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Exome sequencing identifies DYNC2H1 mutations as a common cause of asphyxiating thoracic dystrophy (Jeune syndrome) without major polydactyly, renal or retinal involvement

Identifieur interne : 000397 ( Main/Exploration ); précédent : 000396; suivant : 000398

Exome sequencing identifies DYNC2H1 mutations as a common cause of asphyxiating thoracic dystrophy (Jeune syndrome) without major polydactyly, renal or retinal involvement

Auteurs : Miriam Schmidts [Royaume-Uni] ; Heleen H. Arts [Pays-Bas] ; Ernie M H F. Bongers [Pays-Bas] ; Zhimin Yap [Royaume-Uni] ; Machteld M. Oud [Pays-Bas] ; Dinu Antony [Royaume-Uni] ; Lonneke Duijkers [Pays-Bas] ; Richard D. Emes [Royaume-Uni] ; Jim Stalker [Royaume-Uni] ; Jan-Bart L. Yntema [Pays-Bas] ; Vincent Plagnol [Royaume-Uni] ; Alexander Hoischen [Pays-Bas] ; Christian Gilissen [Pays-Bas] ; Elisabeth Forsythe [Royaume-Uni] ; Ekkehart Lausch [Allemagne] ; Joris A. Veltman [Pays-Bas] ; Nel Roeleveld [Pays-Bas] ; Andrea Superti-Furga [Suisse] ; Anna Kutkowska-Kazmierczak [Pologne] ; Erik-Jan Kamsteeg [Pays-Bas] ; Nursel Elçio Lu [Turquie] ; Merel C. Van Maarle [Pays-Bas] ; Luitgard M. Graul-Neumann [Allemagne] ; Koenraad Devriendt [Belgique] ; Sarah F. Smithson [Royaume-Uni] ; Diana Wellesley [Royaume-Uni] ; Nienke E. Verbeek [Pays-Bas] ; Raoul C M. Hennekam [Pays-Bas] ; Hulya Kayserili [Turquie] ; Peter J. Scambler [Royaume-Uni] ; Philip L. Beales [Royaume-Uni] ; Nine Vam Knoers [Pays-Bas] ; Ronald Roepman [Pays-Bas] ; Hannah M. Mitchison [Royaume-Uni]

Source :

RBID : ISTEX:EFE630C08BA484FCC659095E33A3C3349589E1E3

Abstract

Background Jeune asphyxiating thoracic dystrophy (JATD) is a rare, often lethal, recessively inherited chondrodysplasia characterised by shortened ribs and long bones, sometimes accompanied by polydactyly, and renal, liver and retinal disease. Mutations in intraflagellar transport (IFT) genes cause JATD, including the IFT dynein-2 motor subunit gene DYNC2H1. Genetic heterogeneity and the large DYNC2H1 gene size have hindered JATD genetic diagnosis. Aims and methods To determine the contribution to JATD we screened DYNC2H1 in 71 JATD patients JATD patients combining SNP mapping, Sanger sequencing and exome sequencing. Results and conclusions We detected 34 DYNC2H1 mutations in 29/71 (41%) patients from 19/57 families (33%), showing it as a major cause of JATD especially in Northern European patients. This included 13 early protein termination mutations (nonsense/frameshift, deletion, splice site) but no patients carried these in combination, suggesting the human phenotype is at least partly hypomorphic. In addition, 21 missense mutations were distributed across DYNC2H1 and these showed some clustering to functional domains, especially the ATP motor domain. DYNC2H1 patients largely lacked significant extra-skeletal involvement, demonstrating an important genotype–phenotype correlation in JATD. Significant variability exists in the course and severity of the thoracic phenotype, both between affected siblings with identical DYNC2H1 alleles and among individuals with different alleles, which suggests the DYNC2H1 phenotype might be subject to modifier alleles, non-genetic or epigenetic factors. Assessment of fibroblasts from patients showed accumulation of anterograde IFT proteins in the ciliary tips, confirming defects similar to patients with other retrograde IFT machinery mutations, which may be of undervalued potential for diagnostic purposes.

