Variants in the degron of AFF3 are associated with intellectual disability, mesomelic dysplasia, horseshoe kidney, and epileptic encephalopathy

Norine Voisin, Rhonda E. Schnur, Sofia Douzgou, Susan M. Hiatt, Cecilie F. Rustad, Natasha J. Brown, Dawn L. Earl, Boris Keren, Olga Levchenko, Sinje Geuer, Sarah Verheyen, Diana Johnson, Yuri A. Zarate, Miroslava Hančárová, David J. Amor, E. Martina Bebin, Jasmin Blatterer, Alfredo Brusco, Gerarda Cappuccio, Joel CharrowNicolas Chatron, Gregory M. Cooper, Thomas Courtin, Elena Dadali, Julien Delafontaine, Ennio Del Giudice, Martine Doco, Ganka Douglas, Astrid Eisenkölbl, Tara Funari, Giuliana Giannuzzi, Ursula Gruber-Sedlmayr, Nicolas Guex, Delphine Heron, Øystein L. Holla, Anna C.E. Hurst, Jane Juusola, David Kronn, Alexander Lavrov, Crystle Lee, Séverine Lorrain, Else Merckoll, Anna Mikhaleva, Jennifer Norman, Sylvain Pradervand, Darina Prchalová, Lindsay Rhodes, Victoria R. Sanders, Zdeněk Sedláček, Heidelis A. Seebacher, Elizabeth A. Sellars, Fabio Sirchia, Toshiki Takenouchi, Akemi J. Tanaka, Heidi Taska-Tench, Elin Tønne, Kristian Tveten, Giuseppina Vitiello, Markéta Vlčková, Tomoko Uehara, Caroline Nava, Binnaz Yalcin, Kenjiro Kosaki, Dian Donnai, Stefan Mundlos, Nicola Brunetti-Pierri, Wendy K. Chung, Alexandre Reymond*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


The ALF transcription factor paralogs, AFF1, AFF2, AFF3, and AFF4, are components of the transcriptional super elongation complex that regulates expression of genes involved in neurogenesis and development. We describe an autosomal dominant disorder associated with de novo missense variants in the degron of AFF3, a nine amino acid sequence important for its binding to ubiquitin ligase, or with de novo deletions of this region. The sixteen affected individuals we identified, along with two previously reported individuals, present with a recognizable pattern of anomalies, which we named KINSSHIP syndrome (KI for horseshoe kidney, NS for Nievergelt/Savarirayan type of mesomelic dysplasia, S for seizures, H for hypertrichosis, I for intellectual disability, and P for pulmonary involvement), partially overlapping the AFF4-associated CHOPS syndrome. Whereas homozygous Aff3 knockout mice display skeletal anomalies, kidney defects, brain malformations, and neurological anomalies, knockin animals modeling one of the microdeletions and the most common of the missense variants identified in affected individuals presented with lower mesomelic limb deformities like KINSSHIP-affected individuals and early lethality, respectively. Overexpression of AFF3 in zebrafish resulted in body axis anomalies, providing some support for the pathological effect of increased amount of AFF3. The only partial phenotypic overlap of AFF3- and AFF4-associated syndromes and the previously published transcriptome analyses of ALF transcription factors suggest that these factors are not redundant and each contributes uniquely to proper development.

Original languageEnglish (US)
Pages (from-to)857-873
Number of pages17
JournalAmerican journal of human genetics
Issue number5
StatePublished - May 6 2021


  • AFF3
  • AFF4
  • horseshoe kidney
  • intellectual disability
  • mesomelic dysplasia

ASJC Scopus subject areas

  • Genetics(clinical)
  • Genetics


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