Nail-Patella Syndrome via the LMX1B Gene
Summary and Pricing 
Test Method
Exome Sequencing with CNV Detection
| Test Code | Test Copy Genes | Test CPT Code | Gene CPT Codes Copy CPT Code | Base Price | |
|---|---|---|---|---|---|
| 8581 | LMX1B | 81479 | 81479,81479 | $990 | Order Options and Pricing |
Pricing Comments
Our favored testing approach is exome based NextGen sequencing with CNV analysis. This will allow cost effective reflexing to PGxome or other exome based tests. However, if full gene Sanger sequencing is desired for STAT turnaround time, insurance, or other reasons, please see link below for Test Code, pricing, and turnaround time information. If the Sanger option is selected, CNV detection may be ordered through Test #600.
An additional 25% charge will be applied to STAT orders. STAT orders are prioritized throughout the testing process.
Click here for costs to reflex to whole PGxome (if original test is on PGxome Sequencing platform).
Click here for costs to reflex to whole PGnome (if original test is on PGnome Sequencing platform).
The Sanger Sequencing method for this test is NY State approved.
For Sanger Sequencing click here.Turnaround Time
3 weeks on average for standard orders or 2 weeks on average for STAT orders.
Please note: Once the testing process begins, an Estimated Report Date (ERD) range will be displayed in the portal. This is the most accurate prediction of when your report will be complete and may differ from the average TAT published on our website. About 85% of our tests will be reported within or before the ERD range. We will notify you of significant delays or holds which will impact the ERD. Learn more about turnaround times here.
Targeted Testing
For ordering sequencing of targeted known variants, go to our Targeted Variants page.
Clinical Features and Genetics
Clinical Features
Nail-patella syndrome (NPS; OMIM# 161200) is a pleiotropic disorder affecting nails, the skeletal system, kidneys, and eyes. Clinical features include dysplastic nails, absent or hypoplastic patellae, elbow dysplasia, iliac horns, nephropathy, and glaucoma (Sweeney et al., 2003; Sweeney et al., 2009; Bongers et al., 2005). Neurological and vasomotor symptoms are also within the phenotypic spectrum of NPS (Sweeney et al., 2003). Sensorineural hearing impairment has also been associated with NPS (Bongers et al., 2005). The clinical spectrum of NPS is wide and substantial phenotypic variability can occur even within the same family. NPS can be diagnosed at birth.
Genetics
Nail-patella syndrome is an autosomal dominant disorder caused by mutations in the LMX1B gene (Dreyer et al., 1998; McIntosh et al., 1998; Vollrath et al., 1998). LMX1B has 8 coding exons that encode the LIM-homeodomain transcription factor, which is essential for the normal development of dorsal limb structures, the glomerular basement membrane, the anterior segment of the eye, and dopaminergic and serotonergic neurons. Clustered within the functional domains of the protein (LIM domains and the homeodomain), genetic defects of LMX1B include missense, nonsense, splicing site mutations, small deletion/insertions (Human Gene Mutation Database). Large deletions and duplications involving LMX1B have also been reported, but are relatively uncommon. Notably, transmission of a mutated LMX1B allele from mosaic unaffected parents to NPS patients has been reported (Marini et al., 2010).
Clinical Sensitivity - Sequencing with CNV PGxome
LMX1B mutations can be found via DNA sequencing in 80-85% of patients with Nail-patella syndrome (Sweeney et al., 2003; Marini et al., 2010).
Testing Strategy
This test provides full coverage of all coding exons of the LMX1B gene plus 10 bases of flanking noncoding DNA in all available transcripts along with other non-coding regions in which pathogenic variants have been identified at PreventionGenetics or reported elsewhere. We define full coverage as >20X NGS reads or Sanger sequencing. PGnome panels typically provide slightly increased coverage over the PGxome equivalent. PGnome sequencing panels have the added benefit of additional analysis and reporting of deep intronic regions (where applicable).
Dependent on the sequencing backbone selected for this testing, discounted reflex testing to any other similar backbone-based test is available (i.e., PGxome panel to whole PGxome; PGnome panel to whole PGnome).