Url:
DOI: 10.1136/jmedgenet-2012-101284


Affiliations:


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<wicri:regionArea>Department of Human Genetics, Radboud University Medical Centre, Nijmegen</wicri:regionArea>
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<region type="province" nuts="2">Gueldre</region>
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<wicri:regionArea>Nijmegen Centre for Molecular Life Sciences, Radboud University, Nijmegen</wicri:regionArea>
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<affiliation wicri:level="3">
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Institute for Genetic and Metabolic Disease, Radboud University, Nijmegen</wicri:regionArea>
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<affiliation wicri:level="3">
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Epidemiology, Biostatistics and HTA, Radboud University Medical Centre, Nijmegen</wicri:regionArea>
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<settlement type="city">Nimègue</settlement>
<region type="province" nuts="2">Gueldre</region>
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<wicri:regionArea>Nijmegen Centre for Evidence Based Practice, Radboud University, Nijmegen</wicri:regionArea>
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<country xml:lang="fr">Suisse</country>
<wicri:regionArea>Department of Pediatrics, Lausanne University Hospital and University of Lausanne, Lausanne</wicri:regionArea>
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<settlement type="city">Lausanne</settlement>
<region nuts="3" type="region">Canton de Vaud</region>
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<name sortKey="Kutkowska Kazmierczak, Anna" sort="Kutkowska Kazmierczak, Anna" uniqKey="Kutkowska Kazmierczak A" first="Anna" last="Kutkowska-Kazmierczak">Anna Kutkowska-Kazmierczak</name>
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<country xml:lang="fr">Pologne</country>
<wicri:regionArea>Department of Medical Genetics, Institute of Mother and Child, Warsaw</wicri:regionArea>
<wicri:noRegion>Warsaw</wicri:noRegion>
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</author>
<author>
<name sortKey="Kamsteeg, Erik Jan" sort="Kamsteeg, Erik Jan" uniqKey="Kamsteeg E" first="Erik-Jan" last="Kamsteeg">Erik-Jan Kamsteeg</name>
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<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Human Genetics, Radboud University Medical Centre, Nijmegen</wicri:regionArea>
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<settlement type="city">Nimègue</settlement>
<region type="province" nuts="2">Gueldre</region>
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<affiliation wicri:level="3">
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Nijmegen Centre for Molecular Life Sciences, Radboud University, Nijmegen</wicri:regionArea>
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<settlement type="city">Nimègue</settlement>
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<affiliation wicri:level="3">
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Institute for Genetic and Metabolic Disease, Radboud University, Nijmegen</wicri:regionArea>
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<settlement type="city">Nimègue</settlement>
<region type="province" nuts="2">Gueldre</region>
</placeName>
</affiliation>
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<author>
<name sortKey="Elcio Lu, Nursel" sort="Elcio Lu, Nursel" uniqKey="Elcio Lu N" first="Nursel" last="Elçio Lu">Nursel Elçio Lu</name>
<affiliation wicri:level="1">
<country xml:lang="fr">Turquie</country>
<wicri:regionArea>Department of Pediatric Genetics, Marmara University Hospital, Istanbul</wicri:regionArea>
<wicri:noRegion>Istanbul</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Van Maarle, Merel C" sort="Van Maarle, Merel C" uniqKey="Van Maarle M" first="Merel C" last="Van Maarle">Merel C. Van Maarle</name>
