Expanding the phenotypic spectrum associated with ZIC1 variants: A neurodevelopmental disorder with and without craniosynostosis.
Overview
and 43 other authors
Susan E Holder15, Virginia E Clowes15,16, Jan M Cobben16, Andrew T Timberlake17, Ellen R Elias18, Helen Stewart1, Diana Johnson19, Julie S Cohen20,21, Kristin W Barañano21, Sophia Ceulemans22, Marilyn C Jones22,23, Rita I Ortega Rico24, Marte G Haug25, Siren Berland26, Hannah M Bombei27, Anna Paulson27, Alpa Sidhu27, Catherine F Gooch28, Kátia M da Rocha29, Maria Rita Passos Bueno29, Alexandra Ţopa30,31, Aida Z Muslimovic31, Giovanni Maltese32, Tiong Yang Tan33,34, Emma McCann35, Helen Lord36, Hui-lin Chin37,38, Jeremy Lin37,38, Denise Li-Meng Goh37,38, Boris Keren39, Perrine Charles39, Trayan Delchev40, Daniela Avdjieva-Tzavella40, Salem Alawbathani41, Ligia Almeida41, Ameni Kdissa41, Ruslan Al-Ali41, Aida M Bertoli-Avella41, David Johnson42, Andrew OM Wilkie1,3,42,43, Ruth M Arkell2, Deborah J Shears1, Stephen RF Twigg3,4343 affiliations
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- John Curtin School of Medical Research, Garran Rd, The Australian National University, Acton, ACT, Australia
- Clinical Genetics Group, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
- Grupo de Investigación en Biomedicina Molecular, Celular y Genómica, Unidad CIBERER, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
- Molecular Neurosciences, Developmental Neurosciences, Zayed Centre for Research into Rare Disease in Children, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Department of Neurology, Great Ormond Street Hospital, London, United Kingdom
- Kids Neuroscience Centre, The Children’s Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Université Paris Cité, INSERM UMR1163, Institut Imagine, Developmental Brain Disorders Laboratory, Paris, France
- Département de Radiologie Pédiatrique, INSERM UMR 1163 and INSERM U1299, Institut Imagine, AP-HP, Necker Enfant Malade Hospital, Paris, France
- Service de Médecine Génomique des Maladies Rares, Fédération de Génétique et Médecine Génomique, AP-HP, Hôpital Necker Enfants Malades, Paris, France
- North of Scotland Regional Genetics Service, Ashgrove House, Foresterhill, Aberdeen, United Kingdom
- Yorkshire Regional Genetics Service, Chapel Allerton Hospital, Leeds, United Kingdom; Castle Hill Hospital, Cottingham, Hull, United Kingdom
- Genetics and Precision Medicine Department of Pediatrics, King Abdullah Specialized Children Hospital, King Abdulaziz Medical City, MNGHA, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences, MNGHA, Riyadh, Saudi Arabia
- North West Thames Regional Genetics Service, London North West Healthcare NHS Trust, London, United Kingdom
- Section of Genetics and Genomics, Department of Metabolism Digestion and Reproduction, Faculty of Medicine, Imperial College, London, United Kingdom
- Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, NY
- Departments of Pediatrics and Genetics, University of Colorado School of Medicine, Aurora, CO
- Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Genetics at Rady Children's Hospital, San Diego, CA
- Department of Pediatrics at University of California, San Diego, CA
- Fundación Centro Colombiano de Epilepsia y Enfermedades Neurológicas, FIRE, Cartagena de Indias, Colombia
- Department of Medical Genetics, St. Olav's University Hospital, Trondheim, Norway
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
- Division of Medical Genetics and Genomics, Stead Family Department of Pediatrics, University of Iowa Healthcare, Iowa City, IA
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University in St Louis, St Louis, MO
- Human Genome and Stem Cell Research Center, University of São Paulo, Institute of Bioscience, Department of Genetics and Evolutionary Biology, São Paulo, Brazil
- Department of Laboratory Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Plastic Surgery, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Department of Clinical Genetics, Liverpool Women's NHS Foundation Trust, Liverpool, United Kingdom
- Oxford Genetics Laboratories, Oxford University Hospitals NHS Foundation Trust, The Churchill Hospital, Oxford, United Kingdom
- Division of Genetics and Metabolism, Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, Singapore
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Assistance Publique-Hôpitaux de Paris, Département de Génétique, Hôpital Pitié-Salpêtrière, Paris, France
- Department of Clinical Genetics, University Pediatric Hospital, Sofia, Bulgaria
- CENTOGENE GmbH, Rostock, Germany
- Craniofacial Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- NIHR Oxford Biomedical Centre, Oxford, United Kingdom
Abstract
Purpose: ZIC1 encodes a transcription factor with critical roles in vertebrate neural and skeletal development. Heterozygous deletions encompassing ZIC1 and ZIC4 cause Dandy-Walker malformation, whilst in the final exon heterozygous ZIC1 variants result in a distinct phenotype of craniosynostosis with variable intellectual disability via a gain-of-function mechanism. We describe the largest group of individuals harboring ZIC1 variants to date, significantly expanding the phenotypic spectrum and allowing genotype-phenotype correlation.
