Ⅰ型胶原基因突变与成骨不全研究进展

成骨不全（osteogenesis imperfecta,OI）（OIⅠ,MIM#166200;OIⅡ,MIM#166210;OIⅢ,MIM#259420;OIⅣ,MIM#166220）又称脆骨病,是一种全身性结缔组织遗传病,多数为常染色体显性遗传,少数为常染色体隐性遗传,发病率约为1∶10000。临床表现主要包括骨脆性增加、蓝巩膜、牙本质发育不全、听力下降等。90%以上的OI患者具有Ⅰ型胶原基因（COL1A1,COL1A2）突变,尤以COL1A1基因突变为主。Ⅰ型胶原基因突变的位点与OI临床表型有一定的相关性。本文主要就Ⅰ型胶原基因突变与OI的研究进展作一综述。     

Mutations in the COL1A2 gene of type I collagen that result in nonlethal forms of osteogenesis imperfecta

Although virtually all mutations that result in osteogenesis imperfecta (OI) affect the genes that encode the chains of type I procollagen, the effects of mutations in the COL1A2 gene have received less attention than those in the COL1A1 gene. We have characterized mutations in 4 families that give rise to different OI phenotypes. In three families substitutions of glycine residues by cysteine in the triple helical domain (a single example at position 259 and 2 families in which substitution of glycine at 646 by cysteine) have been identified, and in the fourth a G for A transition at position + 4 in intron 33 led to use of an alternative splice site and inclusion of 6 amino acids (val-gly-arg-ile-leu-phe) between residues 585 and 586 of the normal triple helix. The relation between position of substitution of glycine by cysteine in the COL1A2 gene does not follow the pattern developed in the COL1A1 gene. To determine how COL1A2 mutations produce OI phenotypes, we have produced a full-length mouse cDNA into which we plan to place mutations and examine their effects in stably transfected osteogenic cells and in transgenic animals.     

High efficiency of mutation detection in type 1 stickler syndrome using a two-stage approach: vitreoretinal assessment coupled with exon sequencing for screening COL2A1

Stickler syndrome is a genetically heterogeneous disorder that affects the ocular, skeletal, and auditory systems. To date three genes, COL2A1, COL11A1, and COL11A2, encoding the heterotypic type II/XI collagen fibrils present in vitreous and cartilage have been shown to have mutations that result in Stickler syndrome. As systemic features in this disorder are variable we have used an ophthalmic examination to differentiate those patients with a membranous vitreous phenotype associated with mutations in COL2A1, from other patients who may have mutations in other genes. Gene amplification and exon sequencing was used to screen 50 families or sporadic cases with this membranous phenotype, for mutations in COL2A1. Mutations were detected in 47 (94%) cases consisting of 166 affected and 78 unaffected individuals. We also demonstrate that the predominantly ocular form of type 1 Stickler syndrome is not confined to mutations in the alternatively spliced exon 2. Using splicing reporter constructs we demonstrate that a mutant GC donor splice site in intron 51 can be spliced normally; this contributed to the predominantly ocular phenotype in the family in which it occurred.     

Haplotype analysis of collagen type I genes in the general population and in osteogenesis imperfecta families

The allele frequencies of 2 new polymorphic markers of collagen type I proalpha 1 (COL1A1) and proalpha 2 (COL1A2) genes were determined in a random sample of chromosomes by polymerase chain reaction. The minor allele frequencies were 0.27 for COL1A1/+88Mn1I, and 0.39 for COL1A2/1446 PvuII RFLPs, respectively. These 2 polymorphisms increased the combined (PIC) values we previously determined in the Italian population with Southern blotting procedures, from 0.71 at the COL1A1 locus to 0.81, and from 0.71 at the COL1A2 locus to 0.88, respectively. With a combination of these markers, we have carried out the segregation analysis of 4 new families in which osteogenesis imperfecta (OI) segregated as a dominant trait. The disease segregated with COL1A1 in 2 OI type I families, and with COL1A2 in one OI type IV family. In one OI type I family the concordant locus was uncertain. This analysis was extended to the 7 dominant OI families we previously reported: in 3 out of 11 pedigrees either locus still could not be excluded, indicating the need for more genetic markers. COL1A1 and COL1A2 haplotype frequencies were compared in normal and OI chromosomes: no preferential association of the disease with a given haplotype was detected. The correlation between affected locus and clinical aspects is discussed.     

