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Background  Mutations in the genes encoding leptin ( LEP ), the leptin receptor ( LEPR ), and the melanocortin 4 receptor ( MC4R ) are known to cause severe early-onset childhood obesity. The aim of the current study was to examine the prevalence of damaging  LEP, LEPR,  and  MC4R  mutations in Pakistani families having a recessive heritance of early-onset obesity.    Methods  Using targeted resequencing, the presence of rare mutations in  LEP ,  LEPR , and  MC4R , was investigated in individuals from 25 families suspected of having autosomal recessive early-onset obesity. Segregation patterns of variants were assessed based on chip-based genotyping .Results  Homozygous  LEPR  variants were identified in two probands. One carried a deletion (c.3260AG) resulting in the frameshift mutation p.Ser1090Trpfs*6, and the second carried a substitution (c.2675C > G) resulting in the missense mutation p.Pro892Arg. Both mutations were located within regions of homozygosity shared only among affected individuals. Both probands displayed early-onset obesity, hyperphagia and diabetes. No mutations were found in  LEP  and  MC4R .    Conclusions  The current study highlights the implication of  LEPR  mutations in cases of severe early-onset obesity in consanguineous Pakistani families. Through targeted resequencing, we identified novel damaging mutations, and our approach may therefore be utilized in clinical testing or diagnosis of known forms of monogenic obesity with the aim of optimizing obesity treatment.    Electronic supplementary material  The online version of this article (10.1186/s12881-018-0710-x) contains supplementary material, which is available to authorized users.

Identification of novel LEPR mutations in Pakistani families with morbid childhood obesity