The present invention relates to genetic diagnosis of intellectual disability. In particular, the present invention relates to a genetic marker associated with intellectually disabled individuals and methods and kits for use of these markers.
Intellectual disability, also called mental retardation, is a devastating neurodevelopmental disorder with serious impact on the affected individuals and their families, as well as on health and social services. It is believed to occur with a prevalence of approximately 1-3% within the population, and is frequently the result of genetic aberrations. Intellectual disability may present as the sole clinical feature (non-syndromic), or may be present with additional clinical or dysmorphological features (syndromic). Intellectual disability is significantly more frequent in males than in females and it had been assumed that approximately 25% of severe cases were X-linked. A recent review, however, suggests that X-linked mutations contribute to no more than 10% of cases (Ropers, H. H. and Hamel, B. C. Nat Rev Genet 2005 6:46-57). Little is known about autosomal non-syndromic forms of intellectual disability.
Autosomal recessive forms of non-syndromic intellectual disability are believed to be more common. To date, 6 autosomal recessive genes for non-syndromic forms of intellectual disability have been reported.
A locus was identified as harboring a gene for non-syndromic autosomal recessive mental retardation in 78 consanguineous Iranian families (Najmabadi et al. Hum Genet 2007; 121:43-48). No causative gene was reported.
A number of additional loci have also been mapped.
The present invention relates to identification of a gene in human chromosomal locus 5p15.32-p15.31 associated with intellectual disability.
Thus, an aspect of the present invention relates to identification of mutations in the NSUN2 gene located at chromosomal locus 5p15.32-p15.31 associated with intellectual disability.
In one embodiment, the present invention relates to a point mutation in exon 19 of the NSUN2 gene resulting in a missense mutation in the encoded protein associated with intellectual disability.
In one embodiment, the present invention relates to a homozygous base substitution exon 19 of the NSUN2 gene resulting in a missense mutation in the encoded protein associated with intellectual disability.
In one embodiment, the present invention relates to a homozygous G>A substitution (see SEQ ID NO:1 and 2 and
In one embodiment, the present invention relates to a missense mutation Gly679Arg (see SEQ ID NO:3 and 4 and
Another aspect of the present invention relates to isolated polynucleotides and polypeptides encoded thereby comprising a genetic marker for intellectual disability.
In one embodiment, the marker is the NSUN2 gene located at chromosomal locus 5p15.32-p15.31.
In one embodiment, the marker is exon 19 of the NSUN2 gene located at chromosomal locus 5p15.32-p15.31.
In one embodiment, the marker is a homozygous G>A substitution (see SEQ ID NO: 1 and 2 and
In one embodiment, the marker is a missense mutation Gly679Arg (see SEQ ID NO: 3 and 4 and
Another aspect of the present invention relates to a method of screening an individual for a genetic marker associated with intellectual disability.
In one embodiment, the method comprises analyzing exon 19 of the NSUN2 gene located at chromosomal locus 5p15.32-p15.31 in an individual for a mutation.
In one embodiment, the method comprises analyzing an individual for a homozygous G>A substitution (see SEQ ID NO:1 and 2 and
In one embodiment, the method comprises analyzing an individual for a missense mutation Gly679Arg (see SEQ ID NO:3 and 4 and
Another aspect of the present invention relates to compositions and kits useful in these screening methods.
Another aspect of the present invention relates to a method of genetically diagnosing intellectual disability in an individual.
Another aspect of the present invention relates to compositions and kits useful in methods of genetically diagnosing intellectual disability in an individual.
Another aspect of the present invention relates to a method for identifying individuals predisposed genetically to offspring suffering from intellectual disability.
Another aspect of the present invention relates to compositions and kits useful in methods for identifying individuals predisposed genetically to offspring suffering from intellectual disability.
Other and further objects, features, and advantages will be apparent and readily understood by reading the following specification and by reference to the accompanying drawings forming a part thereof, or any examples of the presently preferred embodiments of the invention given for the purpose of the disclosure.
