome (Ear-patella-short stature syndrome) AR 2 2
CDC45 Meier-Gorlin syndrome 7 AR 10 19
CDKN1C Beckwith-Wiedemann syndrome, IMAGE syndrome AD 28 81
CDT1 Meier-Gorlin syndrome (Ear-patella-short stature syndrome) AR 6 11
CENPJ Seckel syndrome, Microcephaly AR 32 9
CEP63 Seckel syndrome AR 7 2
CEP152# Seckel syndrome, Microcephaly AR 19 20
CHST3 Spondyloepiphyseal dysplasia with congenital joint dislocations (recessive Larsen syndrome) AR 19 36
CHST14 Ehlers-Danlos syndrome, musculocontractural AR 14 21
CHSY1 Temtamy preaxial brachydactyly syndrome AR 6 11
CKAP2L Filippi syndrome AR 7 7
CLCN5 Proteinuria, low molecular weight, with hypercalciuric nephrocalcinosis, Hypophosphatemic rickets,, Nephrolithiasis, I, Dent disease XL 45 267
CLCN7 Osteopetrosis AD/AR 13 95
COL1A1 Ehlers-Danlos syndrome, Caffey disease, Osteogenesis imperfecta type 1, Osteogenesis imperfecta type 2, Osteogenesis imperfecta type 3, Osteogenesis imperfecta type 4 AD 290 943
COL1A2 Ehlers-Danlos syndrome, cardiac valvular form, Osteogenesis imperfecta type 1, Osteogenesis imperfecta type 2, Osteogenesis imperfecta type 3, Osteogenesis imperfecta type 4 AD/AR 162 496
COL2A1 Avascular necrosis of femoral head, Rhegmatogenous retinal detachment, Epiphyseal dysplasia, with myopia and deafness, Czech dysplasia, Achondrogenesis type 2, Platyspondylic dysplasia Torrance type, Hypochondrogenesis, Spondyloepiphyseal dysplasia congenital (SEDC), Spondyloepimetaphyseal dysplasia (SEMD) Strudwick type, Kniest dysplasia, Spondyloperipheral dysplasia, Mild SED with premature onset arthrosis, SED with metatarsal shortening, Stickler syndrome type 1 AD 166 544
COL3A1 Ehlers-Danlos syndrome AD 499 625
COL5A1 Ehlers-Danlos syndrome AD 84 151
COL5A2 Ehlers-Danlos syndrome AD 21 34
COL9A1 Stickler syndrome recessive type, Multiple epiphyseal dysplasia type 6 (EDM6) AR 9 5
COL9A2 Stickler syndrome, Multiple epiphyseal dysplasia type 2 (EDM2) AD/AR 7 12
COL9A3 Multiple epihyseal dysplasia type 3 (EDM3) AD/AR 10 15
COL10A1 Metaphyseal chondrodysplasia, Schmid AD 21 51
COL11A1 Marshall syndrome, Fibrochondrogenesis, Stickler syndrome type 2 AD/AR 30 86
COL11A2 Weissenbacher-Zweymuller syndrome, Deafness, Otospondylomegaepiphyseal dysplasia, Fibrochondrogenesis, Stickler syndrome type 3 (non-ocular) AD/AR 28 55
COMP Pseudoachondroplasia, Multiple ephiphyseal dysplasia AD 43 184
CREB3L1 Osteogenesis imperfecta, type XVI AR 1
CREBBP Rubinstein-Taybi syndrome AD 156 348
CRTAP Osteogenesis imperfecta type 2, Osteogenesis imperfecta type 3, Osteogenesis imperfecta type 4 AR 12 28
CSPP1 Jeune asphyxiating thoracic dystrophy, Joubert syndrome AR 27 27
CTSK Pycnodysostosis AR 25 54
CUL7 3-M syndrome, Yakut short stature syndrome AR 26 80
CYP27B1 Vitamin D-dependent rickets AR 23 73
DDR2 Spondylometaepiphyseal dysplasia, short limb-hand type AR 11 7
DHCR7 Smith-Lemli-Opitz syndrome AR 67 216
DHCR24 Desmosterolosis AR 6 8
DHODH Postaxial acrofacial dysostosis (Miller syndrome) AR 8 20
DLL3 Spondylocostal dysostosis AR 11 23
DLL4 Adams-Oliver syndrome AD 10 12
DLX3 Amelogenesis imperfecta, Trichodontoosseous syndrome AD 5 6
DLX5 Split-hand/foot malformation with sensorineural hearing loss AR 3 8
DMP1 Hypophosphatemic rickets AR 5 10
DOCK6 Adams-Oliver syndrome AR 21 19
DVL1 Robinow syndrome AD 16 17
DYM Dyggve-Melchior-Clausen dysplasia, Smith-McCort dysplasia AR 21 34
DYNC2H1 Short -rib thoracic dysplasia with or without polydactyly type 1, Short -rib thoracic dysplasia with or without polydactyly type 3, Asphyxiating thoracic dysplasia (ATD; Jeune), SRPS type 2 (Majewski) AR/Digenic 144 109
EBP Chondrodysplasia punctata, Male EBP disorder with neurologic defects (MEND) XL 43 90
EFNB1 Craniofrontonasal dysplasia XL 27 115
EFTUD2 Mandibulofacial dysostosis with microcephaly, Esophageal atresia, syndromic AD 43 93
EIF2AK3 SED, Wolcott-Rallison type AR 9 78
ENAM Amelogenesis imperfecta AR 8 18
ENPP1 Arterial calcification, Hypophosphatemic rickets AR 20 68
EOGT Adams-Oliver syndrome AR 3 5
EP300 Rubinstein-Taybi syndrome AD 57 91
ERCC4 Fanconi anemia, Xeroderma pigmentosum, XFE progeroid syndrome AR 11 59
ESCO2 SC phocomelia syndrome, Roberts syndrome AR 29 30
EVC Weyers acrofacial dysostosis, Ellis-van Creveld syndrome AD/AR 22 80
EVC2 Ellis-van Creveld syndrome, Weyers acrodental dysostosis AD/AR 34 67
EXT1 Multiple cartilagenious exostoses 1 AD 67 497
EXT2 Multiple cartilagenious exostoses 2 AD 32 242
EXTL3 Immunoskeletal dysplasia with neurodevelopmental abnormalities (ISDNA) AR 4 7
