10例血友病A患者的FⅧ因子基因内含子22倒位分析

１０例血友病Ａ患者的ＦⅧ因子基因内含子２２倒位分析吴竞生，陈云弟，王寅文，陈美珏，王祖贻，潘理明，汪健，丁浩血友病Ａ（ＨＡ）是凝血因于Ⅷ（ＦⅧ）基因缺陷所致的Ｘ－连锁隐性出血性遗传病。ＦⅧ因子基因突变类型众多，１９９３年发现约一半重型ＨＡ是由ＦⅧ基因...     

用长距离PCR技术检测江西籍重型血友病甲Ⅷ因子基因倒位基因

目的用长距离PCR（LD-PCR）技术检测江西籍重型血友病A（hemophiliaA,HA）有无Ⅷ因子基因倒位。方法用Bigg′s一期法检测血浆凝血因子FⅧ活性（FⅧ：C）,LD-PCR方法,以0.6%琼脂糖凝胶电泳技术,检测55例江西籍重型HA进行凝血因子Ⅷ（FⅧ）倒位基因,电泳出现11kb带,示FⅧ基因倒位;12kb带,示非FⅧ倒位,这两条带同时出现者为FⅧ倒位基因携带者。结果检测30例无亲缘关系的重型HA患者中,发现11例患者（或家属成员）有FⅧ倒位基因,占重型HA患者的36.7%;9家系中查出基因倒位携带者4名。结论LD-PCR技术结合血浆FⅧ：C可快速、准确检测重型血友病FⅧ基因倒位。     

应用长距离PCR技术对60例重型血友病甲进行Ⅷ因子基因倒位的基因诊断

目的对天津60例重型血友病甲(hemophiliaA,HA)患者作出有无FⅧ基因倒位的基因诊断.方法外周血提取DNA,通过长距离PCR(long distance-polymerase chain     

甲型血友病基因诊断及产前诊断的研究进展

甲型血友病是最常见的遗传性出血性疾病,受到了国内外研究者们的极大关注.由于此病尚无彻底根治方法,所以基因诊断及产前诊断显得尤为重要.基因诊断可分为直接基因诊断及间接连锁分析的方法;产前诊断的手段也在近年飞速发展.本文就直接基因诊断、间接连锁分析及产前诊断新技术这几方面的研究进展综述如下.     

甲型血友病基因诊断及产前诊断的研究进展

甲型血友病是最常见的遗传性出血性疾病,受到了国内外研究者们的极大关注.由于此病尚无彻底根治方法,所以基因诊断及产前诊断显得尤为重要.基因诊断可分为直接基因诊断及间接连锁分析的方法;产前诊断的手段也在近年飞速发展.本文就直接基因诊断、间接连锁分析及产前诊断新技术这几方面的研究进展综述如下.     

甲型血友病基因诊断及产前诊断的研究进展

甲型血友病是最常见的遗传性出血性疾病,受到了国内外研究者们的极大关注.由于此病尚无彻底根治方法,所以基因诊断及产前诊断显得尤为重要.基因诊断可分为直接基因诊断及间接连锁分析的方法;产前诊断的手段也在近年飞速发展.本文就直接基因诊断、间接连锁分析及产前诊断新技术这几方面的研究进展综述如下.     

甲型血友病基因诊断及产前诊断的研究进展

甲型血友病是最常见的遗传性出血性疾病,受到了国内外研究者们的极大关注.由于此病尚无彻底根治方法,所以基因诊断及产前诊断显得尤为重要.基因诊断可分为直接基因诊断及间接连锁分析的方法;产前诊断的手段也在近年飞速发展.本文就直接基因诊断、间接连锁分析及产前诊断新技术这几方面的研究进展综述如下.     

FⅧ基因倒位与血友病甲

最近发现F Ⅷ基因的内含子22倒位是约半数重型血友病甲(HA)患者的共同分子缺陷。由F Ⅷ基因内含子22内的F ⅧA基因拷贝与F Ⅷ基因上游约500kb处的两个FⅧA基因拷贝之一发生同源重组在Xq28所引入的大片段。DNA倒位把F Ⅷ基因分成两半,从而导致重型HA。倒位可以通过Southern印迹杂交技术检测。这一发现明确了一类HA的分子机制,并且为这类HA的携带者检测和产前诊断提供了一个直接方法,具有重要的应用价值。     

甲型血友病基因诊断及产前诊断的研究进展

甲型血友病是最常见的遗传性出血性疾病,受到了国内外研究者们的极大关注.由于此病尚无彻底根治方法,所以基因诊断及产前诊断显得尤为重要.基因诊断可分为直接基因诊断及间接连锁分析的方法;产前诊断的手段也在近年飞速发展.本文就直接基因诊断、间接连锁分析及产前诊断新技术这几方面的研究进展综述如下.     

