Gillespie syndrome caused by a novel ITPR1 gene variant: a phenotype-genotype correlation

Gillespie syndrome (GS) is a rare congenital disorder with ocular and neurological defects. Classically, it has been noted to have a triad of cerebellar ataxia, variable absence of iris but always with a scalloped edge and intellectual disability. This scalloped iris edge is essential to make a diagnosis of GS. Both autosomal dominant and recessive inheritance have been reported with de novo pathogenic variants in the inositol 1,4,5-trisphosphate receptor type 1 gene (ITPR1). We report a novel variant of ITPR1 gene causing Gillespie syndrome in multiple members of a family.

A retrospective chart review of a single pedigree was performed. Three pediatric patients and a parent underwent complete ophthalmic examinations. Molecular genetic testing was pursued where clinically indicated.

Two siblings (one male, one female) were being evaluated for ataxia. Genetic testing identified a paternally inherited ITPR1 variant, c.5970A>C, p.Gln1990His, in both siblings. A third sibling (female) was later evaluated and also found to have the familial ITPR1 variant. On ophthalmic examination, all three siblings and their father had characteristic iris hypoplasia confirming the diagnosis of Gillespie syndrome.

We report a new variant of ITPR1 gene causing Gillespie syndrome in the described family. Clinical and molecular analyses and their correlation helped to establish the clinical relevance of this variant.