EZH2 Weaver syndrome AD 29 40
FAM20A Amelogenesis imperfecta (Enamel-renal syndrome) AR 17 41
FAM20C Hypophosphatemia, hyperphosphaturia, dental anomalies, intracerebral calcifications and osteosclerosis (Raine syndrome) AR 13 23
FAM58A Toe syndactyly, telecanthus, and anogenital and renal malformations (STAR syndrome) XL 8 11
FAM83H Amelogenesis imperfecta AD 14 29
FAM111A Kenny-Caffey syndrome, type 2 AD 4 9
FANCA Fanconi anemia AR 76 541
FANCB Fanconi anemia XL 10 20
FANCC Fanconi anemia AR 70 58
FANCD2* Fanconi anemia AR 14 57
FANCE Fanconi anemia AR 5 16
FANCF Fanconia anemia AR 7 16
FANCG Fanconi anemia AR 13 89
FANCI Fanconi anemia AR 12 43
FANCL Fanconi anemia AR 7 22
FANCM Fanconi anemia AR 2 49
FBN1 MASS syndrome, Marfan syndrome, Acromicric dysplasia, Geleophysic dysplasia AD 919 2548
FBN2 Congenital contractural arachnodactyly (Beals syndrome) AD 45 95
FGD1 Aarskog-Scott syndrome, Mental retardation, syndromic XL 26 49
FGF10 Aplasia of lacrimal and salivary glands AD 9 12
FGF23 Tumoral calcinosis, hyperphosphatemic, Hypophosphatemic rickets AD/AR 10 16
FGFR1 Pfeiffer syndrome, Trigonocephaly, Hypogonadotropic hypogonadism, Osteoglophonic Dwarfism - Craniostenosis, Hartsfield syndrome AD/Digenic/Multigenic 69 241
FGFR2 Apert syndrome, Pfeiffer syndrome, Jackson-Weiss syndrome, Lacrimoauriculodentodigital syndrome, Beare-Stevenson cutis gyrata syndrome, Antley-Bixler syndrome without genital anomalies or disordered steroidogenesis, Craniofacial-skeletal-dermatological dysplasia, Crouzon syndrome, Bent bone dysplasia AD 93 150
FGFR3 Lacrimoauriculodentodigital syndrome, Muenke syndrome, Crouzon syndrome with acanthosis nigricans, Camptodactyly, tall stature, and hearing loss (CATSHL) syndrome, Achondroplasia, Hypochondroplasia, Thanatophoric dysplasia type 1, Thanatophoric dysplasia type 2, SADDAN AD/AR 53 72
FKBP10 Bruck syndrome type 2, Osteogenesis imperfecta type 3, Osteogenesis imperfecta type 4 AR 20 37
FLNA Frontometaphyseal dysplasia, Osteodysplasty Melnick-Needles, Otopalatodigital syndrome type 1, Otopalatodigital syndrome type 2, Terminal osseous dysplasia with pigmentary defects XL 119 235
FLNB Larsen syndrome (dominant), Atelosteogenesis type 1, Atelosteogenesis type 3, Spondylo-carpal-tarsal dyspasia AD/AR 41 103
GALNT3 Tumoral calcinosis, hyperphosphatemic AR 16 34
GDF5 Multiple synostoses syndrome, Fibular hypoplasia and complex brachydactyly, Acromesomelic dysplasia, Hunter-Thompson, Symphalangism, proximal, Chondrodysplasia, Brachydactyly type A2, Brachydactyly type C, Grebe dysplasia AD/AR 23 50
GH1* Isolated growth hormone deficiency, Kowarski syndrome AD/AR 25 86
GHR Growth hormone insensitivity syndrome (Laron syndrome) AD/AR 35 109
GHRHR Isolated growth hormone deficiency AR 13 43
GJA1* Oculodentodigital dysplasia mild type, Oculodentodigital dysplasia severe type, Syndactyly type 3 AD/AR 32 106
GLI2 Culler-Jones syndrome AD 26 76
GLI3 Acrocallosal syndrome, Pallister-Hall syndrome, Grieg cephalopolysndactyly syndrome, Postaxial polydactyly type A, Preaxial polydactyly type 3, Preaxial polydactyly type 4 AD 63 229
GNAS McCune-Albright syndrome, Progressive osseous heteroplasia, Pseudohypoparathyroidism, Albright hereditary osteodystrophy AD 62 265
GNPAT Rhizomelic chondrodysplasia punctata, rhizomelic AR 8 14
GPC6 Omodysplasia 1 AR 11 9
HDAC8 Cornelia de Lange syndrome XL 33 44
HESX1 Septooptic dysplasia, Pituitary hormone deficiency, combined AR/AD 14 26
HOXA13 Hand-foot-uterus syndrome, Hand-foot-genital syndrome, Guttmacher syndrome AD 8 24
HOXD13 Brachydactyly-syndactyly syndrome, Synopolydactyly, Syndactyly, Synopolydactyly with clefting, Brachydactyly type D AD/AR 18 40
HRAS Costello syndrome, Congenital myopathy with excess of muscle spindles AD 41 29
HSPG2 Schwartz-Jampel syndrome, Dyssegmental dysplasia Silverman-Handmaker type, Dyssegmental dysplasia Rolland-Desbuquis type AD/AR 16 56
IDS* Mucopolysaccharidosis XL 80 631
IFITM5 Osteogenesis imperfecta type 5 AD 2 2
IFT43 Cranioectodermal dysplasia 3 AR 4 6
IFT80 Short -rib thoracic dysplasia with or without polydactyly, Asphyxiating thoracic dysplasia (ATD; Jeune) AR 11 7
IFT122* Sensenbrenner syndrome, Cranioectodermal dysplasia (Levin-Sensenbrenner) type 1, Cranioectodermal dysplasia (Levin-Sensenbrenner) type 2 AR 11 21
IFT140 Short -rib thoracic dysplasia with or without polydactyly, Asphyxiating thoracic dysplasia (ATD; Jeune) AR 37 54
