Smith-Lemli-Opitz syndrome – detection of the 3 most common mutations in the DHCR7 gene (p.Trp151Ter, p.Val326Leu and c.964-1G>C)
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The DHCR7 gene encodes the enzyme 7-dehydrocholesterol reductase. This enzyme is responsible for the final step in cholesterol production. Mutations in the DHCR7 gene therefore lead to decreased cholesterol and elevated cholesterol precursors leading to Smith–Lemli–Opitz syndrome (SLOS). The accumulation of this cholesterol precursor is embryotoxic and can lead to intrauterine foetal death. The spectrum of malformations in SLOS is quite diverse, e.g. microcephaly, cleft palate, 2/3 finger syndactyly, polydactyly, facial malformations, heart and kidney anomalies, ambiguously differentiated genitalia in boys. Clinical manifestations are highly variable from moderate dysmorphism with mild mental retardation (SLO I) to intrauterine death or death at an early age of the foetus with SLO syndrome (SLO II). SLOS with fully manifested symptoms is estimated to be the cause of some spontaneous abortions. It is the only disease that is treated by administering cholesterol. Sanger sequencing is used to detect the 3 most common mutations in the DHCR7 gene: c.452G>A (p.Trp151Ter), c.976G>T (p.Val326Leu) and c.964-1G>C (IVS8-1G>C).