Key result
Digital PCR matches MLPA for SMN2 quantification while long-read sequencing identifies 6 novel hybrid structures.
Why the study?
Accurate SMN2 copy number quantification is critical for SMA stratification and treatment, yet remains challenging at high copy numbers and does not fully explain phenotypic variability.
Do complementary molecular approaches like dPCR and LRS improve the accuracy of SMN2 copy number quantification and structural characterization compared to MLPA and AmplideX in patients with SMA?
Observational (n=78)
No
Do complementary molecular approaches like dPCR and LRS improve the accuracy of SMN2 copy number quantification and structural characterization compared to MLPA and AmplideX in patients with SMA?
An integrated diagnostic strategy combining MLPA or dPCR for copy-number quantification with long-read sequencing for structural characterization improves the molecular resolution of the SMN locus in SMA.
dPCR and MLPA concordant for SMN2 quantification in SMA; LRS reveals novel hybrids but leaves phenotypic impact open.
Spinal muscular atrophy (SMA) is a severe neuromuscular disorder caused by biallelic disruption of the Survival Motor Neuron 1 (SMN1) gene. Accurate quantification of Survival Motor Neuron 2 (SMN2) copy number is essential for patient stratification, prognosis, and treatment decisions, yet remains challenging at high copy numbers and does not fully explain phenotypic variability. We compared complementary molecular approaches in 78 Spanish patients with genetically confirmed SMA. Multiplex ligation-dependent probe amplification (MLPA) and digital PCR (dPCR) showed complete concordance, supporting their reliability for SMN2 quantification. In contrast, the AmplideX PCR/CE SMN1/2 Plus Kit showed discrepancies in seven patients, mainly at clinically relevant thresholds (three vs. four SMN2 copies), indicating higher sensitivity to technical variability. Notably, dPCR resolved a case with >5 SMN2 copies, demonstrating superior resolution. Long-read sequencing (LRS) in ten patients with MLPA-detected rearrangements enabled high-resolution reconstruction of the SMN locus and revealed six previously undescribed SMN hybrid structures. Structural haplotype architecture, rather than copy number alone, may further determine SMN variability and contribute to phenotype heterogeneity. Overall, our findings support an integrated diagnostic strategy in which copy-number quantification is complemented by structural characterisation in complex cases, improving molecular resolution of the SMN locus.
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Berzal-Serrano et al. (2026) conducted an observational in Spinal muscular atrophy (SMA) (n=78). Multiplex ligation-dependent probe amplification (MLPA), digital PCR (dPCR), AmplideX PCR/CE SMN1/2 Plus, and long-read sequencing (LRS) vs. MLPA (reference standard) was evaluated on SMN2 copy number quantification and hybrid gene identification. Multiplex ligation-dependent probe amplification and digital PCR showed complete concordance for SMN2 quantification, while long-read sequencing revealed six previously undescribed SMN hybrid structures.
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