De novo and biallelic DEAF1 variants cause a phenotypic spectrum



To investigate the effect of different DEAF1 variants on the phenotype of patients with autosomal dominant and recessive inheritance patterns and on DEAF1 activity in vitro.


We assembled a cohort of 23 patients with de novo and biallelic DEAF1 variants, described the genotype–phenotype correlation, and investigated the differential effect of de novo and recessive variants on transcription assays using DEAF1 and Eif4g3 promoter luciferase constructs.


The proportion of the most prevalent phenotypic features, including intellectual disability, speech delay, motor delay, autism, sleep disturbances, and a high pain threshold, were not significantly different in patients with biallelic and pathogenic de novo DEAF1 variants. However, microcephaly was exclusively observed in patients with recessive variants (p < 0.0001).


We propose that different variants in the DEAF1 gene result in a phenotypic spectrum centered around neurodevelopmental delay. While a pathogenic de novo dominant variant would also incapacitate the product of the wild-type allele and result in a dominant-negative effect, a combination of two recessive variants would result in a partial loss of function. Because the clinical picture can be nonspecific, detailed phenotype information, segregation, and functional analysis are fundamental to determine the pathogenicity of novel variants and to improve the care of these patients.

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Fig. 1: Genotype and facial phenotype of individuals with DEAF1-associated neurodevelopmental disorders (DAND).
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We thank the patients and their parents for participating in this study. We are grateful to Claire Thompson, from the Medical Photography Department, Ninewells Hospital and Medical School, Dundee, Angus, UK for taking and providing the clinical photographs of individual AD/3. This work was financially supported by grants from the Dutch Organization for Health Research and Development (ZON-MW grants 917–86–319 and 912–12–109 to B.B.A.d.V.), the Cedars-Sinai Diana and Steve Marienhoff Fashion Industries Guild Endowed Fellowship in Pediatric Neuromuscular Diseases (to T.M.P.), the March of Dimes (grant 6-FY14–422 to M.C.M.), and the National Institutes of Health (grants NINDS 5R21NS091724 to P.J.J. and NINDS R01NS069605 to H.C.M.).

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Correspondence to Bert B. A. de Vries MD, PhD.

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  • DEAF1
  • neurodevelopmental disorder
  • intellectual disability
  • genotype
  • phenotype