HNRNPH2-related disorders

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hnRNPH2-related disorders
Other names: Bain type X-linked intellectual disability
This condition is inherited in an X-linked dominant manner.
SymptomsImpairments in language and coordination, gastrointestinal issues, strabismus[1]

HNRNPH2-related disorder is considered as a neurodevelopmental disorder (NDD) caused by heterozygous mutation in the HNRNPH2 gene on the chromosome Xq22.[1][2]

This gene (GenBank: NM_019597.4)[3] encodes a member of a family of ubiquitous heterogeneous nuclear ribonucleoproteins (HNRNP). The HNRNPs are a large group of RNA binding proteins with distinct nucleic acid binding properties.[4] These ribonucleoproteins act as a shuttle between the nucleus and the cytoplasm and act on pre-mRNA to positively or negatively affect spliceosome assembly at nearby splice sites, thereby controlling pre-mRNA splicing.[5][6]

HNRNPH2 genetic mutations will be manifested by neurodevelopmental phenotype including developmental delay, intellectual disability, hypotonia, and seizures, among other characteristics.[1] Because the disorder is X-linked, and because of an initial difficulty in identifying male patients, it was initially believed that the disorder affected females only while male conceptuses were unviable[4] More recent studies have identified male patients, though they are still significantly fewer.[7]

Signs and symptoms

HNRNPH2-related disorders typically manifest in children before the age of 12 months. Symptoms are abnormally slow development, especially in the area of motor development. After the first year the majority of children with these disorders show either nonverbal or minimally verbal speech disorders.[1]

Many caregivers will notice problems with feeding and report abnormal weight issues and a failure to thrive with continuing gastrointestinal issues such as chronic constipation, poor appetite and difficulty swallowing.[1]

Many children develop orthopedic issues such as scoliosis and hip dysplasia, and nearly all children have hypotonia (decreased muscle tone) leading to difficulties in walking and other forms of movement.[1]Nearly three quarters of children have vision problems, with a majority of these reporting strabismus (crossed eyes), and many patients have sensory processing disorders and other sensory issues.[1]Almost half of individuals with HNRNPH2-related disorders have suffered seizures, with the earliest reported first-seizure at the age of three, and the latest first-seizure at the age of thirty-four.[1]

Molecular mechanism

Location of identified HNRNPH2 variants (male individuals) -a)Schematic protein structure of HNRNPH2 show conserved domains b)evolutionary conservation of residues affected by missense mutations[1][8]

HNRNPs are proteins that have roles in RNA metabolism (transcription, splicing, translation) Variants can result in neurodevelopmental/neurodegenerative disorders.[9][10]

It is located at the X chromosome (Xq22.1). A nuclear localization sequence between 194 and 220 (AA) interacts with transportin 1 a nuclear transport receptor;pathogenic variants are usually located near the NLS.[9]


A positive diagnosis for HNRNPH2-related disorder is confirmed through reviews of whole exome sequencing genetic reports by qualified medical professionals along with additional information provided by the primary caregivers.


Currently there are no cures for HNRNPH2-related disorder, though not all patients require treatment or additional therapies.

It is important that specialists in paediatric neurology, paediatric orthopedics, paediatric gastroenterology, and paediatric ophthalmology are consulted.

Therapies that are known to be beneficial to HNRNPH2-related disorder patients include physical therapy, occupational therapy and speech therapy. Some patients take additional therapy and medication for anxiety, gastrointestinal issues, seizures etc.[11] Every patient should work with their medical team to develop the appropriate therapeutic program that will meet their specific needs.


HNRNPH2-related disorder is described as being an ultra-rare disease; in 2021 there were 33 diagnosed cases worldwide.[1]


1.^ There is currently no review article available on this information.


