Hennekam Lymphangiectasia-Lymphedema Syndrome via the CCBE1 Gene

  • Summary and Pricing
  • Clinical Features and Genetics
  • Citations
  • Methods
  • Ordering/Specimens
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Test Code Test Copy GenesIndividual Gene PriceCPT Code Copy CPT Codes
284 CCBE1$750.00 81479 Add to Order
Targeted Testing

For ordering targeted known variants, please proceed to our Targeted Variants landing page.

Turnaround Time

The great majority of tests are completed within 18 days.

Clinical Sensitivity

Sensitivity of this test is unknown.

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Deletion/Duplication Testing via aCGH

Test Code Test Copy GenesIndividual Gene PriceCPT Code Copy CPT Codes
600 CCBE1$690.00 81479 Add to Order
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Turnaround Time

The great majority of tests are completed within 28 days.

Clinical Features

Primary Lymphedema is a chronic condition that arises from an abnormality of the lymphatic system. Hennekam Syndrome (OMIM 235510) is a type of primary lymphedema characterized by severe lymphedema in the limbs, genitalia and face complicated by facial dysmorphism and mental retardation (Hennekam et al. Am J Med Genet 34:593-600, 1989). Facial features vary, but are typically characterized by a flattened face and nasal bridge, hypertelorism, epicanthal folds, small mouth, tooth anomalies, and ear defects accompanied by hearing loss. Lymphedema is progressive, often beginning in utero with hydrops fetalis, and can be asymmetrical (Van Balkom et al. Am J Med Genet 112:412-421, 2002). Edema is typically accompanied by hypoproteinemia and immunologic abnormalities such as hypogammaglobulinemia and lymphocytopenia. Angiectasias of lymph vessels in the intestines and other organs (e.g. pleura pericardium, thyroid, and kidneys) are a hallmark of Hennekam Syndrome (Hennekam et al. Am J Med Genet 34:593-600, 1989; Alders et al. Nat Genet 41:1272-1274, 2009). Additional features may include congenital heart defects, pyloric stenosis, glaucoma, hypothyroidism, camptodactyly, rectal prolapse and renal anomalies (Angle and Hersh. Am J Med Genet 71:211-214, 1997; Van Balkom et al. Am J Med Genet 112:412-421, 2002; Al-Gazali et al. Clin Dysmorphol 12:227-232, 2003; Bellini et al. Am J Med Genet 120A:92-96, 2003).


Phenotypic abnormalities arise due to impaired prenatal and postnatal lymphatic flow resulting from insufficient CCBE1 gene function during lymphangiogenesis. The CCBE1 protein plays a direct role in lymphatic vessel formation and venous sprouting. Mutations throughout the CCBE1 gene have been identified as causes of Hennekam Syndrome (Hennekam et al. Am J Med Genet 34:593-600, 1989; Hogan et al. Nat Genet 41:396-398, 2009; Connell et al. Hum Genet 127:231-241, 2010). Details of the molecular mechanism of the CCBE1 protein function remain incomplete, however it is speculated that CCBE may be a component of the extracellular matrix involved in guidance of migrating cells during lymphangiogenesis (Hogan et al. Nat Genet 41:396-398, 2009). Mutations in the CCBE1 gene are inherited in an autosomal recessive manner and comprise primarily missense and nonsense mutations. No predominant CCBE1 mutations have been identified to date.

Testing Strategy

This test involves bidirectional DNA sequencing of the 11 coding exons in the CCBE1 gene plus ~20 bp of flanking non-coding DNA on either side of each exon. We will also sequence and single exon (Test #100) in family members of patients with a known mutation or to confirm research results.

Indications for Test

Patients with clinical features of Hennekam Syndrome or a family history of lymphedema, and patients with lymphedema that test negative for mutations in the FLT4 and FOXC2 genes.


Official Gene Symbol OMIM ID
CCBE1 612753
Inheritance Abbreviation
Autosomal Dominant AD
Autosomal Recessive AR
X-Linked XL
Mitochondrial MT


