The Hidden Architecture of Brain Structural Variability in 22q11.2 Deletion Syndrome: A Multi-site Study
Overview
and 42 other authors
Nancy 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 Group45 affiliations
- 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
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, USA
- Centre de recherche CHU Sainte-Justine and University of Montreal, Canada
- Department of Psychology, University of Oslo, Oslo, Norway
- Centre for Precision Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Pediatrics, University of California, Davis, Sacramento, CA, USA
- Department of Psychology, Syracuse University, Syracuse, NY, USA
- Mental Health and Neuroscience Research Institute (MHeNs), Maastricht University, Maastricht, The Netherlands
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- The Dalglish Family 22q Clinic, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- School of Psychological Sciences, College of Science, Engineering and Environment, University of Newcastle, Australia
- Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
- 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
- Department of Psychiatry, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centro de Interés Nacional para Investigación e Innovación en Niñez, Adolescencia, Resiliencia y Adversidad, IINARA, Chile
- Department of Human Neurosciences, Sapienza University, Rome, Italy
- Cardiff University’s Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, United Kingdom
- Department of Pediatrics, University of Pennsylvania, School of Medicine and, Division of Genetics the Children’s Hospital of Philadelphia
- Departments of Pediatrics and Psychology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Psychology, University of Washington, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, NY, USA
- Centre for Research in Psychological Wellbeing (CREW), School of Psychology, University of Roehampton, London, UK
- Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Lifespan Brain Institute (LiBI), Children’s Hospital of Philadelphia and Penn Medicine, Philadelphia, PA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
- Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, Boston, MA
- Department of Psychiatry, Harvard Medical School, Boston, MA
- Department of Medicine and Public Health, University of Newcastle, Australia
- 22q and You Center and Division of Genetic and Genomic Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
- Institute of Psychiatry Psychology and Neuroscience, King’s College London
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Neuroscience and Mental Health Innovation Institute, Cardiff University, Cardiff, UK
- Rare Diseases Program, Institute for Science and Innovation in Medicine, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Departments of Radiology and Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Steven J. Sharp Center for Mental Health Innovation, Oregon Health & Science University, Portland, OR, USA
- Department of Psychiatry and Behavioral Sciences and UC Davis MIND Institute, University of California Davis, Davis, CA, USA
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Program in Genetics and Genome Biology, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
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
Availability: 1 check, the latest on 28 September 2026: the link answers (HTTP 200)
- 28 September 2026: the link answers (HTTP 200)
Tracing map
Proposed by the machine: these links were found in the paper and verified at the source, without human review. The map will receive a Zenodo DOI once one of the paper's authors has validated it with their ORCID.
What the map holds:
- 1 repository of the authors' code, each at its verified commit, with its license and how the link was found in the paper;
- 0 scripts, each with its path and the digest of its content;
- no match between paragraphs and code yet;
- neither the text of the paper nor the code itself.
Its JSON (tracing-map.json) is deposited on Zenodo with its DOI once the map is validated.
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://
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/
url = {https://
}
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/
PB - medRxiv
DO - 10.64898/
UR - https://
LA - en
ER -
CSL-JSON
{
"id": "10.64898/
"type": "article",
"title": "The Hidden Architecture of Brain Structural Variability in 22q11.2 Deletion Syndrome: A Multi-site Study",
"container-title": "medRxiv (preprint)",
"author": [
{
"family": "Boen",
"given": "Rune"
},
{
"family": "O’Hora",
"given": "Kathleen P."
},
{
"family": "Fung",
"given": "Hoki"
},
{
"family": "Kushan",
"given": "Leila"
},
{
"family": "Schleifer",
"given": "Charles H."
},
{
"family": "Dietterich",
"given": "Tyler E."
},
{
"family": "Amir",
"given": "Carolyn M."
},
{
"family": "Klein",
"given": "Samuel"
},
{
"family": "Kang",
"given": "Jee Won"
},
{
"family": "Wang",
"given": "Haley R."
