Unraveling the Genetics of Congenital Diaphragmatic Hernia: An Ongoing Challenge

Erwin Brosens*, Nina C.J. Peters, Kim S. van Weelden, Charlotte Bendixen, Rutger W.W. Brouwer, Frank Sleutels, Hennie T. Bruggenwirth, Wilfred F.J. van Ijcken, Danielle C.M. Veenma, Suzan C.M.Cochius Den Otter, Rene M.H. Wijnen, Alex J. Eggink, Marieke F. van Dooren, Heiko Martin Reutter, Robbert J. Rottier, J. Marco Schnater, Dick Tibboel, Annelies de Klein

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

12 Citations (Scopus)
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Congenital diaphragmatic hernia (CDH) is a congenital structural anomaly in which the diaphragm has not developed properly. It may occur either as an isolated anomaly or with additional anomalies. It is thought to be a multifactorial disease in which genetic factors could either substantially contribute to or directly result in the developmental defect. Patients with aneuploidies, pathogenic variants or de novo Copy Number Variations (CNVs) impacting specific genes and loci develop CDH typically in the form of a monogenetic syndrome. These patients often have other associated anatomical malformations. In patients without a known monogenetic syndrome, an increased genetic burden of de novo coding variants contributes to disease development. In early years, genetic evaluation was based on karyotyping and SNP-array. Today, genomes are commonly analyzed with next generation sequencing (NGS) based approaches. While more potential pathogenic variants are being detected, analysis of the data presents a bottleneck—largely due to the lack of full appreciation of the functional consequence and/or relevance of the detected variant. The exact heritability of CDH is still unknown. Damaging de novo alterations are associated with the more severe and complex phenotypes and worse clinical outcome. Phenotypic, genetic—and likely mechanistic—variability hampers individual patient diagnosis, short and long-term morbidity prediction and subsequent care strategies. Detailed phenotyping, clinical follow-up at regular intervals and detailed registries are needed to find associations between long-term morbidity, genetic alterations, and clinical parameters. Since CDH is a relatively rare disorder with only a few recurrent changes large cohorts of patients are needed to identify genetic associations. Retrospective whole genome sequencing of historical patient cohorts using will yield valuable data from which today's patients and parents will profit Trio whole genome sequencing has an excellent potential for future re-analysis and data-sharing increasing the chance to provide a genetic diagnosis and predict clinical prognosis. In this review, we explore the pitfalls and challenges in the analysis and interpretation of genetic information, present what is currently known and what still needs further study, and propose strategies to reap the benefits of genetic screening.

Original languageEnglish
Article number800915
JournalFrontiers in Pediatrics
Publication statusPublished - 3 Feb 2022

Bibliographical note

Funding Information:
This work was supported by the Sophia Foundation for Scientific Research [Grant Numbers 493 (DT and AdK) and S13-09 (DT, AdK, and EB)].

Publisher Copyright:
Copyright © 2022 Brosens, Peters, van Weelden, Bendixen, Brouwer, Sleutels, Bruggenwirth, van Ijcken, Veenma, Otter, Wijnen, Eggink, van Dooren, Reutter, Rottier, Schnater, Tibboel and de Klein.


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