Stability related bias in residues replacing glycines within the collagen triple helix (Gly-Xaa-Yaa) in inherited connective tissue disorders

A missense mutation leading to the replacement of one Gly in the (Gly-Xaa-Yaa)n repeat of the collagen triple helix can cause a range of heritable connective tissue disorders that depend on the gene in which the mutation occurs. Osteogenesis imperfecta results from mutations in type I collagen, Ehlers-Danlos syndrome type IV from mutations in type III collagen, Alport syndrome from mutations in type IV collagen, and dystrophic epidermolysis bullosa from mutations in type VII collagen. The predicted rates of substitutions by different amino acids for glycine in the alpha1(I), alpha2(I), alpha1(III), alpha5(IV), and alpha1(VII) chains (encoded by COL1A1, COL1A2, COL3A1, COL4A5, and COL7A1, respectively) were compared with missense mutations in those chains that have been observed to cause disease. The spectrum of amino acids replacing Gly was not significantly different from that expected for the alpha1(VII) chains, suggesting that any Gly replacement will cause disease. The distribution of residues replacing Gly was significantly different from that expected for all other collagen chains studied, with a particularly strong bias seen for alpha1(I) and alpha1(III) collagen chains. The bias did not correlate with the degree of chemical dissimilarity between Gly and the replacement residues, but in some cases a relationship was observed with the predicted extent of destabilization of the triple helix. For alpha1(III) collagen chains, the more destabilizing mutations were identified more often than expected. For alpha1(I), the most destabilizing residues, Val, Glu, and Asp, and the least destabilizing residue, Ala, were underrepresented. This bias supports the hypothesis that the level of triple-helix destabilization determines clinical outcome.     

Stickler syndrome and the vitreous phenotype: mutations in COL2A1 and COL11A1

Stickler syndrome is a dominantly inherited disorder affecting the fibrillar type II/XI collagen molecules expressed in vitreous and cartilage. Mutations have been found in COL2A1, COL11A1 and COL11A2. It has a highly variable phenotype that can include midline clefting, hearing loss, premature osteoarthritis, congenital high myopia and blindness through retinal detachment. Although the systemic phenotype is highly variable, the vitreous phenotype has been used successfully to differentiate between patients with mutations in these different genes. Mutations in COL2A1 usually result in a congenital membranous vitreous anomaly. In contrast mutations in COL11A1 result in a different vitreous phenotype where the lamellae have an irregular and beaded appearance. However, it is now apparent that a new sub‐group of COL2A1 mutations is emerging that result in a different phenotype with a hypoplastic vitreous that fills the posterior chamber of the eye, and is either optically empty or has sparse irregular lamellae. Here we characterise a further 89 families with Stickler syndrome or a type II collagenopathy, and correlate the mutations with the vitreous phenotype. We have identified 57 novel mutations including missense changes in both COL2A1 and COL11A1 and have also detected two cases of complete COL2A1 gene deletions using MLPA. ©2010 Wiley‐Liss, Inc.     

