De novo variants of NR4A2 are associated with neurodevelopmental disorder and epilepsy

Sakshi Singh, Aditi Gupta, Michael Zech, Ashley N Sigafoos, Karl J Clark, Yasemin Dincer, Matias Wagner, Jennifer B Humberson, Sarah Green, Koen van Gassen, Tracy Brandt, Rhonda E Schnur, Francisca Millan, Yue Si, Volker Mall, Juliane Winkelmann, Ralitza H Gavrilova, Eric W Klee, Kendra Engleman, Nicole P SafinaRachel Slaugh, Emily M Bryant, Wen-Hann Tan, Jorge Granadillo, Sunita N Misra, G Bradley Schaefer, Shelley Towner, Eva H Brilstra, Bobby P C Koeleman

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PURPOSE: This study characterizes the clinical and genetic features of nine unrelated patients with de novo variants in the NR4A2 gene.

METHODS: Variants were identified and de novo origins were confirmed through trio exome sequencing in all but one patient. Targeted RNA sequencing was performed for one variant to confirm its splicing effect. Independent discoveries were shared through GeneMatcher.

RESULTS: Missense and loss-of-function variants in NR4A2 were identified in patients from eight unrelated families. One patient carried a larger deletion including adjacent genes. The cases presented with developmental delay, hypotonia (six cases), and epilepsy (six cases). De novo status was confirmed for eight patients. One variant was demonstrated to affect splicing and result in expression of abnormal transcripts likely subject to nonsense-mediated decay.

CONCLUSION: Our study underscores the importance of NR4A2 as a disease gene for neurodevelopmental disorders and epilepsy. The identified variants are likely causative of the seizures and additional developmental phenotypes in these patients.

Original languageEnglish
Pages (from-to)1413-1417
Number of pages5
JournalGenetics in medicine : official journal of the American College of Medical Genetics
Issue number8
Early online date5 May 2020
Publication statusPublished - Aug 2020


  • NR4A2
  • developmental disorder
  • epilepsy
  • neurodevelopmental disorder
  • seizures


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