The clinical and molecular spectrum of AGO2-associated Lessel-Kreienkamp neurodevelopmental syndrome.
Overview
and 60 other authors
Stephanie A. Bottomley12, Ágnes Till13, Kinga Hadzsiev13, Renata Szalai13, Kathryn Nicole Weaver14,15, Joel Fluss16, Henri Margot17, Berta Almoguera18,19, Isabel Lorda-Sánchez18,19, Lucía López-López18, J. Austin Hamm20, Himanshu Goel21,22, Yasemin Alanay23,24,25, Ozlem Akgun Doğan23,24,25, Gulşah Şebnem Ozkose-Iyigel24,26, Genevieve Baujat27, Marion Lesieur-Sebellin27, Sophie Rondeau27, Katherine Schon28,29, Joseph Christopher28,29, Bertrand Isidor30,31, Benjamin Cogne30,31, Neena S. Agrawal32, Ryan Dahlhauser32, Yutaka Furuta32, Rachel Rabin33, John Pappas33, Chirag Patel34,35, Irma Järvelä36, Merja Rauhala37, Isabelle Schrauwen38, Suzanne M. Leal39, Siddharth Banka40,41, Riya Tharakan40, Céline Pebrel-Richard42, Fanny Laffargue43, Nelly Durand43, Tristan Celse44, Maja Hempel45, Ilia Valentin45, Andrea Gregorova46, Lenka Noskova47, Sara Baumgartner48, Christa Überbacher49, Kai Muru50,51, Ülle Murumets51, Stella Lilles52, Katharina Steindl53, Anita Rauch53, Federica Ruscitti54, Alain Verloes54, Jonathan Levy55, Joohyun Park56, Tobias B. Haack56, Ingrid Bader56, Sophie Julia57, Guillaume Banneau57, Alison M. Muir58, Davor Lessel1,2,3,59, Hans-Jürgen Kreienkamp159 affiliations
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf,Martinistrasse 52, Hamburg, 20246 Germany
- Institute of Human Genetics, University of Regensburg,Regensburg, Germany
- Institute of Human Genetics, University Hospital Salzburg,Salzburg, Austria
- Section in Developmental Neurogenomics, Human Genetics Branch, National Institute of Mental Health, National Institutes of Health (NIH),Bethesda, MD USA
- Hospital Dr. Exequiel González Cortés,Santiago, Chile
- Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH),Santiago, Chile
- Oxford Centre for Genomic Medicine, Oxford University Hospitals NHS Foundation Trust,Oxford, UK
- Oxford Genetics Laboratories, Oxford University Hospitals NHS Foundation Trust, The Churchill Hospital,Oxford, UK
- Retina Service, Wills Eye Hospital,840 Walnut Street, Philadelphia, PA 19107 USA
- Department of Ophthalmology, Northwestern University, Feinberg School of Medicine,Chicago, IL 60611 USA
- Service de Génétique Clinique, CLAD Ouest, CHU Rennes, Hôpital Sud,Rennes, France
- Department of Human Genetics, University of California Los Angeles,Los Angeles, CA USA
- Department of Medical Genetics, Medical School, Clinical Centre, University of Pécs,Pécs, Hungary
- The Heart Institute and Division of Human Genetics, Cincinnati Children’s Hospital Medical Center,Cincinnati, USA
- Department of Pediatrics, University of Cincinnati College of Medicine,Cincinnati, USA
- Child Neurology Unit, Subspecialties Service, Geneva University Children’s Hospital,Geneva, Switzerland
- Genetic Medicine Division, Diagnostics Department, University Hospitals of Geneva,Geneva, Switzerland
- Department of Genetics and Genomics, Fundacion Jimenez Diaz University Hospital, Health Research Institute-Fundacion Jimenez Diaz, Universidad Autonoma de Madrid (IIS-FJD, UAM),Madrid, Spain
- Center for Biomedical Network Research On Rare Diseases (CIBERER),Madrid, Spain
- Pediatric Genetics, Dolly Parton Children’s Hospital, Knoxville, USA
- General Genetics Service, Hunter Genetics,Waratah, NSW Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle,Callaghan, NSW Australia
- Division of Pediatric Genetics, Department of Pediatrics, School of Medicine, Acibadem University,Istanbul, Türkiye
- Rare Diseases and Orphan Drugs Application and Research Center (ACURARE), Acibadem University,Istanbul, Türkiye
- Department of Genome Studies, Health Sciences Institute, Acibadem University,Istanbul, Türkiye
- Department of Translational Medicine, Health Sciences Institute, Acibadem University,Istanbul, Türkiye
