DMPK-associated myotonic dystrophy and CTG repeats in Alabama African Americans

Myotonic dystrophy type 1 (DM1) is a result of a CTG expansion in the 3'-untranslated region of the DMPK gene. DM1 is rare among African blacks who have fewer large CTG repeats in the normal range than other racial/ethnic groups. Neither the prevalence of DM1 nor the relationship of CTG expansion to clinical status in African Americans (AAs) is well documented. We describe two AA brothers with DM1, each of whom had CTG repeats of 5/639; their father was reported to have DM1 and had CTG repeats of 5/60. Other family members had CTG repeats of 5-14. An unrelated AA patient from a second kinship also had DM1; an analysis revealed CTG repeats of 27/191. In 161 Alabama AA control subjects, we observed 18 CTG alleles from 5 to 28 repeats; the most common allele had five CTG repeats. The frequency of CTG repeats >or=15 were greater (p < 0.0003) in Pygmy, Amhara Ethiopian, Ashkenazi Jewish, North African Jewish, Israeli Muslim Arab, European white, and Japanese populations than in the Alabama AA population. These data suggest that the risk for DM1 in AAs is intermediate between that of African blacks and whites of European descent.     

Increased (CTG/CAG)(n) lengths in myotonic dystrophy type 1 and Machado-Joseph disease genes in idiopathic azoospermia patients

BACKGROUND: An increase in CAG trinucleotide repeat length in the androgen receptor (AR) gene has been linked to idiopathic azoospermia. METHODS: In order to test whether other (CAG/CTG)(n) loci are also affected, the (CAG/CTG)(n) frequency distribution at myotonic dystrophy type 1 (DM1), Machado-Joseph disease (MJD), dentatorubral-pallidoluysian atrophy (DRPLA) and spinocerebellar ataxia type 8 (SCA8) loci, in addition to the AR gene, was investigated in 48 azoospermia patients and 47 controls. RESULTS: The median CAG repeat length in the AR gene was significantly longer in azoospermia patients than in controls (23 versus 21, P < 0.001). Significant differences were also noted in the upper tails of trinucleotide repeat length distributions at both DM1 and MJD loci between the two populations. At the DM1 locus, alleles of more than 18 repeats were observed only in azoospermia patients, and not in controls (P = 0.014). At the MJD locus, the frequency of normal alleles (ANs) with 29 or more CAG repeats was also much higher in azoospermia patients (29.2 versus 7.4%; P = 0.0001). However, the repeat length distribution at DRPLA and SCA8 loci did not differ in the two groups. CONCLUSIONS: These data indicated that, at least in a subset of azoospermia patients, there was an increase in the number of trinucleotide repeats in some disease loci. Thus, it is noteworthy to evaluate whether offspring of these azoospermia patients, if born by assisted reproductive technologies, have an increased risk of trinucleotide repeat diseases.     

Comparison of the myotonic dystrophy associated CTG repeat in European and Japanese populations.

Gene amplification using polymerase chain reaction (PCR) was carried out on DNA samples from a total of 92 normal subjects and 52 subjects with myotonic dystrophy (DM) from European and Japanese populations, to determine the copy number of the CTG repeat associated with DM for each group. In the two populations, the number of repeats on normal chromosomes only were compared, as CTG copy number on DM chromosomes was difficult to determine by PCR alone. In this study, normal chromosomes were found which had as many as 35 copies of the repeat, which is larger than the normal range reported previously but still does not overlap with the repeat number associated with DM pathology, which is at least 50 copies. Using data from normal chromosomes from unrelated subjects, the frequencies of five, 11, and 13 copies of the CTG repeat were found to be significantly different between the two populations, with five and 11 copies more commonly seen in the European population and 13 copies in the Japanese population. This difference may be the result of natural divergence of the normal chromosomes between the population groups.     

