通过虚假阳性SMA新生儿查测试发现的SMN1变异:治疗障碍和功能和流行病学解决方案
Brunhilde Wirth1, Joyosmita Das2, Heike Kölbel3
1Institute of Human Genetics, University of Cologne, Faculty of Medicine, Cologne, Germany; Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany; Center for Rare Diseases, University Hospital of Cologne, University of Cologne, Cologne, Germany.
新生儿查脊髓肌缩 (SMA) 错过了两名患有罕见SMN1变异的婴儿. 这些携带新型SMN1异型的婴儿保持健康,挑战目前的诊断假设.
科学领域:
- 遗传学和分子生物学
- 神经学 神经学
- 新生儿查 新生儿查
背景情况:
- 新生儿查 (NBS) 脊髓肌缩 (SMA) 取决于检测SMN1缺失.
- 标准PCR测定错过了罕见的SMN1变异,可能导致错过诊断.
- 脊柱肌肉缩是由SMN1基因中的双基删除引起的.
研究的目的:
- 报告两例由NBS确定为缺乏SMN1,但携带罕见,可检测的SMN1变异的婴儿的病例.
- 描述已识别的SMN1变种及其对SMN蛋白的影响.
- 评估患有这些新型SMN1变异的婴儿的临床结果.
主要方法:
- 基因特异性远程PCR和桑格测序用于识别SMN1变异.
- 功能性测试以评估SMN蛋白质的丰度,拼接和热稳定性.
- 斑马鱼模型用于评估新型SMN1蛋白质异型体内的活体功能.
主要成果:
- 在SMN1第7个外基因 (c.855_858delAGAA和c.861_864delAAGG) 中发现了两个不同的4-bp删除.
- 这些删除创建了一个新型的移变体 (p.Arg288AlafsTer5),破坏了NBS测试初始部位.
- 这种新型的SMN1异型体在体内显示保存了拼接和蛋白质功能,拯救了斑马鱼的运动缺陷.
- 携带这些带有SMN1删除的变异的个体仍然无症状,这挑战了立即治疗的必要性.
结论:
- 罕见的SMN1变种可以逃避标准NBS检测.
- 一种具有潜在增强功能效率的新型SMN1蛋白质异型可以维持正常的运动发育.
- 目前关于SMN1功能完全丧失,始终导致SMA的假设可能需要修订.
- 这些发现影响了SMA的诊断策略和治疗决策.
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