DIS3L2

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  • Turnaround time:
    10–21 calendar days (14 days on average)
  • Preferred specimen:
    3mL whole blood in a purple-top tube
  • Alternate specimens:
    DNA or saliva/assisted saliva
  • Sample requirements
  • Request a sample kit
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Associated disorders

The DIS3L2 gene is associated with autosomal recessive Perlman syndrome (MedGen UID: 162909). Additionally, the DIS3L2 gene has preliminary evidence supporting a correlation with autosomal dominant non-syndromic Wilms tumor (PMID: 25670083).

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DIS3L2

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Invitae tests that include this gene:

DIS3L2 gene encodes a nuclear ribonuclease that is part of the exosome complex involved in RNA metabolism and control of cell growth and division.

DIS3L2 heterozygote
MedGen UID: 162909

Clinical condition
The DIS3L2 gene is associated with autosomal recessive Perlman syndrome.
Perlman syndrome is an overgrowth disorder characterized by polyhydramnios, fetal ascites, fetal/neonatal macrosomia, hypotonia, organomegaly, renal dysplasia, nephroblastomatosis, and high risk of Wilms tumor (PMID: 23613427).

Additional findings include diaphragmatic hernia, volvulus, distal ileal atresia, hypertrophy of the islets of Langerhans, hyperinsulinism, interrupted aortic arch, cryptorchidism, characteristic facial features (inverted V-shaped upper lip, prominent forehead, deep-set eyes, broad and flat nasal bridge, micrognathia, upsweep of anterior scalp hair, low-set ears), corpus callosum agenesis, cerebral atrophy, grey matter heterotopias, white matter hypoplasia, and developmental delay (PMID: 22306653, 18780370).

The incidence of Wilms tumor in those who survive the neonatal period has been estimated at 64% (PMID: 18780370). The tumor is diagnosed at an earlier age compared with sporadic cases (less than 2 years versus 3-4 years of age, respectively), and there is a high frequency of bilateral tumors (55%) (PMID: 22306653). Histologic examination of the kidneys in individuals with Perlman syndrome frequently shows nephroblastomatosis, which is a precursor lesion for Wilms tumor (PMID: 22306653).

Gene information
The DIS3L2 gene has high sequence similarity with catalytic exosome subunits that function as 3’-5’-exoribonucleases. 3’-5’-exoribonucleases mediate the degradation of mRNAs that have been polyuridylated at the 3’ end. The transcript is essential for ensuring correct mitosis, regulation of cell proliferation, and is believed to play a role in the maintenance of embryonic stem cells ( UniProtKB – Q8IYB7 (DI3L2_HUMAN). Accessed April 2016).

Inheritance
Perlman syndrome is an autosomal recessive condition that results when an individual inherits a pathogenic DIS3L2 variant from each parent. For there to be a risk of Perlman syndrome in offspring, both the patient and their partner would each have to carry a pathogenic variant in DIS3L2. In this case, the risk of having have an affected child is 25%.

Management
It is suggested that management for Perlman syndrome be supportive and multidisciplinary ( Orphanet: ORPHA2849. Perlman syndrome. Accessed April 2016). Lapunzina has proposed the following medical management protocol (PMID: 16010678):

  • From birth to 4 years of age:
    • Physical examination every 4 months
    • Serum alpha fetoprotein (AFP) screening and CBC with differential once per year
    • Urinalysis, urine vanillymandelic acid (VMA), homovanillic acid (HVA), and catecholamines once per year
    • Abdominal ultrasound and chest X-ray once per year
    • Central nervous system imaging by CT or MRI every two years
  • From 4 to 7 years of age:
    • Physical examination twice per year
    • Serum alpha fetoprotein (AFP) screening and CBC with differential once per year
    • Urinalysis, urine vanillymandelic acid (VMA), homovanillic acid (HVA), and catecholamines once per year
    • Abdominal ultrasound and chest X-ray once per year
    • Central nervous system imaging by CT or MRI every two years
  • For individuals age 7 years and beyond:
    • Physical examination once per year
    • Serum alpha fetoprotein (AFP) screening and CBC with differential once per year
    • Urinalysis, urine vanillymandelic acid (VMA), homovanillic acid (HVA), and catecholamines once per year
    • Abdominal ultrasound and chest X-ray once per year
    • Central nervous system imaging by CT or MRI every two years

An individual’s cancer risk and medical management are not determined by genetic test results alone. Overall cancer risk assessment incorporates additional factors, including personal medical history, family history, and any available genetic information that may result in a personalized plan for cancer prevention and surveillance.

Knowing if a pathogenic variant is present in the DIS3L2 gene is advantageous. At-risk relatives can be identified, allowing pursuit of a diagnostic evaluation. In addition, the available information regarding hereditary cancer susceptibility genes is constantly evolving and more clinically relevant DIS3L2 information is likely to become available in the near future. Awareness of this variant encourages patients and their providers to inform at-risk family members, to consider implementing established screening protocols, and to be vigilant in maintaining close and regular contact with their local genetics clinic in anticipation of new information.

Review date: July 2016

Assay and technical information

Invitae is a College of American Pathologists (CAP)-accredited and Clinical Laboratory Improvement Amendments (CLIA)-certified clinical diagnostic laboratory performing full-gene sequencing and deletion/duplication analysis using next-generation sequencing technology (NGS).

Our sequence analysis covers clinically important regions of each gene, including coding exons, +/- 10 base pairs of adjacent intronic sequence, and select noncoding variants. Our assay provides a Q30 quality-adjusted mean coverage depth of 350x (50x minimum, or supplemented with additional analysis). Variants classified as pathogenic or likely pathogenic are confirmed with orthogonal methods, except individual variants that have high quality scores and previously validated in at least ten unrelated samples.

Our analysis detects most intragenic deletions and duplications at single exon resolution. However, in rare situations, single-exon copy number events may not be analyzed due to inherent sequence properties or isolated reduction in data quality. If you are requesting the detection of a specific single-exon copy number variation, please contact Client Services before placing your order.

Gene Transcript reference Sequencing analysis Deletion/Duplication analysis
DIS3L2 NM_152383.4