RNU4ATAC-opathy: Clinical, molecular and transcriptomic insights from a large cohort

Matalon, Dena R., Duker, Angela L., Arriaga, Taylor M., Russell, Kathryn, Mendez, Hector Rodrigo, Bonner, Devon E., Harley, Margaret E., Singer-Berk, Moriel, Wojcik, Monica H., Pais, Lynn, DiTroia, Stephanie, O'Leary, Melanie, Cassini, Thomas, Ezell, Kimberly, Niehaus, Anne D., Kaplan, Julie, Wargowski, David S., Smid, Cory J., Longenecker, Emily D., Rodriguez Barreto, Ana Maria, Miller, Danny E., Keefe, Alexandra C., Calderwood, Laurel, Enns, Gregory M., Tekin, Mustafa, Bivona, Stephanie A., Vora, Neeta L., Gilmore, Kelly L., Khan, Tahir N., Davis, Erica E., Wang, Amber W., Khan, Sameena, Maddirevula, Sateesh, AlAbdi, Lama, Abuyousef, Omar, Shamseldin, Hanan E., Alkhalifi, Salwa, Abdulwahab, Firdous, Alqahtani, Mashael, Alhumaidi, Zainab A., Nadeef, Seba, Al Hashem, Amal M., Bakur, Khadijah, Faqeih, Eissa A., Abdalla, Ebtesam, Clarke, Angus ORCID: https://orcid.org/0000-0002-1200-9286, Fletcher, Elaine, Keng, Wee Teik, Ousager, Lilian Bomme, de Silva, Deepthi C., Haniffa, Muzhirah, Mari, Francesca, Lam, Wayne, Campbell, Jennifer, Homfray, Tessa, Nampoothiri, Sheela, Li, Chumei, Chaudhari, Bimal P., Truxal, Kristen, Bernstein, Jonathan A., Montgomery, Stephen B., Wheeler, Matthew T., Alkuraya, Fowzan S., O?Donnell-Luria, Anne, Jackson, Andrew P., Campbell, Ian M., Ganesh, Vijay S., Robertson, Nic and Lemire, Gabrielle 2026. RNU4ATAC-opathy: Clinical, molecular and transcriptomic insights from a large cohort. Genetics in Medicine , 102633. 10.1016/j.gim.2026.102633

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Abstract

Purpose We aim to better define the genotype and phenotype spectrum of RNU4ATAC-opathy, demonstrate the utility of RNA sequencing for variant classification, and highlight challenges in detecting variants in this noncoding gene. Methods Sixty individuals with molecularly confirmed RNU4ATAC-opathy were recruited from multiple clinical and research centers internationally. RNA sequencing was available for seven affected individuals. Results We report the clinical and molecular findings of 60 individuals, including 42 not previously described, and 33 distinct RNU4ATAC variants, 13 of which are novel. Core features in this cohort—present in most individuals assessed and varying in severity—include microcephaly, short stature, skeletal anomalies, developmental delay, cerebral anomalies, skin conditions and immune deficiency. Additional findings such as diabetes, holoprosencephaly, and absence of various core features in some individuals highlight the broad phenotypic spectrum. All individuals with RNA sequencing showed a consistent pattern of minor intron retention. In six, RNA-seq enabled reclassification of variants of uncertain significance as likely pathogenic. While RNU4ATAC variants are generally covered by clinical exomes, they are often overlooked in analysis due to the noncoding nature. Conclusion This study further highlights the variability of phenotypes and genotypes associated with RNU4ATAC-opathy. Laboratories should ensure RNU4ATAC and other noncoding genes are appropriately assessed by their analysis pipelines.

Item Type:	Article
Date Type:	Published Online
Status:	In Press
Schools:	Schools > Medicine
Publisher:	Nature Publishing Group
ISSN:	1098-3600
Date of First Compliant Deposit:	9 July 2026
Date of Acceptance:	9 June 2026
Last Modified:	09 Jul 2026 14:39
URI:	https://orca.cardiff.ac.uk/id/eprint/188046

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