OSCR

The Hidden Architecture of Brain Structural Variability in 22q11.2 Deletion Syndrome: A Multi-site Study

Overview

Authors: Rune Boen1, Kathleen P. O’Hora1, Hoki Fung1, Leila Kushan1, Charles H. Schleifer1, Tyler E. Dietterich1, Carolyn M. Amir1, Samuel Klein1, Jee Won Kang2, Haley R. Wang1,2, Dylan E. Hughes2, Julio E. Villalon-Reina3, Melody J.Y. Kang3, Yanghee Im3, Kuldeep Kumar4, Dag Alnæs5,6, Kathleen Angkustsiri7, Kevin M. Antshel8, Geor Bakker9, Anne S. Bassett10,11,12
and 42 other authorsNancy J. Butcher11,13, Linda E. Campbell14, Samuel J.R.A. Chawner15, Eva W.C. Chow16, Michael C. Craig17, Nicolas A. Crossley18,19, Eileen Daly17, Fabio Di Fabio20, Joanne L. Doherty15,21, Beverly S. Emanuel22, Ania M. Fiksinski23, Jennifer K. Forsyth24, Marianna Frascarelli20, Wanda P. Fremont25, Maria Gudbrandsen26,17, Raquel E. Gur27,28, Joachim F. Hallmayer29, Maria Jalbrzikowski30,31, Wendy R. Kates25, David E. Linden15,9, Kathryn L. McCabe32, Donna M. McDonald-McGinn33,34, Declan Murphy35, Kieran C. Murphy36, Ruth O'Hara29, Michael J. Owen15,37, Allan L. Reiss29, Gabriela M. Repetto38, David R. Roalf39, Kosha Ruparel27, J Eric Schmitt40, Sam A. Sievertsen24,41, Tony J. Simon42, Zachary H. Trevorrow24, Therese van Amelsvoort9, Marianne B.M. van den Bree15,37, Jacob A.S. Vorstman43,44,45, Elaine H. Zackai33,34, Christopher R.K. Ching3, Paul M. Thompson3, Carrie E. Bearden1,2, for the ENIGMA-22q Working Group
45 affiliations
  1. Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior and Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
  2. Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
  3. Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
  4. Centre de recherche CHU Sainte-Justine and University of Montreal, Canada
  5. Department of Psychology, University of Oslo, Oslo, Norway
  6. Centre for Precision Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  7. Department of Pediatrics, University of California, Davis, Sacramento, CA, USA
  8. Department of Psychology, Syracuse University, Syracuse, NY, USA
  9. Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, Maastricht, The Netherlands
  10. Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
  11. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  12. The Dalglish Family 22q Clinic, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
  13. Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
  14. School of Psychological Sciences, College of Science, Engineering and Environment, University of Newcastle, Australia
  15. Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
  16. Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
  17. Department of Forensic and Neurodevelopmental Sciences and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
  18. Department of Psychiatry, Pontificia Universidad Católica de Chile, Santiago, Chile
  19. Centro de Interés Nacional para Investigación e Innovación en Niñez, Adolescencia, Resiliencia y Adversidad, IINARA, Chile
  20. Department of Human Neurosciences, Sapienza University, Rome, Italy
  21. Cardiff University’s Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom
  22. Department of Pediatrics, University of Pennsylvania, School of Medicine and, Division of Genetics the Children’s Hospital of Philadelphia
  23. Departments of Pediatrics and Psychology, University Medical Center Utrecht, Utrecht, the Netherlands
  24. Department of Psychology, University of Washington, Seattle, WA, USA
  25. Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, NY, USA
  26. Centre for Research in Psychological Wellbeing (CREW), School of Psychology, University of Roehampton, London, UK
  27. Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
  28. Lifespan Brain Institute (LiBI), Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
  29. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
  30. Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, MA
  31. Department of Psychiatry, Harvard Medical School, Boston, MA
  32. Department of Medicine and Public Health, University of Newcastle, Australia
  33. 22q and You Center and Division of Genetic and Genomic Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
  34. Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
  35. Institute of Psychiatry Psychology and Neuroscience, King’s College London
  36. Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
  37. Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK
  38. Rare Diseases Program, Institute for Science and Innovation in Medicine, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile
  39. Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
  40. Departments of Radiology and Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
  41. Department of Psychiatry, Steven J. Sharp Center for Mental Health Innovation, Oregon Health & Science University, Portland, OR, USA
  42. Department of Psychiatry and Behavioral Sciences and UC Davis MIND Institute, University of California Davis, Davis, CA, USA
  43. Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
  44. Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
  45. Program in Genetics and Genome Biology, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
Dates: published online 21 May 2026
Type: Preprint · Language: English
License: CC BY-NC
Identifiers: DOI 10.64898/2026.05.18.26353539 · OpenAlex W7162002413
Open access: green, a free copy (OpenAlex)
Status: code verified
Categories: structural MRI / diffusion (modality), human (organism)
Methods: Statistics, Preprocessing
Keywords: 22q11.2 deletion syndrome, cortical thickness, cortical surface area, heterogeneity
Topic: Congenital heart defects research (Molecular Biology, Biochemistry, Genetics and Molecular Biology), according to OpenAlex
Funding: Wellcome Trust (226709/Z/22/Z, 227882/Z/23/Z, 100202/Z/12/Z)
Citations: not cited yet (Europe PMC); 61 references in the paper

