Biallelic variants in RNU2-2 cause a remarkably frequent developmental and epileptic encephalopathy

Jackson A., Blakes AJM., Alhaddad B., Henry OJ., Delgado-Vega AM., Wall E., Abdelhadi O., Agrawal S., Bakur K., Blair E., Brady AF., Brittain H., Chandler KE., Clarke N., Danelli M., Drinkall N., Duba I., Elmslie F., Ellingford J., Ewans LJ., Fennell AP., Gazdagh G., Heller SP., Hammarsjö A., Karrman K., Kini U., Lesko N., Lindstrand A., Macintosh R., Mansour S., Menzies L., Metcalfe K., Milhench A., Nashef L., O’Keefe RT., Pacheco NP., Palmer EE., Parida A., Prescott K., Redman M., Renieri A., Fallerini C., Rizzo CL., Sachdev R., Simons C., Sisodiya SM., Stewart H., Stödberg T., Banos-Pinero B., Taylan F., Thomas HB., Tinella F., Wiafe S., Wedell A., Whiffin N., Walker S., Rius R., Chae JH., Nordgren A., Alkuraya F., Lord J., Banka S.

Abstract Neurodevelopmental disorders (NDDs) affect 2–4% of the population, are predominantly genetic and remain unsolved in ~50% of individuals. We show that rare biallelic variants in RNU2-2 are enriched and over-transmitted in individuals with unresolved NDDs. We define a recessive RNU2-2 syndrome, delineate its unique genetic architecture and show that it manifests clinically as a severe developmental and epileptic encephalopathy. We find that candidate biallelic variants are significantly correlated with reduced U2-2 abundance, implicating compromised transcript stability as a probable pathomechanism. We identify a decreased ratio of U2-2 to its paralog U2-1 as a potential diagnostic biomarker for this condition. We show that the recessive RNU2-2 syndrome is genetically, clinically and mechanistically distinct from the dominant RNU2-2 disorder. Within our cohort, the recessive RNU2-2 syndrome emerges as by far the most frequent recessive NDD, greatly disproportionate to the small genomic footprint of this non-protein-coding gene.

DOI

10.1038/s41588-026-02551-9

Type

Journal article

Publisher

Springer Science and Business Media LLC

Publication Date

2026-04-01T00:00:00+00:00

Volume

58

Pages

798 - 809

Total pages

11

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