OSCR

Expanding the phenotypic spectrum associated with ZIC1 variants: A neurodevelopmental disorder with and without craniosynostosis.

Overview

Authors: Laura M Watts1, Michelle SM Chang2, Elizabeth Lewis-Orr3, Isaac S Walton3, Lisa Leinhos3, Rebecca S Tooze3, Yang Pei3, Eduardo Calpena3,4, J Heather Vedovato-dos-Santos3, Dora Steel5,6, Kimberley M Reid5, Manju A Kurian5,6, Shekeeb S Mohammad7, Vincent Cantagrel8, Karine Siquier8, Nathalie Boddaert9, Marlene Rio8,10, Moira Blyth11, Alison Kraus12, Fuad Al Mutairi13,14
and 43 other authorsSusan 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 Twigg3,43
43 affiliations
  1. Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
  2. John Curtin School of Medical Research, Garran Rd, The Australian National University, Acton, ACT, Australia
  3. Clinical Genetics Group, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
  4. Grupo de Investigación en Biomedicina Molecular, Celular y Genómica, Unidad CIBERER, Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
  5. Molecular Neurosciences, Developmental Neurosciences, Zayed Centre for Research into Rare Disease in Children, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
  6. Department of Neurology, Great Ormond Street Hospital, London, United Kingdom
  7. Kids Neuroscience Centre, The Children’s Hospital at Westmead, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
  8. Université Paris Cité, INSERM UMR1163, Institut Imagine, Developmental Brain Disorders Laboratory, Paris, France
  9. Département de Radiologie Pédiatrique, INSERM UMR 1163 and INSERM U1299, Institut Imagine, AP-HP, Necker Enfant Malade Hospital, Paris, France
  10. Service de Médecine Génomique des Maladies Rares, Fédération de Génétique et Médecine Génomique, AP-HP, Hôpital Necker Enfants Malades, Paris, France
  11. North of Scotland Regional Genetics Service, Ashgrove House, Foresterhill, Aberdeen, United Kingdom
  12. Yorkshire Regional Genetics Service, Chapel Allerton Hospital, Leeds, United Kingdom; Castle Hill Hospital, Cottingham, Hull, United Kingdom
  13. Genetics and Precision Medicine Department of Pediatrics, King Abdullah Specialized Children Hospital, King Abdulaziz Medical City, MNGHA, Riyadh, Saudi Arabia
  14. King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences, MNGHA, Riyadh, Saudi Arabia
  15. North West Thames Regional Genetics Service, London North West Healthcare NHS Trust, London, United Kingdom
  16. Section of Genetics and Genomics, Department of Metabolism Digestion and Reproduction, Faculty of Medicine, Imperial College, London, United Kingdom
  17. Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, NY
  18. Departments of Pediatrics and Genetics, University of Colorado School of Medicine, Aurora, CO
  19. Sheffield Clinical Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, United Kingdom
  20. Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD
  21. Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
  22. Division of Genetics at Rady Children's Hospital, San Diego, CA
  23. Department of Pediatrics at University of California, San Diego, CA
  24. Fundación Centro Colombiano de Epilepsia y Enfermedades Neurológicas, FIRE, Cartagena de Indias, Colombia
  25. Department of Medical Genetics, St. Olav's University Hospital, Trondheim, Norway
  26. Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
  27. Division of Medical Genetics and Genomics, Stead Family Department of Pediatrics, University of Iowa Healthcare, Iowa City, IA
  28. Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University in St Louis, St Louis, MO
  29. Human Genome and Stem Cell Research Center, University of São Paulo, Institute of Bioscience, Department of Genetics and Evolutionary Biology, São Paulo, Brazil
  30. Department of Laboratory Medicine, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
  31. Department of Clinical Genetics and Genomics, Sahlgrenska University Hospital, Gothenburg, Sweden
  32. Department of Plastic Surgery, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
  33. Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Royal Children’s Hospital, Melbourne, Australia
  34. Department of Paediatrics, University of Melbourne, Melbourne, Australia
  35. Department of Clinical Genetics, Liverpool Women's NHS Foundation Trust, Liverpool, United Kingdom
  36. Oxford Genetics Laboratories, Oxford University Hospitals NHS Foundation Trust, The Churchill Hospital, Oxford, United Kingdom
  37. Division of Genetics and Metabolism, Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, Singapore
  38. Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  39. Assistance Publique-Hôpitaux de Paris, Département de Génétique, Hôpital Pitié-Salpêtrière, Paris, France