},
{
"family": "Hughes",
"given": "Dylan E."
},
{
"family": "Villalon-Reina",
"given": "Julio E."
},
{
"family": "Kang",
"given": "Melody J.Y."
},
{
"family": "Im",
"given": "Yanghee"
},
{
"family": "Kumar",
"given": "Kuldeep"
},
{
"family": "Alnæs",
"given": "Dag"
},
{
"family": "Angkustsiri",
"given": "Kathleen"
},
{
"family": "Antshel",
"given": "Kevin M."
},
{
"family": "Bakker",
"given": "Geor"
},
{
"family": "Bassett",
"given": "Anne S."
},
{
"family": "Butcher",
"given": "Nancy J."
},
{
"family": "Campbell",
"given": "Linda E."
},
{
"family": "Chawner",
"given": "Samuel J.R.A."
},
{
"family": "Chow",
"given": "Eva W.C."
},
{
"family": "Craig",
"given": "Michael C."
},
{
"family": "Crossley",
"given": "Nicolas A."
},
{
"family": "Daly",
"given": "Eileen"
},
{
"family": "Di Fabio",
"given": "Fabio"
},
{
"family": "Doherty",
"given": "Joanne L."
},
{
"family": "Emanuel",
"given": "Beverly S."
},
{
"family": "Fiksinski",
"given": "Ania M."
},
{
"family": "Forsyth",
"given": "Jennifer K."
},
{
"family": "Frascarelli",
"given": "Marianna"
},
{
"family": "Fremont",
"given": "Wanda P."
},
{
"family": "Gudbrandsen",
"given": "Maria"
},
{
"family": "Gur",
"given": "Raquel E."
},
{
"family": "Hallmayer",
"given": "Joachim F."
},
{
"family": "Jalbrzikowski",
"given": "Maria"
},
{
"family": "Kates",
"given": "Wendy R."
},
{
"family": "Linden",
"given": "David E."
},
{
"family": "McCabe",
"given": "Kathryn L."
},
{
"family": "McDonald-McGinn",
"given": "Donna M."
},
{
"family": "Murphy",
"given": "Declan"
},
{
"family": "Murphy",
"given": "Kieran C."
},
{
"family": "O'Hara",
"given": "Ruth"
},
{
"family": "Owen",
"given": "Michael J."
},
{
"family": "Reiss",
"given": "Allan L."
},
{
"family": "Repetto",
"given": "Gabriela M."
},
{
"family": "Roalf",
"given": "David R."
},
{
"family": "Ruparel",
"given": "Kosha"
},
{
"family": "Schmitt",
"given": "J Eric"
},
{
"family": "Sievertsen",
"given": "Sam A."
},
{
"family": "Simon",
"given": "Tony J."
},
{
"family": "Trevorrow",
"given": "Zachary H."
},
{
"family": "van Amelsvoort",
"given": "Therese"
},
{
"family": "van den Bree",
"given": "Marianne B.M."
},
{
"family": "Vorstman",
"given": "Jacob A.S."
},
{
"family": "Zackai",
"given": "Elaine H."
},
{
"family": "Ching",
"given": "Christopher R.K."
},
{
"family": "Thompson",
"given": "Paul M."
},
{
"family": "Bearden",
"given": "Carrie E."
},
{
"literal": "for the ENIGMA-22q Working Group"
}
],
"container-title-short":
"DOI": "10.64898/
"publisher": "medRxiv",
"URL": "https://
"language": "en",
"issued": {
"date-parts": [
[
2026,
5,
21
]
]
}
}
The tracing map gets a citation of its own once an author has validated it and it has a DOI.
Similar papers
The papers with a page that share the most with this one: the tools found in their code, their categories, datasets, cited references and authors, the rarest counting most.