Abstract

Importance: 22q11.2 deletion syndrome (22q11DS) is among the strongest genetic risk factors for neuropsychiatric disorders and has marked effects on brain structure. Yet, it remains unclear which neuroanatomical features reflect uniform effects of the deletion versus inter-individual biological processes relevant to psychiatric outcomes. Identifying these features is critical for developing targeted treatments and interventions.

Objective: To identify brain regions where 22q11DS exerts its most consistent and most variable impacts, and to test whether these patterns align with normative neurotransmitter receptor distributions and cortical growth trajectories.

Design: Multisite cross-sectional case-control study.

Setting: T1-weighted brain MRI data were obtained across 15 scanners. MRI data underwent standardized processing, quality control procedures and statistical site-adjustment using ComBat.

Participants: A total of N = 438 individuals with 22q11DS (5-54 years, 48% females) and 380 typically developing controls (6-58 years, 48% females).

Main Outcomes and Measures: Primary outcomes were global and regional cortical thickness and surface area. Mean and dispersion estimates were calculated using double generalized linear models, correcting for age, age2, sex (and intracranial volume for surface area). Quantile shift functions characterized fine-scale distributional differences. Sensitivity analyses adjustedt for co-occurring neuropsychiatric disorders, antipsychotic use and deletion subtype. Secondary outcomes included spatial correspondence between regional structural alterations and normative maps of neurotransmitter receptor density and cortical expansion.

Results: Compared with controls, individuals with 22q11DS showed widespread mean differences in cortical thickness and surface area. Notably, 22q11DS was associated with greater regional heterogeneity in both measures, except for reduced dispersion in the anterior cingulate. Effects were attenuated after covariate adjustment. Cortical thickness differences spatially overlapped with regions enriched for glutamatergic and GABAergic receptors. There was partial evidence linking surface area dispersion patterns to normative cortical growth trajectories.

Conclusions and Relevance: 22q11DS exerts broad effects on cortical structure consistent with a global developmental mechanism, reflected in widespread mean shifts. Beyond these, region-specific variability, particularly in cortical thickness, suggests individualized neurobiological processes. The anterior cingulate emerges as a region of consistent structural deviation. Overall, structural variability in 22q11DS aligns with normative patterns of excitatory-inhibitory signaling and cortical development, implicating these pathways as potential targets for intervention.

Reproduced under the paper's license (CC BY-NC), from the paper cited above.

Code

No file of the authors' code could be read here: it is described below, and read at its source.

ENIGMA-git

License: none: the authors keep all their rights
State: the link answers, verified on 28 September 2026
Evidence: the link answers
Software Heritage: not checked
Found in: the text, “MRI Processing”
Not found: README, license file, CITATION.cff, environment file, tests, continuous integration, documentation
Availability: 1 check, the latest on 28 September 2026: the link answers (HTTP 200)
  • 28 September 2026: the link answers (HTTP 200)
At the source: github.com/ENIGMA-git

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Data

No dataset and no data link were found in the paper.

Data sharing statement

Data were derived from the ENIGMA-22q Working Group from cohorts contributing structural MRI data. Requests for individual level data must be directed to the individual site PIs.

Reproduced under the paper's license (CC BY-NC), 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 2, 28 September 2026

  • Language: n/a → en

Version 1, 28 September 2026: the first record

Recorded: type, journal, dates, 62 authors, 4 keywords, 1 funder, 57 references.

Cite

This paper

Boen, R., O’Hora, K. P., Fung, H., Kushan, L., Schleifer, C. H., Dietterich, T. E., Amir, C. M., Klein, S., Kang, J. W., Wang, H. R., Hughes, D. E., Villalon-Reina, J. E., Kang, M. J., Im, Y., Kumar, K., Alnæs, D., Angkustsiri, K., Antshel, K. M., Bakker, G., . . . for the ENIGMA-22q Working Group. (2026). The Hidden Architecture of Brain Structural Variability in 22q11.2 Deletion Syndrome: A Multi-site Study. medRxiv (preprint). https://doi.org/10.64898/2026.05.18.26353539

