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Adato O, Brenner R, Levy A, Shinar Y, Shemer A, Dvir S, Ben-Zvi I, Livneh A, Unger R, Kivity S. Determining the origin of different variants associated with familial mediterranean fever by machine-learning. Sci Rep 2022; 12:15206. [PMID: 36076017 PMCID: PMC9458679 DOI: 10.1038/s41598-022-19538-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 08/30/2022] [Indexed: 11/09/2022] Open
Abstract
A growing number of familial Mediterranean fever (FMF) patients in Israel do not have a single country of origin for all four grandparents. We aimed to predict the Mediterranean fever gene (MEFV) variant most likely to be found for an individual FMF patient, by a machine learning approach. This study was conducted at the Sheba Medical Center, a referral center for FMF in Israel. All Jewish referrals included in this study carried an FMF associated variant in MEFV as shown by genetic testing performed between 2001 and 2017. We introduced the term 'origin score' to capture the dose and different combinations of the grandparents' origin. A machine learning approach was used to analyze the data. In a total of 1781 referrals included in this study, the p.Met694Val variant was the most common, and the variants p.Glu148Gln and p.Val726Ala second and third most common, respectively. Of 26 countries of origin analyzed, those that increased the likelihood of a referral to carry specific variants were identified in North Africa for p.Met694Val, Europe for p.Val726Ala, and west Asia for p.Glu148Gln. Fourteen of the studied countries did not show a highly probable variant. Based on our results, it is possible to describe an association between modern day origins of the three most common MEFV variant types and a geographical region. A strong geographic association could arise from positive selection of a specific MEFV variant conferring resistance to endemic infectious agents.
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Affiliation(s)
- Orit Adato
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Ronen Brenner
- Institute of Oncology, Wolfson Medical Center, Holon, Israel.,Sackler Medical School, Tel Aviv University, Tel-Aviv, Israel
| | - Avi Levy
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Yael Shinar
- Israel Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Asaf Shemer
- Sackler Medical School, Tel Aviv University, Tel-Aviv, Israel. .,Department of Medicine B, Assuta Ashdod Medical Center, Ashdod, Israel. .,Department of Ophthalmology, Shamir Medical Center (Formerly Assaf-Harofeh), Tzrifin, Israel. .,Department of Ophthalmology, Shamir Medical Center, 70300, Be'er Ya'akov, Israel.
| | - Shalem Dvir
- Department of Medicine B, Assuta Ashdod Medical Center, Ashdod, Israel
| | - Ilan Ben-Zvi
- Sackler Medical School, Tel Aviv University, Tel-Aviv, Israel.,Department of Medicine F, Sheba Medical Center, Tel-Hashomer, Israel
| | - Avi Livneh
- Sackler Medical School, Tel Aviv University, Tel-Aviv, Israel.,Israel Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Israel.,Department of Medicine F, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ron Unger
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Shaye Kivity
- Sackler Medical School, Tel Aviv University, Tel-Aviv, Israel.,Rheumatology Unit, Meir Medical Center, Cfar-Saba, Israel
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Arpacı A, Doğan S, Erdoğan HF, El Ç, Cura SE. Presentation of a new mutation in FMF and evaluating the frequency of distribution of the MEFV gene mutation in our region with clinical findings. Mol Biol Rep 2021; 48:2025-2033. [PMID: 33738724 PMCID: PMC8060170 DOI: 10.1007/s11033-020-06040-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/27/2020] [Indexed: 12/22/2022]
Abstract
Familial Mediterranean Fever (FMF), which is an autosomal recessive disease characterized by recurrent self-limiting fever, peritonitis, pleuritis, arthritis and erysipelas-like erythemas, has been common among ethnic groups such as Turkish, Armenian, Arabic and Jewish. The clinical presentation is caused by mutations in the MEFV gene encoding the Pyrin protein. In this study, we aimed to present a new mutation that has not been previously defined from the mutations in the MEFV gene which is responsible for the genetic pathology of familial Mediterranean fever and to evaluate the frequency of distribution of the MEFV gene mutation among different ethnic groups living in our region. In present retrospective study, a total of 2639 clinically suspected FMF patients who were referred to Hatay Mustafa Kemal University Hospital between 2010 and 2017 were recorded. MEFV gene mutations were observed using DNA sequence analysis. MEFV mutations were found in 2079 of the 2639 patients (78.7%) Among these patients 184 (6.97%) were homozygous, while 1365 (51.72%) were heterozygous. The most frequently observed mutation was R202Q (1319, 19.55%) followed by E148Q (n = 476, 7.05%), M694V (n = 439, 6.51%), V726A (n = 146, 2.16%) and M680I (n = 135, 2%). In a case clinically diagnosed as FMF, a new mutation called S145G (p. Ser145Gly, c.433A > G) was identified in exon 2 of the MEFV gene. Besides, addition of a new pathogenic MEFV variant to the literature, the relationship between the FMF clinic and homozygous form of R202Q, which was previously considered as a polymorphism, was highlighted.
