Exome sequencing of 175 autism spectrum disorder parent–child trios reveals that few de novo point mutations have a role in autism spectrum disorder and those that do are distributed across many genes and are incompletely penetrant, further supporting extreme genetic heterogeneity of this spectrum disorder. Although it is well accepted that genetics makes a strong contribution to autism spectrum disorder, most of the underlying causes of the condition remain unknown. Three groups present large-scale exome-sequencing studies of individuals with sporadic autism spectrum disorder, including many parent–child trios and unaffected siblings. The overall message from the three papers is that there is extreme locus heterogeneity among autistic individuals, with hundreds of genes involved in the condition, and with no single gene contributing to more than a small fraction of cases. Sanders et al. report the association of the gene SCN2A, previously identified in epilepsy syndromes, with the risk of autism. Neale et al. find strong evidence that CHD8 and KATNAL2 are autism risk factors. O'Roak et al. observe that a large proportion of the mutated proteins have crucial roles in fundamental developmental pathways, including β-catenin and p53 signalling. Autism spectrum disorders (ASD) are believed to have genetic and environmental origins, yet in only a modest fraction of individuals can specific causes be identified1,2. To identify further genetic risk factors, here we assess the role of de novo mutations in ASD by sequencing the exomes of ASD cases and their parents (n = 175 trios). Fewer than half of the cases (46.3%) carry a missense or nonsense de novo variant, and the overall rate of mutation is only modestly higher than the expected rate. In contrast, the proteins encoded by genes that harboured de novo missense or nonsense mutations showed a higher degree of connectivity among themselves and to previous ASD genes3 as indexed by protein-protein interaction screens. The small increase in the rate of de novo events, when taken together with the protein interaction results, are consistent with an important but limited role for de novo point mutations in ASD, similar to that documented for de novo copy number variants. Genetic models incorporating these data indicate that most of the observed de novo events are unconnected to ASD; those that do confer risk are distributed across many genes and are incompletely penetrant (that is, not necessarily sufficient for disease). Our results support polygenic models in which spontaneous coding mutations in any of a large number of genes increases risk by 5- to 20-fold. Despite the challenge posed by such models, results from de novo events and a large parallel case–control study provide strong evidence in favour of CHD8 and KATNAL2 as genuine autism risk factors.

Patterns and rates of exonic de novo mutations in autism spectrum disorders