High frequency of the c.3207C>A (p.H1069Q) mutation in ATP7B gene of Lithuanian patients with hepatic presentation of Wilson's disease

AIM: To investigate the prevalence of the ATP7B gene mutation in patients with hepatic presentation of Wilson's disease (WD) in Lithuania. METHODS: Eleven unrelated Lithuanian families, including 13 WD patients were tested. Clinically WD diagnosis was established in accordance to the Leipzig scoring system. Genomic DNA was extracted fromwhole venous blood using a salt precipitation method. Firstly, the semi-nested polymerase chain reaction (PCR) technique was used to detect the c.3207C>A (p.H1069Q) mutation. Patients not homozygous for the c.3207C>A (p.H1069Q) mutation were further analyzed. The 21 exons of the WD gene were amplified in a thermal cycler (Biometra T3 Thermocycler, G?ttingen, Germany). Direct sequencing of the amplified PCR products was performed by cycle sequencing using fluorescent dye terminators in an automatic sequencer (Applied Biosystems, Darmstadt, Germany). RESULTS: Total of 13 WD patients (mean age 26.4 years; range 17-40; male/female 3/10) presented with hepatic disorders and 16 their first degree relatives (including 12 siblings) were studied. Some of WD patients, in addition to hepatic symptoms, have had extrahepatic disorders (hemolytic anemia 3; Fanconi syndrome 1; neurophsychiatric and behavioural disorder 2). Liver biopsy specimens were available in all of 13 WD patients (8 had cirrhosis; 1-chronic hepatitis; 3-acute liver failure, 1-liver steatosis). Twelve of 13 (92.3%) WD patients had the c.3207C>A (p.H1069Q) mutation, 6 of them in both chromosomes, 6 were presented as compound heterozygotes with additional c.3472-82delGGTTTAACCAT, c.3402delC, c.3121C>T (p.R1041W) or unknown mutations. For one patient with liver cirrhosis and psychiatric disorder (Leipzig score 6), no mutations were found. Out of 16 first degree WD relatives, 11 (68.7%) were heterozygous for the c.3207C>A (p.H1069Q) mutation. Two patients with fulminant WD died from acute liver failure and 11 are in full remission under penicillamine or zinc acetate treatment. Three women with WD successfully delivered healthy babies. CONCLUSION: The c.3207C>A (p.H1069Q) missense mutation is the most characteristic mutation for Lithuanian patients with WD. Even 92.3% of WD patients with hepatic presentation of the disease are homozygous or compound heterozygotes for the p.H1069Q mutation.

Clinical manifestations and gene mutation in a case of Machado-Joseph disease

This study reports a case of a 75-year-old female Machado-Joseph disease patient exhibiting unstable walking and inaccurate hand holding for 8 months, which progressively worsened. Physical examination on admission showed cerebellar ataxia and a history of hypertension. Crania MRI demonstrated cerebellar and brain stem atrophy. Gene analysis showed abnormal amplification of the CAG trinucleotide repeat in exon 10 of the ataxin-3 （ATXN3） gene, resulting in 70-81 CAG repeats in the patient, with a significant positive family history.

Wilson disease: Identification of two novel mutations and clinical correlation in Eastern Chinese patients

AIM: To study mutations in the P-type ATPase (ATP7B) gene responsible for Wilson disease (WD) in the Eastern Chinese population, and the possible correlation of specific mutations with clinical characteristics. METHODS: Mutations of the ATP7B gene were sought by means of direct sequencing in 50 Eastern Chinese WD patients of Han ethnic origin. RESULTS: Two novel mutations, Asp96Gly and Asp196Glu, were first identified. We also compared the characterization of mutations in ATP7B with the clinical findings, and a significant correlation with hepatic manifestations between patients carrying the Arg778Leu mutation and those without was found. CONCLUSION: Gene sequencing analysis was shown to have a high detection rate and accuracy. It may become the first priority in screening of WD patients.

