遗传性血管性水肿1家系C1抑制物基因突变分析

目的对一个中国遗传性血管性水肿家系进行C1抑制物(C1INH)基因突变检测分析。方法采用聚合酶链反应(PCR)和直接测序法检测C1INH基因8个外显子及每个外显子与内含子的相邻序列,将检测结果与GenBank公布的C1INH基因正常序列进行比较。为除外基因多态性可能,在50名正常人群对照中对该突变进行分析。血清补体C4和C1INH浓度采用速率散射比浊法测定,血清C1INH功能水平通过酶联免疫吸附试验(ELISA)测定。结果 4例患者的第3外显子均检测到1个无义突变(c.400G>T),该突变导致编码第134位的谷氨酸变为终止密码子(p.E134X)。家系中4例正常对照和50例健康人群对照未检测到该突变。4例患者的血清C4浓度、C1INH浓度及功能水平均低于正常值下限。该家系中2例正常对照和2例健康人群对照血清C4浓度、C1INH浓度及功能水平均在正常范围内。结论在该家系中发现C1INH基因突变c.400G>T,该突变为此家系发病的分子基础。     

Self‐administration of icatibant in acute attacks of Type I hereditary angioedema: A case report and review of hereditary angioedema

Hereditary angioedema (HAE) is a rare group of genetic disease characterized by non‐itchy swelling of subcutaneous and submucosal tissues of the extremities, genitalia, gastrointestinal tract, and upper airways, which can be life threatening. Moreover, unpredictability and recurrence of HAE attacks significantly affect patients' quality of life. Short‐ and long‐term prophylaxis is used to decrease the severity and frequency of attacks, but during severe or potentially severe acute episodes, treatment with C1‐INH replacement or icatibant is mandatory. Icatibant is a selective bradykinin B2 receptor antagonist that has been licensed for self‐administration at home, resulting in earlier treatment of the attack and quicker recovery, less emergency admittance with a significant improvement of patients' quality of life, and decrease of health care costs. The authors present a case of a young woman, affected by Type I HAE, who has been successfully treated with icatibant on demand at home, resulting in reduction of emergency admissions and improvement of quality of life. The authors also review the different types HAE, their clinical aspects, diagnosis, and management.     

遗传性出血性毛细血管扩张症一家系ALK1基因突变研究

目的:研究遗传性出血性毛细血管扩张症(HHT)一家系ALK1基因突变情况,分析基因型与表现型之间的关系.方法:收集1例HHT家系,采用聚合酶链反应(PCR)扩增该家系成员的ALK1基因全部编码外显子及其侧翼序列,并对PCR产物进行序列分析,以家系中的健康者和100例无血缘关系的正常人作对照.结果:该家系中所有患者均出现ALK1基因的错义突变c.101 0T>C(p.L337P),即第1010位碱基由胸腺嘧啶(T)突变为胞嘧啶(C),使得ALK1基因第7号外显子第337位密码子由CTG变为CCG,导致正常的亮氨酸被脯氨酸替代.结论:ALK1基因的错义突变c.1010T>C(p.L337P)是导致该家系临床表型的主要原因.     

遗传性血管性水肿C1INH基因1440V变异及其对结构的影响

目的 通过基因测序了解遗传性血管性水肿(HAE)患者C1酯酶抑制剂(C1INH)基因第八外显子的变异情况.方法 从HAE患者外周血白细胞中提取基因组DNA,PCR扩增第八外显子片段后插入pUC19质粒载体冉转化入感受态大肠杆菌TG1菌株,培养扩增质粒DNA,提取纯化后进行基因测序.将患者血清进行SDS-PAGE及Westem印迹,以了解该变异对CIINH结构的可能影响.结果 在1例I型HAE患者的第八外显子中发现一个变异位点,16776A＞G,致440位的异亮氨酸突变成缬氨酸(1440V),SDS-PAGE及Westem印迹显示该患者血清中C1INH全部表现为96 000片段而非正常的105 000片段.结论 1440v是一个新的C1INH基因变异,位于C1INH反应中心环的P4位,变异可能导致C1INH分子构象发生改变.     