A gene has now been identified on the human chromosomal locus 5p15.32-p15.31, associated with intellectual disability. The present invention provides genetic markers for intellectual disability related to this gene comprising isolated polynucleotides and polypeptides encoded thereby, as well as methods, compositions and kits for genetically diagnosing intellectual disability in an individual and identifying individuals predisposed genetically to offspring suffering from intellectual disability.
In particular, a polymorphism associated with intellectual disability has now been identified in exon 19 of the NSUN2 gene. The polymorphism corresponds to nucleotide position 2035 from the translation start site in the mRNA of GENBANK sequence accession no. AK291144 (also depicted herein as nucleotide 2099 of SEQ ID NO:1 and
The single nucleotide polymorphism of the present invention was identified in a consanguineous family from Pakistan multiplex with non-syndromic intellectual disability. Pedigree analysis as depicted in
Microarray analysis using Affymetrix 250K NspI arrays was performed on affected family members. A 2.7 Mb region was identified on 5p15.32-p15.31 with a continuous run of 798 single nucleotide polymorphisms homozygous common among all affecteds in the family.
Homozygosity mapper analysis of the microarray single nucleotide polymorphism data is depicted in
Additional genotype data from microsatellite markers on 5p verified findings from the microarray analysis. Two-point linkage analysis produced a lod score of 2.77. These data are depicted in Table 1.
Physical position was selected according to UCSC February 2009 (GRCh37/hg19) assembly. For reference, the common homozygosity-by-descent locus for the Pakistani family and for the Iranian family M192 studied by Najmabadi et al. (Hum Genet 2007; 121:43-48) extends from single nucleotide polymorphisms rs1824938 (5.092 Mb) to rs2914296 (7.658 Mb). NSUN2 is located between 6.599 and 6.633 Mb (see
All known coding genes within this region were screened for mutations by sequencing. A homozygous G>A base substitution at nucleotide position 2035 (from the translation start site in mRNA of GENBANK sequence accession no. AK291144) was detected within exon 19 of the gene NSUN2, one of 8 known genes within this locus. To the best of the inventors' knowledge, this substitution is not a known single nucleotide polymorphism in any single nucleotide polymorphism database. Further, this mutation was not present in over 400 chromosomes from Pakistani control individuals.
A 250 bp insertion just following exon 9 was also identified. However, after genotyping Pakistani controls, it was apparent that this is a relatively common polymorphism.
NSUN2 encodes a methyltransferase that catalyzes the intron-dependent formation of 5-methylcytosine at C34 of tRNA-leu(CAA) (Brzezicha et al. Nucleic Acids Res 2006 34:6034-6043). It also functions in spindle assembly during mitosis as well as chromosome segregation (Hussain et al. J Cell Biol 2009 186:27-40).
The homozygous G>A base substitution at nucleotide position 2035 results in a missense mutation, Gly679Arg in the encoded amino acid sequence. This amino acid residue appears to be conserved across the animal and plant kingdoms. The Gly679Arg substitution does not appear to be known single nucleotide polymorphism and to the best of the inventor's knowledge has not been identified to date in any databases for single nucleotide polymorphisms. The Gly679Arg substitution was also not present in over 400 chromosomes from Pakistani control individuals.
The NSUN2 protein carrying the Gly679Arg missense mutation was found to function incorrectly when transfected into cells thus establishing a distinct cellular phenotype for this missense mutation from wild type NSUN2 (WT NSUN2). While the wild type construct correctly localized to the nucleolus, the correct cellular location for NSUN2 protein, the Gly679Arg mutant NSUN2 was excluded from the nucleolus.