Novel ATP7B gene mutations in Chinese Han patients with hepatolenticular degeneration

BACKGROUND： ATP7B gene exon 8 Arg778Leu and exon 12 Arg952Lys are gene mutation hot spots in Chinese Han patients with hepatolenticular degeneration, or Wilson＇s disease （WD）. However, the gene fragments are too short for detection and the mutation detection rate remains low. OBJECTIVE： To analyze DNA sequences of ATP7B gene exon 8-exon 9 and exon 10-exon 12 sections. DESIGN, TIME AND SE＇I-rlNG： A concurrent, non-randomized, controlled, genetic polymorphism study was performed at the Anhui Medical Genetics Center, Anhui, China from March to July in 2009. PARTICIPANTS： Fifty patients, who were admitted to the Department of Neurology at the First Affiliated Hospital of Anhui Traditional Chinese Medical College between March and July in 2009, were diagnosed with WD. The WD group comprised 32 males and 18 females, with an average age of （18.8 ± 8.3） years. WD was confirmed by clinical observation, as well as physical, imaging, and biochemical examinations, including testing for serum copper, ceruloplasmin, and copper oxidase. The control group comprised 20 normal subjects, who underwent physical examination at the First Affiliated Hospital of Anhui Traditional Chinese Medical College, and included 13 males and 7 females, with an average age of （27.9 ± 2.4） years. All subjects were Chinese Han population. METHODS： Genomic DNA was extracted from 50 WD patients and 20 normal controls. Polymerase chain reaction amplification of ATP7B gene exon 8-exon 9 （about 1 100 bp） and exon 10-exon 12 （about 850 bp） segments was performed. DNA exon-intron amplification products from all subjects were processed through direct bidirectional sequencing, and sequencing results were analyzed. MAIN OUTCOME MEASURES： Sequence changes of ATPTB gene exon 8-exon 9 and exon 10-exon 12 segments. RESULTS： In the 50 included WD patients, ATP7B gene intron 8 nt53592A → G with nt53671G→ A homozygous mutation was detected between exon 8-exon 9 in seven cases; exon 8 Arg778Leu mutations with Leu770Leu synonymous mutation was detected in four cases; exert 11 Gly790Arg heterozygous missense mutation between exon 10-exon 12 was found in four cases; exon 12 Arg952Lys heterozygous missense mutation was seen in 11 cases; and two additional cases were associated with exon 1211e929Val polymorphism. CONCLUSION： ATP7B gene intron 8 mutation is a possible pathogenic mutation that is associated with WD pathogenesis. The exon 11 mutation rate accounts for 8% of all WD patients, and the very few previously reported cases deserve further study.

Identification of a mutation hotspot in exon 8 of Wilson disease gene by cycle sequencing

Objective To screen for mutation hotspot of Wilson disease (WD) gene in Chinese population Methods Cycle sequencing was used to detect mutation in exon 8 of WD gene in 30 patients with Wilson disease Results The same missense mutation, Arg779Leu, was identified in 14 WD patients, four of whom were homozygous and the other heterozygous for this mutation The frequency of this mutation in Chinese patients was 30% Conclusion The codon 779 (CCG→CTG) of exon 8 of WD gene was one of mutation hotspots in Chinese

Late onset fulminant Wilson's disease:A case report and review of the literature

Wilson’s disease(WD)is an autosomal recessive inherited disorder of hepatic copper metabolism.WD can be present in different clinical conditions,with the most common ones being liver disease and neuropsychiatric disturbances.Most cases present symptoms at<40years of age.However,few reports exist in the literature on patients in whom the disease presented beyond this age.In this report,we present a case of late onset fulminant WD in a 58-year-old patient in whom the diagnosis was established clinically,by genetic analysis of the ATP7B gene disclosing rare mutations(G1099S and c.1707+3ins T)as well as by high hepatic copper content.We also reviewed the relevant literature.The diagnosis of WD with late onset presentation is easily overlooked.The diagnostic features and the geneticbackground in patients with late onset WD are not different from those in patients with early onset WD,except for the age.Effective treatments for this disorder that can be fatal are available and will prevent or reverse many manifestations if the disease is discovered early.

