# DLL1 haploinsufficiency in prenatal brain anomalies: a retrospective analysis of 6q terminal deletions

## TL;DR

This study examines how DLL1 gene deletion on chromosome 6q causes prenatal brain abnormalities and highlights the importance of combining genetic tests for accurate diagnosis.

## Contribution

The study demonstrates that combining CNV-Seq with WES improves detection of 6q terminal deletions involving DLL1 in prenatal brain anomalies.

## Key findings

- Five fetuses with 6q terminal deletions showed reduced cerebellar diameter and ventriculomegaly.
- CNV-Seq identified deletions in four cases, while WES was needed for the fifth due to coverage limitations.
- DLL1 haploinsufficiency is linked to prenatal brain structural dysplasia.

## Abstract

6q terminal deletion is a rare genetic cause of prenatal brain anomalies. We evaluated five cases of cerebral dysplasia within a familial context for genetic diagnosis. Aims to analyze prenatal brain abnormalities from 6q terminal deletion of DLL1 and support prenatal diagnosis and genetic counseling.

A retrospective analysis was conducted on data from five families with fetal brain structural dysplasia, collected at Gansu Provincial Maternity and Child-care Hospital (Gansu Central Hospital) between January 2017 and April 2024. We applied copy number variation sequencing (CNV-Seq) and when negative, whole-exome sequencing (WES) to define genomic etiologies of prenatal brain anomalies.

A total of 5 fetuses were included in this study. All fetuses exhibited a cerebellar diameter smaller than expected for their gestational age, as determined by US, 4/5 cases underwent MRI. In fetuses 1–4, CNV-Seq analysis identified heterozygous deletions of 1.74 Mb, 2.88 Mb, 0.72 Mb, and 21.99 Mb at the terminal region of chromosome 6q. In fetus 5, WES successfully identified the deletion that CNV-seq had missed, likely terminal coverage drop/binning limit.

Fetuses with reduced transverse cerebellar diameter and ventriculomegaly should be evaluated for 6q terminal deletions involving DLL1; combining CNV-seq with reflex WES reduces missed diagnoses and informs counseling.