IFT172 Retinitis pigmentosa, Short -rib thoracic dysplasia with or without polydactyly, Asphyxiating thoracic dysplasia (ATD; Jeune) AR 21 23
IGF1 Insulin-like growth factor I deficiency AR 4 8
IGF1R Insulin-like growth factor I, resistance AD/AR 12 61
IGFALS Insulin-like growth factor-binding protein, acid-labile subunit, deficiency AR 5 33
IHH Acrocapitofemoral dysplasia, Brachydactyly, Syndactyly type Lueken AD/AR 12 20
IMPAD1 Chondrodysplasia with joint dislocations, GPAPP type AR 5 5
INPPL1 Opsismodysplasia AR 17 32
INSR Hyperinsulinemic hypoglycemia, familial, Rabson-Mendenhall syndrome, Donohoe syndrome AD/AR 44 183
IRS1 Diabetes mellitus, noninsulin-dependent AD/AR 3 16
KAT6B Ohdo syndrome, SBBYS variant, Genitopatellar syndrome AD 38 62
KIF7 Acrocallosal syndrome, Hydrolethalus syndrome, Al-Gazali-Bakalinova syndrome, Joubert syndrome AR/Digenic 23 40
KIF22 Spondyloepimetaphyseal dysplasia with joint laxity, type 2 AD 4 4
KMT2A Wiedemann-Steiner syndrome AD 107 83
KRAS* Noonan syndrome, Cardiofaciocutaneous syndrome AD 61 34
LARP7 Alazami syndrome AR 16 6
LBR Pelger-Huet anomaly, Reynolds syndrome, Greenberg/HEM skeletal dysplasia, Hydrops-ectopic calcification-moth-eaten skeletal dysplasia AD 18 23
LEMD3 Buschke-Ollendorff syndrome, Osteopoikilosis AD 11 31
LHX3 Pituitary hormone deficiency, combined AR 9 16
LHX4 Pituitary hormone deficiency, combined AD 10 23
LIFR Stuve-Wiedemann dysplasia, Schwartz-Jampel type 2 syndrome AR 11 32
LMNA Heart-hand syndrome, Slovenian, Limb-girdle muscular dystrophy, Muscular dystrophy, congenital, LMNA-related, Lipodystrophy (Dunnigan), Emery-Dreiffus muscular dystrophy, Malouf syndrome, Dilated cardiomyopathy (DCM), Mandibuloacral dysplasia type A, Progeria Hutchinson-Gilford type AD/AR 231 553
LMX1B Nail-patella syndrome AD 26 192
LONP1 Cerebral, Ocular, Dental, Auricular, and Skeletal anomalies (CODAS) syndrome AR 7 16
LRP4 Cenani-Lenz syndactyly syndrome, Sclerosteosis, Myasthenic syndrome, congenital AD/AR 13 24
LRP5* Van Buchem disease, Osteoporosis-pseudoglioma syndrome, Hyperostosis, endosteal, Osteosclerosis, Exudative vitreoretinopathy, Osteopetrosis late-onset form type 1, LRP5 primary osteoporosis AD/AR/Digenic 55 188
LTBP2 Weill-Marchesani syndrome, Microspherophakia and/or megalocornea, with ectopia lentis and with or without secondary glaucoma, Glaucoma, primary congenital AR 21 26
LTBP3 Dental anomalies and short stature AR 15 10
LZTR1 Schwannomatosis, Noonan syndrome AD 27 64
MAFB Multicentric carpotarsal osteolysis AD 13 22
MAP2K1 Cardiofaciocutaneous syndrome AD 45 21
MAP2K2 Cardiofaciocutaneous syndrome AD 21 35
MATN3 Spondyloepimetaphyseal dysplasia Matrilin type, Multiple epiphyseal dysplasia type 5 (EDM5) AD/AR 8 24
MBTPS2 Keratosis follicularis spinulosa decalvans, IFAP syndrome, Palmoplantar keratoderma, mutilating, with periorificial keratotic plaques XL 10 24
MESP2 Spondylocostal dysostosis 2, autosomal recessive AR 7 5
MGP Keutel syndrome AR 5 7
MMP2 Torg-Winchester syndrome, Multicentric osteolysis, nodulosis, and arthropathy AR 8 22
MMP9 Metaphyseal anadysplasia AR 1 6
MMP13 Metaphyseal anadysplasia 1, Metaphyseal dysplasia, Spahr type, Spondyloepimetaphyseal dysplasia, Missouri type AD/AR 7 6
MSX2* Parietal foramina, Parietal foramina with cleidocranial dysplasia, Craniosynostosis Boston type AD 9 25
MYCN Feingold syndrome AD 25 40
NANS Spondyloepimetaphyseal dysplasiam Genevieve type AR 8 12
NEK1 Short -rib thoracic dysplasia with or without polydactyly, SRPS type 2 (Majewski) AR/Digenic 21 20
NF1* Watson syndrome, Neurofibromatosis, Neurofibromatosis-Noonan syndrome AD 810 2703
NFIX Marshall-Smithsyndrome AD 43 65
NIPBL Cornelia de Lange syndrome AD 290 419
NKX3-2 Spondylo-megaepiphyseal-metaphyseal dysplasia AR 3 4
NOG Tarsal-carpal coalition syndrome, Multiple synostosis syndrome, Stapes ankylosis with broad thumb and toes (Teunissen-Cremers syndrome), Symphalangism, proximal, Brachydactyly type B2 AD 20 62
NOTCH1 Aortic valve disease AD 44 91
NOTCH2* Alagille syndrome, Hajdu-Cheney syndrome AD 35 63
NPR2 Acromesomelic dysplasia type Maroteaux, Epiphyseal chondrodysplasia, Miura, Short stature with nonspecific skeletal abnormalities AD/AR 30 67
NRAS Noonan syndrome AD 31 14
NSD1 Sotos syndrome, Weaver syndrome, Beckwith-Wiedemann syndrome AD 303 515
NSDHL Congenital hemidysplasia with ichthyosiform erythroderma and limb defects (CHILD syndrome), CK syndrome XL 15 28
OBSL1 3-M syndrome AR 13 33
ORC1 Meier-Gorlin syndrome (Ear-patella-short stature syndrome) AR 9 9