Methods: Through international collaboration we identified 18 different heterozygous ZIC1 variants from 22 families, comprising 30 individuals.
Results: Twelve families segregated a phenotype comprising craniosynostosis with facial dysmorphism, structural brain abnormalities and developmental delay, whereas 10 families had a neurodevelopmental disorder alone without craniosynostosis. Variants associated with craniosynostosis were clustered in the final exon (3) and were predominantly truncating variants predicted to escape nonsense-mediated decay. Variants associated with neurodevelopmental disorder alone included missense substitutions within exons 1 and 2 predicted to disrupt the normal function of the zinc-finger domain, leading to loss of ZIC1 function, which was confirmed in a functional assay.
Conclusion: This study presents evidence for a ZIC1 genotype-phenotype correlation differentiating variants that cause a neurodevelopmental phenotype with and without craniosynostosis.
Reproduced under the paper's license (CC BY), from the paper cited above.
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Data
Datasets cited
- rcsb.org/
3d-view , at PDB; found in the text, “Functional studies” - rcsb.org/
structure/ , at PDB; found in the text, “Functional studies”2rpc
Data Availability
All data are available in the manuscript and supplemental material.
Reproduced under the paper's license (CC BY), from the paper cited above.
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Version 1, 29 September 2026: the first record
Recorded: type, language, journal, volume, issue, pages, dates, 63 authors, 5 keywords, 13 MeSH terms, 8 funders, 48 references.
Cite
This paper
Watts, L. M., Chang, M. S., Lewis-Orr, E., Walton, I. S., Leinhos, L., Tooze, R. S., Pei, Y., Calpena, E., Vedovato-dos-Santos, J. H., Steel, D., Reid, K. M., Kurian, M. A., Mohammad, S. S., Cantagrel, V., Siquier, K., Boddaert, N., Rio, M., Blyth, M., Kraus, A., . . . Twigg, S. R. (2026). Expanding the phenotypic spectrum associated with ZIC1 variants: A neurodevelopmental disorder with and without craniosynostosis. Genetics in medicine : official journal of the American College of Medical Genetics, 28(6), 102585. https://
BibTeX
@article{watts2026expand
author = {Watts, Laura M and Chang, Michelle SM and Lewis-Orr, Elizabeth and Walton, Isaac S and Leinhos, Lisa and Tooze, Rebecca S and Pei, Yang and Calpena, Eduardo and Vedovato-dos-Santos, J Heather and Steel, Dora and Reid, Kimberley M and Kurian, Manju A and Mohammad, Shekeeb S and Cantagrel, Vincent and Siquier, Karine and Boddaert, Nathalie and Rio, Marlene and Blyth, Moira and Kraus, Alison and Al Mutairi, Fuad and Holder, Susan E and Clowes, Virginia E and Cobben, Jan M and Timberlake, Andrew T and Elias, Ellen R and Stewart, Helen and Johnson, Diana and Cohen, Julie S and Barañano, Kristin W and Ceulemans, Sophia and Jones, Marilyn