Expanding the genetic and phenotypic spectrum of skeletal dysplasias

Skeletal dysplasias constitute a large and heterogeneous group of disorders, many causing disabilities with profound effects on the quality of life of the affected individuals and their families. Each individual skeletal dysplasia is rare, however, as more than 450 different disorders have been described, skeletal dysplasias as a group affect approximately three in 10 000 individuals. The age of onset for skeletal dysplasias ranges from prenatal to adult, but most of the affected individuals are diagnosed in childhood. Skeletal dysplasias mainly affect bone and cartilage, but symptoms may involve other organs, such as sensorineural hearing loss in Stickler syndrome, nephronophthisis in Sensenbrenner syndrome, and structural heart abnormalities in acromicric dysplasia. Therefore, most skeletal dysplasias can be defined as syndromes with a significant skeletal involvement. Clinical diagnosis of skeletal dysplasias is based on meticulous phenotypic characterization, skeletal radiography (for pattern recognition) and genetic testing. Molecular diagnostics has improved significantly by massively parallel sequencing (MPS) technologies, such as whole exome and genome sequencing. However, even after extensive clinical phenotyping and advanced molecular analyses, many patients with congenital skeletal disorders still lack molecular diagnoses and many clinical entities are not well-characterized regarding their natural course and complications. Molecular diagnosis is important since it gives information about prognosis and recurrence risk, as well as, in some cases possibilities to offer targeted treatment, participation in clinical trials, and tailored medical follow-up. This thesis focuses on gene discovery, studies of previously clinically defined skeletal dysplasias with unknown genetic background and aims to improve the molecular analyses for patients with diagnoses which are difficult to solve. In study I, we identify a novel pathogenic variant in ALG9, as the cause of