- Service de Médecine Génomique des Maladies Rares et Institut Imagine UMR-1163 Inserm, Université Paris Cité, Hôpital Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris,Paris, France
- East Anglian Medical Genetics Service, Cambridge University Hospitals NHS Foundation Trust,Cambridge, UK
- Department of Genomic Medicine, University of Cambridge,Cambridge, UK
- Service de Génétique Médicale, CHU Nantes,9 Quai Moncousu, Nantes Cedex 1, 44093 France
- L’Institut du Thorax, INSERM, CNRS, Université de Nantes,Nantes, 44007 France
- Department of Pediatrics, Division of Medical Genetics and Genomic Medicine, Vanderbilt University Medical Center,Nashville, TN USA
- Department of Pediatrics, New York University Grossman School of Medicine,New York, NY 10016 USA
- Genetic Health Queensland, Royal Brisbane & Women’s Hospital,Brisbane, QLD Australia
- Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland,Brisbane, QLD Australia
- Department of Medical Genetics, University of Helsinki,Helsinki, Finland
- Disability Services, Wellbeing Services County of Kainuu, Kajaani, Finland
- Department of Translational Neurosciences, University of Arizona College of Medicine – Phoenix,Phoenix, AZ 85004 USA
- Center for Statistical Genetics, Gertrude H. Sergievsky Center, Department of Neurology, Columbia University Medical Centre,New York, NY 10032 USA
- Manchester Centre for Genomic Medicine, St Mary’s Hospital, Manchester University NHS Foundation Trust, Health Innovation Manchester,Manchester, UK
- Division of Evolution, Infection & Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester,Manchester, UK
- Service de Cytogénétique Médicale, UIC CYTMRR, CHU Clermont-Ferrand,Clermont-Ferrand, France
- Service de Génétique Médicale, CHU de Clermont Ferrand,Clermont Ferrand, France
- Service de Génétique, Génomique Et Procréation, CHU Grenoble Alpes,Grenoble, France
- Institute of Human Genetics, University Heidelberg,Heidelberg, Germany
- Department of Medical Genetics, University Hospital Ostrava,Ostrava, Czech Republic
- Research Unit for Rare Diseases, Department of Pediatrics and Inherited Metabolic Disorders, 1st Faculty of Medicine, Charles University in Prague,Prague, Czech Republic
- Clinic for Pediatrics I, Medical University of Innsbruck,Innsbruck, Austria
- Institute for Human Genetics, Medical University Innsbruck,Innsbruck, Austria
- Institute of Clinical Medicine, University of Tartu,Tartu, Estonia
- Genetics and Personalized Medicine Clinic, Tartu University Hospital,Tartu, Estonia
- Children’s Clinic, Department of General Paediatrics and Neurology, Tartu University Hospital,Tartu, Estonia
- Institute of Medical Genetics, University of Zurich,Schlieren-Zurich, Switzerland
- Service de Génétique Clinique, Robert Debré - APHP Nord - Université Paris Cité, ERN-ITHACA,Paris, France
- Service de Cytogénomique, Hôpital Robert-Debré, APHP,Paris, France
- Institute of Medical Genetics and Applied Genomics, University of Tübingen,Tübingen, Germany
- Department of Clinical Genetics, CHU Toulouse,Toulouse, France
- GeneDx, LLC,Gaithersburg, MD USA
- Institute of Clinical Human Genetics, University Hospital Regensburg,Franz-Josef-Strauss-Allee 11, Regensburg, 93053 Germany
Abstract
Background: Pathogenic variants in AGO2, encoding a central component of the RNA-induced silencing complex (RISC), cause the neurodevelopmental disorder Lessel-Kreienkamp syndrome (LESKRES). The variant spectrum and associated molecular mechanisms underlying phenotypic variability and disease severity remain incompletely understood.
Methods: We investigated 45 newly identified individuals carrying 33 distinct AGO2 variants, 30 of which were previously unreported. Phenotypic data from these and previously reported cases (n = 70) were integrated to delineate the LESKRES-associated clinical spectrum and genotype–phenotype correlations. Functional studies included shRNA-based silencing, co-immunoprecipitation, subcellular localization, and sequencing of AGO2-bound miRNAs.
