OSGEP -associated Galloway–Mowat syndrome: a longitudinal genotype–phenotype correlation from prenatal imaging markers to lifespan neurologic-renal trajectories

BACKGROUND: Galloway-Mowat syndrome type 3 (GAMOS3) is a rare autosomal recessive disorder characterized by the co-occurrence of renal and neurological abnormalities in early childhood, caused by OSGEP gene variants. AIM: This study aims to characterize the genetic and phenotypic spectrum of GAMOS3 and evaluate correlations from prenatal imaging features to lifelong neurological and renal manifestations. METHOD: We retrospectively reviewed the medical records of cases genetically diagnosed with OSGEP-associated GAMOS3 at our center between January 2016 and August 2024. Additionally, a systematic review of reported cases in literature was conducted. The clinical validity of the gene-disease relationship between OSGEP and GAMOS3 was also evaluated in accordance with the ClinGen Gene-Disease Clinical Validity Curation Framework. RESULTS: The postnatal renal and neurological dysfunction was associated with prenatal manifestations, indicating disease progression. Prominent prenatal features included fetal growth restriction (FGR), microcephaly, oligohydramnios and abnormal cranial imaging. Notably, FGR worsened with advancing gestation, predominantly affecting fetal head and abdominal growth while sparing long bones. Fetal central nervous system magnetic resonance imaging revealed uncommon findings such as abnormal sulcation and increased T2 signal in the white matter, suggestive of myelination defects or leukoencephalopathy. Trio-based medical exome sequencing identified novel variants in the OSGEP gene within this cohort, expanding the known genetic spectrum of GAMOS3. Furthermore, the gene-disease relationship between OSGEP and GAMOS3 was conclusively validated as 'Definitive' according to clinical-genetic criteria. CONCLUSIONS: This study provides a comprehensive overview of the clinical phenotypes and genetic spectrum of GAMOS3, spanning from the prenatal period throughout the life course.