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Razipour M, Alavinejad E, Sajedi SZ, Talebi S, Entezam M, Mohajer N, Kazemi-Sefat GE, Gharesouran J, Setoodeh A, Mohaddes Ardebili SM, Keramatipour M. Genetic study of the PAH locus in the Iranian population: familial gene mutations and minihaplotypes. Metab Brain Dis 2017; 32:1685-1691. [PMID: 28676969 DOI: 10.1007/s11011-017-0048-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 06/02/2017] [Indexed: 01/17/2023]
Abstract
Phenylketonuria (PKU), one of the most common inborn errors of amino acid metabolism, is caused by mutations in the phenylalanine hydroxylase (PAH) gene (PAH). PKU has wide allelic heterogeneity, and over 600 different disease-causing mutations in PAH have been detected to date. Up to now, there have been no reports on the minihaplotype (VNTR/STR) analysis of PAH locus in the Iranian population. The aims of the present study were to determine PAH mutations and minihaplotypes in Iranian families with PAH deficiency and to investigate the correlation between them. A total of 81 Iranian families with PAH deficiency were examined using PCR-sequencing of all 13 PAH exons and their flanking intron regions to identify sequence variations. Fragment analysis of the PAH minihaplotypes was performed by capillary electrophoresis for 59 families. In our study, 33 different mutations were found accounting for 95% of the total mutant alleles. The majority of these mutations (72%) were distributed across exons 7, 11, 2 and their flanking intronic regions. Mutation c.1066-11G > A was the most common with a frequency of 20.37%. The less frequent mutations, p.Arg261Gln (8%), p.Arg243Ter (7.4%), p.Leu48Ser (7.4%), p.Lys363Asnfs*37 (6.79%), c.969 + 5G > A (6.17%), p.Pro281Leu (5.56), c.168 + 5G > C (5.56), and p.Arg261Ter (4.94) together comprised about 52% of all mutant alleles. In this study, a total of seventeen PAH gene minihaplotypes were detected, six of which associated exclusively with particular mutations. Our findings indicate a broad PAH mutation spectrum in the Iranian population, which is consistent with previous studies reporting a wide range of PAH mutations, most likely due to ethnic heterogeneity. High prevalence of c.1066-11G > A mutation linked to minihaplotype 7/250 among both Iranian and Mediterranean populations is indicative of historical and geographical links between them. Also, strong association between particular mutations and minihaplotypes could be useful for prenatal diagnosis (PND) and preimplantation genetic diagnosis (PGD) in affected families.
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Affiliation(s)
- Masoumeh Razipour
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Elaheh Alavinejad
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyede Zahra Sajedi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Medical Genetics, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Talebi
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mona Entezam
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Mohajer
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Golnaz-Ensieh Kazemi-Sefat
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Department of Molecular Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Jalal Gharesouran
- Department of Medical Genetics, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Aria Setoodeh
- Department of Endocrinology, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Mojtaba Mohaddes Ardebili
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
- Department of Medical Genetics, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mohammad Keramatipour
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Gemperle-Britschgi C, Iorgulescu D, Mager MA, Anton-Paduraru D, Vulturar R, Thöny B. A novel common large genomic deletion and two new missense mutations identified in the Romanian phenylketonuria population. Gene 2015; 576:182-8. [PMID: 26481238 DOI: 10.1016/j.gene.2015.10.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/02/2015] [Accepted: 10/12/2015] [Indexed: 10/22/2022]
Abstract
The mutation spectrum for the phenylalanine hydroxylase (PAH) gene was investigated in a cohort of 84 hyperphenylalaninemia (HPA) patients from Romania identified through newborn screening or neurometabolic investigations. Differential diagnosis identified 81 patients with classic PAH deficiency while 3 had tetrahydropterin-cofactor deficiency and/or remained uncertain due to insufficient specimen. PAH-genetic analysis included a combination of Sanger sequencing of exons and exon–intron boundaries, MLPA and NGS with genomic DNA, and cDNA analysis from immortalized lymphoblasts. A diagnostic efficiency of 99.4% was achieved, as for one allele (out of a total of 162 alleles) no mutation could be identified. The most prevalent mutation was p.Arg408Trp which was found in ~ 38% of all PKU alleles. Three novel mutations were identified, including the two missense mutations p.Gln226Lys and p.Tyr268Cys that were both disease causing by prediction algorithms, and the large genomic deletion EX6del7831 (c.509 + 4140_706 + 510del7831) that resulted in skipping of exon 6 based on PAH-cDNA analysis in immortalized lymphocytes. The genomic deletion was present in a heterozygous state in 12 patients, i.e. in ~ 8% of all the analyzed PKU alleles, and might have originated from a Romanian founder.