In these studies, a cDNA clone for NSUN2 in the vector pcDNA-Myc, site-directed mutagenesis was used to re-create the 2035 G>A/Gly679Arg mutation. Wild type (WT) and mutant constructs were transfected into the human breast cancer cell line HCC1954, and also into COST (monkey kidney) cells. Twenty-four hours later cells were stained with antibodies to the Myc epitope in order to detect transfected proteins. While the WT NSUN2 protein was detected in the nucleus and nucleolus of transfected HCC1954 cells (
In addition, antibodies to the nucleolar marker protein, nucleophosmin (NPM1) were used to confirm co-localization in the nucleoli (
A co-staining with the proliferating cell nuclear antigen (PCNA) was used determine that the transfected cells displaying normal localization of the Gly679Arg mutant were not S-phase cells. When cells are fixed and extracted in methanol/acetone, S-phase cells are marked by a distinctively speckled staining of PCNA. However, as shown in
In transfected COS7 cells, overexpressed WT NSUN2 localized to the nucleus and nucleoli and was always excluded from the cytoplasm. In contrast, the Gly679Arg mutant, localised to the cytoplasm in most of these cells and was excluded from the nucleoli and nucleus. Thus, exclusion of the Gly679Arg mutant to the cytoplasm in these cells may be a species-specific effect. It was also observed that the mutant could still localise to the nucleoli in some cells during S-phase (see
In parallel, cDNA constructs for WT and mutant were generated in pcDNA with GFP tag, and transfected into HeLa (human cervical cancer) cells, and into the human endothelial cell line EA.hy 926 (from umbilical vein). In transfected HeLa cells, after 24 hours plus a 2-3 hour incubation with colcemid (0.6 μg/ml of medium) a similar similar localization pattern to HCC1954 for WT and mutant was observed, with 34% GFP signal for mutant NSUN2 cells from the cytoplasm compared to 5% for WT, and exclusion of mutant NSUN2 from the nucleoli. Also, in EA.hy 926 cells WT NSUN2-GFP colocalized with the nucleophosmin 1 antibody (Santa Cruz) in the nucleoli, whereas the Gly679Arg mutant NSUN2-GFP remained in the nucleoplasm.
Accordingly, the present invention provides isolated polynucleotides and polypeptides encoded thereby useful as genetic markers for intellectual disability.
By “polynucleotide” it is meant to refer to any polymeric form of nucleotides and includes both sense and antisense strands of RNA, cDNA, genomic DNA, and synthetic forms and mixed polymers of the above. “Polynucleotide” as used herein is synonymous with “nucleic acid” and “nucleic acid molecule.” The term “polynucleotide” usually refers to a molecule of at least 10 bases in length, unless otherwise specified. The term includes single and double stranded forms of DNA. In addition, a polynucleotide may include either or both naturally occurring and modified nucleotides linked together by naturally occurring and/or non-naturally occurring nucleotide linkages.
In one embodiment of the present invention, the isolated polynucleotide comprises a mutant NSUN2 gene. The terms “mutant”, “mutated”, or “mutation” when applied to polynucleotides mean that nucleotides in the polynucleotide may be inserted, deleted or changed compared to a reference nucleic acid sequence. A single alteration may be made at a locus (a point mutation) or multiple nucleotides may be inserted, deleted or changed at a single locus. In addition, one or more alterations may be made at any number of loci within the polynucleotides. In the present invention, the reference nucleic acid sequence is the wild type NSUN2 gene. Wild-type NSUN2 is disclosed in, for example, GENBANK sequence accession No. AK291144, SEQ ID NO:1 which is depicted herein in
“Stringent hybridization conditions” and “stringent wash conditions” in the context of selective hybridization of polynucleotides of the present invention depends upon a number of different physical parameters. Important parameters include temperature of hybridization, base composition of the nucleic acids, salt concentration and length of the nucleic acid. Those of ordinary skill in the art understand how to vary these parameters to achieve a particular stringency of hybridization. In general, “stringent hybridization” is performed at about 25° C. below the thermal melting point (Tm) for the specific DNA hybrid under a particular set of conditions. “Stringent washing” is performed at temperatures about 5° C. lower than the Tm for the specific DNA hybrid under a particular set of conditions. The Tm is the temperature at which 50% of the target sequence hybridizes to a perfectly matched probe. See, e.g., Sambrook et al., Molecular Cloning: A Laboratory Manual, 2d ed., Cold Spring Harbor Laboratory Press (1989) and Sambrook et al., Molecular Cloning: A Laboratory Manual, 3d ed., Cold Spring Harbor Press (2001).