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Affiliation(s)
- Abdullah Arpacı
- Department of Medical Genetics, Hatay Mustafa Kemal University Faculty of Medicine, Alahan, Tayfur Sökmen Campus, 31001, Antakya, Hatay, Turkey.
| | - Serdar Doğan
- Department of Medical Biochemistry, Hatay Mustafa Kemal University Faculty of Medicine, Antakya, Hatay, Turkey
| | - Hazal Fatma Erdoğan
- Department of Medical Biochemistry, Hatay Mustafa Kemal University Faculty of Medicine, Antakya, Hatay, Turkey
| | - Çiğdem El
- Department of Child Health and Diseases, Hatay Mustafa Kemal University Faculty of Medicine, Antakya, Hatay, Turkey
| | - Sibel Elmacıoğlu Cura
- Department of Medical Genetics, Hatay Mustafa Kemal University Faculty of Medicine, Alahan, Tayfur Sökmen Campus, 31001, Antakya, Hatay, Turkey
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The spectrum of Familial Mediterranean Fever gene ( MEFV ) mutations and genotypes in Iran, and report of a novel missense variant (R204H). Eur J Med Genet 2017; 60:701-705. [DOI: 10.1016/j.ejmg.2017.09.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/16/2017] [Accepted: 09/18/2017] [Indexed: 11/21/2022]
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Prevalence of common MEFV mutations and carrier frequencies in a large cohort of Iranian populations. J Genet 2017; 95:667-74. [PMID: 27659338 DOI: 10.1007/s12041-016-0682-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disorder caused by mutations in the MEFV gene. The disease is especially common among Armenian, Turkish, Jewish and Middle East Arab populations. To identify the frequency and the spectrum of common MEFV mutations in different Iranian populations, we investigated a cohort of 208 unselected asymptomatic individuals and 743 FMF patients. Nine hundred and fifty-one samples were analysed for the presence of 12 MEFV mutations by PCR and reverse-hybridization (FMF StripAssay, ViennaLab, Vienna, Austria). Confirmatory dideoxy sequencing of all MEFV gene exons was performed for 39 patients. Fifty-seven (27.4%) healthy individual carried mutant MEFV alleles. Three hundred and ninety-one (52.6%) FMF patients were found positive for either one (172/743; 23.1%), two or three MEFV mutations. Using dideoxy sequencing, three novel variants, A66P, R202W and H300Q, could be identified. Our analysis revealed an allele frequency and carrier rate of 15.6 and 27.4%, respectively, among healthy Iranians. Still moderate compared to neighbouring Armenia, but higher than in Turkey or Iraq, these data suggest that FMF is remarkably common among Iranian populations. E148Q was most frequent in the group of healthy individuals, whereas M694V was the most common mutation among FMF patients, thereby corroborating previous studies on MEFV mutational spectra in the Middle East. Accordingly, MEFV mutations are frequent in healthy Iranian individuals across different ethnic groups. Based on this finding, the awareness for FMF and the implementation of augmented carrier screening programmes considering the multiethnic nature of the Iranian population should be promoted.