C and Ortega Rico, Rita I and Haug, Marte G and Berland, Siren and Bombei, Hannah M and Paulson, Anna and Sidhu, Alpa and Gooch, Catherine F and da Rocha, Kátia M and Passos Bueno, Maria Rita and Ţopa, Alexandra and Muslimovic, Aida Z and Maltese, Giovanni and Tan, Tiong Yang and McCann, Emma and Lord, Helen and Chin, Hui-lin and Lin, Jeremy and Li-Meng Goh, Denise and Keren, Boris and Charles, Perrine and Delchev, Trayan and Avdjieva-Tzavella, Daniela and Alawbathani, Salem and Almeida, Ligia and Kdissa, Ameni and Al-Ali, Ruslan and Bertoli-Avella, Aida M and Johnson, David and Wilkie, Andrew OM and Arkell, Ruth M and Shears, Deborah J and Twigg, Stephen RF},
title = {{Expanding the phenotypic spectrum associated with ZIC1 variants: A neurodevelopmental disorder with and without craniosynostosis}},
journal = {Genetics in medicine : official journal of the American College of Medical Genetics},
year = {2026},
month = apr,
volume = {28},
number = {6},
pages = {102585},
publisher = {Elsevier BV},
issn = {1098-3600},
doi = {10.1016/
url = {https://
pmid = {42028696},
pmcid = {PMC13328068}
}
RIS
TY - JOUR
AU - Watts, Laura M
AU - Chang, Michelle SM
AU - Lewis-Orr, Elizabeth
AU - Walton, Isaac S
AU - Leinhos, Lisa
AU - Tooze, Rebecca S
AU - Pei, Yang
AU - Calpena, Eduardo
AU - Vedovato-dos-Santos, J Heather
AU - Steel, Dora
AU - Reid, Kimberley M
AU - Kurian, Manju A
AU - Mohammad, Shekeeb S
AU - Cantagrel, Vincent
AU - Siquier, Karine
AU - Boddaert, Nathalie
AU - Rio, Marlene
AU - Blyth, Moira
AU - Kraus, Alison
AU - Al Mutairi, Fuad
AU - Holder, Susan E
AU - Clowes, Virginia E
AU - Cobben, Jan M
AU - Timberlake, Andrew T
AU - Elias, Ellen R
AU - Stewart, Helen
AU - Johnson, Diana
AU - Cohen, Julie S
AU - Barañano, Kristin W
AU - Ceulemans, Sophia
AU - Jones, Marilyn C
AU - Ortega Rico, Rita I
AU - Haug, Marte G
AU - Berland, Siren
AU - Bombei, Hannah M
AU - Paulson, Anna
AU - Sidhu, Alpa
AU - Gooch, Catherine F
AU - da Rocha, Kátia M
AU - Passos Bueno, Maria Rita
AU - Ţopa, Alexandra
AU - Muslimovic, Aida Z
AU - Maltese, Giovanni
AU - Tan, Tiong Yang
AU - McCann, Emma
AU - Lord, Helen
AU - Chin, Hui-lin
AU - Lin, Jeremy
AU - Li-Meng Goh, Denise
AU - Keren, Boris
AU - Charles, Perrine
AU - Delchev, Trayan
AU - Avdjieva-Tzavella, Daniela
AU - Alawbathani, Salem
AU - Almeida, Ligia
AU - Kdissa, Ameni
AU - Al-Ali, Ruslan
AU - Bertoli-Avella, Aida M
AU - Johnson, David
AU - Wilkie, Andrew OM
AU - Arkell, Ruth M
AU - Shears, Deborah J
AU - Twigg, Stephen RF
TI - Expanding the phenotypic spectrum associated with ZIC1 variants: A neurodevelopmental disorder with and without craniosynostosis
T2 - Genetics in medicine : official journal of the American College of Medical Genetics
J2 - Genet Med
PY - 2026
DA - 2026/
VL - 28
IS - 6
SP - 102585
SN - 1098-3600
PB - Elsevier BV
DO - 10.1016/
UR - https://
LA - en
ER -
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