The Tm for a particular DNA-DNA hybrid can be estimated by the formula:
T
m=81.5° C.+16.6(log10[Na+])+0.41(fraction G+C)−0.63(% formamide)−(600/l) where l is the length of the hybrid in base pairs.
The Tm for a particular RNA-RNA hybrid can be estimated by the formula:
T
m=79.8° C.+18.5(log10[Na+])+0.58(fraction G+C)+11.8(fraction G+C)2−0.35(% formamide)−(820/l).
The Tm for a particular RNA-DNA hybrid can be estimated by the formula:
T
m=79.8° C.+18.5(log10[Na+])+0.58(fraction G+C)+11.8(fraction G+C)2−0.50(% formamide)−(820/l).
In general, the Tm decreases by 1-1.5° C. for each 1% of mismatch between two nucleic acid sequences. Thus, one of ordinary skill in the art can alter hybridization and/or washing conditions to obtain sequences that have higher or lower degrees of sequence identity to the target nucleic acid. For instance, to obtain hybridizing nucleic acids that contain up to 10 mismatch from the target nucleic acid sequence, 10-15° C. would be subtracted from the calculated Tm of a perfectly matched hybrid, and then the hybridization and washing temperatures adjusted accordingly. Probe sequences may also hybridize specifically to duplex DNA under certain conditions to form triplex or other higher order DNA complexes. The preparation of such probes and suitable hybridization conditions are well known in the art.
Further, various methods to detect mutations in a nucleic acid sequence have been described and can be adapted routinely by those skilled in the art to detect additional mutations in the NSUN2 gene to those exemplified herein associated with intellectual disability. For example, but without limitation, mutations can be detected by primer extension, polymerase chain reaction (including long-range PCR) sequencing, single stranded conformation polymorphism, mismatch oligonucleotide mutation detection, mass spectroscopy, DNA microarray, HPLC, microarray, SNP PCR genotyping, or a combination thereof. Methods involving allele-specific probes for analyzing particular nucleotide sequences such as described by Saiki et al., Nature 324, 163-166 (1986) can also be used. Particular nucleic acid mutations can also be identified by hybridization to oligonucleotide arrays or subarrays such as described in WO 95/11995. Methods for determining the identity of the nucleotide present at a particular site that employs a specialized exonuclease-resistant nucleotide derivative can also be used. Solution-based methods for determining the identity of the nucleotide of a particular site such as described in U.S. Pat. No. 4,420,902 can also be used. Additional methods for detection of the nucleic acid genetic markers of the present invention include, but are not limited to Genetic Bit Analysis or GBA™, Oligonucleotide Ligation Assay or OLA, nucleic acid detection assays combining PCR and OLA, and primer-guided nucleotide incorporation procedures for assaying particular sites in DNA.
In one embodiment, the isolated polynucleotides of the present invention can be used in the development of hybridization probes to detect, characterize, and quantify hybridizing nucleic acids in, and isolate hybridizing nucleic acids from, both genomic and transcript-derived nucleic acid samples. Probes may be detectably labeled, particularly when used free in solution, or may be unlabeled, particularly when bound to a substrate, as in a microarray. Such probes can be used to detect and characterize alterations in the NSUN2 gene associated with intellectual disability.
The isolated polynucleotides of the present invention are also useful in the development of amplification primers.
