Copy Number Gains at 17p11.2 Sparing <scp> <i>RAI1</i> </scp> : A Shared Phenotype Pattern

A variety of genomic rearrangement mechanisms contribute to copy number variations at the 17p11.2 locus driven in part by its complex genomic architecture which is characterized by low copy repeats (LCRs) and other repetitive elements. These copy number variants are primarily mediated by nonallelic homologous recombination (NAHR) leading to recurrent tandem duplications and reciprocal deletions of the genomic interval mapping between the repeats. Two notable neurodevelopmental genomic disorders: Potocki-Lupski Syndrome (PTLS; MIM: 610883) and Smith-Magenis Syndrome (SMS; MIM: 182290) are driven by LCRs that undergo NAHR between the directly oriented repeats causing a duplication (PTLS) or deletion (SMS) encompassing the dosage-sensitive gene RAI1. We observed that other uncommon gains of varying sizes and extent at the 17p11.2 locus, which do not include the RAI1 gene, could be found in patients ascertained with a neurodevelopmental delay (NDD) phenotype. We ascertained 15 individuals from 11 families with copy number gains at the 17p11.2 locus not encompassing the driver gene-RAI1; such individuals manifested a broad spectrum of neurodevelopmental phenotypes. To validate our genomic findings, investigate DNA rearrangement mechanism(s), and refine our understanding at the breakpoint junctions, we performed a combination of high-resolution array CGH (n = 15), short-read whole-genome sequencing (sr-GS, n = 4), long-read GS (lr-GS; ONT; n = 4 and PacBio HiFi; n = 4), and breakpoint junctional analysis on this subset. Phenotypes in each individual were systematically studied. The phenotypes noted in these 15 individuals from 11 families primarily included developmental delay, intellectual disability, and behavioral problems. The genomic variations found in these 11 families included simple copy number gains (n = 7), higher order amplifications (n = 2), and complex genomic rearrangements (n = 2) at the 17p11.2 locus, surrounding the RAI1 gene and not encompassing it. Individuals from 4/11 families carried inherited variants. Identification of such rearrangement gains at the 17p11.2 locus that do not include the driver gene RAI1 and yet research subjects still exhibit neurodevelopmental phenotypes creates an opportunity to (i) dissect the gene(s) and genetic mechanisms that might contribute to phenotypic variability at the PTLS locus and (ii) uncover previously unrecognized genes or disease pathways and mechanisms.