BibTeX

@article{boen2026hidden,
author = {Boen, Rune and O’Hora, Kathleen P. and Fung, Hoki and Kushan, Leila and Schleifer, Charles H. and Dietterich, Tyler E. and Amir, Carolyn M. and Klein, Samuel and Kang, Jee Won and Wang, Haley R. and Hughes, Dylan E. and Villalon-Reina, Julio E. and Kang, Melody J.Y. and Im, Yanghee and Kumar, Kuldeep and Alnæs, Dag and Angkustsiri, Kathleen and Antshel, Kevin M. and Bakker, Geor and Bassett, Anne S. and Butcher, Nancy J. and Campbell, Linda E. and Chawner, Samuel J.R.A. and Chow, Eva W.C. and Craig, Michael C. and Crossley, Nicolas A. and Daly, Eileen and Di Fabio, Fabio and Doherty, Joanne L. and Emanuel, Beverly S. and Fiksinski, Ania M. and Forsyth, Jennifer K. and Frascarelli, Marianna and Fremont, Wanda P. and Gudbrandsen, Maria and Gur, Raquel E. and Hallmayer, Joachim F. and Jalbrzikowski, Maria and Kates, Wendy R. and Linden, David E. and McCabe, Kathryn L. and McDonald-McGinn, Donna M. and Murphy, Declan and Murphy, Kieran C. and O'Hara, Ruth and Owen, Michael J. and Reiss, Allan L. and Repetto, Gabriela M. and Roalf, David R. and Ruparel, Kosha and Schmitt, J Eric and Sievertsen, Sam A. and Simon, Tony J. and Trevorrow, Zachary H. and van Amelsvoort, Therese and van den Bree, Marianne B.M. and Vorstman, Jacob A.S. and Zackai, Elaine H. and Ching, Christopher R.K. and Thompson, Paul M. and Bearden, Carrie E. and {for the ENIGMA-22q Working Group}},
title = {{The Hidden Architecture of Brain Structural Variability in 22q11.2 Deletion Syndrome: A Multi-site Study}},
journal = {medRxiv (preprint)},
year = {2026},
month = may,
publisher = {medRxiv},
doi = {10.64898/2026.05.18.26353539},
url = {https://doi.org/10.64898/2026.05.18.26353539}
}

RIS

TY - JOUR
AU - Boen, Rune
AU - O’Hora, Kathleen P.
AU - Fung, Hoki
AU - Kushan, Leila
AU - Schleifer, Charles H.
AU - Dietterich, Tyler E.
AU - Amir, Carolyn M.
AU - Klein, Samuel
AU - Kang, Jee Won
AU - Wang, Haley R.
AU - Hughes, Dylan E.
AU - Villalon-Reina, Julio E.
AU - Kang, Melody J.Y.
AU - Im, Yanghee
AU - Kumar, Kuldeep
AU - Alnæs, Dag
AU - Angkustsiri, Kathleen
AU - Antshel, Kevin M.
AU - Bakker, Geor
AU - Bassett, Anne S.
AU - Butcher, Nancy J.
AU - Campbell, Linda E.
AU - Chawner, Samuel J.R.A.
AU - Chow, Eva W.C.
AU - Craig, Michael C.
AU - Crossley, Nicolas A.
AU - Daly, Eileen
AU - Di Fabio, Fabio
AU - Doherty, Joanne L.
AU - Emanuel, Beverly S.
AU - Fiksinski, Ania M.
AU - Forsyth, Jennifer K.
AU - Frascarelli, Marianna
AU - Fremont, Wanda P.
AU - Gudbrandsen, Maria
AU - Gur, Raquel E.
AU - Hallmayer, Joachim F.
AU - Jalbrzikowski, Maria
AU - Kates, Wendy R.
AU - Linden, David E.
AU - McCabe, Kathryn L.
AU - McDonald-McGinn, Donna M.
AU - Murphy, Declan
AU - Murphy, Kieran C.
AU - O'Hara, Ruth
AU - Owen, Michael J.
AU - Reiss, Allan L.
AU - Repetto, Gabriela M.
AU - Roalf, David R.
AU - Ruparel, Kosha
AU - Schmitt, J Eric
AU - Sievertsen, Sam A.
AU - Simon, Tony J.
AU - Trevorrow, Zachary H.
AU - van Amelsvoort, Therese
AU - van den Bree, Marianne B.M.
AU - Vorstman, Jacob A.S.
AU - Zackai, Elaine H.
AU - Ching, Christopher R.K.
AU - Thompson, Paul M.
AU - Bearden, Carrie E.
AU - for the ENIGMA-22q Working Group
TI - The Hidden Architecture of Brain Structural Variability in 22q11.2 Deletion Syndrome: A Multi-site Study
T2 - medRxiv (preprint)
J2 - medRxiv
PY - 2026
DA - 2026/05/21
PB - medRxiv
DO - 10.64898/2026.05.18.26353539
UR - https://doi.org/10.64898/2026.05.18.26353539
LA - en
ER -

CSL-JSON

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