- [1] doi:10.1038/s41380-026-03547-x [code]
- Multiscale characterization of cortical signatures in positive and negative schizotypy: a worldwide ENIGMA study.Journal: Molecular psychiatryIn common: structural MRI / diffusion, 7 references
- [2] doi:10.21203/rs.3.rs-9246968/v1 [code]
- Copy number variants reveal divergent genetic and diagnostic cortical signatures across psychiatric disordersJournal: Research Square (preprint)In common: 7 references
- [3] doi:10.1038/s41467-026-75959-w [code]
- Charting higher-order models of brain function beyond pairwise interactions.Journal: Nature communicationsIn common: 5 references
- [4] doi:10.1093/braincomms/fcag097 [code]
- Long-term effects of preterm birth on cortical folding trajectories in early childhood.Journal: Brain communicationsIn common: 4 references
- [5] doi:10.1038/s42003-026-09956-6 [code]
- Linking changes in sulcal morphometry to cognitive development from childhood to adolescence.Journal: Communications biologyIn common: structural MRI / diffusion, 4 references
- [6] doi:10.64898/2026.08.13.26360304 [code]
- Lifespan brain structural variation reveals shared organization across mental health conditionsJournal: medRxiv (preprint)In common: 4 references
- [7] doi:10.1038/s41467-026-75582-9 [code]
- Biophysical modeling of anatomically realistic prenatal cortical folding development.Journal: Nature communicationsIn common: structural MRI / diffusion, 3 references
- [8] doi:10.1038/s41380-026-03497-4 [code]
- Transcriptome-informed brain cartography of polygenic risk and association with brain structure in major psychiatric disorders.Journal: Molecular psychiatryIn common: 4 references
- [9] doi:10.1093/schbul/sbaf078
- Orbitofrontal Thickness and Network Associations as Transdiagnostic Signature of Amotivation Along the Bipolar-Schizophrenia Spectrum.Journal: Schizophrenia bulletinIn common: structural MRI / diffusion, 3 references
- [10] doi:10.1371/journal.pbio.3003927 [code]
- Brain structural and functional connectivity converge prenatally but diverge after birth.Journal: PLoS biologyIn common: structural MRI / diffusion, 3 references
Contribute
The authors of this paper can claim it, correct its record and validate its tracing map, and the maintainers of its code (its owner, or a public member of its organization) correct what it says of their repository; anyone signed in can ask for its removal. Every request goes to OSCR's own machine, which answers it; your account page follows them.
Sign in with ORCID to claim this paper as one of its authors, correct its record or validate its tracing map: when the paper's metadata lists your ORCID iD, you are recognized at once. Maintainers of its code: sign in with GitHub, then claim the repository on your account page.
Claim this paper
Correct its record
Say what each link of this record is, remove the ones that are not the paper's, add the ones that are missing. The correction becomes a new version of the record, in its Versions section.
Validate its tracing map
You validate the map as this page shows it: 1 repository of the authors' code, each at its verified commit and with its license, 0 scripts, and 0 matches between paragraphs and code (see the Code and Map sections). It then receives a DOI on Zenodo, with you (your ORCID iD) and OSCR as its creators; the code itself is not deposited.
The map's fingerprint: sha256:7cfd354e653b7cbc…
Add the badge to its README
The badge links the code to this page. Copy one of these into the README of the paper's code: only you decide where it goes, and nothing is changed for you.
Markdown
[, paste the snippet at the top, then “Commit changes…” and, to review it first, “Create a new branch and start a pull request”. You open the pull request; OSCR asks for no permission.
Request its removal
To ask OSCR to remove this record, the copies of its authors' scripts or its tracing map, use the removal request page: signed in, you say who you are, what to remove and why, then review and confirm the request. Published rules decide every request (how).
Discussion, reproductions, activity
Discussion: questions and error reports about this paper and its code, from signed-in readers and its authors. It opens with sign-in.
Reproductions: reports from readers who ran the authors' code: what they reproduced, with which environment, commit and data. It opens with sign-in.
Activity: what happens around this paper: new versions of its record, its map's validation, discussions and reproductions. It opens with sign-in.