COL1A1/COL1A2基因突变分析与成骨不全的产前基因诊断

目的对有成骨不全(Osteogenesis Imperfecta,OI)孕史的患者,进行系统B超及COL1A1/COL1A2基因检测,希望建立OI患儿产前诊断方案,为OI患儿进行产前诊断提供技术保障。方法对于有OI孕史的孕妇,进行系统B超监测;根据胎儿股骨、长骨的超声影像学表现,初诊为成骨不全。抽取羊水,采用直接测序法对羊水DNA的COL1A1和COL1A2基因全编码外显子及启动子区域进行突变位点检测。检出的新突变,对孕妇夫妇及家系其他成员直接测序证实。产前诊断标本均需做母血污染鉴定。结果胎儿超声影像学表现为股骨短小,胫腓骨弯曲成角,颅骨变薄且发现多处骨折,考虑OI。STR法鉴定,羊水无母血污染。DNA序列分析结果显示COL1A1基因鉴定出19个SNP位点,没有鉴定出突变位点;COL1A2基因鉴定出13个SNP位点及第36外显子的第2180位置碱基发生错义突变位点(c.2180G>A,p.Gly727Asp)。孕妇在COL1A2基因的第36外显子亦存在错义突变位点(c.2180G>A,p.Gly727Asp),但其临床特征不一致。其他成员均未检测到Gly727Asp突变。结论有OI孕史的孕妇,采取B超和COL1A1/COL1A2基因诊断技术,可以快速、有效对高危胎儿做出确诊,为预防患病胎儿出生提供技术保障。     

IL-13和乙醇促进人肺成纤维细胞胶原的表达

目的:研究乙醇和/或白细胞介素13(IL-13)对人肺成纤维细胞(HFL-1)Ⅰ、Ⅲ型胶原α1链基因(COL1A1、COL3A1)以及Ⅰ型胶原蛋白(CoⅠ)表达的影响,探讨肺纤维化的机制。方法:培养HFL-1,通过实时定量荧光RT-PCR检测乙醇和/或IL-13对HFL-1细胞IL-13受体(IL-13Rα1、IL-13Rα2、IL-4Rα)mRNA、COL1A1 mRNA和COL3A1 mRNA表达的影响,ELISA的方法检测乙醇和/或IL-13对HFL-1分泌CoⅠ的影响。结果:单独低浓度乙醇(25、50、100、200mmol/L)作用HFL-1后,与对照组相比IL-13Rα1 mRNA与IL-4Rα mRNA水平比对照组显著增高(P<0.05),而IL-13Rα2 mRNA水平比对照组显著降低(P<0.05)。单独低浓度乙醇(25、50、100、200 mmol/L)对HFL-1的COL1A1 mR-NA和COL3A1 mRNA表达无影响(P>0.05)。IL-13(10、20、50μg/L)可以促进HFL-1的COL1A1 mRNA和COL3A1 mR-NA的表达(P<0.05),且存在浓度依赖性。乙醇(200 mmol/L)与IL-13(10、20、50μg/L)共同作用刺激HFL-1促进COL1A1 mRNA和COL3A1 mRNA的表达比IL-13(10、20、50μg/L)单独作用强(P<0.05)。IL-13组(10、20、50μg/L)和乙醇(200 mmol/L)与IL-13(10、20、50μg/L)共同刺激组HFL-1均有CoⅠ的分泌,但共同刺激组HFL-1分泌CoⅠ量显著增加(P<0.05)。结论:单独低浓度乙醇(25、50、100、200mmol/L)不影响HFL-1细胞的COL1A1和COL3A1表达,但可以影响HFL-1细胞IL-4Rα、IL-13Rα1和IL-13Rα2的表达,而乙醇与IL-13共同刺激与单独IL-13刺激相比对HFL-1的COL1A1和COL3A1以及CoⅠ的表达有显著的促进作用。     

六个成骨不全家系的临床表型分析及基因变异检测

目的分析6个成骨不全家系的临床表型并明确其致病变异,为遗传咨询及产前诊断提供依据。方法收集6个家系的临床资料以及外周血或引产组织样本,应用二代测序(next generation sequencing,NGS)技术对先证者的全部基因进行检测,用PCR反应扩增检出的变异位点,之后进行Sanger测序。在6个家系的所有成员以及100名健康对照中对检测到的变异位点进行验证。结果家系1的先证者及其女儿携带COL1A1基因c.1976G>C杂合变异,家系2~6的先证者分别携带COL1A2基因c.2224G>A、COL1A1基因c.2533G>A、COL1A2基因c.2845G>A、COL1A1基因c.2532_2540delCGGACCCGC以及COL1A2基因c.1847G>A杂合变异。先证者的双亲均未携带相应变异,在100名健康对照中均未检测到上述变异。结论6个成骨不全家系的致病原因可能均为COL1A1/2基因的变异。新发现的变异丰富了成骨不全症的表现型-基因型数据库,并为这些家系的遗传咨询及产前诊断提供了依据。     

