Menke-Hennekam syndrome; delineation of domain-specific subtypes with distinct clinical and DNA methylation profiles

CREB-binding protein (CBP, encoded by CREBBP) and its paralog E1A-associated protein (p300, encoded by EP300) are involved in histone acetylation and transcriptional regulation. Variants that produce a null allele or disrupt the catalytic domain of either protein cause Rubinstein-Taybi syndrome (RSTS), while pathogenic missense and in-frame indel variants in parts of exons 30 and 31 cause phenotypes recently described as Menke-Hennekam syndrome (MKHK). To distinguish MKHK subtypes and define their characteristics, molecular and extended clinical data on 82 individuals (54 unpublished) with variants affecting CBP (n=71) or p300 (n=11) (NP_004371.2 residues 1705-1875 and NP_001420.2 residues 1668-1833, respectively) were summarized. Additionally, genome-wide DNA methylation profiles were assessed in DNA extracted from whole peripheral blood from 54 individuals. Most variants clustered closely around the zinc binding residues of two zinc finger domains (ZZ and TAZ2) and within the first α-helix of the fourth intrinsically disordered linker (ID4) of CBP/p300. Domain-specific methylation profiles were discerned for the ZZ domain in CBP/p300 (found in 9/10 tested individuals) and TAZ2 domain in CBP (in 14/20), while a domain-specific diagnostic episignature was refined for the ID4 domain in CBP/p300 (in 21/21). Phenotypes including intellectual disability of varying degree, and distinct physical features were defined for each of the regions. These findings demonstrate existence of at least three MKHK subtypes, which are domain-specific (MKHK-ZZ, MKHK-TAZ2, and MKHK-ID4) rather than gene-specific (CREBBP/EP300). DNA methylation episignatures enable stratification of molecular pathophysiologic entities within a gene or across a family of paralogous genes.