Carrier Detection and Presymptomatic Identification of Wilson Disease in Chinese by Non-Isotopic Linkage Analysis with Four Short Tandem Repeat Polymorphisms

Summary: Wilson disease (WD) is an autosomal recessive disorder of copper metabolism. To establish an efficient, accurate and fast diagnostic method for carrier detection and presymptomatic identification of WD in Chinese population, we studied haplotypes of short tandem repeat (STR) polymorphisms flanking the WD gene in 40 Chinese WD families. The results suggested that this genetic diagnosis system based on the four STR polymorphisms is of high value for the detection of potential carriers and WD homozygotes in families with at least one previously affected child. It is an efficient, accurate and fast diagnostic method that can be well suited for routine use in clinical laboratories.

中国人Wilson病ATP7B基因Arg778Leu/Gln点突变与中医证型的相关性研究

目的 :探讨中国人Wilson病 (WD)ATP7B基因Arg778Leu/Gln点突变与中医证型的关系。方法 :应用PCR技术分别扩增 90例WD患者和 30名健康人ATP7B基因的第 8外显子 ,其PCR产物行限制性内切酶MspⅠ酶切分析。 90例WD患者进行中医辨证分型。结果 :90例WD患者有 34例Arg778Leu/Gln点突变 ;WD患者中医辨证分型属肝风内动者Arg778Leu/Gln点突变占 2 0例。 结论 :Arg778Leu/Gln点突变组患者的发病年龄迟于未见该点突变组的患者 。

中国人Wilson病患者基因高频突变位点的快速检测

目的建立可用于临床的中国人Wilson病(WD)患者快速、高效的基因检测方法。方法PCR扩增142例非同源家系的WD患者ATP7B基因第8、12、13外显子(以30例健康人为正常对照),分别以限制性内切酶MspI、TaiI和BstDsI消化扩增产物,2%琼脂糖凝胶电泳分离,根据各外显子的限制性酶切图谱分析有无突变,其结果经DNA测序验证。结果48.59%(69/142)的患者在第8外显子检出Arg778Leu突变,其中纯合突变13例,杂合突变56例,染色体突变频率为28.87%(82/284);5.63%(8/142)的患者在第12外显子检出Thr935Met杂合突变,染色体突变频率为2.82%(8/284);24.65%(35/142)的患者在第13外显子检出Pro992Leu突变,其中纯合突变3例,杂合突变32例,染色体突变频率为13.38%(38/284)。检出突变的患者中有12例为Arg778Leu/Pro992Leu复合杂合突变,1例Arg778Leu/Thr935Met复合杂合突变,1例Arg778Leu纯合突变合并Pro992Leu杂合突变,总检出率为69.01%(98/142)。以上结果均经DNA测序证实。结论13外显子Pro992Leu突变是中国人WD患者的基因突变热点之一。采用限制性酶谱分析法能快速、准确检出WD患者基因高频突变位点,可用于对WD疑诊患者及其家系成员的基因诊断。

PCR-酶切法检测Wilson病935密码子基因突变

目的 :应用PCR 酶切法对中国人WD患者ATP7B基因的高频突变点进行检测 ,企图建立一种能应用于临床的中国人WD快速基因诊断方法。方法 :用限制性内切酶MaeⅡ对 48例患者及 30例正常人的ATP7B基因第 12外显子 935密码子PCR扩增后进行酶切分析。结论 :ATP7B基因第 12外显子 935密码子为中国人WD患者的高频突变点之一 ;PCR 酶切法可作为WD常用的基因诊断方法应用于症状前期患者的筛选及产前诊断。

中国人Wilson病ATP7B基因Thr935Met突变与临床表型的关系研究

目的 探讨Wilson病 (Wilsondisease,WD)ATP7B基因突变的高频位点之一Thr 935Met与临床表现的关系。方法 应用PCR技术扩增 90例WD患者和 30例正常人ATP7B基因第 12外显子 ,其PCR产物行限制性内切酶TaiI酶切分析。结果 正常人组酶切未见异常。 90例WD组第 12外显子有 10例Thr 935Met杂合突变 ,未见纯合突变 ,检出率为 11 1%。突变组的平均发病年龄为 19 10岁± 8 5 2岁 ,无突变组的平均发病年龄为 14 0 0岁± 7 4 2岁 ,差异有显著意义 (P =0 0 4 7)。结论 Thr 935Met突变组患者的发病年龄迟于未见该点突变组的患者 ,而性别、首发症状及铜生化水平与该点突变无明显相关性。