Genetic variation and evolutionary stability of the FMR1 CGG repeat in six closed human populations

In an attempt to understand the allelic diversity and mutability of the human FMR1 CGG repeat, we have analyzed the AGG substructure of this locus within six genetically-closed populations (Mbuti pygmy, Baka pygmy, R. surui, Karitiana, Mayan, and Hutterite). Most alleles (61/92 or 66%) possessed two AGG interspersions occurring with a periodicity of one AGG every nine or ten CGG repeats, indicating that this pattern is highly conserved in all human populations. Significant differences in allele distribution were observed among the populations for rare variants possessing fewer or more AGG interruptions than the canonical FMR1 CGG repeat sequence. Comparisons of expected heterozygosity of the FMR1 CGG repeat locus with 30 other microsatellite loci, demonstrated remarkably similar levels of polymorphism within each population, suggesting that most FMR1 CGG repeat alleles mutate at rates indistinguishable from other microsatellite loci. A single allele (1 out of 92) was identified with a large uninterrupted tract of pure repeats (42 pure CGG triplets). Retrospective pedigree analysis indicated that this allele had been transmitted unstably. Although such alleles mutate rapidly and likely represent evolving premutations, our analysis suggests that in spite of the estimated frequency of their occurrence, these unstable alleles do not significantly alter the expected heterozygosity of the FMR1 CGG repeat in the human population. © 1996 Wiley-Liss, Inc.     

Studies on the CTA/CTG trinucleotide repeats of ATXN8OS gene in Chinese Hans

OBJECTIVE: To study the normal range of (CTA/CTG)n repeats of ATXN8OS gene in Chinese Hans, and the frequency of ATXN8OS (CTA/CTG)n repeat expansion in spinocerebellar ataxia(SCA) patients in Mainland China. METHODS: The (CTA/CTG)n repeats of ATXN8OS gene were detected using fluorescence-PCR, 8% denaturing polyacrylamide gel and capillary electrophoresis technique in 132 SCA patients in whom CAG expansion at the SCA1, SCA2, SCA3, SCA6, SCA7, SCA12, SCA17 and dentatorubral-pallidoluysian atrophy(DRPLA) loci has been excluded, and 261 healthy controls. RESULTS: There were no obvious abnormal changes of the (CTA/CTG)n repeats of ATXN8OS gene in the 132 SCA patients. Thirty-five SCA patients were homozygotes (26.5%), and the range of CTA/CTG repeat number was 17 to 47 (24.20+/-4.57), among which 18 repeats appeared most frequently. In 261 normal controls, 70 were homozygotes (26.8%), and the range of the CTA/CTG repeat number was from 12 to 43 (24.04+/-4.53), among which 18 repeats was the most frequent. CONCLUSION: SCA8 is a rare subtype of SCA in Mainland China. The low prevalence of SCA8 seems to be correlated with the low frequency of large (CTA/CTG)n copy number alleles in Chinese population.     

中国汉族人群ATXN8OS基因CTA/CTG三核苷酸重复研究

目的 研究中国正常人群脊髓小脑性共济失调(spinocerebellar ataxia,SCA)8型(SCA8)致病基因ATXN8OS(CTA/CTG)n正常变异范围,以及AIXN8OS基因(CTA/CTG)n扩展突变在中国大陆SCA患者中的分布.方法 应用荧光PCR、8%变性聚丙烯酰胺凝胶电泳和毛细管凝胶电泳等方法对132例已经排除SCA1、SCA2、SCA3、SCA6、SCA7、SCA12、SCA17和齿状核红核苍白球路易体萎缩(dentatorubral-pallidoluysian atrophy,DRPLA)的SCA患者及261名正常汉族对照人群进行ATXN8OS基因三核苷酸重复次数分析.结果 未发现ATXN8OS基因(CTA/CTG)n核苷酸扩展突变;132例SCA患者中ATXN8OS基因(CTA/CTG)n变异范围为17～47次,平均重复次数(24.20+4.57)次,18次重复最常见,纯合子35例,纯合率为26.5%;261名正常对照人群ATXN8OS基因(CTA/CTG)n正常变异范围为12～43次,均重复次数(24.04+4.53)次,18次重复最常见,纯合子70人,纯合率为26.8%.结论 SCA8在中国大陆为罕见的SCA亚型,中国大陆SCA8发病率低可能和正常人群较大(CTA/CTG)n重复次数的等位基因少见有关.     

