Insights of Non-canonical Splice-site Variants on RNA Splicing in Patients with Congenital Hypothyroidism.

Context Congenital hypothyroidism (CH) is caused by mutations in the genes for thyroid hormone synthesis. In our previous investigation of CH patients, ~53% of patients had mutations in either coding exons or canonical splice-sites of causative genes. Non-canonical splice-sites variants in the intron were detected but their pathogenic significance was not known. Objective To evaluate non-canonical splice-site variants on pre-mRNA splicing of CH-causing genes. Methods Next-generation sequencing data of 55 CH cases in 47 families were analyzed to identify rare intron variants. The effects of variants on pre-mRNA splicing were investigated by minigene RNA-splicing assays. Results Four intron variants were found in 3 patients: SLC26A4 c.1544 + 9C>T and c.1707 + 94C>T in one patient, and SLC5A5 c.970-48G>C and c.1652-97A>C in two other patients. The c.1707 + 94C>T and c.970-48G>C caused exons 15 and 16 skipping, and exon 8 skipping, respectively. The remaining variants had no effect on RNA splicing. Furthermore, we analyzed 28 previously reported non-canonical splice-site variants (4 in TG and 24 in SLC26A4). Among them, 15 variants (~54%) resulted in aberrant splicing and 13 variants had no effect on RNA splicing. These data were compared with three variant-prediction programs (FATHMM-XF, FATHMM-MKL, and CADD). Among 32 variants, FATHMM-XF, FATHMM-MKL, and CADD correctly predicted 20 (63%), 17 (53%), and 26 (81%) variants, respectively. Conclusions Two novel deep intron mutations have been identified in SLC26A4 and SLC5A5, bringing the total number of solved families with disease-causing mutations to ~45% in our cohort. Approximately 46% (13/28) reported non-canonical splice-site mutations do not disrupt pre-mRNA splicing. CADD provides highest prediction accuracy of non-canonical splice-site variants.