ORC4 Meier-Gorlin syndrome (Ear-patella-short stature syndrome) AR 22 6
ORC6 Meier-Gorlin syndrome (Ear-patella-short stature syndrome) AR 7 6
OSTM1 Osteopetrosis, autosomal recessive 5 AR 5 9
OTX2 Microphthalmia, syndromic, Pituitary hormone deficiency, combined, Retinal dystrophy, early-onset, and pituitary dysfunction AD 21 68
P3H1 Osteogenesis imperfecta AR 15 55
PALB2 Fanconi anemia, Pancreatic cancer, Breast cancer AD/AR 422 358
PAPSS2 Brachyolmia 4 with mild epiphyseal and metaphyseal changes, SEMD PAPPS2 type AR 11 19
PCNT Microcephalic osteodysplastic primordial dwarfism AR 48 84
PCYT1A Spondylometaphyseal dysplasia with cone-rod dystrophy AR 12 20
PDE4D Acrodysostosis 2, with or without hormone resistance AD 14 36
PEX7 Refsum disease, Rhizomelic CDP type 1 AR 37 52
PEX14 Peroxisome biogenesis factor disorder 14, Zellweger syndrome AR 5 4
PEX19 Peroxisome biogenesis disorder, 19, Zellweger syndrome AR 3 3
PGM3 Immunodeficiency 23 AR 13 14
PHEX Hypophosphatemic rickets XL 262 428
PIK3CA* Cowden syndrome, CLOVES AD 86 53
PITX2 Axenfeld-Rieger syndrome, Ring dermoid of cornea, Iridogoniodysgenesis, Peters anomaly AD 23 96
PLOD2 Bruck syndrome, Osteogenesis imperfecta type 3 AR 8 17
PLS3 Osteoporosis and osteoporotic fractures XL 1 14
POC1A Short stature, onychodysplasia, facial dysmorphism, and hypotrichosis (SOFT syndrome) AR 4 8
POLR1C Treacher Collins syndrome AR 16 20
POLR1D Treacher Collins syndrome AD/AR 8 26
POR Disordered steroidogenesis due to cytochrome p450 oxidoreductase deficiency, Antley-Bixler syndrome AR 12 68
POU1F1 Pituitary hormone deficiency, combined AR 19 41
PPIB Osteogenesis imperfecta type 2, Osteogenesis imperfecta type 3, Osteogenesis imperfecta type 4 AR 8 13
PRKAR1A Myxoma, intracardiac, Acrodysostosis, Pigmented nodular adrenocortical disease, Carney complex AD 66 180
PROP1 Pituitary hormone deficiency, combined AR 27 37
PTDSS1 Lenz-Majewski hyperostotic dwarfism AD 5 5
PTH1R Metaphyseal chondrodysplasia Jansen type, Failure of tooth eruption, Eiken dysplasia, Blomstrand dysplasia AD/AR 13 40
PTHLH Brachydactyly, type E2 AD 5 17
PTPN11 Noonan syndrome, Metachondromatosis AD 128 139
PYCR1 Cutis laxa AR type 2B AR 19 38
RAB33B Dyggve-Melchior-Clausen syndrome, Smith-McCort dysplasia 2 AR 6 7
RAD21* Cornelia de Lange syndrome 4 AD 9 11
RAD51C Fanconi anemia, Breast-ovarian cancer, familial AD/AR 92 112
RAF1 LEOPARD syndrome, Noonan syndrome, Dilated cardiomyopathy (DCM) AD 44 48
RASA2# Noonan syndrome AD 1 3
RBBP8 Seckel syndrome, Jawad syndrome AR 6 6
RBM8A*,# Thrombocytopenia - absent radius AD/AR 4 10
RBPJ* Adams-Oliver syndrome AD 4 5
RECQL4 Baller-Gerold syndrome, RAPADILINO syndrome, Rothmund-Thomson syndrome AR 53 100
RIT1 Noonan syndrome AD 20 25
RMRP Cartilage-hair hypoplasia, Metaphyseal dysplasia without hypotrichosis, Anauxetic dysplasia AR 34 123
RNU4ATAC Roifman syndrome, Microcephalic osteodysplastic primordial dwarfism type 1, Microcephalic osteodysplastic primordial dwarfism type 3 AR 15 21
ROR2 Robinow syndrome recessive type, Brachydactyly type B AD/AR 19 40
RRAS Noonan-syndrome like phenotype AD/AR 2
RTTN Microcephaly, short stature, and polymicrogyria with or without seizures AR 13 10
RUNX2 Cleidocranial dysplasia, Metaphyseal dysplasia with maxillary hypoplasia AD 21 213
SALL1* Townes-Brocks syndrome 1 AD 27 84
SALL4 Acro-renal-ocular syndrome, Duane-radial ray/Okohiro syndrome AD 19 55
SBDS* Aplastic anemia, Shwachman-Diamond syndrome, Severe spondylometaphyseal dysplasia AD/AR 21 90
SEC24D Cole-Carpenter syndrome 2 AR 4 11
SERPINF1 Osteogenesis imperfecta type 3, Osteogenesis imperfecta type 4 AR 9 35
SERPINH1 Osteogenesis imperfecta type 3 AR 3 3
SETBP1 Mental retardation, autosomal dominant 29, Schinzel-Giedion midface retraction syndrome AD 21 40
SF3B4 Acrofacial dysostosis 1, Nager AD 27 36
SH3BP2 Cherubism AD 9 16
SH3PXD2B Frank-ter Haar syndrome AR 9 18
SHOC2 Noonan-like syndrome with loose anagen hair AD 2 4
SHOX* Leri-Weill dyschondrosteosis, Langer mesomelic dysplasia, Short stature XL/PAR 25 426
SKI Shprintzen-Goldberg syndrome AD 17 21
SLC26A2 Diastrophic dysplasia, Atelosteogenesis type 2, De la Chapelle dysplasia, Recessive Multiple Epiphyseal dysplasia, Achondrogenesis type 1B AR 55 50
SLC29A3 Histiocytosis-lymphadenopathy plus syndrome, Dysosteosclerosis AR 16 24
SLC34A3 Hypophosphatemic rickets with hypercalciuria AR 22 36
SLC35D1 Schneckenbecken dysplasia AR 7 7
SLC39A13 Spondylodysplastic Ehlers-Danlos syndrome AR 2 8