Ethnicity and myotonic dystrophy: a possible explanation for its absence in sub-Saharan Africa

The CTG trinucleotide repeat, in the myotonic dystrophy (DM) myotonin protein kinase gene, was studied by PCR analysis in a total of 246 unrelated South African Bantu-speaking Negroids, 116 San and 27 Pygmies. The size and distribution of the CTG repeat were determined and showed that the alleles ranged in length from 5 to 22 repeats. The most common CTG repeat is 5 (25% of chromosomes) in the South African Negroids but 11 (27 % of chromosomes) in the San population and 12 (22% of chromosomes) in the Pygmies. The southern African Bantu-speaking Negroids and San were found to have significantly fewer large repeat length alleles than do Caucasoid and Japanese populations. Since DM has not been observed in southern African Negroids, it is possible that the occurrence of fewer large CTG repeats in the normal range may, in part, explain this absence. It seems likely, that the rare DM mutation event postulated to have occurred on a specific chromosomal haplotype, occurred after the migration of humans from Africa.     

SCA8 CTG repeat: en masse contractions in sperm and intergenerational sequence changes may play a role in reduced penetrance

We recently described an untranslated CTG expansion that causes a previously undescribed form of spinocerebellar ataxia (SCA8). The SCA8 CTG repeat is preceded by a polymorphic but stable CTA tract, with the configuration (CTA)(1-21)(CTG)(n). The CTG portion of the repeat is elongated on pathogenic alleles, which nearly always change in size when transmitted from generation to generation. To better understand the reduced penetrance and maternal penetrance bias associated with SCA8 we analyzed the sequence configurations and instability patterns of the CTG repeat in affected and unaffected family members. In contrast to other triplet repeat diseases, expanded alleles found in affected SCA8 individuals can have either a pure uninterrupted CTG repeat tract or an allele with one or more CCG, CTA, CTC, CCA or CTT interruptions. Surprisingly, we found six different sequence configurations of the CTG repeat on expanded alleles in a seven generation family. In two instances duplication of CCG interruptions occurred over a single generation and in other instances duplications that had occurred in different branches of the family could be inferred. We also evaluated SCA8 instability in sperm samples from individuals with expansions ranging in size from 80 to 800 repeats in blood. Surprisingly the SCA8 repeat tract in sperm underwent contractions, with nearly all of the resulting expanded alleles having repeat lengths of <100 CTGs, a size that is not often associated with disease. These en masse repeat contractions in sperm likely underlie the reduced penetrance associated with paternal transmission.     

Absence of myotonic dystrophy in southern African Negroids is associated with a significantly lower number of CTG trinucleotide repeats.

Myotonic dystrophy (DM) is associated with an increased number of CTG repeats in the 3' untranslated region of the myotonin gene. Because DM has not been observed in southern African Negroids, a study of the CTG repeat polymorphism in this population was undertake. A total of 210 unrelated subjects was studied by PCR analysis of the trinucleotide repeat in the DM gene and the size and distribution of the CTG repeat were determined. The alleles ranged in length from five to 22 repeats. A previously undescribed BglI polymorphism was found which could lead to erroneous diagnosis of DM in people from this population. South African Negroids were found to have significantly fewer large repeat lengths than do white and Japanese populations. It is suggested that the occurrence of fewer large CTG repeats in the normal range may, in part, explain the absence of DM in southern African Negroids.     

实时定量PCR在强直性肌营养不良1型重复突变检测中的应用

目的 鉴定一个强直性肌营养不良(dystrophy myotonica,DM)家系的致病突变,探讨实时定量PCR能否用于检测导致DM1的CTG重复延展突变.方法 采集家系成员外周血,提取基因组DNA.针对DM1位点DMPK基因内的CTG重复区和DM2位点CNBP基因内的CCTG重复区进行普通PCR、实时荧光定量PCR、微卫星标记连锁分析.结果 CTG重复区普通PCR产物电泳显示患者特有大于2 kb的弥散带.定量PCR显示,患者CTG重复区相对拷贝数约为0.5,CCTG重复区相对拷贝数约为1.在DM1位点的微卫星标记,患者均有共享等位基因;而在DM2位点的大部分标记,患者没有共享等位基因.结论 此DM家系的致病突变是DM1位点的CTG重复延展突变;应用实时定量PCR可以确定高度重复延展片段扩增失败,从而推断重复延展突变的存在,达到快速检测DM1的目的.     