In general, a probe or primer is at least 10 to 22 nucleotides in length. Primers and probes may also be longer in length. For instance, a probe or primer may be 25 nucleotides in length, or may be 30, 40 or 50 nucleotides in length. Nonlimiting examples of PCR primers of the present invention used for mutation screening of the NSUN2 gene are depicted in Table 2.
All amplicons amplified at 59 annealing temperature except for exons 1 and 2, for which a Q-solution (Qiagen, Mississauga, Ontario, Calif.) protocol was used.
Methods of performing nucleic acid hybridization using probes and methods of performing primer-directed amplification via, for example, PCR or RT-PCR are well known in the art.
PCR and hybridization methods may be used to identify and/or isolate polynucleotides of the present invention including allelic variants, homologous nucleic acid molecules and fragments. PCR and hybridization methods may also be used to identify, amplify and/or isolate polynucleotides of the present invention that encode homologous proteins. Nucleic acid primers as described herein can be used to prime amplification of polynucleotides of the present invention, using transcript-derived or genomic DNA as template.
The present invention also provides polypeptides as genetic markers of intellectual disability. The polypeptide is a mutant polypeptide as compared to the protein encoded by wild type NSUN2 gene. The term “mutant”, “mutated” or “mutation” when referring to a polypeptide of the present invention relates to an amino acid sequence containing substitutions, insertions or deletions of one or more amino acids compared to the amino acid sequence encoded by NSUN2 gene. In one embodiment, the isolated polypeptide of the present invention comprises an amino acid sequence mutated as compared to the amino acid sequence of SEQ ID NO:3 depicted in
The present invention also provides methods for screening an individual for a genetic marker associated with intellectual disability. In this method, a sample obtained from the individual is assayed for the presence of a genetic marker of the present invention. Presence of the genetic marker in the individual indicates that the individual has a gene sequence associated with intellectual disability. In one embodiment of this method, a sample comprising DNA or RNA is obtained from the individual and the sample is assayed for mutations in the NSUN2 gene indicative of intellectual disability. In another embodiment, a sample comprising proteins is obtained from the individual and the sample is tested for the presence of a mutant polypeptide as compared to the protein encoded by wild type NSUN2 gene. Presence of mutant polypeptide may be detected as a change in subcellular localization, level, activity and/or structure as compared to protein encoded by wild type NSUN2 gene.
The present invention also provides methods for genetically diagnosing intellectual disability in an individual by detecting in the individual a genetic marker of the present invention. In one embodiment of this method, a sample comprising DNA or RNA is obtained from the individual and the sample is assayed for mutations in the NSUN2 gene indicative of intellectual disability. In another embodiment, a sample comprising proteins is obtained from the individual and the sample is tested for the presence of a mutant polypeptide as compared to the protein encoded by wild type NSUN2 gene. Presence of mutant polypeptide may be detected as a change in subcellular localization, level, activity and/or structure as compared to protein encoded by wild type NSUN2 gene.
The present invention also provides methods for identifying individuals predisposed genetically to offspring suffering from intellectual disability by detection of these genetic markers. As intellectual disability is a recessive trait, carriers are heterozygous for a mutant NSUN2 gene. Mating of two carriers results in a one in four chance that the offspring will by homozygous for a mutant NSUN2 gene and intellectually disabled. Carrier status is detected by obtaining a sample comprising DNA from an individual and sequencing the DNA in the sample.
Samples obtained from an individual which can be analyzed in accordance with these methods may comprise any tissue or biological fluid sample from which DNA, RNA and/or proteins can be obtained. Examples include, but are in no way limited to, blood, plasma, serum, hair follicle cells, skin cells, cheek cells, saliva cells, tissue biopsy, and the like. In one embodiment, the sample is blood or serum.
Various methods and reagents for detection of nucleic acid sequences have been described and can be adapted routinely by those skilled in the art for detection of the genetic markers described herein. Examples include, but are in no way limited to, hybridization assays, nucleotide sequencing, PCR, and combinations thereof. mRNA expression can also be measured by, for example, Northern blot, quantitative or qualitative reverse transcriptase PCR (RT-PCR), microarray, dot or slot blots and in situ hybridization.