甲型血友病基因诊断及产前诊断的研究进展

甲型血友病是最常见的遗传性出血性疾病,受到了国内外研究者们的极大关注.由于此病尚无彻底根治方法,所以基因诊断及产前诊断显得尤为重要.基因诊断可分为直接基因诊断及间接连锁分析的方法;产前诊断的手段也在近年飞速发展.本文就直接基因诊断、间接连锁分析及产前诊断新技术这几方面的研究进展综述如下.     

Detection of 95 novel mutations in coagulation factor VIII gene F8 responsible for hemophilia A: results from a single institution

Hemophilia A (HA) is an X‐linked hereditary bleeding disorder defined by a qualitative and/or quantitative factor VIII (FVIII) deficiency. The molecular diagnosis of HA is challenging because of the high number of different causative mutations that are distributed throughout the large F8 gene. The putative role of the novel mutations, especially missense mutations, may be difficult to interpret as causing HA. We identified 95 novel mutations out of 180 different mutations responsible for HA in 515 patients from 406 unrelated families followed up at a single hemophilia treatment center of the Bicêtre university hospital (Assistance Publique‐Hôpitaux de Paris [AP‐HP], Le Kremlin‐Bicêtre). These 95 novel mutations comprised 55 missense mutations, 12 nonsense mutations, 11 splice site mutations, and 17 small insertions/deletions. We therefore developed a mutation analysis based on a body of proof that combines the familial segregation of the mutation, the resulting biological and clinical HA phenotype, and the molecular consequences of the amino acid (AA) substitution. For the latter, we studied the putative biochemical modifications: its conservation status with cross‐species FVIII and homologous proteins, its putative location in known FVIII functional regions, and its spatial position in the available FVIII 3D structures. The usefulness of such a strategy in interpreting the causality of novel F8 mutations is emphasized. Hum Mutat 27(7), 676–685, 2006. © 2006 Wiley‐Liss, Inc.     

Prevalence of small rearrangements in the factor VIII gene F8C among patients with severe hemophilia A

Hemophilia A is a common X-linked bleeding disorder caused by various types of mutations in the factor VIII gene F8C. The most common intron 22-inversion is responsible for about 40% of the severe hemophilia A cases while large deletions, point mutations and small (less than 100 bp) deletions or insertions are responsible for the disease in the rest of patients. We report on nine novel (6 deletions, two indels and one partial duplication) and five recurrent small rearrangements identified in 15 German patients with severe hemophilia A, negative for the intron 22-inversion. c.2208-2214delTTATTAC/c.2207-2215insCTCTT and c.4665-4678del/c.4664-4678insAAGGAA identified in the present study are the first small indels described in the factor VIII gene. Our analyses suggest that the prevalence of this type of mutations (predominantly located in exon 14) among patients with severe phenotype and negative for the common intron 22-inversion, is about 30%. The correlation between these molecular defects and formation of factor VIII inhibitors as well as the parental origin of the de novo mutations are evaluated. Finally we show that denaturing HPLC (DHPLC) and classic heteroduplex analysis (HA) are able to detect these sequence alterations on 100% and could be preferred as a screening approach when analysing for mutations in factor VIII in severely affected patients.     