实时定量PCR在强直性肌营养不良1型重复突变检测中的应用

目的 鉴定一个强直性肌营养不良(dystrophy myotonica,DM)家系的致病突变,探讨实时定量PCR能否用于检测导致DM1的CTG重复延展突变.方法 采集家系成员外周血,提取基因组DNA.针对DM1位点DMPK基因内的CTG重复区和DM2位点CNBP基因内的CCTG重复区进行普通PCR、实时荧光定量PCR、微卫星标记连锁分析.结果 CTG重复区普通PCR产物电泳显示患者特有大于2 kb的弥散带.定量PCR显示,患者CTG重复区相对拷贝数约为0.5,CCTG重复区相对拷贝数约为1.在DM1位点的微卫星标记,患者均有共享等位基因;而在DM2位点的大部分标记,患者没有共享等位基因.结论 此DM家系的致病突变是DM1位点的CTG重复延展突变;应用实时定量PCR可以确定高度重复延展片段扩增失败,从而推断重复延展突变的存在,达到快速检测DM1的目的.     

实时定量PCR在强直性肌营养不良1型重复突变检测中的应用

目的 鉴定一个强直性肌营养不良(dystrophy myotonica,DM)家系的致病突变,探讨实时定量PCR能否用于检测导致DM1的CTG重复延展突变.方法 采集家系成员外周血,提取基因组DNA.针对DM1位点DMPK基因内的CTG重复区和DM2位点CNBP基因内的CCTG重复区进行普通PCR、实时荧光定量PCR、微卫星标记连锁分析.结果 CTG重复区普通PCR产物电泳显示患者特有大于2 kb的弥散带.定量PCR显示,患者CTG重复区相对拷贝数约为0.5,CCTG重复区相对拷贝数约为1.在DM1位点的微卫星标记,患者均有共享等位基因;而在DM2位点的大部分标记,患者没有共享等位基因.结论 此DM家系的致病突变是DM1位点的CTG重复延展突变;应用实时定量PCR可以确定高度重复延展片段扩增失败,从而推断重复延展突变的存在,达到快速检测DM1的目的.     

中国汉族人强直性肌营养不良基因CTG重复序列多态性的初步研究

强直性肌营养不良是由于ＭＴ－ＰＫ基因３＇非编码区ＣＴＧ三核苷酸重复序列的过度扩增。文献报道一般正常人ＣＴＧ的拷贝数为５～３５次，而患者在５０次以上，且有民族差异。目前尚无我国人群的资料。为了解中国汉族人群ＣＴＧ三核苷酸重复序列的分布情况，采用ＰＣＲ聚丙烯酰胺凝胶电泳和银染等技术，对成都地区１５９例正常汉族人该重复序列进行了分析，发现汉族与其它民族ＣＴＧ重复序列的拷贝数分布不尽相同，在分析的３１８条染色体中，共发现１４种等位基因，其中ＣＴＧ拷贝数以５的频率最高，占３９．３％，其余依次为１１拷贝（２０．７５％）、１２拷贝（１８．２４％）、１３拷贝（１１．３２％）及１０拷贝（４．０９）．拷贝数大于１４的等位基因很少，占４．０８％，拷贝数大于１９的等位基因更少，仅占０．９４％。此外拷贝数为６～９的等位基因很少，仅６拷贝和８拷贝的等位基因各一个。共发现纯合子４０例，其中：２６例５／５，６例１１／１１，５例１２／１２和３例１３／１３，杂合率为７４．８％，本系统的多态信息容量值为０．７６。     