Various methods and reagents for detection of proteins have also been described and can be adapted routinely by those skilled in the art for detection of the genetic markers described herein. Examples of methods for determining altered levels of polypeptide expression include, but are not limited to, radioimmunoassays, competitive-binding assays, ELISA, Western blot, FACS, immunohistochemistry, immunoprecipitation, proteomic approaches: two-dimensional gel electrophoresis (2D electrophoresis) and non-gel-based approaches such as mass spectrometry or protein interaction profiling. Alterations in the structure of a polypeptide encoded by a mutant NSUN2 gene may be determined by any method known in the art, including, but not limited to use of antibodies that specifically recognize a mutated residue, two-dimensional polyacrylamide gel electrophoresis (2D PAGE) and/or chemical analysis of amino acid residues of the protein.
Identification of mutations in the NSUN2 gene and/or the polypeptide encoded thereby is expected to lead to identification of proteins with a unique structure, protein subcellular localization, biochemical processing and/or function. This information can be used to directly or indirectly to facilitate the generation of therapeutics and additional diagnostics for intellectual disability. Specifically, the polynucleotides and polypeptides of the present invention may enable the production of antibodies or compounds directed against the novel region for use as a therapeutic or diagnostic. Alternatively, the polynucleotides and polypeptides of the present invention may alter the biochemical or biological properties of the encoded protein in such a way as to enable the generation of improved or different therapeutics targeting this protein. One may determine whether polypeptides of the present invention are functional by methods known in the art. For example, residues that are tolerant of change while retaining function can be identified by altering the polypeptide at known residues using methods known in the art, such as alanine scanning mutagenesis (Cunningham et al. 1989 Science 244(4908):1081-5), transposon linker scanning mutagenesis (Chen et al. Gene 2001 263(1-2): 39-48); combinations of homolog- and alanine-scanning mutagenesis (Jin et al. J. Mol. Biol. 1992 226(3):851-65) and/or combinatorial alanine scanning (Weiss et al. Proc. Natl. Acad. Sci USA 2000 97(16):8950-4), followed by functional assay.
The present invention also provides for kits for screening individuals for a genetic marker of intellectual disability, genetically diagnosing intellectual disability and/or identifying individuals predisposed genetically to offspring suffering from intellectual disability. Any of the means described herein for identification of a mutation in NSUN2 may be comprised in a kit. In a non-limiting example, a probe or primer, control nucleic acid (including wildtype NSUN2), and amplification reagents may be comprised in a kit in suitable container means. The components of the kits may be packaged either in aqueous media or, for example, in lyophilized form. The kits may further comprise at least one vial, test tube, flask, bottle, syringe and/or other container means, into which a component may be placed. Where there is more than one component in the kit, the kit may further comprise additional containers into which the additional components may be separately placed. Kits of the present invention will also typically comprise written instructions for their use. Kits of the present invention may also comprise a means for containing the components of the kit in close confinement for commercial sale and/or storage.
The following nonlimiting examples are provided to further illustrate the present invention.
The family ascertained in this study is from a farming community in the district of Khairpur, within the province of Sindh in Pakistan. The pedigree structure indicates a high degree of consanguinity (see
Neurological assessment was performed by a consultant neurologist. Clinical examination of affected individuals revealed that motor development was delayed, occipito-frontal circumferences were within the normal range and facial appearances were normal. There were no dysmorphic features, no hepatosplenomegaly, no heart murmur, and no skin abnormalities. Computed tomography of the brain was performed for two affected individuals, which was generally normal. Affected individuals had normal ventricles and cerebral volume. Gray and white matter differentiation was preserved, and posterior fossa was unremarkable.
Photographs of all affected individuals were assessed for dysmorphic features by an experienced clinical geneticist. No unusual facial features were apparent.