SLCO2A1 Hypertrophic osteoarthropathy AD/AR 13 71
SLX4 Fanconi anemia AR 14 54
SMAD3 Aneurysms-osteoarthritis syndrome, Loeys-Dietz syndrome AD 43 55
SMAD4 Juvenile polyposis/hereditary hemorrhagic telangiectasia syndrome, Polyposis, juvenile intestinal, Myhre dysplasia, Hereditary hemorrhagic telangiectasia AD 162 141
SMARCAL1 Schimke immunoosseous dysplasia AR 17 88
SMC1A Cornelia de Lange syndrome XL 56 87
SMC3 Cornelia de Lange syndrome AD 21 20
SNX10 Osteopetrosis, autosomal recessive 8 AR 3 13
SOS1 Noonan syndrome AD 45 67
SOST Craniodiaphyseal dysplasia, autosomal dominant, Sclerosteosis 1, van Buchem disease AD/AR 6 14
SOX2* Microphthalmia, syndromic AD 31 100
SOX3 Panhypopituitarism XL 4 25
SOX9 Campomelic dysplasia, 46,XY sex reversal, Brachydactyly with anonychia (Cooks syndrome) AD 44 141
SP7 Osteogenesis imperfecta, type XII AR 1 1
SPARC Keratoconus, Osteogenesis imperfecta, type XVII AD/AR 2 3
SRCAP Floating-Harbor syndrome AD 13 40
STAMBP Microcephaly-capillary malformation syndrome AR 14 19
STAT5B* Growth hormone insensitivity with immunodeficiency AR 8 10
TBX3 Ulnar-Mammary syndrome AD 6 20
TBX4 Small patella syndrome AD 5 30
TBX5 Holt-Oram syndrome AD 55 126
TBX6 Spondylocostal dysostosis 5 AD 9 34
TBX15 Cousin syndrome AR 2 3
TBX19 Adrenocorticotropic hormone deficiency AR 8 27
TCF12 Craniosynostosis AD 21 53
TCIRG1 Osteopetrosis, severe neonatal or infantile forms (OPTB1) AD/AR 14 130
TCOF1 Treacher Collins syndrome AD 42 320
TCTN3 Orofaciodigital syndrome (Mohr-Majewski syndrome), Joubert syndrome AR 9 10
TGFB1 Diaphyseal dysplasia Camurati-Engelmann AD 15 18
TGFB2 Loeys-Dietz syndrome AD 34 28
TGFB3 Loeys-Dietz syndrome (Reinhoff syndrome), Arrhythmogenic right ventricular dysplasia AD 17 22
TGFBR1 Loeys-Dietz syndrome AD 37 69
TGFBR2 Loeys-Dietz syndrome AD 58 136
TMEM38B Osteogenesis imperfecta, type XIV AR 2 6
TNFRSF11A Familial expansile osteolysis, Paget disease of bone, Osteopetrosis, severe neonatal or infantile forms (OPTB1) AD/AR 8 23
TNFRSF11B Paget disease of bone, juvenile AR 8 18
TNFSF11 Osteopetrosis, autosomal recessive 2 AR 3 5
TP63 Rapp-Hodgkin syndrome, Orofacial cleft, ADULT syndrome, Ectrodactyly, ectodermal dysplasia, and cleft lip/palate syndrome, Ankyloblepharon-ectodermal defects-cleft lip/palate, Split-hand/foot malformation, Limb-mammary syndrome AD 55 116
TRAPPC2* Spondyloepiphyseal dysplasia tarda XL 12 54
TRIM37 Mulibrey nanism AR 19 21
TRIP11* Achondrogenesis, type IA AR 7 13
TRPS1 Trichorhinophalangeal syndrome type 1, Trichorhinophalangeal syndrome type 3 AD 59 139
TRPV4 Metatropic dysplasia, Spondyloepiphyseal dysplasia Maroteaux type, Parastremmatic dwarfism, Hereditary motor and sensory neuropathy, Spondylometaphyseal dysplasia Kozlowski type, Spinal muscular atrophy, Charcot-Marie-Tooth disease, Brachyolmia (autosomal dominant type), Familial Digital arthropathy with brachydactyly AD 60 76
TTC21B Short-rib thoracic dysplasia, Nephronophthisis, Asphyxiating thoracic dysplasia (ATD; Jeune) AR 17 53
TWIST1 Saethre-Chotzen syndrome, Robinow-Sorauf syndrome, Craniosynostosis AD 20 203
TYROBP Nasu-Hakola disease, Polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy AR 8 14
VDR Vitamin D-dependent rickets AD/AR 17 65
VIPAS39 Arthrogryposis, renal dysfunction, and cholestasis 2 AR 8 13
WDR19 Retinitis pigmentosa, Nephronophthisis, Short -rib thoracic dysplasia with or without polydactyly, Senior-Loken syndrome, Cranioectodermal dysplasia (Levin-Sensenbrenner) type 1, Cranioectodermal dysplasia (Levin-Sensenbrenner) type 2, Asphyxiating thoracic dysplasia (ATD; Jeune) AD/AR 30 28
WDR34 Short -rib thoracic dysplasia with or without polydactyly, Asphyxiating thoracic dysplasia (ATD; Jeune) AR 16 15
WDR35 Cranioectodermal dysplasia (Levin-Sensenbrenner) type 1, Cranioectodermal dysplasia (Levin-Sensenbrenner) type 2, Short rib-polydactyly syndrome type 5 AR 26 28
WDR60 Short-rib thoracic dysplasia 8 with or without polydactyly AR 10 5
WISP3 Arthropathy, progressive pseudorheumatoid, of childhood, Spondyloepiphyseal dysplasia tarda with progressive arthropathy AR 16 69
WNT1 Osteoprosis, autosomal dominant, Osteogenesis imperfecta, type XV AD/AR 8 27
WNT5A Robinow syndrome AD 8 10
WNT7A Ulna and fibula, absence of, with severe limb deficiency (Al-Awadi/Raas-Rothschild/Schinzel phocomelia syndrome), Fuhrmann syndrome AR 6 11
XRCC2 Hereditary breast cancer AD/AR 10 20
XRCC4 Short stature, microcephaly, and endocrine dysfunction AR 9 11
XYLT1 Desbuquois dysplasia 2 AR 10 16