Population genetics of trinucleotide repeat polymorphisms

Trinucleotide repeats at five disease loci (DM, DRPLA, HD, SBMAand SCA1) were surveyed in phenotypically normal individualsfrom three continental populations. This is the first analysisto examine the population dynamics of these five disease-relatedtrinucieotide repeats in the same individuals from worldwidepopulations. Roughly half of all alleles observed at each locusare shared between all continental groups. For three loci, diseaseprevalence in each population corresponds with the number ofalleles in the upper tail of the allele-size distribution. Theallele-size distributions of African, Asian and Caucasian groupsshow a high degree of variation, and gene diversity estimatesfor trinucieotide repeat loci exceed estimates derived fromdinucleotide or tetranucleotide repeats. Analyses that comparedinfinite alleles and stepwise mutation models suggest that normalvariation at trinucieotide loci is not generated by stepwisemutation alone. Trees constructed for subpopulations using trinucieotiderepeat loci show accurate continental clustering. Interpopu-lationgenetic distance estimates show remarkable similarity to distanceestimates produced from tetranucleotide repeats or nuclear restrictionsite polymorphisms. This finding is especially noteworthy inlight of the fact that trinucieotide repeat polymorphisms atthese loci can cause disease, while restriction site and tetranucleotidepolymorphisms appear to be selectively neutral. In contrast,genetic distance estimates from trinucieotide loci are poorlycorrelated with genetic distance estimates from mitochondrialsequence data.     

Long repeat tracts at SCA8 in major psychosis

Expansion at a recently identified unstable trinucleotide repeat on chromosome 13q21 has been reported as the molecular cause for spinocerebellar ataxia type 8 (SCA8). The trinucleotide repeat, which consists of a [CTA]n repeat and adjacent [CTG]n repeat, was reported to have a pathogenic range of 107-127 CTG repeats (or 110-130 combined CTA and CTG repeats) in a large ataxia kindred. This repeat region was also cloned by our group from a bipolar affective disorder (BPAD) patient, who has approximately 600 combined repeats, and large alleles (>100 repeats) were reported to be present in 0.7% of controls and 1.5% of major psychosis patients (n = 710 and n = 1,120, respectively). We have followed up these findings by screening three new samples of BPAD and schizophrenia (SCZ) patients and controls, including 272 individuals from 14 BPAD families from Sweden, 130 individuals from 32 SCZ and BPAD families/trios from the Azores Islands, and 206 SCZ individuals from the United Kingdom and Ireland, and 219 matched controls. We found large repeat alleles above the SCA8 pathogenic range in individuals from 3 of 32 Azorean pedigrees and in 1 of 206 SCZ individuals from the United Kingdom, and repeat alleles within the SCA8 pathogenic range in 1 of 14 Swedish families. Although the rarity of major psychosis patients carrying the SCA8 expansion mutation would require a much larger sample size to reach statistical significance, these results support the previously reported observation of increased occurrence of large repeats at SCA8 in major psychosis. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:873-876, 2000.     

French myotonic dystrophy families show expansion of a CTG repeat in complete linkage disequilibrium with an intragenic 1 kb insertion.

The molecular basis of myotonic dystrophy (DM) has been characterised. All DM mutations characterised to date appear as an unstable elongation of a fragment containing a tandem repeat of a CTG motif, which can be visualised in both EcoRI and BamHI digests. It has been shown that the fragment is polymorphic in the normal population. Another 1 kb insertion/deletion polymorphism located near the unstable CTG repeat region has been identified. The 1 kb insertion allele is present in all DM patients. These different polymorphic systems can be distinguished using cDNA25 and BamHI, because this enzyme cuts between the site of the 1 kb insertion and the CTG repeat. We thus haplotyped DM patients from 72 French families and clearly showed that all chromosomes (100%) with the DM mutation carried the 1 kb insertion as well. In addition to this association, we detected significant linkage disequilibrium between the DM locus and D19S63 for which allelic frequencies were different from other European populations. Our results in the French DM population are thus in agreement with the hypothesis that the CTG expansion occurred on one or a few ancestral chromosomes carrying the large 1 kb insertion allele.     

Eleven trinucleotide repeat loci that map to chromosome 12 excluded from involvement in the pathogenesis of bipolar disorder

The hypothesis that one or more genes containing expanded trinucleotide repeats contribute to the pathogenesis of bipolar disorder has received support from three independent studies demonstrating that bipolar patients tend to have larger CAG/CTG repeat expansion detection products than controls. In an attempt to identify the specific expanded CAG/CTG locus or loci which are associated with bipolar disorder, we determined repeat size at CAG/CTG loci mapping to candidate regions for bipolar disorder. Recent linkage studies suggest the existence of a bipolar susceptibility gene on chromosome 12q23-q24.1 in the region of the Darier's disease (DAR) gene. In this study we report our findings from 11 loci which map to chromosome 12, including CAG repeat polymorphisms within the genes SCA2 and ASH1. We conclude that all of these loci are excluded as candidates for CAG/CTG repeat expansion in bipolar disorder.     