Name Inheritance OMIM ID
Hennekam Syndrome 235510

Related Test

Lymphedema Sequencing Panel


Genetic Counselors
  • Al-Gazali LI, Hertecant J, Ahmed R, Khan NA, Padmanabhan R. 2003. Further delineation of Hennekam syndrome. Clinical Dysmorphology 12: 227–232. PubMed ID: 14564208
  • Alders M, Hogan BM, Gjini E, Salehi F, Al-Gazali L, Hennekam EA, Holmberg EE, Mannens MMAM, Mulder MF, Offerhaus GJA, Prescott TE, Schroor EJ, et al. 2009. Mutations in CCBE1 cause generalized lymph vessel dysplasia in humans. Nature Genetics 41: 1272–1274. PubMed ID: 19935664
  • Angle B, Hersh JH. 1997. Expansion of the phenotype in Hennekam syndrome: a case with new manifestations. Am. J. Med. Genet. 71: 211–214. PubMed ID: 9217224
  • Balkom IDC Van, Alders M, Allanson J, Bellini C, Frank U, Jong G De, Kolbe I, Lacombe D, Rockson S, Rowe P, Wijburg F, Hennekam RCM. 2002. Lymphedema-lymphangiectasia-mental retardation (Hennekam) syndrome: A review. American Journal of Medical Genetics 112: 412–421. PubMed ID: 12376947
  • Bellini C, Mazzella M, Arioni C, Campisi C, Taddei G, Tomà P, Boccardo F, Hennekam RC, Serra G. 2003. Hennekam syndrome presenting as nonimmune hydrops fetalis, congenital chylothorax, and congenital pulmonary lymphangiectasia. Am. J. Med. Genet. A 120A: 92–96. PubMed ID: 12794699
  • Connell, F., (2010). "Linkage and sequence analysis indicate that CCBE1 is mutated in recessively inherited generalised lymphatic dysplasia." Hum Genet 127(2): 231-41. PubMed ID: 19911200
  • Hennekam RCM, Geerdink RA, Hamel BCJ, Hennekam FAM, Kraus P, Rammeloo JA, Tillemans AAW. 1989. Autosomal recessive intestinal lymphangiectasia and lymphedema, with facial anomalies and mental retardation. American journal of medical genetics 34: 593–600. PubMed ID: 2624276
  • Hogan, B. M., (2009). "Ccbe1 is required for embryonic lymphangiogenesis and venous sprouting." Nat Genet 41(4): 396-8. PubMed ID: 19287381
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Bi-Directional Sanger Sequencing

Test Procedure

Nomenclature for sequence variants was from the Human Genome Variation Society (  As required, DNA is extracted from the patient specimen.  PCR is used to amplify the indicated exons plus additional flanking non-coding sequence.  After cleaning of the PCR products, cycle sequencing is carried out using the ABI Big Dye Terminator v.3.0 kit.  Products are resolved by electrophoresis on an ABI 3730xl capillary sequencer.  In most cases, sequencing is performed in both forward and reverse directions; in some cases, sequencing is performed twice in either the forward or reverse directions.  In nearly all cases, the full coding region of each exon as well as 20 bases of non-coding DNA flanking the exon are sequenced.

Analytical Validity

As of March 2016, we compared 17.37 Mb of Sanger DNA sequence generated at PreventionGenetics to NextGen sequence generated in other labs. We detected only 4 errors in our Sanger sequences, and these were all due to allele dropout during PCR. For Proficiency Testing, both external and internal, in the 12 years of our lab operation we have Sanger sequenced roughly 8,800 PCR amplicons. Only one error has been identified, and this was due to sequence analysis error.

Our Sanger sequencing is capable of detecting virtually all nucleotide substitutions within the PCR amplicons. Similarly, we detect essentially all heterozygous or homozygous deletions within the amplicons. Homozygous deletions which overlap one or more PCR primer annealing sites are detectable as PCR failure. Heterozygous deletions which overlap one or more PCR primer annealing sites are usually not detected (see Analytical Limitations). All heterozygous insertions within the amplicons up to about 100 nucleotides in length appear to be detectable. Larger heterozygous insertions may not be detected. All homozygous insertions within the amplicons up to about 300 nucleotides in length appear to be detectable. Larger homozygous insertions may masquerade as homozygous deletions (PCR failure).

Analytical Limitations

In exons where our sequencing did not reveal any variation between the two alleles, we cannot be certain that we were able to PCR amplify both of the patient’s alleles. Occasionally, a patient may carry an allele which does not amplify, due for example to a deletion or a large insertion. In these cases, the report contains no information about the second allele.

Similarly, our sequencing tests have almost no power to detect duplications, triplications, etc. of the gene sequences.

In most cases, only the indicated exons and roughly 20 bp of flanking non-coding sequence on each side are analyzed. Test reports contain little or no information about other portions of the gene, including many regulatory regions.

In nearly all cases, we are unable to determine the phase of sequence variants. In particular, when we find two likely causative mutations for recessive disorders, we cannot be certain that the mutations are on different alleles.

