Improvement in the molecular diagnosis of Machado-Joseph disease

被引:103
作者
Maciel, P
Costa, MDC
Ferro, A
Rousseau, M
Santos, CS
Gaspar, C
Barros, J
Rouleau, GA
Coutinho, P
Sequeiros, J
机构
[1] Univ Porto, IBMC, UnIGENe, P-4150180 Oporto, Portugal
[2] Univ Porto, Dept Estudos Populacoes, Inst Ciencias Biomed Abel Salazar, P-4150180 Oporto, Portugal
[3] Hosp St Antonio, Neurol Serv, Oporto, Portugal
[4] Inst Super Ciencias Sude Norte, Pasedes, Portugal
[5] McGill Univ, Ctr Res Neurosci, Montreal, PQ, Canada
[6] Montreal Gen Hosp, Res Inst, Montreal, PQ H3G 1A4, Canada
[7] Hosp St Sebastiao, Neurol Serv, Santa Maria Feira, Portugal
关键词
D O I
10.1001/archneur.58.11.1821
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Direct detection of the gene mutation allows for the confirmation of the clinical diagnosis of Machado-Joseph disease (MJD), the most frequent cause of autosomal dominant spinocerebellar ataxia worldwide. Objective: To address the main difficulties in our national MJD predictive testing program. The first was the emergence of intermediate alleles, for which it is not yet possible to determine whether they will cause disease. The second was the issue of homoallelism, ie, homozygosity for 2 normal alleles with exactly the same (CAG)(n) length, which occurs in about 10% of all test results. Methods: A large pedigree with 1 affected patient carrying a 71 and a 51 CAG repeat and 2 asymptomatic relatives carrying the 51 CAG repeat and normal-size alleles underwent clinical and molecular studies. Intragenic haplotypes for these alleles were determined, A representative sample of the healthy population in the region was obtained to assess the distribution of the normal (CAG), length. We established the genotype for 4 intragenic polymorphisms in the gene for MJD (MJD1) in 21 homoallelic individuals, to distinguish their 2 normal chromosomes. In addition, we developed a new Southern blot method to completely exclude cases of nonamplification of expanded alleles in the homoallelic individuals. Results: The study of the family in which the 51 CAG repeat was found suggests that the allele is apparently associated with disease. These intermediate alleles were not present in a large sample of the healthy from the same region. Intragenic polymorphisms allowed distinction of the 2 different normal alleles in cases of homoallelism, The absence of an expanded allele was also confirmed by Southern blot. Conclusions: We propose an improved protocol for molecular testing for MJD. These strategies, developed to overcome the practical difficulties mostly in the presymptomatic and prenatal diagnosis of MJD, should useful for other polyglutamine -related disorders.
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页码:1821 / 1827
页数:7
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