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Disrupted epigenetics in the Sotos syndrome neurobehavioral phenotype

Harris, Jacqueline R.a,b,c; Fahrner, Jill A.b,c

Current Opinion in Psychiatry: March 2019 - Volume 32 - Issue 2 - p 55–59
doi: 10.1097/YCO.0000000000000481

Purpose of review Sotos syndrome is among a growing list of disorders resulting from mutations in epigenetic machinery genes. These Mendelian disorders of the epigenetic machinery (MDEMs) exhibit phenotypic overlap broadly characterized by intellectual disability and atypical growth and behaviors. Manifestations of Sotos syndrome include a distinct facial appearance, overgrowth, intellectual disability, and behavioral issues. Herein we review key aspects of Sotos syndrome, focusing on the neurobehavioral phenotype. Additionally, we highlight recent advances in our understanding of molecular pathogenesis implicating epigenetic mechanisms.

Recent findings Increasing evidence suggests MDEMs account for ∼19% of intellectual disability and ∼45% of overgrowth combined with intellectual disability, with Sotos syndrome constituting most of the latter. Although the genetic cause of Sotos syndrome, disruption of the histone methyltransferase writer NSD1, is well established, recent studies have further delineated the neurobehavioral phenotype and provided insight into disease pathogenesis. Explicitly, NSD1 target genes accounting for a subset of Sotos syndrome features and a specific DNA methylation signature have been identified.

Summary Sotos syndrome is, therefore, a genetic disorder with epigenetic consequences. Its characteristic neurobehavioral phenotype and those of related MDEMs illustrate the essential role epigenetic mechanisms play in neurologic development. Improvement in our understanding of molecular pathogenesis has important implications for development of diagnostic tests and therapeutic interventions.

aDepartment of Neurogenetics, Kennedy Krieger Institute

bDepartment of Pediatrics

cMcKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Correspondence to Jill A. Fahrner, MD, PhD, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins School of Medicine, Miller Research Building, Rm 409, 733 North Broadway Street, Baltimore, MD 21205, USA. Tel: +1 443 287 0995; e-mail:

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