Results: All individuals presented with a neurodevelopmental disorder of variable severity. Delayed speech and language development (97%), intellectual disability (97%), and motor delay (93%) were the most consistent features, frequently accompanied by muscular hypotonia, autistic traits, attention deficit hyperactivity disorder, visual impairment and structural brain anomalies. Systemic manifestations, including skeletal, craniofacial, cardiac, and male urogenital anomalies were common, underscoring AGO2’s multisystemic role. Moreover, we report occurrence of gonadal mosaicism and reveal the presence of interfamilial and variant-specific clinical heterogeneity. Variants clustered in defined regions of AGO2, including the L1 loop, helix-7, and multiple loops of the PIWI domain, highlight structural hotspots critical for RISC activity. Not all pathogenic variants impaired shRNA-mediated silencing; this was restricted to p.(Arg714Trp) and p.(Asn729His). Biochemical analyses revealed that p.(Asp619Asn) impaired GW182 binding and P-body assembly. Variants p.(Arg506Gln), p.(Glu531Gln) p.(Gly604Arg) and p.(Asp619Asn), reduced C-terminal phosphorylation, implicating defective AGO2 recycling. AGO2–miRNA co-immunoprecipitation and sequencing demonstrated variant-specific perturbations in miRNA association, strand selectivity, and isomiR generation. Variants near the hinge of the helix-7 region, especially p.(Phe182del), induced extensive changes in miRNA association and 3′-end modification, suggesting impaired anchoring within the miRNA-binding pocket.
Conclusions: Our findings substantially broaden the clinical and molecular landscape of LESKRES, establishing AGO2 as a pivotal regulator of neurodevelopment whose structural integrity is essential for precise miRNA-mediated gene regulation. Pathogenic variants disrupt distinct interconnected processes: P-body association, phosphorylation-dependen
Supplementary Information: The online version contains supplementary material available at 10.1186/
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Data
Datasets cited
- figshare:33326029, at figshare; found in DataCite
- figshare:33326038, at figshare; found in DataCite
Other data links
- ncbi.nlm.nih.gov/
geo , NCBI; found in “Data availability”
Data availability
The raw RNA sequence data have been deposited in the gene expression omnibus database (https://
The newly identified AGO2 variants have been deposited to the Leiden Open Variation Database (LOVD) [47 with the variant numbers #0001080193—#0001080237 https://
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All other data supporting the findings of this study are available within the paper and its Supplementary material. Materials (e.g. plasmids) are available from the corresponding authors upon request.
Reproduced under the paper's license (CC BY), from the paper cited above.
Versions
The history of this record: each version stored by the harvester or made by a correction of its authors or of the maintainers of its code, and what changed in its facts. The texts of the paper (its abstract, its availability statements) are not part of it; versions that changed only those are not listed.
Version 1, 27 September 2026: the first record
Recorded: type, language, journal, volume, issue, pages, dates, 80 authors, 5 keywords, 14 MeSH terms, 1 funder, 47 references.
Cite
This paper
Tibbe, D., Kiel, C., Ielesicheva, O., Robles de Maruri, K., Mahboobi, H., Züghart, J., Hönck, H.-H., Meier, C., Biasella, F., Legüe, M., Lopez Avaria, M. F., Blair, E., Lester, T., Banos-Pinero, B., Pulido, J. S., Schneider, A., Procopio, R., Quelin, C., Leal, B. J., . . . Kreienkamp, H.-J. (2026). The clinical and molecular spectrum of AGO2-associated Lessel-Kreienkamp neurodevelopmental syndrome. Genome medicine, 18(1), 125. https://
BibTeX
@article{tibbe2026clinic