High throughput mutation screening of the factor VIII gene (F8C) in hemophilia A: 37 novel mutations and genotype-phenotype correlation

Hemophilia A (HEMA) is an X-linked bleeding disorder caused by mutations in the factor VIII gene (F8C). Molecular genetic testing for the factor VIII gene is challenging due to its large size. Here we present results of high throughput mutation scanning based on Southern blot analysis and direct sequencing of all PCR amplified coding exons and the exon-intron boundaries of the factor VIII gene. The results of mutation analysis on 89 hemophiliac males showed presence of a disease-causing mutation in 80 individuals (90%, 95% CI of 82%-95%). Seven out of nine mutation-negative individuals were severe cases of hemophilia A with < 1% factor VIII protein in the blood. The correlation of phenotype with genotype as observed in this study was not absolute. This finding is supported by similar observations in the international database for hemophilia A mutations (HAMSTeRS). This issue raises the importance of genotypes at other loci that can act as modifiers for the phenotype. Thirty-four novel mutations and three novel substitutions for previously reported amino acid residues were identified in this series of 80 mutations. The mutations cover the full spectrum including rearrangements, deletions, frameshift, and point mutations. The novel missense mutations require careful evaluation. Prediction of a mutation as the disease-causing allele was made from the nature of the substitution and the degree of conservation of the mutated amino acid among species that have diverged in evolution. In some cases segregation analysis of the mutation with disease condition was performed when other family members were available.     

血友病甲基因分析技术的改进及其在产前诊断中的应用

目的对血友病甲基因分析技术进行改进并应用于携带者检查和产前诊断。方法长距离聚合酶链反应方法直接检测凝血因子Ⅷ第22内含子倒位,对非倒位家系用FⅧ基因内限制酶切位点XbaⅠ、HindⅢ、二核苷酸重复序列多态性位点STR13和STR22,以及基因外可变数目串联重复序列DXS52(St14)位点进行基因连锁分析。结果52个家系共检出71位携带者。21个家系为第22内含子倒位,28个家系经连锁分析得到明确诊断,3个家系无法诊断,可诊断家系占94.2%。为18个家系做胎儿产前诊断,其中10例诊断为血友病甲胎儿;诊断7例正常男胎和1例携带者女胎,随访1年发育正常。结论应用长距离聚合酶链反应和多位点基因连锁分析技术可以快速有效地进行血友病甲携带者检查和产前诊断。     

Spectrum of molecular defects and mutation detection rate in patients with mild and moderate hemophilia A

The amount of residual F8 (FVIII:C) determines the clinical severity of hemophilia A. Recently, we showed that the mutation detection rate in severely affected male patients (FVIII:C<1% of normal) is virtually 100% when testing for the common intron 22-/intron 1- inversions and big deletions, followed by genomic sequencing of the F8 gene. Here we report on the spectrum of mutations and their distribution throughout the F8 gene sequence in 135 patients with moderate (n=23) or mild (n=112) hemophilia A. In contrast to the severe form of the disorder, analysis on the genomic level failed to detect the molecular defect in approximately 4% of the moderately and in approximately 12% of the mildly affected patients. A total of 36 of the mutations identified in this study are novel. The vast majority of the detected changes were missense. The newly detected amino acid substitutions were scored for potential distant or local conformational changes and influence on molecular stability for every single F8 domain with available structures, using homology modeling. Two molecular changes in the promoter region of the factor VIII gene (c.-112G>A and -219C>T), affecting the core segment (minimal promoter) were detected in two patients with mild hemophilia A. To our knowledge this is the first report on promoter mutations in the F8 gene.     

Identification of 217 unreported mutations in the F8 gene in a group of 1,410 unselected Italian patients with hemophilia A

To provide a National database, 1,410 unrelated hemophilia A (HA) patients were investigated using screening methods denaturing high-performance liquid chromatography (DHPLC), conformational-sensitive gel electrophoresis (CSGE)] and/or direct sequencing. F8 gene mutations were identified in 877 (81%), 146 (82%), and 133 (89%) families with severe, moderate, or mild HA, respectively. Among the 382 different mutations detected, 217 (57%) have not previously been reported in the F8 Haemophilia A Mutation, Structure, Test and Resource Site (HAMSTeRS) database. Mutations leading to a null allele accounted for 82, 15%, and less than 1% of severe, moderate, or mild HA, respectively. A missense mutation was identified in 16%, 68%, and 81% of severe, moderate, or mild HA, respectively. They included 105 missense mutations (48%), 41 small deletions (19%), 25 splice site mutations (12%), 24 nonsense mutations (11%), 18 insertions (8%), three large deletions (1%), and one deletion plus insertion. Unreported mutations were distributed throughout the F8 gene, as they affected all F8 exons but exon 20. We report a wide spectrum of mutations collected in a large National database. The type of mutation was a strong predictor of the clinical phenotype. This database is expected to considerably improve the genetic counseling and medical care of HA families in Italy.     