Our ability to detect minor sequence variants, due for example to somatic mosaicism is limited. Sequence variants that are present in less than 50% of the patient’s nucleated cells may not be detected.

Runs of mononucleotide repeats (eg (A)n or (T)n) with n >8 in the reference sequence are generally not analyzed because of strand slippage during PCR and cycle sequencing.

Unless otherwise indicated, the sequence data that we report are based on DNA isolated from a specific tissue (usually leukocytes). Test reports contain no information about gene sequences in other tissues.

Deletion/Duplication Testing Via Array Comparative Genomic Hybridization

Test Procedure

Equal amounts of genomic DNA from the patient and a gender matched reference sample are amplified and labeled with Cy3 and Cy5 dyes, respectively. To prevent any sample cross contamination, a unique sample tracking control is added into each patient sample. Each labeled patient product is then purified, quantified, and combined with the same amount of reference product. The combined sample is loaded onto the designed array and hybridized for at least 22-42 hours at 65°C. Arrays are then washed and scanned immediately with 2.5 µM resolution. Only data for the gene(s) of interest for each patient are extracted and analyzed.

Analytical Validity

PreventionGenetics' high density gene-centric custom designed aCGH enables the detection of relatively small deletions and duplications within a single exon of a given gene or deletions and duplications encompassing the entire gene. PreventionGenetics has established and verified this test's accuracy and precision.

Analytical Limitations

Our dense probe coverage may allow detection of deletions/duplications down to 100 bp; however due to limitations and probe spacing this cannot be guaranteed across all exons of all genes. Therefore, some copy number changes smaller than 100-300 bp within a targeted large exon may not be detected by our array.

This array may not detect deletions and duplications present at low levels of mosaicism or those present in genes that have pseudogene copies or repeats elsewhere in the genome.

aCGH will not detect balanced translocations, inversions, or point mutations that may be responsible for the clinical phenotype.

Breakpoints, if occurring outside the targeted gene, may be hard to define.

The sensitivity of this assay may be reduced when DNA is extracted by an outside laboratory.

Order Kits

Ordering Options

myPrevent - Online Ordering
  • The test can be added to your online orders in the Summary and Pricing section.
  • Once the test has been added log in to myPrevent to fill out an online requisition form.
  • A completed requisition form must accompany all specimens.
  • Billing information along with specimen and shipping instructions are within the requisition form.
  • All testing must be ordered by a qualified healthcare provider.


(Delivery accepted Monday - Saturday)

  • Collect 3 ml -5 ml (5 ml preferred) of whole blood in EDTA (purple top tube) or ACD (yellow top tube). For Test #500-DNA Banking only, collect 10 ml -20 ml of whole blood.
  • For small babies, we require a minimum of 1 ml of blood.
  • Only one blood tube is required for multiple tests.
  • Ship blood tubes at room temperature in an insulated container. Do not freeze blood.
  • During hot weather, include a frozen ice pack in the shipping container. Place a paper towel or other thin material between the ice pack and the blood tube.
  • In cold weather, include an unfrozen ice pack in the shipping container as insulation.
  • At room temperature, blood specimen is stable for up to 48 hours.
  • If refrigerated, blood specimen is stable for up to one week.
  • Label the tube with the patient name, date of birth and/or ID number.


(Delivery accepted Monday - Saturday)

  • Send in screw cap tube at least 5 µg -10 µg of purified DNA at a concentration of at least 20 µg/ml for NGS and Sanger tests and at least 5 µg of purified DNA at a concentration of at least 100 µg/ml for gene-centric aCGH, MLPA, and CMA tests, minimum 2 µg for limited specimens.
  • For requests requiring more than one test, send an additional 5 µg DNA per test ordered when possible.
  • DNA may be shipped at room temperature.
  • Label the tube with the composition of the solute, DNA concentration as well as the patient’s name, date of birth, and/or ID number.
  • We only accept genomic DNA for testing. We do NOT accept products of whole genome amplification reactions or other amplification reactions.


(Delivery preferred Monday - Thursday)

  • PreventionGenetics should be notified in advance of arrival of a cell culture.
  • Culture and send at least two T25 flasks of confluent cells.
  • Some panels may require additional flasks (dependent on size of genes, amount of Sanger sequencing required, etc.). Multiple test requests may also require additional flasks. Please contact us for details.
  • Send specimens in insulated, shatterproof container overnight.
  • Cell cultures may be shipped at room temperature or refrigerated.
  • Label the flasks with the patient name, date of birth, and/or ID number.
  • We strongly recommend maintaining a local back-up culture. We do not culture cells.
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