"Mitotic drive" of expanded CTG repeats in myotonic dystrophy type 1 (DM1)

In myotonic dystrophy type 1 (DM1), an expanded CTG repeat shows repeat size instability in somatic and germ line tissues with a strong bias toward further expansion. To investigate the mechanism of this expansion bias, 29 DM1 and six normal lymphoblastoid cell lines (LBCLs) were single-cell cloned from blood cells of 18 DM1 patients and six normal subjects. In all 29 cell lines, the expanded CTG repeat alleles gradually shifted toward further expansion by "step-wise" mutations. Of these 29 cell lines, eight yielded a rapidly proliferating mutant with a gain of large repeat size that became the major allele population, eventually replacing the progenitor allele population. By mixing cell lines with different repeat expansions, we found that cells with larger CTG repeat expansion had a growth advantage over those with smaller expansions in culture. This growth advantage was attributable to increased cell proliferation mediated by Erk1,2 activation, which is negatively regulated by p21(WAF1). This phenomenon, which we designated "mitotic drive" , is a novel mechanism which can explain the expansion bias of DM1 CTG repeat instability at the tissue level, on a basis independent of the DNA-based expansion models. The lifespans of the DM1 LBCLs were significantly shorter than normal cell lines. Thus, we propose a hypothesis that DM1 LBCLs drive themselves to extinction through a process related to increased proliferation.     

Haplotype analysis of the myotonic dystrophy type 1 (DM1) locus in Taiwan: implications for low prevalence and founder mutations of Taiwanese myotonic dystrophy type 1

Myotonic dystrophy type 1 (DM1) is an autosomal dominant neuromuscular disorder caused by a CTG trinucleotide expansion at the DM1 locus. In this study, we investigated the frequency distribution of various CTG repeats in normal alleles and haplotyped the normal and expanded DM1 locus in a group of Taiwanese people. In the 496 normal chromosomes examined, up to 18 alleles with different CTG lengths from 5 to 30 repeats were found and the frequency of (CTG)(>18) alleles was only 1.4% (7/496), predicting a low prevalence of DM1. In addition, there is no absolute association between (CTG)(5-19) alleles and Alu insertion/deletion polymorphism observed on normal chromosomes. All DM1 alleles examined, however, were found to be associated with the Alu insertion. Further detailed genetic analysis demonstrated that at least eight haplotypes, including a new haplotype (L), were present in the Taiwanese population and that all DM1 alleles were with the same haplotype (haplotype A) as that identified in Canadian and Japanese DM1 populations. These findings support the notion that the out-of-Africa DM1 alleles were originated by stepwise expansion from a pool of large-sized normal chromosomes with haplotype A.     

Transmission ratio distortion in the myotonic dystrophy locus in human preimplantation embryos

One form of myotonic dystrophy, dystrophia myotonica 1 (DM1), is caused by the expansion of a (CTG)(n) repeat within the dystrophia myotonica-protein kinase (DMPK) gene located in chromosome region 19q13.3. Unaffected individuals carry alleles with repeat size (CTG)(5-37), premutation carriers (CTG)(38-49) and DM1 affected individuals (CTG)(50-6,000). Preferential transmission both of expanded repeats from DM1-affected parents and larger DMPK alleles in the normal-size range have been reported in live-born offspring. To determine the moment in development when transmission ratio distortion (TRD) for larger normal-size DMPK alleles is generated, the transmission from heterozygous parents with one repeat within the (CTG)(5-18) range (Group I repeat) and the other within the (CTG)(19-37) range (Group II repeat) to human preimplantation embryos was analysed. A statistically significant TRD of 59% (95% confidence interval of 54-64) in favour of Group II repeats from both mothers and fathers was observed in preimplantation embryos, which remained significant when female embryos were considered separately. In contrast, no significant TRD was detected for repeats from informative Group I/Group I parents. Our analysis showed that Group II repeats specifically were preferentially transmitted in human preimplantation embryos. We suggest that TRD, in Group II repeats at the DMPK locus, is likely to result from events occurring at or around the time of fertilisation.