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Bonyadi M, Younesi M, Rafeey M, Sadeghi Shabestari M, Mortazavi F. MEFV mutations in Iranian Azari Turkish patients with Henoch-Schönlein purpura. Turk J Med Sci 2016; 46:967-71. [PMID: 27513391 DOI: 10.3906/sag-1505-131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 09/01/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM The aim of the current study was to screen the rate of MEFV mutations in Henoch-Schönlein purpura (HSP) and to investigate the association of these mutations plus clinical symptoms with HSP disease in the Iranian Azari Turkish ethnic group. MATERIALS AND METHODS The study groups included 40 unrelated HSP patients and 200 apparently healthy people without any kind of inflammatory diseases as a control group. Molecular screening was performed for eight main mutations, namely M694V, M694I, M680I, V726A, E148Q, R761H, P396S, and R408Q, using polymerase chain reaction (PCR), restriction fragment length polymorphism (RFLP), and sequencing. RESULTS Out of the 40 studied patients, 27 subjects (67.5%) did not show any mutation, whereas 10 patients (25%) were heterozygotes for one of the following mutations: M694V, M680I, V726A, E148Q. Moreover, three patients (7.5%) were compound heterozygotes for P369S and R408Q. The significant differences between the patient and control groups for M680I, V726A, E148Q, P396S, and R408Q were P = 0.0043, P = 0.0324, P = 0.0145, P = 0.0043, and P = 0.0043, respectively. Furthermore, no significant difference in clinical manifestations was observed between the two groups of patients with and without mutations. CONCLUSION Based on the results, MEFV mutations could be considered effective genetic factors for development of HSP in the Iranian Azari Turkish ethnic group.
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Affiliation(s)
- Mortaza Bonyadi
- Center of Excellence for Biodiversity, Faculty of Natural Sciences, University of Tabriz & Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdieh Younesi
- Center of Excellence for Biodiversity, Faculty of Natural Sciences, University of Tabriz, Tabriz, Iran
| | - Mandana Rafeey
- Liver and Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahnaz Sadeghi Shabestari
- Tuberculosis and Lung Disease Research Center, Children Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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Mazicioglu MM. Final comment on the nationality of Ibni Sina. Arch Gynecol Obstet 2015; 293:925-7. [PMID: 26671486 DOI: 10.1007/s00404-015-3979-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 11/27/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Mumtaz M Mazicioglu
- Department of Family Medicine, Faculty of Medicine, Erciyes University, 38040, Kayseri, Turkey.
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Familial Mediterranean Fever in Iran: A Report from FMF Registration Center. Int J Rheumatol 2015; 2015:912137. [PMID: 26413094 PMCID: PMC4564791 DOI: 10.1155/2015/912137] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/14/2015] [Accepted: 08/18/2015] [Indexed: 11/18/2022] Open
Abstract
Background. Familial Mediterranean fever (FMF) is a periodic AR autoinflammatory disorder. This comprehensive study describes FMF in Iran as a country near Mediterranean area. Materials and Methods. From the country FMF registration center 403 patients according to Tel-Hashomer criteria enrolled this study, 239 patients had MEFV gene mutations analyses. Data, if needed, was analyzed by SPSS v20. Results. 175 patients (43.4%) were female and 228 patients (56.6%) were male. The mean age was 21.3 years. Abdominal pain was in 93.3% patients and 88.1% had fever. Abdominal pain was the main complaint of patients in (49.6%). The mean interval between attacks was 36.5 ± 29.6 days and the mean duration of every episodes was 43.3 ± 34.5 hours. 15.1% of patients had positive family history and 12.7% had previous surgery; in 52.3% of patients delay in diagnosis was more than three years. 12 common MEFV gene mutations were analyzed, 21.33% were without mutations, 39.7% had compound heterozygote, 25.52% showed heterozygous, and 13.38% showed homozygous results. The most common compound genotype was M694V-V726A (% 10.46) and in alleles M694V (% 20.9) and V726A (% 12.7) were the most frequent mutations, respectively. Conclusion. M694V was the most common mutation, and the most common compound genotype was M694V-V726A. Our genotype results are similar to Arabs and in some way to Armenians, erysipelas-like skin lesions are not common in this area, and clinical criteria are the preferred methods in diagnosis of FMF.