* Some, or all, of the gene is duplicated in the genome. Read more.

# The gene has suboptimal coverage (means <90% of the gene’s target nucleotides are covered at >20x with mapping quality score (MQ>20) reads).

The sensitivity to detect variants may be limited in genes marked with an asterisk (*) or number sign (#)

Gene refers to the HGNC approved gene symbol; Inheritance refers to inheritance patterns such as autosomal dominant (AD), autosomal recessive (AR), X-linked (XL), X-linked dominant (XLD) and X-linked recessive (XLR); ClinVar refers to the number of variants in the gene classified as pathogenic or likely pathogenic in this database (ClinVar); HGMD refers to the number of variants with possible disease association in the gene listed in Human Gene Mutation Database (HGMD). The list of associated, gene specific phenotypes are generated from CGD or Orphanet databases.

Non-coding variants covered by the panel

Gene Genomic location HG19 HGVS RefSeq RS-number
ALPL Chr1:21835920 c.-195C>T NM_000478.4
ANKH Chr5:14871567 c.-11C>T NM_054027.4
BCS1L Chr2:219524871 c.-147A>G NM_004328.4
BRCA2 Chr13:32889805 c.-40+1G>A NM_000059.3
BRCA2 Chr13:32953872 c.8954-15T>G NM_000059.3
BRCA2 Chr13:32971007 c.9502-28A>G NM_000059.3 rs397508059
BRIP1 Chr17:59858864 c.1629-498A>T NM_032043.2
CANT1 Chr17:77005745 c.-342+1G>A NM_138793.3
CASR Chr3:121994640 c.1378-19A>C NM_001178065.1
CDKN1C Chr11:2905209 c.*5+20G>T NM_000076.2 rs760540648
CLCN7 Chr16:1506057 c.916+57A>T NM_001287.5
COL11A1 Chr1:103488576 c.1027-24A>G NM_080629.2
COL11A1 Chr1:103386637 c.3744+437T>G NM_080629.2
COL1A1 Chr17:48272201 c.1354-12G>A NM_000088.3 rs72648337
COL1A1 Chr17:48268147 c.2343+31T>A NM_000088.3
COL1A1 Chr17:48267611 c.2451+77C>T NM_000088.3 rs72651665
COL1A1 Chr17:48267594 c.2451+94G>T NM_000088.3
COL1A1 Chr17:48273742 c.904-14G>A NM_000088.3
COL2A1 Chr12:48379984 c.1527+135G>A NM_001844.4
COL5A1 Chr9:137680989 c.2647-12A>G NM_000093.4
COL5A1 Chr9:137726806 c.5137-11T>A NM_000093.4 rs183495554
CRTAP Chr3:33160815 c.472-1021C>G NM_006371.4 rs72659360
CUL7 Chr6:43010511 c.3897+29G>A NM_001168370.1
DYNC2H1 Chr11:103019205 c.2819-14A>G NM_001080463.1 rs781091611
EFNB1 ChrX:68049525 c.-95T>C/G NM_004429.4
EP300 Chr22:41537040 c.1879-12A>G NM_001429.3
EVC Chr4:5749725 c.940-150T>G NM_153717.2
FANCA Chr16:89849346 c.1567-20A>G NM_000135.2 rs775154397
FANCA Chr16:89836805 c.2223-138A>G NM_000135.2
FANCA Chr16:89836111 c.2504+134A>G NM_000135.2
FANCA Chr16:89831215 c.2778+83C>G NM_000135.2 rs750997715
FANCA Chr16:89818822 c.2982-192A>G NM_000135.2
FANCA Chr16:89816056 c.3239+82T>G NM_000135.2
FANCA Chr16:89864654 c.893+920C>A NM_000135.2
FANCD2 Chr3:10083186 c.696-121C>G NM_033084.3
FANCI Chr15:89825208 c.1583+142C>T NM_001113378.1
FBN1 Chr15:48739106 c.5672-87A>G NM_000138.4
FBN1 Chr15:48739107 c.5672-88A>G NM_000138.4
FBN1 Chr15:48720682 c.6872-14A>G NM_000138.4
FBN1 Chr15:48721629 c.6872-961A>G NM_000138.4
FBN1 Chr15:48707358 c.8051+375G>T NM_000138.4
FBN1 Chr15:48818478 c.863-26C>T NM_000138.4
FBN2 Chr5:127671284 c.3725-15A>G NM_001999.3
FBN2 Chr5:127670560 c.3974-24A>C NM_001999.3
FBN2 Chr5:127670562 c.3974-26T>G NM_001999.3
FGFR2 Chr10:123099960 c.*139411C>T .
GHR Chr5:42689204 c.287+83G>T NM_001242399.2
GHR Chr5:42700896 c.639+792A>G NM_001242399.2
GHRHR Chr7:31003560 c.-124A>C NM_000823.3
GNAS Chr20:57478716 c.2242-11A>G NM_080425.2
HSPG2 Chr1:22211006 c.1654+15G>A NM_005529.5
HSPG2 Chr1:22215993 c.574+481C>T NM_005529.5
IDS ChrX:148564764 c.1181-15C>A NM_000202.5
IDS ChrX:148578704 c.709-657G>A NM_000202.5
IFITM5 Chr11:299504 c.-14C>T NM_001025295.2 rs587776916 Explain almost all cases of OI type V PMID 23240094
LMNA Chr1:156107037 c.1608+14G>A NM_170707.3
LMNA Chr1:156107433 c.1609-12T>G NM_170707.3 rs267607582
LMNA Chr1:156105681 c.937-11C>G NM_170707.3 rs267607645
LZTR1 Chr22:21340117 c.264-13G>A NM_006767.3 rs587777176
NF1 Chr17:29422056 c.-272G>A NM_001042492.2
NF1 Chr17:29422055 c.-273A>C NM_001042492.2
NF1 Chr17:29530107 c.1260+1604A>G NM_001042492.2
NF1 Chr17:29533239 c.1261-19G>A NM_001042492.2
NF1 Chr17:29534143 c.1392+754T>G NM_001042492.2
NF1 Chr17:29488136 c.288+2025T>G NM_001042492.2
NF1 Chr17:29577082 c.4110+945A>G NM_001042492.2
NF1 Chr17:29580296 c.4173+278A>G NM_001042492.2
NF1 Chr17:29654479 c.5269-38A>G NM_001042492.2
NF1 Chr17:29656858 c.5610-456G>T NM_001042492.2
NF1 Chr17:29508428 c.587-12T>A NM_001042492.2
NF1 Chr17:29508426 c.587-14T>A NM_001042492.2
NF1 Chr17:29664375 c.6428-11T>G NM_001042492.2
NF1 Chr17:29664618 c.6642+18A>G NM_001042492.2
NF1 Chr17:29676126 c.7190-12T>A NM_001042492.2
NF1 Chr17:29685481 c.7971-17C>G NM_001042492.2
NF1 Chr17:29685177 c.7971-321C>G NM_001042492.2
NF1 Chr17:29685665 c.8113+25A>T NM_001042492.2
NF1 Chr17:29510334 c.888+651T>A NM_001042492.2
NF1 Chr17:29510427 c.888+744A>G NM_001042492.2
NF1 Chr17:29510472 c.888+789A>G NM_001042492.2
NIPBL Chr5:36953718 c.-79-2A>G NM_133433.3
NIPBL Chr5:36877266 c.-94C>T NM_133433.3
NIPBL Chr5:37022138 c.5329-15A>G NM_133433.3 rs587783968
PALB2 Chr16:23649285 c.109-12T>A NM_024675.3 rs774949203
PHEX ChrX:22266301 c.*231A>G NM_000444.4
PHEX ChrX:22237137 c.1701-16T>A NM_000444.4
PHEX ChrX:22113485 c.849+1268G>T NM_000444.4
PITX2 Chr4:111539855 c.412-11A>G NM_000325.5
PLS3 ChrX:114856534 c.74-24T>A NM_005032.5
POR Chr7:75544501 c.-5+4A>G NM_000941.2
PRKAR1A Chr17:66508689 c.-7G>A NM_002734.4
PRKAR1A Chr17:66508599 c.-97G>A NM_002734.4
PRKAR1A Chr17:66521878 c.550-17T>A NM_002734.4
PRKAR1A Chr17:66523964 c.709-7_709-2delTTTTTA NM_002734.4 rs281864801
PROP1 Chr5:177420059 c.343-11C>G NM_006261.4
PTH1R Chr3:46942604 c.1049+29C>T NM_000316.2
PTPN11 Chr12:112915602 c.934-59T>A NM_002834.3
RMRP Chr9:35657745 NR_003051.3 rs377349293
RMRP Chr9:35657746 NR_003051.3 rs551655682
SERPINF1 Chr17:1679209 c.787-617G>A NM_002615.5
STAMBP Chr2:74077998 c.1005+358A>G NM_006463.4
TBX5 Chr12:114704515 c.*88822C>A NM_000192.3 rs141875471
TCF12 Chr15:57554272 c.1468-20T>A NM_207036.1
TCIRG1 Chr11:67806587 c.-5+1G>C/T NM_006019.3
TCIRG1 Chr11:67816893 c.1887+132T>C NM_006019.3
TCIRG1 Chr11:67816903 c.1887+142T>A NM_006019.3
TCIRG1 Chr11:67816907 c.1887+146G>A NM_006019.3
TCIRG1 Chr11:67816910 c.1887+149C>T NM_006019.3
TGFBR2 Chr3:30648317 c.-59C>T NM_001024847.2
TRIM37 Chr17:57106096 c.1949-12A>G NM_015294.3
TRPS1 Chr8:116427335 c.2824-23T>G NM_014112.2
WDR35 Chr2:20182313 c.143-18T>A NM_001006657.1
WDR35 Chr2:20151929 c.1434-684G>T NM_001006657.1
WISP3 Chr6:112381431 c.103-763G>T NM_198239.1
WISP3 Chr6:112386227 c.643+27C>G NM_198239.1 rs200472841
XRCC4 Chr5:82400728 c.-10-1G>T NM_022406.2 rs869320678