<affiliation wicri:level="3">
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Clinical Genetics, Center for Human and Clinical Genetics, Leiden University Medical Center, Leiden</wicri:regionArea>
<placeName>
<settlement type="city">Leyde</settlement>
<region nuts="2" type="province">Hollande-Méridionale</region>
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</affiliation>
</author>
<author>
<name sortKey="Graul Neumann, Luitgard M" sort="Graul Neumann, Luitgard M" uniqKey="Graul Neumann L" first="Luitgard M" last="Graul-Neumann">Luitgard M. Graul-Neumann</name>
<affiliation wicri:level="3">
<country xml:lang="fr">Allemagne</country>
<wicri:regionArea>Institute for Medical Genetics and Human Genetics, University Hospital Charité, Berlin</wicri:regionArea>
<placeName>
<region type="land" nuts="3">Berlin</region>
<settlement type="city">Berlin</settlement>
</placeName>
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<author>
<name sortKey="Devriendt, Koenraad" sort="Devriendt, Koenraad" uniqKey="Devriendt K" first="Koenraad" last="Devriendt">Koenraad Devriendt</name>
<affiliation wicri:level="1">
<country xml:lang="fr">Belgique</country>
<wicri:regionArea>Laboratory for Genetics of Human Development, Department of Human Genetics, KU Leuven University, Leuven</wicri:regionArea>
<wicri:noRegion>Leuven</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Smithson, Sarah F" sort="Smithson, Sarah F" uniqKey="Smithson S" first="Sarah F" last="Smithson">Sarah F. Smithson</name>
<affiliation wicri:level="1">
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Department of Clinical Genetics, St. Michael's Hospital, Bristol</wicri:regionArea>
<wicri:noRegion>Bristol</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Wellesley, Diana" sort="Wellesley, Diana" uniqKey="Wellesley D" first="Diana" last="Wellesley">Diana Wellesley</name>
<affiliation wicri:level="1">
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Faculty of Medicine, University of Southampton and Essex Clinical Genetics Service, Princess Anne Hospital, Southampton</wicri:regionArea>
<wicri:noRegion>Southampton</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Verbeek, Nienke E" sort="Verbeek, Nienke E" uniqKey="Verbeek N" first="Nienke E" last="Verbeek">Nienke E. Verbeek</name>
<affiliation wicri:level="3">
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Medical Genetics, University Medical Centre Utrecht, Utrecht</wicri:regionArea>
<placeName>
<settlement type="city">Utrecht</settlement>
<region nuts="2" type="province">Utrecht (province)</region>
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<name sortKey="Hennekam, Raoul C M" sort="Hennekam, Raoul C M" uniqKey="Hennekam R" first="Raoul C M" last="Hennekam">Raoul C M. Hennekam</name>
<affiliation wicri:level="3">
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Pediatrics, Academic Medical Center, University of Amsterdam, Amsterdam</wicri:regionArea>
<placeName>
<settlement type="city">Amsterdam</settlement>
<region nuts="2" type="province">Hollande-Septentrionale</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Kayserili, Hulya" sort="Kayserili, Hulya" uniqKey="Kayserili H" first="Hulya" last="Kayserili">Hulya Kayserili</name>
<affiliation wicri:level="1">
<country xml:lang="fr">Turquie</country>
<wicri:regionArea>Istanbul Medical Faculty, Medical Genetics Department, Istanbul University, Istanbul</wicri:regionArea>
<wicri:noRegion>Istanbul</wicri:noRegion>
</affiliation>
</author>
<author>
<name sortKey="Scambler, Peter J" sort="Scambler, Peter J" uniqKey="Scambler P" first="Peter J" last="Scambler">Peter J. Scambler</name>
<affiliation wicri:level="4">
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Molecular Medicine Unit, Birth Defects Research Centre, University College London (UCL) Institute of Child Health, London</wicri:regionArea>