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Hosseini M, Dolatshahi E, Ebadi H, Zahedi-Shoolami L. Familial Mediterranean fever in the Iranian population: MEFV mutations in different ethnic groups. INDIAN JOURNAL OF RHEUMATOLOGY 2014. [DOI: 10.1016/j.injr.2013.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Latif AH, Tabassomi F, Abolhassani H, Hammarström L. Molecular diagnosis of primary immunodeficiency diseases in a developing country: Iran as an example. Expert Rev Clin Immunol 2014; 10:385-96. [DOI: 10.1586/1744666x.2014.880654] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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10
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Bonyadi M, Shaghaghi Z, Haghi M, Dastgiri S. Plasminogen activator inhibitor-1 gene polymorphism in Iranian Azeri Turkish patients with FMF disease and its association with amyloidosis. Eur J Pediatr 2013; 172:91-8. [PMID: 23052617 DOI: 10.1007/s00431-012-1844-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 09/11/2012] [Accepted: 09/17/2012] [Indexed: 01/03/2023]
Abstract
UNLABELLED Familial Mediterranean fever (FMF) is an autosomal recessive disorder characterized by intermittent episodes of fever with serositis, arthritis, or eriseplemya. Plasminogen activator inhibitor 1 (PAI-1) is a key element in the inhibition of fibrinolysis by inactivating tissue-type and urokinase-type plasminogen activators. We evaluated the association of PAI-1 -675 4G/5G polymorphism with the severity of FMF disease. For this purpose, 89 FMF patients with M694V homozygous mutation and 95 healthy controls from Iranian Azeri Turks were selected. Detection of this polymorphism was performed by polymerase chain reaction using allele-specific primers. No significant association was found between patients and control group. However, these data showed that FMF patients with M694V homozygous mutation carrying 4G/4G genotype have a reduced risk for development of pleuritis (odds ratios (OR) 0.36; 95 % confidence intervals (CI) 0.5-0.85; P value = 0.007) compared with 5G/5G homozygotes who have increased risk for development of amyloidosis (OR = 2.46; 95 %CI = 1.29-4.72; P value = 0.001), pleuritis (OR = 2.55; 95 %CI = 1.31-4.99; P value = 0.001), and fever (OR = 4.68; 95 %CI = 2.04-10.96; P value = 0.000). Furthermore, the allelic frequency of the 4G among the patients with pleuritis was significantly low (OR = 0.5, 95 % CI = 0.27-0.92, P value = 0.008). CONCLUSION Our data suggest a protective role for the 4G allele against pleuritis in FMF patients with M694V homozygous mutation in this cohort. More evaluation of this polymorphism may be important and require further studies.
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Affiliation(s)
- M Bonyadi
- Center of Excellence for Biodiversity, Faculty of Natural Sciences, University of Tabriz, Tabriz, Iran.
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Esmaeili M, Bonyadi M, Khabbazi A, Ebrahimi AA, Sharif SK, Hajialilo M, Kolahi S, Dastgiri S. CommonMEFVmutations in Iranian Azeri Turkish patients with Behçet's disease. Scand J Rheumatol 2011; 40:383-6. [DOI: 10.3109/03009742.2011.562532] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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12
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Jarjour RA, Dodaki R. Arthritis patterns in familial Mediterranean fever patients and association with M694V mutation. Mol Biol Rep 2010; 38:2033-6. [DOI: 10.1007/s11033-010-0326-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 09/03/2010] [Indexed: 11/28/2022]
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Bidari A, Ghavidel-Parsa B, Najmabadi H, Talachian E, Haghighat-Shoar M, Broumand B, Ghalehbaghi B. Common MEFV mutation analysis in 36 Iranian patients with familial Mediterranean fever: clinical and demographic significance. Mod Rheumatol 2010; 20:566-72. [PMID: 20549290 DOI: 10.1007/s10165-010-0317-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 05/07/2010] [Indexed: 11/29/2022]
Abstract
The aim of our study was to determine the spectrum of the 12 most common familial Mediterranean fever gene (MEFV) mutations in Iranian patients with heterogeneous ethnicity, using the familial Mediterranean fever (FMF) strip assay test. A total of 36 patients were diagnosed according to established clinical criteria. Genomic DNA from all patients was tested for 12 common mutations located in exon 2 (E148Q), 3 (P369S), 5 (F479L), 10 [M680I (G>C), M680I (G>A), I692del, M694V, M694I, K695R, V726A, A744S, R761H], respectively, using the FMF strip assay test. Of the 35 patients with mutations, ten were homozygote, 20 were compound heterozygote, and five were heterozygote. The most frequent genotype was M680I/M680I (6 patients, 16.7%). The most frequent mutation was M680I, followed by M694V, and V726A. The FMF strip assay test for common these 12 mutations was positive in 90.6% of alleles in this study, indicating that it appears to be an effective method for FMF mutation screening in Iranian patients.