以肝病为首发表现的Wilson病患者病理及突变位点分析

目的对以肝病为首发表现的Wilson病(Wilson’s disease,WD)患者ATP7B基因外显子进行PCR扩增并测序,研究WD患者基因突变的特点。方法研究对象包括20名无亲缘关系的正常对照者和45例WD患者,提取基因组DNA,扩增外显子的部分片段,并对扩增产物进行测序分析。结果健康对照者未见异常,WD组检测到21种突变,包括4种新发突变,其中12号外显子Lys952Arg和16号外显子Val1140Ala突变频率均为30.2%,为突变热点。肝脏病理主要表现为不同程度的肝脏损伤,48.9%有脂肪变性,所有患者均有不同程度的肝纤维化,86.7%铜染色阳性。结论我国以肝病为首发表现的WD患者ATP7B基因突变是以少数几个热点突变为主和其他广泛存在的少见突变为辅为特征。

微卫星标记AFM 084xc5多态性与Wilson病基因诊断的研究

目的 评估中国人群Ｗｉｌｓｏｎ 病（ＷＤ）基因侧翼微卫星ＤＮＡ（ＳＴＲ）位点ＡＦＭ０８４ｘｃ５的基因多态性及在ＷＤ基因诊断中的价值。方法 采用聚合酶链反应（ＰＣＲ）、变性聚丙烯酰胺凝胶电泳和银染法分析８１ 名无血缘关系中国人ＡＦＭ０８４ｘｃ５ 的片段长度多态性；并对１９ 个ＷＤ家系进行ＳＴＲ连锁分析。结果 ＡＦＭ０８４ｘｃ５ 有１７ 个等位片段，长度范围为７１～１０３ｂｐ，多态信息含量（ＰＩＣ）为０．９０７。共检出７ 例症状前患者，９例基因携带者及１５ 例正常人，５ 例未能确定，基因诊断率达８６．１１％ 。结论 ＡＦＭ０８４ｘｃ５ 在中国人群是优秀的多态性标记，对ＷＤ基因诊断有较重要价值。

中国南方汉人D13S316位点多态性及Wilson病基因诊断的研究

目的 评估中国南方汉人Wilson病 (WD)基因 (WND)侧翼微卫星DNA(STR)位点D13S3 16的基因多态性及在WD基因诊断中的价值。方法 采用聚合酶链反应 (PCR)、变性聚丙烯酰胺凝胶电脉和银染法分析 84名无血缘关系中国南方汉人D13S3 16的片段长度多态性 ;并对 19个WD家系进行STR连锁分析。结果 D13S3 16有 19个等位片段 ,长度范围为 13 4～ 170bp ,多态信息含量 (PIC)为 0 93 1。共检出 8例症状前患者 ,10例致病基因携带者及 15例正常人 ,3例未能确定 ,基因诊断率达 91 67%。结论 D13S3 16大致代表中国南方汉人的多态性标记 ,对WD基因诊断有重要价值。

四引物扩增受阻突变体系快速检测Wilson病基因Arg778Leu突变

目的建立一种不需要限制性片段长度多态性或直接测序的新方法检测肝豆状核变性(WD)病人突变热点ATP7B基因的Arg778Leu突变基因型。方法用四引物扩增受阻突变体系聚合酶链反应(tetra-primer amplification refractory mutation system-PCR,tetra-primer ARMS-PCR)检测47例WD患者和30例正常对照的ATP7B基因Arg778Leu突变,并用测序进行验证。结果47例WD患者中检出Arg778Leu纯合突变4例,杂合突变14例,总检出率38.3%(18/47);30例正常对照未发现突变;DNA测序结果与四引物ARMS-PCR结果完全一致。结论ATP7B基因Arg778Leu突变是中国人WD突变热点;四引物ARMS-PCR法检测Arg778Leu突变有快速、简便、准确的优点,可以区分等位基因是否纯合,适于大样本的人群筛查。此法也可用于检测其他点突变。