author = {Tibbe, Debora and Kiel, Christina and Ielesicheva, Olena and Robles de Maruri, Kerstin and Mahboobi, Helia and Züghart, Joschka and Hönck, Hans-Hinrich and Meier, Christoph and Biasella, Fabiola and Legüe, Marcela and Lopez Avaria, María Francisca and Blair, Edward and Lester, Tracy and Banos-Pinero, Benito and Pulido, Jose S. and Schneider, Adele and Procopio, Rebecca and Quelin, Chloe and Leal, Bailey J. and Martinez-Agosto, Julian A. and Bottomley, Stephanie A. and Till, Ágnes and Hadzsiev, Kinga and Szalai, Renata and Weaver, Kathryn Nicole and Fluss, Joel and Margot, Henri and Almoguera, Berta and Lorda-Sánchez, Isabel and López-López, Lucía and Hamm, J. Austin and Goel, Himanshu and Alanay, Yasemin and Akgun Doğan, Ozlem and Ozkose-Iyigel, Gulşah Şebnem and Baujat, Genevieve and Lesieur-Sebellin, Marion and Rondeau, Sophie and Schon, Katherine and Christopher, Joseph and Isidor, Bertrand and Cogne, Benjamin and Agrawal, Neena S. and Dahlhauser, Ryan and Furuta, Yutaka and Rabin, Rachel and Pappas, John and Patel, Chirag and Järvelä, Irma and Rauhala, Merja and Schrauwen, Isabelle and Leal, Suzanne M. and Banka, Siddharth and Tharakan, Riya and Pebrel-Richard, Céline and Laffargue, Fanny and Durand, Nelly and Celse, Tristan and Hempel, Maja and Valentin, Ilia and Gregorova, Andrea and Noskova, Lenka and Baumgartner, Sara and Überbacher, Christa and Muru, Kai and Murumets, Ülle and Lilles, Stella and Steindl, Katharina and Rauch, Anita and Ruscitti, Federica and Verloes, Alain and Levy, Jonathan and Park, Joohyun and Haack, Tobias B. and Bader, Ingrid and Julia, Sophie and Banneau, Guillaume and Muir, Alison M. and Lessel, Davor and Kreienkamp, Hans-Jürgen},
title = {{The clinical and molecular spectrum of AGO2-associated Lessel-Kreienkamp neurodevelopmental syndrome}},
journal = {Genome medicine},
year = {2026},
month = aug,
volume = {18},
number = {1},
pages = {125},
publisher = {BMC},
issn = {1756-994X},
doi = {10.1186/
url = {https://
pmid = {42638108},
pmcid = {PMC13501643}
}
RIS
TY - JOUR
AU - Tibbe, Debora
AU - Kiel, Christina
AU - Ielesicheva, Olena
AU - Robles de Maruri, Kerstin
AU - Mahboobi, Helia
AU - Züghart, Joschka
AU - Hönck, Hans-Hinrich
AU - Meier, Christoph
AU - Biasella, Fabiola
AU - Legüe, Marcela
AU - Lopez Avaria, María Francisca
AU - Blair, Edward
AU - Lester, Tracy
AU - Banos-Pinero, Benito
AU - Pulido, Jose S.
AU - Schneider, Adele
AU - Procopio, Rebecca
AU - Quelin, Chloe
AU - Leal, Bailey J.
AU - Martinez-Agosto, Julian A.
AU - Bottomley, Stephanie A.
AU - Till, Ágnes
AU - Hadzsiev, Kinga
AU - Szalai, Renata
AU - Weaver, Kathryn Nicole
AU - Fluss, Joel
AU - Margot, Henri
AU - Almoguera, Berta
AU - Lorda-Sánchez, Isabel
AU - López-López, Lucía
AU - Hamm, J. Austin
AU - Goel, Himanshu
AU - Alanay, Yasemin
AU - Akgun Doğan, Ozlem
AU - Ozkose-Iyigel, Gulşah Şebnem
AU - Baujat, Genevieve
AU - Lesieur-Sebellin, Marion
AU - Rondeau, Sophie
AU - Schon, Katherine
AU - Christopher, Joseph
AU - Isidor, Bertrand
AU - Cogne, Benjamin
AU - Agrawal, Neena S.
AU - Dahlhauser, Ryan
AU - Furuta, Yutaka
AU - Rabin, Rachel
AU - Pappas, John
AU - Patel, Chirag
AU - Järvelä, Irma
AU - Rauhala, Merja
AU - Schrauwen, Isabelle
AU - Leal, Suzanne M.
AU - Banka, Siddharth
AU - Tharakan, Riya
AU - Pebrel-Richard, Céline
AU - Laffargue, Fanny
AU - Durand, Nelly
AU - Celse, Tristan
AU - Hempel, Maja
AU - Valentin, Ilia
AU - Gregorova, Andrea
AU - Noskova, Lenka
AU - Baumgartner, Sara
AU - Überbacher, Christa
AU - Muru, Kai
AU - Murumets, Ülle
AU - Lilles, Stella
AU - Steindl, Katharina
AU - Rauch, Anita
AU - Ruscitti, Federica
AU - Verloes, Alain
AU - Levy, Jonathan
AU - Park, Joohyun
AU - Haack, Tobias B.
AU - Bader, Ingrid
AU - Julia, Sophie
AU - Banneau, Guillaume
AU - Muir, Alison M.
AU - Lessel, Davor
AU - Kreienkamp, Hans-Jürgen
TI - The clinical and molecular spectrum of AGO2-associated Lessel-Kreienkamp neurodevelopmental syndrome
T2 - Genome medicine
J2 - Genome Med
PY - 2026
DA - 2026/
VL - 18
IS - 1
SP - 125
SN - 1756-994X
PB - BMC
DO - 10.1186/
UR - https://
LA - en
ER -
CSL-JSON
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