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Affiliation(s)
- Ali Bidari
- Department of Rheumatology, Iran University of Medical Sciences, Tehran, Iran
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El Gezery DA, Abou-Zeid AA, Hashad DI, El-Sayegh HK. MEFV Gene Mutations in Egyptian Patients with Familial Mediterranean Fever. Genet Test Mol Biomarkers 2010; 14:263-8. [DOI: 10.1089/gtmb.2009.0180] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dalal A. El Gezery
- Department of Clinical Pathology, Alexandria University, Alexandria, Egypt
| | - Abla A. Abou-Zeid
- Department of Clinical Pathology, Alexandria University, Alexandria, Egypt
| | - Doaa I. Hashad
- Department of Clinical Pathology, Alexandria University, Alexandria, Egypt
| | - Hesham K. El-Sayegh
- Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Bonyadi M, Esmaeili M, Karimi A, Dastgiri S. Common Mediterranean Fever Gene Mutations in the Azeri Turkish Population of Iran. Genet Test Mol Biomarkers 2010; 14:149-51. [DOI: 10.1089/gtmb.2009.0087] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mortaza Bonyadi
- Faculty of Natural Sciences, Center of Excellence for Biodiversity, University of Tabriz, Tabriz, Iran
- Liver & Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohsen Esmaeili
- Faculty of Natural Sciences, Center of Excellence for Biodiversity, University of Tabriz, Tabriz, Iran
- Liver & Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abbas Karimi
- Faculty of Natural Sciences, Center of Excellence for Biodiversity, University of Tabriz, Tabriz, Iran
- Liver & Gastrointestinal Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Dastgiri
- Department of Community and Family Medicine, School of Medicine, National Public Health Management Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Bonyadi M, Esmaeili M, Jalali H, Somi MH, Ghaffari A, Rafeey M, Sakha K, Lotfalizadeh N, Pourhassan A, Khoshbaten M, Ardalan MR, Laghaeian N. MEFVmutations in Iranian Azeri Turkish patients with familial Mediterranean fever. Clin Genet 2009; 76:477-80. [DOI: 10.1111/j.1399-0004.2009.01270.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Familial Mediterranean fever in Syrian patients: MEFV gene mutations and genotype-phenotype correlation. Mol Biol Rep 2009; 37:1-5. [PMID: 19253030 DOI: 10.1007/s11033-009-9475-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 02/17/2009] [Indexed: 10/21/2022]
Abstract
Familial Mediterranean fever is an autosomal recessive disorder characterized by recurrent attacks of abdominal pain, synovitis and pleuritis. MEFV gene mutations are responsible for the disease. The objective of this study was to identify the frequency and distribution of 12 MEFV mutations in 153 Syrian patients and perform a genotype-phenotype correlation in the patients' cohort. Of the 153 unrelated patients investigated, 97 (63.4%) had at least one mutation. The most frequent mutation was M694V (36.5%), followed by V726A (15.2%), E148Q (14.5%), M680I (G/C) (13.2%), and M694I (10.2%) mutations. Rare mutations (R761H, A744S, M680I (G/A), K695R, P369S, F479L and I692del) were also detected in the patients. M694V was associated with the severe form of the disease. The identification of a significant number of FMF patients with no mutations or only one known mutation identified indicates the presence of new mutations in the MEFV gene which will be investigated in the future.
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