  40. Department of Clinical Genetics, University Pediatric Hospital, Sofia, Bulgaria
  41. CENTOGENE GmbH, Rostock, Germany
  42. Craniofacial Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
  43. NIHR Oxford Biomedical Centre, Oxford, United Kingdom
Institutions: University of Oxford (United Kingdom); Oxford University Hospitals NHS Trust (United Kingdom); Australian National University (Australia); MRC Weatherall Institute of Molecular Medicine (United Kingdom); Centre for Biomedical Network Research on Rare Diseases (Spain); Instituto de Investigación Sanitaria La Fe (Spain); Great Ormond Street Hospital (United Kingdom); University College London (United Kingdom); The University of Sydney (Australia); Children's Hospital at Westmead (Australia); Inserm (France); Université Paris Cité (France); Institut des Maladies Génétiques Imagine (France); Hôpital Necker-Enfants Malades (France); Assistance Publique – Hôpitaux de Paris (France); Trajectoires développementales & psychiatrie; Chapel Allerton Hospital (United Kingdom); Castle Hill Hospital (United Kingdom); King Saud bin Abdulaziz University for Health Sciences (Saudi Arabia); King Abdulaziz Medical City (Saudi Arabia); King Abdullah International Medical Research Center (Saudi Arabia); London North West Healthcare NHS Trust (United Kingdom); Imperial College London (United Kingdom); NYU Langone Health (United States); New York University (United States); University of Colorado Anschutz (United States); University of Colorado Denver (United States); John Radcliffe Hospital (United Kingdom); Sheffield Children's NHS Foundation Trust (United Kingdom); Sheffield Children's Hospital (United Kingdom); Kennedy Krieger Institute (United States); Johns Hopkins University (United States); Johns Hopkins Medicine (United States); Rady Children's Hospital-San Diego (United States); University of California San Diego (United States); Fundacion Centro Colombiano de Epilepsia y en Enfermedades Neurologicas (Colombia); St Olav's University Hospital (Norway); Haukeland University Hospital (Norway); University of Iowa (United States); University of Iowa Hospitals and Clinics (United States); University of Iowa Stead Family Children’s Hospital (United States); University of Iowa Health Care (United States); Washington University in St. Louis (United States); Universidade de São Paulo (Brazil); Sahlgrenska University Hospital (Sweden); University of Gothenburg (Sweden); Royal Children's Hospital (Australia); The University of Melbourne (Australia); Victorian Clinical Genetics Services (Australia); Murdoch Children's Research Institute (Australia); Liverpool Womens NHS Foundation Trust (United Kingdom); Churchill Hospital (United Kingdom); National University of Singapore (Singapore); National University Hospital (Singapore); National University Health System (Singapore); Pitié-Salpêtrière Hospital (France); Centogene (Germany) (Germany)
Dates: received 16 September 2025; accepted 10 April 2026; published online June 2026; in print June 2026
Type: Research article · Language: English
License: CC BY
Identifiers: DOI 10.1016/j.gim.2026.102585 · PMID 42028696 · PMCID PMC13328068 · OpenAlex W7155212203
Open access: hybrid, a free copy (OpenAlex)
Status: data only
Categories: human (organism), other condition (population), developmental (subfield)
Keywords: Craniosynostosis, gain-of-function, loss-of-function, neurodevelopmental disorder, ZIC1
MeSH: Craniosynostoses*, Neurodevelopmental Disorders*, Transcription Factors*, Child, Child, Preschool, Exons, Female, Genetic Association Studies, Heterozygote, Humans, Male, Pedigree, Phenotype (* major topic)
Topic: Craniofacial Disorders and Treatments (Genetics, Biochemistry, Genetics and Molecular Biology), according to OpenAlex
Funding: The VTCT Foundation; UK Research and Innovation Medical Research Council (MC_PC_21044, MR/T031670/1); NIHR Oxford Biomedical Research Centre; Instituto de Salud Carlos III; European Social Fund Plus (ESF+); European Commission; Exeter College, University of Oxford; National Institute on Handicapped Research
Citations: not cited yet (Europe PMC); 48 references in the paper

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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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://doi.org/10.1016/j.gim.2026.102585

BibTeX

@article{watts2026expanding,
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/j.gim.2026.102585},
url = {https://doi.org/10.1016/j.gim.2026.102585},
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 - 2026/04/22
VL - 28
IS - 6
SP - 102585
SN - 1098-3600
PB - Elsevier BV
DO - 10.1016/j.gim.2026.102585
UR - https://doi.org/10.1016/j.gim.2026.102585
LA - en
ER -

CSL-JSON

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