Test strength

The strengths of this test include:
  • CAP and ISO-15189 accreditations covering all operations at Blueprint Genetics including all Whole Exome Sequencing, NGS panels and confirmatory testing
  • CLIA-certified personnel performing clinical testing in a CLIA-certified laboratory
  • Powerful sequencing technologies, advanced target enrichment methods and precision bioinformatics pipelines ensure superior analytical performance
  • Careful construction of clinically effective and scientifically justified gene panels
  • Our Nucleus online portal providing transparent and easy access to quality and performance data at the patient level
  • Our publically available analytic validation demonstrating complete details of test performance
  • ~1,500 non-coding disease causing variants in Blueprint WES assay (please see below ‘Non-coding disease causing variants covered by this panel’)
  • Our rigorous variant classification based on modified ACMG variant classification scheme
  • Our systematic clinical interpretation workflow using proprietary software enabling accurate and traceable processing of NGS data
  • Our comprehensive clinical statements

Test limitations

This test does not detect the following:
  • Complex inversions
  • Gene conversions
  • Balanced translocations
  • Mitochondrial DNA variants
  • Repeat expansion disorders unless specifically mentioned
  • Non-coding variants deeper than ±20 base pairs from exon-intron boundary unless otherwise indicated (please see above Panel Content / non-coding variants covered by the panel).

This test may not reliably detect the following:

  • Low level mosaicism (variant with a minor allele fraction of 14.6% is detected with 90% probability)
  • Stretches of mononucleotide repeats
  • Indels larger than 50bp
  • Single exon deletions or duplications
  • Variants within pseudogene regions/duplicated segments

The sensitivity of this test may be reduced if DNA is extracted by a laboratory other than Blueprint Genetics.

