Ciliopathy disease gene identification by whole exome medical resequencing

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Cilia are finger-like projections from cells that act as a cellular "antenna" to detect and respond to chemical or mechanical cues. One important cue is fluid flow during the process of establishing asymmetry during early embryogenesis, the formation of the kidney nephron, and the formation of other tubular structures such as the neural tube. A group of comparatively common inherited conditions called "ciliopathies" can arise when the structure or function of cilia are defective. For example, cystic kidney disease is a common feature of many ciliopathies, often leads to kidney failure, and is therefore a significant cause of childhood disease and death. The most severe ciliopathy ("Meckel-Gruber syndrome") also involves problems in the development of the brain and spinal cord (called "neural tube defects") that arise during growth of babies in the womb. Reduced or absent mucus clearance from the lungs is the main consequence in other ciliopathies ("primary ciliary dyskinesia"), which causes recurrent respiratory infections and progressive damage to the respiratory system. In many ciliopathies, there are disturbances in the patterns of left-right organization of the lungs and heart, which are also seen in congenital heart defects (CHD), the most common birth defect.This research proposes to identify many of the remaining disease genes that are defective ("mutated") in this group of ciliopathies. To achieve this aim, we will take advantage of recent exciting advances in genetic technology that allow us to analyze the entire coding parts of a patient's genome ("whole exome sequencing"). We are uniquely placed to do this work and have a proven track record of success in this field: we have formed excellent research partnerships with families and their clinicians in the local community to participate in gene identification studies, and we have the appropriate state-of-the-art technology, computer analysis tools and experience.The identification of a new ciliopathy gene provides two major benefits. Firstly, accurate genetic testing then becomes possible for patients and families, with improvements in diagnosis and genetic counselling. Secondly, important and often unexpected scientific insights are made into the disease mechanism of the ciliopathy and into the normal function of the disease gene, which can lead to new treatments. We also expect new insights into the causes of other, more common conditions such as polycystic kidney disease, spina bifida and congenital heart defects.