<placeName>
<settlement type="city">Londres</settlement>
<region type="country">Angleterre</region>
<region type="région" nuts="1">Grand Londres</region>
</placeName>
<orgName type="university">University College de Londres</orgName>
</affiliation>
</author>
<author>
<name sortKey="Beales, Philip L" sort="Beales, Philip L" uniqKey="Beales P" first="Philip L" last="Beales">Philip L. Beales</name>
<affiliation wicri:level="4">
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Molecular Medicine Unit, Birth Defects Research Centre, University College London (UCL) Institute of Child Health, London</wicri:regionArea>
<placeName>
<settlement type="city">Londres</settlement>
<region type="country">Angleterre</region>
<region type="région" nuts="1">Grand Londres</region>
</placeName>
<orgName type="university">University College de Londres</orgName>
</affiliation>
</author>
<author>
<name sortKey="Knoers, Nine Vam" sort="Knoers, Nine Vam" uniqKey="Knoers N" first="Nine Vam" last="Knoers">Nine Vam Knoers</name>
<affiliation wicri:level="3">
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Medical Genetics, University Medical Centre Utrecht, Utrecht</wicri:regionArea>
<placeName>
<settlement type="city">Utrecht</settlement>
<region nuts="2" type="province">Utrecht (province)</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Roepman, Ronald" sort="Roepman, Ronald" uniqKey="Roepman R" first="Ronald" last="Roepman">Ronald Roepman</name>
<affiliation wicri:level="3">
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Department of Human Genetics, Radboud University Medical Centre, Nijmegen</wicri:regionArea>
<placeName>
<settlement type="city">Nimègue</settlement>
<region type="province" nuts="2">Gueldre</region>
</placeName>
</affiliation>
<affiliation wicri:level="3">
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Nijmegen Centre for Molecular Life Sciences, Radboud University, Nijmegen</wicri:regionArea>
<placeName>
<settlement type="city">Nimègue</settlement>
<region type="province" nuts="2">Gueldre</region>
</placeName>
</affiliation>
<affiliation wicri:level="3">
<country xml:lang="fr">Pays-Bas</country>
<wicri:regionArea>Institute for Genetic and Metabolic Disease, Radboud University, Nijmegen</wicri:regionArea>
<placeName>
<settlement type="city">Nimègue</settlement>
<region type="province" nuts="2">Gueldre</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Mitchison, Hannah M" sort="Mitchison, Hannah M" uniqKey="Mitchison H" first="Hannah M" last="Mitchison">Hannah M. Mitchison</name>
<affiliation wicri:level="4">
<country xml:lang="fr">Royaume-Uni</country>
<wicri:regionArea>Molecular Medicine Unit, Birth Defects Research Centre, University College London (UCL) Institute of Child Health, London</wicri:regionArea>
<placeName>
<settlement type="city">Londres</settlement>
<region type="country">Angleterre</region>
<region type="région" nuts="1">Grand Londres</region>
</placeName>
<orgName type="university">University College de Londres</orgName>
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</analytic>
<monogr></monogr>
<series>
<title level="j">Journal of Medical Genetics</title>
<title level="j" type="abbrev">J Med Genet</title>
<idno type="ISSN">0022-2593</idno>
<idno type="eISSN">1468-6244</idno>
<imprint>
<publisher>BMJ Publishing Group Ltd</publisher>
<date type="published" when="2013-05">2013-05</date>
<biblScope unit="volume">50</biblScope>
<biblScope unit="issue">5</biblScope>
<biblScope unit="page" from="309">309</biblScope>
</imprint>
<idno type="ISSN">0022-2593</idno>
</series>
<idno type="istex">EFE630C08BA484FCC659095E33A3C3349589E1E3</idno>
<idno type="DOI">10.1136/jmedgenet-2012-101284</idno>
<idno type="href">jmedgenet-50-309.pdf</idno>
<idno type="ArticleID">jmedgenet-2012-101284</idno>
<idno type="PMID">23456818</idno>