遗传性对称性色素异常症一家系A-DAR1基因新突变

目的:确定一遗传性对称性色素异常症家系ADAR1基因的突变位点。方法:提取家系中2例患者、2名表型正常者及50名与本家系无关的正常对照外周血DNA,采用PCR技术扩增ADAR1基因所有编码区并进行测序。结果:该家系中2例患者均存在ADAR1基因错义突变(c.662CT),导致p.P211R改变,家系中2名未患病的个体和50名健康对照均未发现上述突变。结论:ADAR1基因c.662CT错义突变是导致该家系发生DSH的致病性突变,在国内外属首次报道。     

一个家族性良性天疱疮致病基因的新突变位点

目的 对一个中国人家族性良性天疱疮（HHD）家系进行ATP2C1基因突变检测。方法 调查一个HHD家系3代9人,其中2例具有HHD的临床表现。收集该家系所有成员的外周血,提取基因组DNA,采用PCR扩增ATP2C1基因的27个外显子,用直接测序法进行DNA测序分析。同时设立100例无亲缘关系的正常人作为对照。 结果 在该家系的2例患者中均检测到1个尚未报道过的ATP2C1基因错义突变位点（M 661 R）。在该家系健康个体及无亲缘关系的正常对照均未发现相同突变。结论 在该HHD家系中发现ATP2C1基因一个新的特异性突变位点（M 661 R）。     

Missense mutation in exon 7 of TRPS1 gene in an Italian family with a mild form of trichorhinophalangeal syndrome type I

BACKGROUND: Trichorhinophalangeal syndrome (TRPS) is a rare autosomal dominant disorder, three types of which have been described in the literature. All of them are characterized by alopecia, facial dysmorphism and bone deformities. Deletions and nonsense mutations of the TRPS1 gene are responsible for most of the TRPS I and III cases with no clear genotype-phenotype correlation. The majority of missense mutations have been described at TRPS1 exon 6, encoding a presumptive GATA DNA-binding domain, and are known to be associated with the most severe forms of the phenotypic spectrum of TRPS. Mutation mapping at exon 7 described to date includes nonsense mutations and a familial case with an insertion mutation. OBJECTIVES: To determine a possible correlation between a mutation at exon 7 and mild TRPS phenotype. METHODS: We describe three members of an Italian family with TRPS I. All three showed clinical features typical of TRPS I such as temporal alopecia and facial abnormalities, but no mental retardation. RESULTS: Mutation analysis showed a missense mutation (R952C) in exon 7 of the TRPS1 gene. CONCLUSIONS: R952C is the first missense mutation described outside the GATA zinc-finger domain of TRPS1. In contrast with missense mutations occurring within this region, this mutation prevents the transport of the TRPS1 protein into the nucleus, therefore determining TRPS I by haploinsufficiency. We hypothesize that a TRPS exon 7 mutation could result in a mild phenotype.     

Four novel mutations in ATP2C1 found in Chinese patients with Hailey-Hailey disease

BACKGROUND: Familial benign chronic pemphigus or Hailey-Hailey disease (HHD; OMIM 169600) is an autosomal dominant blistering disease. Pathogenic mutations in ATP2C1 encoding a novel Ca2+ pump have recently been identified. OBJECTIVES: To identify mutations in ATP2C1 in Chinese patients with HHD. METHODS: Eleven unrelated Chinese patients with HHD were subjected to mutation detection in ATP2C1. Eight of them had a family history of HHD. The 27 coding exons and their flanking sequences were amplified and sequenced. RESULTS: Five of the 11 patients were identified to have heterozygous mutations including three nonsense mutations and two splicing mutations in ATP2C1. CONCLUSIONS: Four novel mutations, nonsense mutations S887X and W795X and splicing mutations 118-1 g-->a and 1890+1del(gtgag)ins53, were found in this series of Chinese patients with HHD.     

Hereditary angio-oedema with normal C1 inhibitor in a family with affected women and men

Recurrent angio-oedema is a sign of various acquired and inherited disease entities, including hereditary angio-oedema types I and II that result from a genetic deficiency of C1 inhibitor, and a recently described type of dominantly inherited angio-oedema, which does not show a deficiency of C1 inhibitor. Until now, this new type of hereditary angio-oedema, designated as hereditary angio-oedema type III, has been assumed to be a disorder specific to females. We now describe a four-generation family with dominantly inherited angio-oedema and normal C1 inhibitor in which, in contrast to all previous observations, not only five female but also three male family members were clinically affected. One male patient was mainly affected following the intake of angiotensin-converting enzyme inhibitors. Our current observation leads to new considerations about the classification of hereditary angio-oedema with normal C1 inhibitor. Either hereditary angio-oedema with normal C1 inhibitor can be an entity affecting females predominantly, but not exclusively; in that case, men appear to have a much reduced chance of clinical manifestations. Alternatively, our present observation of hereditary angio-oedema with normal C1 inhibitor affecting both sexes may represent a new disease entity, presumably with a different underlying defect.     