Case 1: A 13 year old girl from Khairpur district, Sindh province (Pakistan) presented with a history of developmental delay, poor cognitive development and aggressive behavior. Her antenatal history is unclear but the mother did not recall any undue complications no ultrasounds were done antenatally. She was born at full term at home via spontaneous vertex delivery. There was apparently no complication noted during or after the time of delivery. Although the mother did not remember the exact milestones, she walked late at around 4 years of age, her speech developed a few years after she started to walk and even at 13 years she could not speak clearly and does not recall her name when asked. She was toilet trained and was able to feed herself, dress and undress by herself, however she was not able to help with daily household chores. She had no history of seizures or loss of consciousness.
Her parents had a consanguineous marriage and were first cousins. She had 6 siblings, 3 males and 3 females. Two of her female siblings had similar issues of delayed and poor cognition and development (see below). There was a strong family history, with one of her male cousins (maternal uncle's son) who also had intellectual disability. The remaining siblings were normal. There was no history of any abortions or still births in the mother.
On examination, her weight was 26.3 kg (<5% tile) and height was 136 cms (<5% centile), and head circumference was 49 cm. Facial features were described as long facies, long pointed nose, pointed chin and wide mouth. She had mild webbing of the neck. She was at Tanner stage 4 and had started her menstruation very recently.
Neurological exam showed that she was alert, was oriented in space and person, and a little shy in her demeanor. Her speech was dysarthric. Her gait was broad based, and she had bilateral pes cavus with some equinus position of both her feet. Her Achilles was tight bilaterally. Her tone was increased in all her limbs and reflexes were brisk. Planters were equivocal. Her cranial nerves were intact. She had normal pupillary response to light, her eye movements were equal in all directions and her face was symmetrical. She had a good gag reflex. Her fundoscopy showed a normal disc. Coordination and sensory exam was grossly normal. Her cardiovascular, respiratory and abdominal exam was normal.
Case 2: A 14 year old girl, who is the older sister of Case 1, was also developmentally delayed and had poor cognitive development. She is the first born and apparently the mother did not notice anything unusual during the antenatal period. She was born full term at home, but cried a little late. She was not hospitalized after birth, nor was there any need for giving oxygen to the baby. There was no jaundice during the early neonatal period. Her developmental milestones were also significantly delayed. She walked at around 5 years and spoke after 5 years of age. She had no history of seizures or loss of consciousness, however after 3 years of age she developed deviation of her right eye which happened after fever. She is able to perform her daily living activities at home, and helps in the household chores. She was never sent to any kind of school.
On examination, her weight was 32 kg (<5th centile) and her height was 152 cm (<5th centile). Her head circumference was 50 cms. She was at Tanner stage 3, and according to the mother she had not started her menstruation as yet. She had lateral strabismus of her right eye, had a long facies, long pointed nose and pointed chin and webbing of her neck. Her fingers were tapering, there was no hyper extensibility noted. Her left foot had pes cavus and the Achilles on left foot was tight. The right foot was normal. Her overall peripheral tone was increased, power was grade 5 and reflexes were brisk. Planters were equivocal. Her gait was broad based and face was symmetrical. Speech was limited to a few words and dysathria was present. Sensory examination and fundoscopy was difficult as she was not cooperative. Rest of her systemic examination was normal.
Case 3: A 6 year old girl, the youngest of all her siblings was also developmentally delayed with no speech development. She had started walking a year ago. On examination she had pectus excavatum, webbing of the neck, brachycephaly with a head circumference of 46 cms (<5th centile). She had partial syndactyly of her 1st and 2nd toe bilaterally. No pes cavus was seen. Her gait was normal, tone was normal, and reflexes were brisk with unsustained clonus. Eye examination showed alternating esotropia and fine horizontal nystagmus, fundus examination could not be done. The rest of her cranial nerve examination was grossly normal. Cardiovascular respiratory and abdominal exam were unremarkable
Blood samples were collected from a total of eight family members, three of which were affected. Genomic DNA was extracted from peripheral blood leukocytes by standard methods such as described by Lahiri et al. in Nucleic Acids Res. 1991 19(19):5444.
