A novel truncating variant of GLI2 associated with Culler-Jones syndrome impairs Hedgehog signalling

Background GLI2 encodes for a transcription factor that controls the expression of several genes in the Hedgehog pathway. Mutations in GLI2 have been described as causative of a spectrum of clinical phenotypes, notably holoprosencephaly, hypopituitarism and postaxial polydactyl. Methods: In order to identify causative genetic variant, we performed exome sequencing of a trio from an Italian family with multiple affected individuals presenting clinical phenotypes in the Culler-Jones syndrome spectrum. We performed a series of assays, both in vitro and in ovo (Chicken model) to test the functional properties of GLI2 mutation. Results Here we report a novel deletion c.3493delC (p.P1167LfsX52) in the C-terminal activation domain of GLI2, and cell-based functional assays confirmed the pathogenicity of the identified variant and revealed a dominant-negative effect of mutant GLI2 on Hedgehog signalling. Conclusion Our results highlight the variable clinical manifestation of GLI2 mutations and emphasize the value of functional characterisation of novel gene variants to assist genetic counselling and diagnosis.