For additional information, please refer to the Test performance section and see our Analytic Validation.

The Blueprint Genetics comprehensive growth disorders / skeletal dysplasias and disorders panel covers classical genes associated with growth related and skeletal disorders. The genes on the panel have been carefully selected based on scientific literature, mutation databases and our experience.

Our panels are sliced from our high-quality whole exome sequencing data. Please see our sequencing and detection performance table for different types of alterations at the whole exome level (Table).

Assays have been validated for different starting materials including EDTA-blood, isolated DNA (no FFPE), saliva and dry blood spots (filter card) and all provide high-quality results. The diagnostic yield varies substantially depending on the assay used, referring healthcare professional, hospital and country. Blueprint Genetics' Plus Analysis (Seq+Del/Dup) maximizes the chance to find a molecular genetic diagnosis for your patient although Sequence Analysis or Del/Dup Analysis may be a cost-effective first line test if your patient's phenotype is suggestive of a specific mutation type.

Performance of Blueprint Genetics Whole Exome Sequencing (WES) assay. All individual panels are sliced from WES data.

Sensitivity % (TP/(TP+FN) Specificity %
Single nucleotide variants 99.65% (412,456/413,893) >99.99%
Insertions, deletions and indels by sequence analysis
1-10 bps 96.94% (17,070/17,608) >99.99%
11-50 bps 99.07% (957/966) >99.99%
Copy number variants (exon level dels/dups)
Clinical samples (small CNVs, n=52)
1 exon level deletion 92.3% (24/26) NA
2 exons level deletion/duplication 100.0% (11/11) NA
3-7 exons level deletion/duplication 93.3% (14/15) NA
Microdeletion/-duplication sdrs (large CNVs, n=37))
Size range (0.1-47 Mb) 100% (37/37)
Simulated CNV detection
2 exons level deletion/duplication 90.98% (7,357/8,086) 99.96%
5 exons level deletion/duplication 98.63% (7,975/8,086) 99.98%
     
The performance presented above reached by WES with the following coverage metrics
     
Mean sequencing depth at exome level 174x
Nucleotides with >20x sequencing coverage (%) 99.4%

Bioinformatics

The target region for each gene includes coding exons and ±20 base pairs from the exon-intron boundary. In addition, the panel includes non-coding variants if listed above (Non-coding variants covered by the panel). Some regions of the gene(s) may be removed from the panel if specifically mentioned in the ‘Test limitations” section above. The sequencing data generated in our laboratory is analyzed with our proprietary data analysis and annotation pipeline, integrating state-of-the art algorithms and industry-standard software solutions. Incorporation of rigorous quality control steps throughout the workflow of the pipeline ensures the consistency, validity and accuracy of results. Our pipeline is streamlined to maximize sensitivity without sacrificing specificity. We have incorporated a number of reference population databases and mutation databases such as, but not limited, to 1000 Genomes Project, gnomAD, ClinVar and HGMD into our clinical interpretation software to make the process effective and efficient. For missense variants, in silico variant prediction tools such as SIFT, PolyPhen, MutationTaster are used to assist with variant classification. Through our online ordering and statement reporting system, Nucleus, the customer has an access to details of the analysis, including patient specific sequencing metrics, a gene level coverage plot and a list of regions with inadequate coverage if present. This reflects our mission to build fully transparent diagnostics where customers have easy access to crucial details of the analysis process.

Clinical interpretation

We provide customers with the most comprehensive clinical report available on the market. Clinical interpretation requires a fundamental understanding of clinical genetics and genetic principles. At Blueprint Genetics, our PhD molecular geneticists, medical geneticists and clinical consultants prepare the clinical statement together by evaluating the identified variants in the context of the phenotypic information provided in the requisition form. Our goal is to provide clinically meaningful statements that are understandable for all medical professionals regardless of whether they have formal training in genetics.

Variant classification is the corner stone of clinical interpretation and resulting patient management decisions. Our classifications follow the Blueprint Genetics Variant Classification Schemes based on the ACMG guideline 2015. Minor modifications were made to increase reproducibility of the variant classification and improve the clinical validity of the report. Our experience with tens of thousands of clinical cases analyzed at our laboratory allowed us to further develop the industry standard.

The final step in the analysis of sequence variants is confirmation of variants classified as pathogenic or likely pathogenic using bi-directional Sanger sequencing. Variant(s) fulfilling the following criteria are not Sanger confirmed: the variant quality score is above the internal threshold for a true positive call, and visual check-up of the variant at IGV is in-line with the variant call. Reported variants of uncertain significance are confirmed with bi-directional Sanger sequencing only if the quality score is below our internally defined quality score for true positive call. Reported copy number variations with a size <10 exons are confirmed by orthogonal methods such as qPCR if the specific CNV has been seen less than three times at Blueprint Genetics.

Our clinical statement includes tables for sequencing and copy number variants that include basic variant information (genomic coordinates, HGVS nomenclature, zygosity, allele frequencies, in silico predictions, OMIM phenotypes and classification of the variant). In addition, the statement includes detailed descriptions of the variant, gene and phenotype(s) including the role of the specific gene in human disease, the mutation profile, information about the gene’s variation in population cohorts and detailed information about related phenotypes. We also provide links to the references used, congress abstracts and mutation databases to help our customers further evaluate the reported findings if desired. The conclusion summarizes all of the existing information and provides our rationale for the classification of the variant.

Identification of pathogenic or likely pathogenic variants in dominant disorders or their combinations in different alleles in recessive disorders are considered molecular confirmation of the clinical diagnosis. In these cases, family member testing can be used for risk stratification within the family. In the case of variants of uncertain significance (VUS), we do not recommend family member risk stratification based on the VUS result. Furthermore, in the case of VUS, we do not recommend the use of genetic information in patient management or genetic counseling.

Our interpretation team analyzes millions of variants from thousands of individuals with rare diseases. Thus, our database, and our understanding of variants and related phenotypes, is growing by leaps and bounds. Our laboratory is therefore well positioned to re-classify previously reported variants as new information becomes available. If a variant previously reported by Blueprint Genetics is re-classified, our laboratory will issue a follow-up statement to the original ordering health care provider at no additional cost.