Icatibant use in Brazilian patients with hereditary angioedema (HAE) type 1 or 2 and HAE with normal C1-INH levels: findings from the Icatibant Outcome Survey Registry Study

BackgroundHereditary angioedema can be caused by C1-Inhibitor (C1-INH) deficiency and/or dysfunction (HAE-1/2) or can occur in patients with normal C1-INH (HAE nC1-INH).MethodsThe Icatibant Outcome Survey (IOS; NCT01034969) registry monitors the safety and effectiveness of icatibant for treating acute angioedema.ObjectivePresent findings from Brazilian patients with HAE-1/2 and HAE nC1-INH participating in IOS.Results42 patients were enrolled (HAE-1/2, n = 26; HAE nC1-INH, n = 16). Median age at symptom onset was significantly lower with HAE-1/2 vs. HAE nC1-INH (10.0 vs. 16.5y, respectively; p = 0.0105), whereas median age at diagnosis (31.1 vs. 40.9y; p = 0.1276) and the median time between symptom onset and diagnosis (15.0 vs. 23.8y; p = 0.6680) were numerically lower vs. HAE nC1-INH, respectively. One icatibant dose was used for > 95% of HAE attacks. Median (range) time-to-event outcomes were shorter for patients with HAE nC1-INH vs. HAE-1/2, including time to first administration (0.5 [0–96.0] vs. 1.0 [0–94.0]h, respectively), time from first administration to complete resolution (1.0 [0–88.0] vs. 5.5 [0–96.0]h, respectively), and total attack duration (7.0 [0.3–99.0] vs. 18.5 [0.1–100.0]h, respectively). Mean (SD) time from attack onset to resolution was significantly shorter for patients with HAE nC1-INH vs. HAE-1/2 (9.8 [18.7] vs. 19.6 [24.0]h, respectively; p = 0.0174). 83 adverse events (AEs) in 42 patients were reported; most were mild (66.3%) or moderate (13.3%) and non-serious (75.9%). The most common icatibant-related AE was injection site erythema (HAE-1/2, 34.6%; HAE nC1-INH, 18.8%).Study limitationsThis was an observational study without a treatment comparator and that relied on patient recall.ConclusionsFindings demonstrate effectiveness and tolerability of icatibant in Brazilian HAE patients.     

I型神经纤维瘤病NF1基因突变检测

目的：检测I型神经纤维瘤病患者的NF1基因突变。方法：提取I型神经纤维瘤病1家系、1例散发患者及200名正常对照外周血DNA,PCR扩增NF1基因全部外显子及侧翼序列并进行Sanger测序。结果：在家系的先证者及其母亲外周血DNA中检测到NF1基因c.3975-2 A〉T突变,其他家系成员未发现突变位点;在散发病例中检测到c.3619delA突变,为国际上首次报道。结论： I型神经纤维瘤病具有遗传基因异质性。     

先天性厚甲症I型一家系K6a基因突变检测

目的：研究先天性厚甲症I型（Pachyonychia congenitatype1,PC-1）一家系K6a基因突变。方法：提取PC-1患者和100名正常对照的外周血白细胞基因组DNA,采取长片段聚合酶链反应（PCR）扩增基因的全部编码序列,然后以产物为模板,采用巢式PCR扩增突变热点区,最后通过DNA直接测序确定基因突变位点和类型。结果：DNA测序发现患者K6a基因第1403位核甘酸由胸腺嘧啶（T）变为腺嘌呤（A）,导致K6a的2B螺旋区末端第468位密码子由亮氨酸（L）变为谷氨酰胺（Q）。而该家系中的正常人及100名正常对照均未发现此突变。结论：该患者存在角蛋白K6aIA68Q突变,进一步证明了螺旋边界序列是角蛋白K6a基因的突变热点区。