Phenotype and genotype of 87 patients with Mowat–Wilson syndrome and recommendations for care

I. Ivanovski, O. Djuric, S.G. Caraffi, D. Santodirocco, M. Pollazzon, S. Rosato, D.M. Cordelli, E. Abdalla, P. Accorsi, M.P. Adam, P.F. Ajmone, M. Badura-Stronka, C. Baldo, M. Baldi, A. Bayat, S. Bigoni, F. Bonvicini, J. Breckpot, B. Callewaert, G. CocchiG. Cuturilo, D. De Brasi, K. Devriendt, M.B. Dinulos, T.D. Hjortshøj, R. Epifanio, F. Faravelli, A. Fiumara, D. Formisano, L. Giordano, M. Grasso, S. Grønborg, A. Iodice, L. Iughetti, V. Kuburovic, A. Kutkowska-Kazmierczak, D. Lacombe, C. Lo Rizzo, A. Luchetti, B. Malbora, I. Mammi, F. Mari, G. Montorsi, S. Moutton, R.S. Møller, P. Muschke, J.E.K. Nielsen, E. Obersztyn, C. Pantaleoni, A. Pellicciari, M.A. Pisanti, I. Prpic, M.L. Poch-Olive, F. Raviglione, A. Renieri, E. Ricci, F. Rivieri, G.W. Santen, S. Savasta, G. Scarano, I. Schanze, A. Selicorni, M. Silengo, R. Smigiel, L. Spaccini, G. Sorge, K. Szczaluba, L. Tarani, L.G. Tone, A. Toutain, A. Trimouille, E.T. Valera, S.S. Vergano, N. Zanotta, M. Zenker, A. Conidi, M. Zollino, A. Rauch, C. Zweier, L. Garavelli

Research output: Contribution to journalArticlepeer-review


Purpose: Mowat–Wilson syndrome (MWS) is a rare intellectual disability/multiple congenital anomalies syndrome caused by heterozygous mutation of the ZEB2 gene. It is generally underestimated because its rarity and phenotypic variability sometimes make it difficult to recognize. Here, we aimed to better delineate the phenotype, natural history, and genotype–phenotype correlations of MWS. Methods: In a collaborative study, we analyzed clinical data for 87 patients with molecularly confirmed diagnosis. We described the prevalence of all clinical aspects, including attainment of neurodevelopmental milestones, and compared the data with the various types of underlying ZEB2 pathogenic variations. Results: All anthropometric, somatic, and behavioral features reported here outline a variable but highly consistent phenotype. By presenting the most comprehensive evaluation of MWS to date, we define its clinical evolution occurring with age and derive suggestions for patient management. Furthermore, we observe that its severity correlates with the kind of ZEB2 variation involved, ranging from ZEB2 locus deletions, associated with severe phenotypes, to rare nonmissense intragenic mutations predicted to preserve some ZEB2 protein functionality, accompanying milder clinical presentations. Conclusion: Knowledge of the phenotypic spectrum of MWS and its correlation with the genotype will improve its detection rate and the prediction of its features, thus improving patient care. © 2018, American College of Medical Genetics and Genomics.
Original languageEnglish
Pages (from-to)965-975
Number of pages11
JournalGenetics in Medicine
Issue number9
Publication statusPublished - 2018


  • Hirschsprung
  • intellectual disability
  • management
  • Mowat–Wilson syndrome
  • ZEB2
  • zinc finger E box binding homeobox 2
  • adolescent
  • adult
  • age
  • Article
  • brain malformation
  • cardiovascular malformation
  • child
  • clinical feature
  • correlational study
  • disease severity
  • epilepsy
  • family history
  • female
  • gene
  • gene deletion
  • gene locus
  • genetic association
  • genetic variation
  • genotype
  • genotype phenotype correlation
  • growth curve
  • head circumference
  • human
  • infant
  • intellectual impairment
  • major clinical study
  • male
  • mental disease
  • missense mutation
  • Mowat Wilson syndrome
  • musculoskeletal system malformation
  • patient care
  • phenotype
  • prediction
  • prevalence
  • protein function
  • ZEB2 gene


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