Indications for Test
Candidates for this test are patients with Nail-patella syndrome. Testing is also indicated for family members of patients who have known LMX1B mutations.
Candidates for this test are patients with Nail-patella syndrome. Testing is also indicated for family members of patients who have known LMX1B mutations.
Gene
| Official Gene Symbol | OMIM ID |
|---|---|
| LMX1B | 602575 |
| Inheritance | Abbreviation |
|---|---|
| Autosomal Dominant | AD |
| Autosomal Recessive | AR |
| X-Linked | XL |
| Mitochondrial | MT |
Disease
| Name | Inheritance | OMIM ID |
|---|---|---|
| Nail-Patella Syndrome | AD | 161200 |
Citations
- Bongers EMHF, Huysmans FT, Levtchenko E, Rooy JW de, Blickman JG, Admiraal RJC, Huygen PLM, Cruysberg JRM, Toolens PAMP, Prins JB, Krabbe PFM, Borm GF, et al. 2005. Genotype-phenotype studies in nail-patella syndrome show that LMX1B mutation location is involved in the risk of developing nephropathy. Eur. J. Hum. Genet. 13: 935–946. PubMed ID: 15928687
- Dreyer SD, Zhou G, Baldini A, Winterpacht A, Zabel B, Cole W, Johnson RL, Lee B. 1998. Mutations in LMX1B cause abnormal skeletal patterning and renal dysplasia in nail patella syndrome. Nat. Genet. 19: 47–50. PubMed ID: 9590287
- Human Gene Mutation Database (Bio-base).
- Marini M, Bocciardi R, Gimelli S, Duca M Di, Divizia MT, Baban A, Gaspar H, Mammi I, Garavelli L, Cerone R, Emma F, Bedeschi MF, et al. 2010. A spectrum of LMX1B mutations in Nail-Patella syndrome: new point mutations, deletion, and evidence of mosaicism in unaffected parents. Genet. Med. 12: 431–439. PubMed ID: 20531206
- McIntosh I, Dreyer SD, Clough MV, Dunston JA, Eyaid W, Roig CM, Montgomery T, Ala-Mello S, Kaitila I, Winterpacht A, Zabel B, Frydman M, et al. 1998. Mutation analysis of LMX1B gene in nail-patella syndrome patients. Am. J. Hum. Genet. 63: 1651–1658. PubMed ID: 9837817
- Sweeney E, Fryer A, Mountford R, Green A, McIntosh I. 2003. Nail patella syndrome: a review of the phenotype aided by developmental biology. J. Med. Genet. 40: 153–162. PubMed ID: 12624132
- Sweeney E, Hoover-Fong JE, McIntosh I. 2009. Nail-Patella Syndrome. GeneReviews. PubMed ID: 20301311
- Vollrath D. et al. 1998. Human Molecular Genetics. 7: 1091-8. PubMed ID: 9618165
Ordering/Specimens
Ordering Options
We offer several options when ordering sequencing tests. For more information on these options, see our Ordering Instructions page. To view available options, click on the Order Options button within the test description.
myPrevent - Online Ordering
- The test can be added to your online orders in the Summary and Pricing section.
- Once the test has been added log in to myPrevent to fill out an online requisition form.
- PGnome sequencing panels can be ordered via the myPrevent portal only at this time.
Requisition Form
- A completed requisition form must accompany all specimens.
- Billing information along with specimen and shipping instructions are within the requisition form.
- All testing must be ordered by a qualified healthcare provider.
For Requisition Forms, visit our Forms page
If ordering a Duo or Trio test, the proband and all comparator samples are required to initiate testing. If we do not receive all required samples for the test ordered within 21 days, we will convert the order to the most effective testing strategy with the samples available. Prior authorization and/or billing in place may be impacted by a change in test code.
Specimen Types
Specimen Requirements and Shipping Details
PGxome (Exome) Sequencing Panel
PGnome (Genome) Sequencing Panel
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ORDER OPTIONS
View Ordering Instructions1) Select Test Type
2) Select Additional Test Options
No Additional Test Options are available for this test.