<idno type="Related-article-href">10.1136/jmedgenet-2012-101282</idno>
<idno type="related-article-ID">RA1</idno>
<idno type="local">jmedgenet;50/5/309</idno>
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<idno type="ISSN">0022-2593</idno>
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<textClass></textClass>
<langUsage>
<language ident="en">en</language>
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<front>
<div type="abstract">Background Jeune asphyxiating thoracic dystrophy (JATD) is a rare, often lethal, recessively inherited chondrodysplasia characterised by shortened ribs and long bones, sometimes accompanied by polydactyly, and renal, liver and retinal disease. Mutations in intraflagellar transport (IFT) genes cause JATD, including the IFT dynein-2 motor subunit gene DYNC2H1. Genetic heterogeneity and the large DYNC2H1 gene size have hindered JATD genetic diagnosis. Aims and methods To determine the contribution to JATD we screened DYNC2H1 in 71 JATD patients JATD patients combining SNP mapping, Sanger sequencing and exome sequencing. Results and conclusions We detected 34 DYNC2H1 mutations in 29/71 (41%) patients from 19/57 families (33%), showing it as a major cause of JATD especially in Northern European patients. This included 13 early protein termination mutations (nonsense/frameshift, deletion, splice site) but no patients carried these in combination, suggesting the human phenotype is at least partly hypomorphic. In addition, 21 missense mutations were distributed across DYNC2H1 and these showed some clustering to functional domains, especially the ATP motor domain. DYNC2H1 patients largely lacked significant extra-skeletal involvement, demonstrating an important genotype–phenotype correlation in JATD. Significant variability exists in the course and severity of the thoracic phenotype, both between affected siblings with identical DYNC2H1 alleles and among individuals with different alleles, which suggests the DYNC2H1 phenotype might be subject to modifier alleles, non-genetic or epigenetic factors. Assessment of fibroblasts from patients showed accumulation of anterograde IFT proteins in the ciliary tips, confirming defects similar to patients with other retrograde IFT machinery mutations, which may be of undervalued potential for diagnostic purposes.</div>
</front>
</TEI>
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<list>
<country>
<li>Allemagne</li>
<li>Belgique</li>
<li>Pays-Bas</li>
<li>Pologne</li>
<li>Royaume-Uni</li>
<li>Suisse</li>
<li>Turquie</li>
</country>
<region>
<li>Angleterre</li>
<li>Bade-Wurtemberg</li>
<li>Berlin</li>
<li>Canton de Vaud</li>
<li>District de Fribourg-en-Brisgau</li>
<li>Grand Londres</li>
<li>Gueldre</li>
<li>Hollande-Méridionale</li>
<li>Hollande-Septentrionale</li>
<li>Nottinghamshire</li>
<li>Utrecht (province)</li>
</region>
<settlement>
<li>Amsterdam</li>
<li>Berlin</li>
<li>Fribourg-en-Brisgau</li>
<li>Lausanne</li>
<li>Leyde</li>
<li>Londres</li>
<li>Nimègue</li>
<li>Nottingham</li>
<li>Utrecht</li>
</settlement>
<orgName>
<li>University College de Londres</li>
<li>Université de Nottingham</li>
</orgName>
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<name sortKey="Antony, Dinu" sort="Antony, Dinu" uniqKey="Antony D" first="Dinu" last="Antony">Dinu Antony</name>
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<name sortKey="Emes, Richard D" sort="Emes, Richard D" uniqKey="Emes R" first="Richard D" last="Emes">Richard D. Emes</name>
<name sortKey="Forsythe, Elisabeth" sort="Forsythe, Elisabeth" uniqKey="Forsythe E" first="Elisabeth" last="Forsythe">Elisabeth Forsythe</name>
<name sortKey="Mitchison, Hannah M" sort="Mitchison, Hannah M" uniqKey="Mitchison H" first="Hannah M" last="Mitchison">Hannah M. Mitchison</name>
<name sortKey="Plagnol, Vincent" sort="Plagnol, Vincent" uniqKey="Plagnol V" first="Vincent" last="Plagnol">Vincent Plagnol</name>