PCR-构象敏感凝胶电泳技术在血友病A基因分型诊断及携带者检测中的应用

所有的HA家系(含散发)进行直接基因诊断,理论上可筛查新突变并明确其突变类型.该法简便、快速、成本低,在HA直接基因诊断及携带者筛查中优势独特,应具重要应用价值.     

The identification and classification of 41 novel mutations in the factor VIII gene (F8C)

Hemophilia A is a bleeding disorder caused by a quantitative or qualitative deficiency in the coagulation factor VIII. Causative mutations are heterogeneous in nature and are distributed throughout the FVIII gene. With the exception of mutations that result in prematurely truncated protein, it has proved difficult to correlate mutation type/amino acid substitution with severity of disease. We have identified 81 mutations in 96 unrelated patients, all of whom have typed negative for the common IVS-22 inversion mutation. Forty-one of these mutations are not recorded on F8C gene mutation databases. We have analyzed these 41 mutations with regard to location, whether or not each is a cross-species conserved region, and type of substitution and correlated this information with the clinical severity of the disease. Our findings support the view that the phenotypic result of a mutation in the FVIII gene correlates more with the position of the amino acid change within the 3D structure of the protein than with the actual nature of the alteration.     

Spectrum of molecular defects and mutation detection rate in patients with severe hemophilia A

Hemophilia A is the most frequently occurring X-linked bleeding disorder, affecting one to two out of 10,000 males worldwide. Various types of mutations in the F8 gene are causative for this condition. It is well known that the most common mutation in severely affected patients is the intron 22 inversion, which accounts for about 45% of cases with F8 residual activity of less than 1%. Therefore, the aim of the present study was to determine the spectrum and distribution of mutations in the F8 gene in a large group of patients with severe hemophilia A who previously tested negative for the common intron 22 inversion. Here we report on a mutation analysis of 86 patients collected under the above-mentioned criterion. The pathogenic molecular defect was identified in all patients, and thus our detection rate was virtually 100%. Thirty-four of the identified mutations are described for the first time. The newly detected amino acid substitutions were scored for potential gross or local conformational changes and influence on molecular stability for every single F8 domain with available structures, using homology modeling.     

DXS52(St14)在血友病甲基因诊断中的方法改进及应用

目的 改进DXS52(St14)在血友病甲(hemophilia A,HA)基因连锁分析中的实验方法并应用于基因诊断,报道DXS52位点与FⅧ基因发生重组的2个家系.方法 采用PCR和琼脂糖凝胶电泳对61个非倒位HA家系的DXS52位点进行基因检测,并用FⅧ基因内的Bcl Ⅰ、HindⅢ、Xba Ⅰ、STRl、STRl3、STR22和STR24这7个位点以及DXS52位点对这61个家系进行基因连锁分析.结果 DXS52位点在43个HA家系中可提供信息,可诊断率为70.5%(43/61).其中8个家系仅DXS52单个位点能提供信息,占13.1%;两个家系的DXS52与FⅧ基因发生基因重组.结论 采用新的实验条件可使DXS52位点基因检测得到准确清晰的实验结果.该位点可诊断率高,目前是HA连锁基因分析中不可缺少的诊断位点,但该位点位于FⅧ基因外,与FⅧ基因间存在重组可能,单独应用于诊断时应谨慎.

Abstract：

Objective To improve the experimental method of DXS52 (St14) and apply it to genetic testing for hemophilia A (HA). Methods PCR of DXS52 and agarose gel electrophoresis were performed for genetic testing in 61 non-inversion HA families. Linkage analysis of 7 loci within the FⅧ gene including Bcl Ⅰ , Hind Ⅲ, Xba Ⅰ , STR1, STR13, STR22 and STR24 were also carried out for the 61 families.Results DXS52 can provide information in 43 out of 61 families and the diagnostic rate was 70. 5%. Eight families can be diagnosed only by DXS52 locus, accounting for 13. 1%. Two families were found to have recombination between DXS52 and FⅧ. Conclusion The new experimental conditions can reach accurate and clear results in DXS52 genetic testing. This gene maker has high diagnostic rate, so it is an indispensable linkage analysis method in HA gene diagnosis. More caution should be paid when using the extragenic locus DXS52 to perform gene diagnosis because of its high recombinant rate with FⅧ.