• Richard Pierce, Weizhen Ji, Eunice C Chan, Zhihui Xie, Lauren M Long, Mustafa Khokha, Saquib Lakhani, and Kirk M Druey.
• Pediatric Genomic Discovery Program, Department of Pediatrics, Yale University, New Haven, Connecticut.
• Shock. 2019 Aug 1; 52 (2): 183-190.

ObjectiveSystemic capillary leak syndrome (SCLS) is a rare disorder that presents with episodes of hypovolemic shock. The extent to which genetic abnormalities contribute to SCLS is unknown. We identified pediatric and adult cohorts with characteristic clinical courses. We sought to describe the clinical characteristics of both cohorts, identify a possible genetic contribution to SCLS, and demonstrate that whole-exome sequencing (WES) may be conducted by critical care providers.DesignProspective observational study of WES of nine adult and eight pediatric SCLS patients and available unaffected first-degree relatives.SettingTertiary children's hospitals and referral research laboratory.PatientsChildren and adults with SCLS.InterventionsNone.MeasurementsPatients and available first-degree relatives underwent WES. Data were analyzed for rare homozygous, biallelic, de novo, and heterozygous variants with allelic enrichment and metabolic pathway analyses.Main ResultsChildren with SCLS presented at a younger age with episodes similar to those experienced by adults. All patients and available relatives underwent satisfactory WES. No overlapping gene variants or metabolic pathways were identified across all SCLS patients. Multiple candidate genes with homozygous or biallelic mutations were identified in individual subjects with SCLS. There was no significant enrichment of genes with rare heterozygous variants.ConclusionsThe clinical characteristics of children and adults with SCLS are similar. We did not identify a uniform germline exomic genetic etiology for SCLS. WES identified several candidate genes in individual patients for future research. WES is a viable way for critical care providers to investigate the etiology of diseases with presumed genetic contributions.

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