Chromosome 5q14.3 Deletion Syndrome via the MEF2C Gene
Summary and Pricing 
Test Method
Sequencing and CNV Detection via NextGen Sequencing using PG-Select Capture Probes| Test Code | Test Copy Genes | Test CPT Code | Gene CPT Codes Copy CPT Code | Base Price | |
|---|---|---|---|---|---|
| 4187 | MEF2C | 81479 | 81479,81479 | $990 | Order Options and Pricing |
Pricing Comments
Testing run on PG-select capture probes includes CNV analysis for the gene(s) on the panel but does not permit the optional add on of exome-wide CNV analysis. Any of the NGS platforms allow reflex to other clinically relevant genes, up to whole exome or whole genome sequencing depending upon the base platform selected for the initial test.
An additional 25% charge will be applied to STAT orders. STAT orders are prioritized throughout the testing process.
This test is also offered via a custom panel (click here) on our exome or genome backbone which permits the optional add on of exome-wide CNV or genome-wide SV analysis.
Turnaround Time
3 weeks on average for standard orders or 2 weeks on average for STAT orders.
Please note: Once the testing process begins, an Estimated Report Date (ERD) range will be displayed in the portal. This is the most accurate prediction of when your report will be complete and may differ from the average TAT published on our website. About 85% of our tests will be reported within or before the ERD range. We will notify you of significant delays or holds which will impact the ERD. Learn more about turnaround times here.
Targeted Testing
For ordering sequencing of targeted known variants, go to our Targeted Variants page.
Clinical Features and Genetics
Clinical Features
Chromosome 5q14.3 deletion syndrome (OMIM:613443) is a neurocognitive disorder characterized by epilepsy and intellectual disability. 5q14.3 deletion syndrome patients show signs of psychomotor delay at around 6 months and many never develop speech. Onset of tonic-clonic seizures occurs during infancy and early childhood. Seizures are usually well controlled with medication (Zweier and Rauch 2011). Other symptoms include muscular hypotonia and limited ability to walk. Brain MRI can reveal various anomalies such as delayed myelination, thickened corpus callosum or enlarged ventricles, but there is no common finding among patients. 5q14.3 deletion syndrome patients share a similar facial gestalt including a broad forehead, flat nose, Cupid's bow lip, macrodontia and strabismus (Zweier et al. 2010). Other rare features seen in a subset of patients include stereotyped hand movements, poor eye contact and autistic features.
Genetics
5q14.3 deletion syndrome is most commonly caused by large deletions encompassing the MEF2C gene. Most identified 5q14.3 deletions include the MEF2C gene as well as neighboring genes, but deletions limited to the MEF2C gene have been identified (Nowakowska et al. 2010; Le Meur et al. 2010). De novo nonsense and missense mutations in the MEF2C gene also result in a phenotype that resembles 5q14.3 deletion syndrome, suggesting that MEF2C haploinsufficiency underlies the disorder (Zweier et al. 2010; Le Meur et al. 2010). A handful of 5q14.3 duplications including the MEF2C gene have been reported and patients present with mild intellectual disability, microcephaly and impaired speech (Novara et al. 2013).
MEF2C encodes a transcription factor that is highly expressed in the muscle, heart and brain. Knocking out MEF2C expression in the mouse brain results in reduced neuronal differentiation and neural networks with fewer synapses and impaired electrical activity. MEF2C knockout mice also had anxious behavior, decreased cognitive function and stereotyped paw motions thus mimicking some features of 5q14.3 deletion syndrome (Li et al. 2008).
Clinical Sensitivity - Sequencing with CNV PG-Select
One study identified de novo mutations in the MEF2C gene in ~1.8% (4 of 221) of patients with severe intellectual disability but without gross malformations or specific dysmorphisms (Zweier et al. 2010).
Testing Strategy
This test provides full coverage of all coding exons of the MEF2C gene, plus ~10 bases of flanking noncoding DNA. We define full coverage as >20X NGS reads or Sanger sequencing.
Indications for Test
MEF2C testing is recommended in patients with symptoms of 5q14.3 deletion syndrome, particularly childhood-onset epilepsy with intellectual disability and hypotonia.
MEF2C testing is recommended in patients with symptoms of 5q14.3 deletion syndrome, particularly childhood-onset epilepsy with intellectual disability and hypotonia.
Gene
| Official Gene Symbol | OMIM ID |
|---|---|
| MEF2C | 600662 |
| Inheritance | Abbreviation |
|---|---|
| Autosomal Dominant | AD |
| Autosomal Recessive | AR |
| X-Linked | XL |
| Mitochondrial | MT |
Disease
| Name | Inheritance | OMIM ID |
|---|---|---|
| Mental Retardation, Stereotypic Movements, Epilepsy, And/Or Cerebral Malformations | AD | 613443 |
Citations
- Li H, Radford JC, Ragusa MJ, Shea KL, McKercher SR, Zaremba JD, Soussou W, Nie Z, Kang Y-J, Nakanishi N. 2008. Transcription factor MEF2C influences neural stem/progenitor cell differentiation and maturation in vivo. Proceedings of the National Academy of Sciences 105: 9397–9402. PubMed ID: 18599437
- Meur N Le, Holder-Espinasse M, Jaillard S, Goldenberg A, Joriot S, Amati-Bonneau P, Guichet A, Barth M, Charollais A, Journel H, Auvin S, Boucher C, et al. 2010. MEF2C haploinsufficiency caused by either microdeletion of the 5q14.3 region or mutation is responsible for severe mental retardation with stereotypic movements, epilepsy and/or cerebral malformations. J. Med. Genet. 47: 22–29. PubMed ID: 19592390
- Novara F, Rizzo A, Bedini G, Girgenti V, Esposito S, Pantaleoni C, Ciccone R, Sciacca FL, Achille V, Della Mina E, Gana S, Zuffardi O, et al. 2013. MEF2C deletions and mutations versus duplications: A clinical comparison. European Journal of Medical Genetics 56: 260–265. PubMed ID: 23402836
- Nowakowska BA, Obersztyn E, Szymańska K, Bekiesińska-Figatowska M, Xia Z, Ricks CB, Bocian E, Stockton DW, Szczałuba K, Nawara M, Patel A, Scott DA, et al. 2010. Severe mental retardation, seizures, and hypotonia due to deletions of MEF2C. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics 153B(5):1042-1051. PubMed ID: 20333642
- Zweier M, Gregor A, Zweier C, Engels H, Sticht H, Wohlleber E, Bijlsma EK, Holder SE, Zenker M, Rossier E, Grasshoff U, Johnson DS, et al. 2010. Mutations in MEF2C from the 5q14.3q15 microdeletion syndrome region are a frequent cause of severe mental retardation and diminish MECP2 and CDKL5 expression. Human Mutation 31: 722–733. PubMed ID: 20513142
- Zweier M, Rauch A. 2011. The MEF2C -Related and 5q14.3q15 Microdeletion Syndrome. Molecular Syndromology 2: 164–170. PubMed ID: 22670137
Ordering/Specimens
Ordering Options
We offer several options when ordering sequencing tests. For more information on these options, see our Ordering Instructions page. To view available options, click on the Order Options button within the test description.
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.
- PGnome sequencing panels can be ordered via the myPrevent portal only at this time.
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.
For Requisition Forms, visit our Forms page
If ordering a Duo or Trio test, the proband and all comparator samples are required to initiate testing. If we do not receive all required samples for the test ordered within 21 days, we will convert the order to the most effective testing strategy with the samples available. Prior authorization and/or billing in place may be impacted by a change in test code.
Specimen Types
Specimen Requirements and Shipping Details
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