<name sortKey="Scambler, Peter J" sort="Scambler, Peter J" uniqKey="Scambler P" first="Peter J" last="Scambler">Peter J. Scambler</name>
<name sortKey="Smithson, Sarah F" sort="Smithson, Sarah F" uniqKey="Smithson S" first="Sarah F" last="Smithson">Sarah F. Smithson</name>
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<name sortKey="Wellesley, Diana" sort="Wellesley, Diana" uniqKey="Wellesley D" first="Diana" last="Wellesley">Diana Wellesley</name>
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<name sortKey="Arts, Heleen H" sort="Arts, Heleen H" uniqKey="Arts H" first="Heleen H" last="Arts">Heleen H. Arts</name>
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<name sortKey="Arts, Heleen H" sort="Arts, Heleen H" uniqKey="Arts H" first="Heleen H" last="Arts">Heleen H. Arts</name>
<name sortKey="Arts, Heleen H" sort="Arts, Heleen H" uniqKey="Arts H" first="Heleen H" last="Arts">Heleen H. Arts</name>
<name sortKey="Bongers, Ernie M H F" sort="Bongers, Ernie M H F" uniqKey="Bongers E" first="Ernie M H F" last="Bongers">Ernie M H F. Bongers</name>
<name sortKey="Bongers, Ernie M H F" sort="Bongers, Ernie M H F" uniqKey="Bongers E" first="Ernie M H F" last="Bongers">Ernie M H F. Bongers</name>
<name sortKey="Bongers, Ernie M H F" sort="Bongers, Ernie M H F" uniqKey="Bongers E" first="Ernie M H F" last="Bongers">Ernie M H F. Bongers</name>
<name sortKey="Duijkers, Lonneke" sort="Duijkers, Lonneke" uniqKey="Duijkers L" first="Lonneke" last="Duijkers">Lonneke Duijkers</name>
<name sortKey="Duijkers, Lonneke" sort="Duijkers, Lonneke" uniqKey="Duijkers L" first="Lonneke" last="Duijkers">Lonneke Duijkers</name>
<name sortKey="Gilissen, Christian" sort="Gilissen, Christian" uniqKey="Gilissen C" first="Christian" last="Gilissen">Christian Gilissen</name>
<name sortKey="Gilissen, Christian" sort="Gilissen, Christian" uniqKey="Gilissen C" first="Christian" last="Gilissen">Christian Gilissen</name>
<name sortKey="Gilissen, Christian" sort="Gilissen, Christian" uniqKey="Gilissen C" first="Christian" last="Gilissen">Christian Gilissen</name>
<name sortKey="Hennekam, Raoul C M" sort="Hennekam, Raoul C M" uniqKey="Hennekam R" first="Raoul C M" last="Hennekam">Raoul C M. Hennekam</name>
<name sortKey="Hoischen, Alexander" sort="Hoischen, Alexander" uniqKey="Hoischen A" first="Alexander" last="Hoischen">Alexander Hoischen</name>
<name sortKey="Hoischen, Alexander" sort="Hoischen, Alexander" uniqKey="Hoischen A" first="Alexander" last="Hoischen">Alexander Hoischen</name>
<name sortKey="Hoischen, Alexander" sort="Hoischen, Alexander" uniqKey="Hoischen A" first="Alexander" last="Hoischen">Alexander Hoischen</name>
<name sortKey="Kamsteeg, Erik Jan" sort="Kamsteeg, Erik Jan" uniqKey="Kamsteeg E" first="Erik-Jan" last="Kamsteeg">Erik-Jan Kamsteeg</name>
<name sortKey="Kamsteeg, Erik Jan" sort="Kamsteeg, Erik Jan" uniqKey="Kamsteeg E" first="Erik-Jan" last="Kamsteeg">Erik-Jan Kamsteeg</name>
<name sortKey="Kamsteeg, Erik Jan" sort="Kamsteeg, Erik Jan" uniqKey="Kamsteeg E" first="Erik-Jan" last="Kamsteeg">Erik-Jan Kamsteeg</name>
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<name sortKey="Oud, Machteld M" sort="Oud, Machteld M" uniqKey="Oud M" first="Machteld M" last="Oud">Machteld M. Oud</name>
<name sortKey="Roeleveld, Nel" sort="Roeleveld, Nel" uniqKey="Roeleveld N" first="Nel" last="Roeleveld">Nel Roeleveld</name>
<name sortKey="Roeleveld, Nel" sort="Roeleveld, Nel" uniqKey="Roeleveld N" first="Nel" last="Roeleveld">Nel Roeleveld</name>
<name sortKey="Roeleveld, Nel" sort="Roeleveld, Nel" uniqKey="Roeleveld N" first="Nel" last="Roeleveld">Nel Roeleveld</name>
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<name sortKey="Roepman, Ronald" sort="Roepman, Ronald" uniqKey="Roepman R" first="Ronald" last="Roepman">Ronald Roepman</name>
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