The Koolen-de Vries syndrome (KdVS) is a multisystem syndrome with variable facial features caused by a 17q21.31 microdeletion or KANSL1 truncating variant. As the facial gestalt of KdVS has resemblance with the gestalt of the 22q11.2 deletion syndrome (22q11.2DS), we assessed whether our previously described hybrid quantitative facial phenotyping algorithm could distinguish between these two syndromes, and whether there is a facial difference between the molecular KdVS subtypes. We applied our algorithm to 2D photographs of 97 patients with KdVS (78 microdeletions, 19 truncating variants (likely) causing KdVS) and 48 patients with 22q11.2DS as well as age, gender and ethnicity matched controls with intellectual disability (n = 145). The facial gestalts of KdVS and 22q11.2DS were both recognisable through significant clustering by the hybrid model, yet different from one another (p = 7.5 × 10−10 and p = 0.0052, respectively). Furthermore, the facial gestalts of KdVS caused by a 17q21.31 microdeletion and KANSL1 truncating variant (likely) causing KdVS were indistinguishable (p = 0.981 and p = 0.130). Further application to three patients with a variant of unknown significance in KANSL1 showed that these faces do not match KdVS. Our data highlight quantitative facial phenotyping not only as a powerful tool to distinguish syndromes with overlapping facial dysmorphisms but also to establish pathogenicity of variants of unknown clinical significance.
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We are grateful to the patients and their parents for their participation, to the Dutch Organisation for Health Research and Development: ZON-MW grants 912-12-109 (to BBAdV and LELMV) and 916-16-015 (to JYHK), Donders Junior researcher grant 2019 (BBAdV and LELMV), Aspasia grant 015.014.066 (to LELMV). Inclusion of Radboudumc data was in part supported by the Solve-RD project that has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement no. 779257. The patient images used for analysis in this study cannot be made openly available due to patient privacy concerns. Please contact the authors with specific queries regarding data access.
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Dingemans, A.J.M., Stremmelaar, D.E., van der Donk, R. et al. Quantitative facial phenotyping for Koolen-de Vries and 22q11.2 deletion syndrome. Eur J Hum Genet (2021). https://doi.org/10.1038/s41431-021-00824-x