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Affiliation(s)
- Corinne Gemperle-Britschgi
- Division of Clinical Chemistry and Biochemistry, Department of Pediatrics, University of Zürich, Zürich, Switzerland
| | - Daniela Iorgulescu
- Center of Newborn Screening, Department of Pediatrics, Institute for Mother and Child Care, Bucharest, 120 Lacul Tei Blv., 020395, Romania
| | - Monica Alina Mager
- "I. Hatieganu" University of Medicine and Pharmacy - Cluj-Napoca, Department of Neurology, Romania
| | - Dana Anton-Paduraru
- "Gr.T.Popa" University of Medicine and Pharmacy, Newborn Screening Center Iasi, 3rd Clinic of Pediatrics, Romania
| | - Romana Vulturar
- "I.Hatieganu" University of Medicine and Pharmacy - Cluj-Napoca, Department of Molecular Sciences, Cluj-Napoca, Romania; Cognitive Neuroscience Laboratory, Babes-Bolyai University - Cluj-Napoca, Romania.
| | - Beat Thöny
- Division of Clinical Chemistry and Biochemistry, Department of Pediatrics, University of Zürich, Zürich, Switzerland; Division of Metabolism, Department of Pediatrics, University of Zurich, Steinwiesstrasse 75, Zurich CH-8032, Switzerland; Neuroscience Centre Zürich, University of Zürich, Zürich, Switzerland; Neuroscience Centre Zürich, ETH Zürich (ZNZ), Zürich, Switzerland; Children's Research Centre (CRC), Zürich, Switzerland.
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Zerjav Tansek M, Groselj U, Angelkova N, Anton D, Baric I, Djordjevic M, Grimci L, Ivanova M, Kadam A, Kotori V, Maksic H, Marginean O, Margineanu O, Miljanovic O, Moldovanu F, Muresan M, Nanu M, Samardzic M, Sarnavka V, Savov A, Stojiljkovic M, Suzic B, Tincheva R, Tahirovic H, Toromanovic A, Usurelu N, Battelino T. Phenylketonuria screening and management in southeastern Europe - survey results from 11 countries. Orphanet J Rare Dis 2015; 10:68. [PMID: 26025111 PMCID: PMC4451731 DOI: 10.1186/s13023-015-0283-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 05/12/2015] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND We aimed to assess the current state of PKU screening and management in the region of southeastern Europe. METHODS A survey was performed involving all identified professionals responsible for the PKU management in the 11 countries from South-Eastern region of Europe (Albania, Bulgaria, Bosnia and Herzegovina, Croatia, Kosovo, Macedonia, Moldova, Montenegro, Romania, Serbia, Slovenia). The questionnaire was designed to assess the characteristics regarding PKU management in three main areas: nation-wide characteristics, PKU screening, and characteristics of the PKU management in the responding centre. It consisted of 56 questions. The distribution and collection of the questionnaires (via e-mail) was taking place from December 2013 to March 2014. RESULTS Responses from participants from 11 countries were included; the countries cumulative population is approx. 52.5 mio. PKU screening was not yet introduced in 4 of 11 countries. Reported PKU incidences ranged from 1/7325 to 1/39338 (and were not known for 5 countries). National PKU guidelines existed in 5 of 11 countries and 7 of 11 countries had PKU registry (registries included 40 to 194 patients). The number of PKU centers in each country varied from 1 to 6. Routine genetic diagnostics was reported in 4 of 11 countries. Most commonly used laboratory method to assess phenylalanine levels was fluorometric. Tetrahydrobiopterine was used in only 2 of 11 countries. Most frequently, pediatricians were caring for the patients. Dietitian was a member of PKU team in only 4 of 11 countries, while regular psychological assessments were performed in 6 of 11 countries. Patient's PKU society existed in 7 of 11 countries. CONCLUSIONS The region of southeastern Europe was facing certain important challenges of PKU screening and management. Neonatal PKU screening should be introduced throughout the region. Furthermore, PKU management was falling behind internationally established standards-of-care in many aspects.
