Fanconi anemia: genetic testing in Ashkenazi Jews

Fanconi anemia (FA) is an autosomal recessive disorder characterized clinically by progressive pancytopenia, diverse congenital abnormalities, and a predisposition to malignancy, particularly acute myelogenous leukemia (AML). Hypersensitivity of FA cells to the clastogenic effect of crosslinking agents such as diepoxybutane (DEB) is used as a diagnostic criterion, because phenotypic heterogeneity makes clinical diagnosis difficult. Studies of genetic heterogeneity have shown that there are at least five different complementation groups, FA-A through FA-E. Overall, FA-A is the most prevalent group, accounting for 60%-65% of all FA. The FAA gene, which maps to chromosome 16q24.3, was recently isolated and methods for molecular diagnosis of FA-A are currently being developed. The first FA gene to be isolated (FAC) maps to chromosome 9q22.3; FA-C accounts for 10%-15% of FA. A variety of mutations and polymorphisms have been described in FAC. The most common of these is IVS4 +4 A-->T, which is the only FAC mutation found in Ashkenazi Jewish FA patients and their families. This mutation has not been found in any affected individual of non-Jewish ancestry. The carrier frequency of the IVS4 mutation was found to be 1 in 89 (1.1%; 95% confidence interval 0.79% to 1.56%) in an Ashkenazi Jewish population, whereas no carriers were identified in an Iraqi Jewish population, which represents the original gene pool of the Jews. We have developed amplification refractory mutation system (ARMS) assays for FAC mutations, which provide a means of rapid, nonradioactive genetic testing. These assays have been used to assign FA patients to Group C, to provide rapid carrier testing and prenatal diagnosis for FA-C families.