DNA samples of three affected and one unaffected members of the family were analyzed using the Affymetrix GENECHIP Mapping 500K array (Affymetrix, Inc. Santa Clara, Calif.). These arrays allow analysis of approximately 500,000 single nucleotide polymorphisms with a median physical distance of 2.5 kb and an average physical distance of 5.8 Kb between single nucleotide polymorphisms. The average heterozygosity of these single nucleotide polymorphisms is 0.30. In these experiments, the NspI chip from the GENECHIP Mapping 500K set was used, which allowed genotyping of approximately 260,000 single nucleotide polymorphisms in the patient DNAs. Sample processing, labeling and hybridization were performed in accordance with the manufacturer's instructions (Affymetrix Mapping 500K Assay Manual). The arrays were scanned with a GENECHIP (Affymetrix Scanner and the data was processed using GENECHIP Operating Software (GCOS) and GENECHIP Genotyping Analysis Software (GTYPE) Software (ver. 3.0.2) to generate SNP allele calls.
Using Affymetrix 5.0 SNP microarrays, 2.565 Mb region was identified on 5p15.32-p15.31 with a continuous run of 798 SNPs homozygous common among all affecteds in the family. The boundaries of the homozygosity-by-descent (HBD) region was set in this family by the flanking SNPs rs2259 and rs2914296, defining a ˜5 Mb region. This region overlaps with a locus previously identified as harboring a gene for NS-ARMR, and has been designated MRT5, however no causative gene has yet been reported for this locus (Najmabadi et al. Hum Genet 2007; 121:43-48). The MRT5 locus was defined by SNP markers rs1824938 (5.092 Mb) and rs60701 (10.734 Mb). Thus, the common region shared between our Pakistani family and the Iranian family was from rs1824938 (5.092 Mb) to rs2914296 (7.657 Mb)—a 2.565 critical region.
Copy Number variations that include deletions, and duplication events were inferred by comparative analysis of hybridization intensities using dChip analyzer (Li C, Wong WH (2003). DNA-Chip Analyzer (dChip). In The analysis of gene expression data: methods and software. Edited by G Parmigiani, E S Garrett, R Irizarry and S L Zeger. Springer; Zhao et al. Cancer Res 2004 64:3060-3071; and Zhao et al. Cancer Res 2005 65:5561-5570 2005). After normalization, CNAG (Nannya et al. Cancer Res 2005 65:6071-6079), which employs a Hidden Markov Model, was used to infer the DNA copy number from the raw signal data. This algorithm uses pairwise data comparisons rather than comparison across all samples (as in dChip), and has a better signal to noise ratio. Both algorithms were used and compared.
Six microsatellite markers (Table 1) across the 5p region were PCR amplified using standard protocols such as described in Molecular Cloning: A Laboratory Manual (Third Edition) By Joseph Sambrook and David Russell, 2001, Cold Spring Harbor Laboratory Press, NY and were electrophoresed on an ABI 3730x1DNA analyzer. The genotypes were called using Genemapper software (Applied Biosystems of Life Technologies, Carlsbad, Calif.) and linkage analysis was performed using MLINK software, part of the LINKAGE software package described by Lathrop et al. in. Am J Hum Genet. 1985 37(3):482-98.
Proband DNA was screened for mutations by PCR followed by ABI BigDye™ (Applied Biosystems of Life Technologies, Carlsbad, Calif.) sequencing for each coding exon.
This patent application claims the benefit of priority from U.S. Provisional Application Ser. No. 61/357,657, filed Jun. 23, 2010, teachings of which are hereby incorporated by reference in their entirety.
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/CA2011/050388 | 6/23/2011 | WO | 00 | 1/17/2013 |
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61357657 | Jun 2010 | US |