中国人Wilson病WD基因12号外显子突变研究

目的 研究中国人Wilson病 (WD)基因第 12外显子突变特征。 方法 应用聚合酶链反应 -单链构象多态型 (PCR -SSCP)银染技术研究 70例无亲缘关系的WD患者和 30例正常组的WD基因 12外显子 ,对有异常泳动者经DNA自动测序技术证实其突变性质和位置。结果 正常组未见异常。患者组发现 11例异常 (11/ 70占 15 .7% ) ,二种错义突变 ,其中 9例为Thr935Met突变 (9/ 70 ,占 12 .9% ) ,2例为Lys95 2Arg突变 (2 / 70占 2 .8% )。结论 第 12外显子是中国人WD基因突变热区之一 ,发现一种未见报道的新型错义突变。

Wilson病基因第8、14和18外显子突变检测的初步研究

目的 :探索中国人群Wilson病基因 (ATP7B)第 8、14、18外显子突变特征。方法 :采用聚合酶链反应 单链构象多态性(PCR SSCP)银染技术初步研究了 30例患者和 15例正常人ATP7B基因第 8、14、18外显子突变频率。结果 :第 8外显子有 6例患者发现泳动异常 ( 2 0 % ,6 / 30 ) ,且均为杂合子 ;14、18外显子及正常人未见异常迁移。结论 :提示中国人ATP7B基因第 8外显子可能为一突变热区。

肝豆状核变性患者的临床表型和ATP7B基因变异分析

目的:分析我国北方部分地区肝豆状核变性(wilson disease,WD)患者的临床特征及ATP7B基因变异情况。方法:以2018年11月至2022年4月期间在河南大学附属郑州颐和医院确诊的50例WD患者为研究对象,提取患者外周血基因组DNA,采用PCR扩增后用Sanger法对患者ATP7B基因外显子/内含子连接区进行序列分析。结果:50例WD患者根据临床症状分为肝型14例、脑型28例和其他型8例。50例WD患者中ATP7B基因变异结果:纯合子3例,复合杂合子32例和单一杂合突变13例,三处杂合突变1例,四处杂合子突变1例。共检测到30种不同的ATP7B基因突变,突变频率比较高的为p.Arg778Leu,p.Pro992Leu,p.Ala874Val,p.Arg919Trp,p.Val1106Ile。结论:本研究发现肝型WD患者发病早期主要表现为转氨酶升高,血清铜蓝蛋白降低,且以幼儿为主。p.Arg778Leu和p.Pro992Leu为ATP7B基因常见的突变,共发现30种ATP7B基因突变,为WD的早期确诊、家系筛查及产前诊断提供科学依据。

DNA测序证实的Wilson′s病ATP7B基因第14外显子一种新型移码突变

目的：了解中国人肝豆状核变性患者基因（ＡＴＰ７Ｂ基因） 第１４ 外显子（ｅｘｏｎ１４） 的突变情况，为该病的基因诊断和治疗提供依据。方法：用聚合酶链反应（ＰＣＲ） 扩增ＡＴＰ７Ｂ基因的第１４ 外显子片段，通过ＤＮＡ 单链构象多态（ＳＳＣＰ） 筛选，以ＰＣＲ产物（ＰＣＲＤＮＡ）循环测序予以鉴定。结果：在８５ 例肝豆状核变性患者和３９ 例正常人的ＰＣＲＳＳＣＰ均呈现两种泳动带型（ Ⅰ、Ⅱ型） ，我们分别对两组中各种带型的ＰＣＲＤＮＡ进行循环测序，发现Ⅱ型中ＷＤ 患者第１０４６ 密码子后插入了碱基Ａ（１０４６ｉｎｓＡ） 而产生移码突变。结论：肝豆状核变性患者中发现一种未见报道的新型移码突变。

STR连锁分析在Wilson病基因诊断中的应用

本文选择与Wilson病致病基因紧密连锁的3个STR序列D(13)S(228)、D(13)S(301)、D(13)S(137)为遗传标记，用扩增片段长度多态性（AmP－FLP）方法对中国人群的多态性进行了检测，发现具有高度多态性，多态信息量（PIC）分别为0．60、0，78、0、79，联合这3个STR序列对2个WD家系进行单体型连锁分析，确定了家系各成员的基因型。表明STR连锁分析可对WD家系进行症状前及产前基因诊断。