  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Bain, JM; Thornburg, O; Pan, C; Rome-Martin, D; Boyle, L; Fan, X; Devinsky, O; Frye, R; Hamp, S; Keator, CG; LaMarca, NM; Maddocks, ABR; Madruga-Garrido, M; Niederhoffer, KY; Novara, F; Peron, A; Poole-Di Salvo, E; Salazar, R; Skinner, SA; Soares, G; Goldman, S; Chung, WK (February 2021). "Detailed Clinical and Psychological Phenotype of the X-linked HNRNPH2-Related Neurodevelopmental Disorder". Neurology. Genetics. 7 (1): e551. doi:10.1212/NXG.0000000000000551. PMC 7954461. PMID 33728377. S2CID 231884700.
  2. "Entry #300986 - INTELLECTUAL DEVELOPMENTAL DISORDER, X-LINKED, SYNDROMIC, BAIN TYPE; MRXSB - OMIM". Archived from the original on 2022-03-08. Retrieved 2022-07-05.
  3. "Homo sapiens heterogeneous nuclear ribonucleoprotein H2 (HNRNPH2), transcript variant 1, mRNA". 21 October 2018. Archived from the original on 22 June 2022. Retrieved 5 July 2022.
  4. 4.0 4.1 Bain, JM; Cho, MT; Telegrafi, A; Wilson, A; Brooks, S; Botti, C; Gowans, G; Autullo, LA; Krishnamurthy, V; Willing, MC; Toler, TL; Ben-Zev, B; Elpeleg, O; Shen, Y; Retterer, K; Monaghan, KG; Chung, WK (1 September 2016). "Variants in HNRNPH2 on the X Chromosome Are Associated with a Neurodevelopmental Disorder in Females". American Journal of Human Genetics. 99 (3): 728–734. doi:10.1016/j.ajhg.2016.06.028. PMC 5011042. PMID 27545675.
  5. Cáceres, JF; Stamm, S; Helfman, DM; Krainer, AR (16 September 1994). "Regulation of alternative splicing in vivo by overexpression of antagonistic splicing factors". Science. 265 (5179): 1706–9. Bibcode:1994Sci...265.1706C. doi:10.1126/science.8085156. PMID 8085156.
  6. Sohail, M; Xie, J (June 2015). "Evolutionary emergence of a novel splice variant with an opposite effect on the cell cycle". Molecular and Cellular Biology. 35 (12): 2203–14. doi:10.1128/MCB.00190-15. PMC 4438240. PMID 25870105.
  7. Jepsen, Wayne M.; Ramsey, Keri; Szelinger, Szabolcs; Llaci, Lorida; Balak, Chris; Belnap, Newell; Bilagody, Cherae; De Both, Matthew; Gupta, Raj; Naymik, Marcus; Pandey, Richa; Piras, Ignazio S.; Sanchez‐Castillo, Meredith; Rangasamy, Sampathkumar; Narayanan, Vinodh; Huentelman, Matthew J. (August 2019). "Two additional males with X‐linked, syndromic mental retardation carry de novo mutations in HNRNPH2". Clinical Genetics. 96 (2): 183–185. doi:10.1111/cge.13580. PMC 6852257. PMID 31236915.
  8. Kreienkamp, Hans-Jürgen; Wagner, Matias; Weigand, Heike; McConkie-Rossell, Allyn; McDonald, Marie; Keren, Boris; Mignot, Cyril; Gauthier, Julie; Soucy, Jean-François; Michaud, Jacques L.; Dumas, Meghan; Smith, Rosemarie; Löbel, Ulrike; Hempel, Maja; Kubisch, Christian; Denecke, Jonas; Campeau, Philippe M.; Bain, Jennifer M.; Lessel, Davor (1 February 2022). "Variant-specific effects define the phenotypic spectrum of HNRNPH2-associated neurodevelopmental disorders in males". Human Genetics. 141 (2): 257–272. doi:10.1007/s00439-021-02412-x. ISSN 1432-1203. Retrieved 5 November 2023.
  9. 9.0 9.1 Madhok, Sehajvir; Bain, Jennifer (1993). "HNRNPH2-Related Neurodevelopmental Disorder". GeneReviews®. University of Washington, Seattle. Archived from the original on 2023-05-26. Retrieved 2023-11-05.
  10. Brownmiller, Tayvia; Caplen, Natasha J. (September 2023). "The HNRNPF /H RNA binding proteins and disease". WIREs RNA. 14 (5). doi:10.1002/wrna.1788. ISSN 1757-7004. Archived from the original on 7 November 2023. Retrieved 5 November 2023.
  11. "Yellow Brick Road Project - Treatment". Yellow Brick Road Project. Archived from the original on 20 May 2022. Retrieved 22 June 2022.

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