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Affiliation(s)
- Mojca Zerjav Tansek
- University Children's Hospital Ljubljana, UMC Ljubljana, Ljubljana, Slovenia.
| | - Urh Groselj
- University Children's Hospital Ljubljana, UMC Ljubljana, Ljubljana, Slovenia.
| | | | - Dana Anton
- Clinical Hospital for Children "Sfanta Maria", Iasi, Romania.
| | - Ivo Baric
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia. .,School of Medicine, University of Zagreb, Zagreb, Croatia.
| | - Maja Djordjevic
- Mother and Child Health Care Institute of Serbia, Belgrade, Serbia.
| | - Lindita Grimci
- University Hospital Center "Mother Teresa", Tirana, Albania.
| | | | - Adil Kadam
- University Pediatric Hospital Sofia, Sofia, Bulgaria.
| | - Vjosa Kotori
- Pediatric Clinic, University Clinical Center Pristina, Pristina, Kosovo.
| | - Hajrija Maksic
- University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina.
| | | | | | - Olivera Miljanovic
- Institute for Sick Children, Clinical Center of Montenegro, Podgorica, Montenegro.
| | | | - Mariana Muresan
- Clinical Hospital for Children "Iuliu Hateganu", Cluj-Napoca, Romania.
| | - Michaela Nanu
- Mother and Child Health Care Institute "Alfred Rusescu", Bucharest, Romania.
| | - Mira Samardzic
- Institute for Sick Children, Clinical Center of Montenegro, Podgorica, Montenegro.
| | - Vladimir Sarnavka
- Department of Pediatrics, University Hospital Center Zagreb, Zagreb, Croatia.
| | | | - Maja Stojiljkovic
- Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia.
| | - Biljana Suzic
- Children Hospital Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina.
| | | | - Husref Tahirovic
- Department of Medical Sciences, Academy of Sciences and Arts of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina.
| | - Alma Toromanovic
- Department of Pediatrics, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
| | - Natalia Usurelu
- Institute of Mother and Child, Centre of Reproductive Health and Medical Genetics, Chisinau, Moldova.
| | - Tadej Battelino
- University Children's Hospital Ljubljana, UMC Ljubljana, Ljubljana, Slovenia. .,Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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Santana da Silva LC, Carvalho TS, da Silva FB, Morari L, Fachel AA, Pires R, Refosco LF, Desnick RJ, Giugliani R, Saraiva Pereira ML. Molecular characterization of phenylketonuria in South Brazil. Mol Genet Metab 2003; 79:17-24. [PMID: 12765842 DOI: 10.1016/s1096-7192(03)00032-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Phenylketonuria (PKU) is an autosomal recessive disorder due to phenylalanine hydroxylase (PAH) deficiency. The PAH gene, located at 12q22-q24.1, includes about 90kb and contains 13 exons. To date, more than 420 different alterations have been identified in the PAH gene. To determine the nature and frequency of PAH mutations in PKU patients from South Brazil, mutation analysis was performed on genomic DNA from 23 unrelated PKU patients. The 13 exons and flanking regions of the PAH gene were amplified by PCR and the amplicons were analyzed by single strand conformation polymorphism (SSCP). Amplicons that showed abnormal migration patterns were analyzed by restriction endonuclease digestion and/or sequencing. Twenty-two previously reported mutations were identified including R261X, R408W, IVS2nt5g-->c, R261Q, and V388M. Polymorphisms were observed in 48.8% of the PKU patients, the most frequent being IVS2nt19t-->c, V245V, and IVS12nt-35c-->t. In addition, two novel sequence variants were identified: 1378g-->t in the 3(')-untranslated region in exon 13 which may be disease-causing and an intron 12 polymorphism, IVS12nt-15t-->c. The mutation spectrum in the patients from Southern Brazil differed from that observed in patients from other Latin American countries and further defined the molecular heterogeneity of this disease.
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Abstract
Phenylketonuria (PKU) is heterogeneous. More than 400 different mutations in the phenylalanine hydroxylase (PAH) gene have been identified. In a systematic review of the molecular genetics of PKU in Europe we identified 29 mutations that may be regarded as prevalent in European populations. Comprehensive regional data for these mutations were collated from all available studies. The spectrum of mutations found in individual regions results from a combination of factors including founder effect, range expansion and migration, genetic drift, and probably heterozygote advantage. Common mutations include R408W on a haplotype 2 background in Eastern Europe, IVS10-11G>A in the Mediterranean, IVS12+1G>A in Denmark and England, Y414C in Scandinavia, I65T in Western Europe, and R408W on haplotype 1 in the British Isles. Molecular data from mild hyperphenylalaninemia (MHP) patients are available from a number of countries, but it is currently not possible to calculate relative allele frequencies. The available data on PAH mutations are useful for the understanding of both the clinical features and the population genetics of PAH deficiency in Europe.
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Affiliation(s)
- Johannes Zschocke
- Institut für Humangenetik, Ruprecht-Karls-Universität, Heidelberg, Germany.
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