ARHGAP31 is a GTPase activating protein that inactivates Rac1 and Cdc42 by promoting their conversion from the GTP to GDP bound state. Pathologic variants in ARHGAP31 are primarily associated with Adams-Oliver syndrome (AOS), a congenital disorder characterized by aplasia cutis congenita (ACC) and terminal transverse limb defects (TTLDs), attributed to disrupted Rho GTPase signaling. In this study, exome sequencing and bioinformatic analysis were employed to investigate a 6-year-old male presenting with craniofacial anomalies (high palate, dental malalignment), developmental delay (motor and speech), and gastrointestinal dysmotility (feeding difficulties, constipation) notably without ACC or TTLDs. Trio exome sequencing revealed a heterozygous de novo frameshift variant in ARHGAP31 (NM_020754.4:c.732del, p.(Met245Ter)), absent from population databases (gnomAD, dbSNP) and both parental genomes. In silico predictions (MutationTaster, SWISS-MODEL) suggested a pathogenic effect (probability: 0.99), with nonsense-mediated decay (NMD) and truncation of the RhoGAP domain critical for cytoskeletal regulation. The variant's proximal truncation site likely disrupts autoinhibitory regulation, enhancing RhoGAP activity and impairing Cdc42/Rac1 signaling. Despite parental consanguinity, the de novo variant highlights the diagnostic value of trio sequencing in consanguineous families. Moreover, until now only gain-of-function mutation of ARHGAP31 was found to be associated with AOS, while this article reports a brand-new loss-of-function mutation. Overall, these findings support the existence of a novel ARHGAP31-related neurodevelopmental disorder distinct from AOS, expanding the allelic and phenotypic spectrum associated with this gene.
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