COL1-related overlap disorder: A novel connective tissue disorder incorporating the osteogenesis imperfecta/Ehlers-Danlos syndrome overlap

The 2017 classification of Ehlers-Danlos syndromes (EDS) identifies three types associated with causative variants in COL1A1/COL1A2 and distinct from osteogenesis imperfecta (OI). Previously, patients have been described with variable features of both disorders, and causative variants in COL1A1/COL1A2; but this phenotype has not been included in the current classification. Here, we expand and re-define this OI/EDS overlap as a missing EDS type. Twenty-one individuals from 13 families were reported, in whom COL1A1/COL1A2 variants were found after a suspicion of EDS. None of them could be classified as affected by OI or by any of the three recognized EDS variants associated with COL1A1/COL1A2. This phenotype is dominated by EDS-related features. OI-related features were limited to mildly reduced bone mass, occasional fractures and short stature. Eight COL1A1/COL1A2 variants were novel and five recurrent with a predominance of glycine substitutions affecting residues within the procollagen N-proteinase cleavage site of α1(I) and α2(I) procollagens. Selected variants were investigated by biochemical, ultrastructural and immunofluorescence studies. The pattern of observed changes in the dermis and in vitro for selected variants was more typical of EDS rather than OI. Our findings indicate the existence of a wider recognizable spectrum associated with COL1A1/COL1A2.     

Osteogenesis imperfecta: Mosaicism and refinement of the genotype‐phenotype map in OI type III

Non‐lethal OI III (OMIM 259420) is caused by structural aberrations of collagen I. We report four novel glycine substitutions, one in the a1(I) chain of collagen I (G688S) and three in the a2(I) chain (G241D, G247C, G883V). In each of two families (G241D and G883V), we found parental mosaicism for the substitution explaining recurrence and intrafamilial variability of OI. The G247C and the G883V are the most N‐terminally and C‐terminally, respectively, placed cysteine and valine substitutions reported. The new substitutions add important information to the genotype‐phenotype map and in particular the importance of a‐chain stoichiometry is underlined. Data regarding the G688S substitution may suggest a different effect of the two a‐chains in the development of dentinogenesis imperfecta (DI). Hum Mutat 13:503, 1999. © 1999 Wiley‐Liss, Inc.     

COL1A1 and COL1A2 variants in Ehlers-Danlos syndrome phenotypes and COL1-related overlap disorder

Pathogenic variants in COL1A1 and COL1A2 are involved in osteogenesis imperfecta (OI) and, rarely, Ehlers-Danlos syndrome (EDS) subtypes and OI-EDS overlap syndromes (OIEDS1 and OIEDS2, respectively). Here we describe a cohort of 34 individuals with likely pathogenic and pathogenic variants in COL1A1 and COL1A2, 15 of whom have potential OIEDS1 (n = 5) or OIEDS2 (n = 10). A predominant OI phenotype and COL1A1 frameshift variants are present in 4/5 cases with potential OIEDS1. On the other hand, 9/10 potential OIEDS2 cases have a predominant EDS phenotype, including four with an initial diagnosis of hypermobile EDS (hEDS). An additional case with a predominant EDS phenotype had a COL1A1 arginine-to-cysteine variant that was originally misclassified as a variant of uncertain significance despite this type of variant being associated with classical EDS with vascular fragility. Vascular/arterial fragility was observed in 4/15 individuals (including one individual with an original diagnosis of hEDS), which underscores the unique clinical surveillance and management needs in these patients. In comparison to previously described OIEDS1/2, we observed differentiating features that should be considered to refine currently proposed criteria for genetic testing in OIEDS, which will be beneficial for diagnosis and management. Additionally, these results highlight the importance of gene-specific knowledge for informed variant classification and point to a potential genetic resolution (COL1A2) for some cases of clinically diagnosed hEDS.