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Original Studies |
Academic Medical Center, University of Amsterdam, Emma Childrens Hospital AMC, Division of Pediatric Endocrinology (B.B., H.B., T.V., J.J.M.d.V.), Department of Clinical Genetics, Institute for Clinical Genetics (M.S., R.H.), 1100 DE Amsterdam, The Netherlands; and St. Joseph Hospital, Department of Pediatrics (E.J.P.L.), 5500 MB Veldhoven, The Netherlands
Address all correspondence and requests for reprints to: Hennie Bikker, Ph.D., Academic Medical Center, University of Amsterdam, Emma Childrens Hospital AMC, Division of Pediatric Endocrinology, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands. E-mail: h.bikker{at}amc.uva.nl or egbertbakker@xs4all.nl.
| Abstract |
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T2512 (codon 808)] in exon 14 was identified in a patient with
classical TIOD. The transmission pattern of the TPO gene in this family
was anomalous; the mother was heterozygous for the deletion; and the
mutation was absent in the father. Polymorphic short tandem repeat
(STR) markers confirmed paternity and demonstrated on chromosome 2 that
the propositus was homozygous for most markers on chromosome 2p and
that these were identical to one of the maternal 2p homologs. A normal
karyotype was found in the propositus, his parents and sister. We
conclude that the homozygosity in the patient is due to partial
maternal isodisomy of the short arm of chromosome 2, carrying a
defective TPO gene. The patient, born small for gestational age,
develops and grows well and appears healthy (while being treated with
thyroxine) and has a normal phenotype except for a unilateral
preauricular skin tag. This shows that partial maternal isodisomy for
chromosome 2p (2pter - 2p12) is compatible with a minimal influence on
normal development. | Introduction |
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| Materials and Methods |
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Genomic DNA was extracted from peripheral blood lymphocytes by standard methods, using QIAGEN G100 Genomic tips (QIAGEN, Valencia, CA).
The coding sequence and intron/exon boundaries of the TPO gene of the proband was studied using restriction enzyme digestion and denaturing gradient gel electrophoresis (DGGE) analysis of PCR-amplified genomic DNA (5, 7). Exons with aberrant DGGE patterns were sequenced using ABI Prism BigDye primer cycle sequencing chemistry (Perkin-Elmer Corp. PE Applied Biosystems, Foster City, CA) on an ABI 377 DNA sequencer.
Locus specific microsatellite marker analysis
Genotypic analysis with polymorphic STR markers was used to
validate paternity (Geneprint Powerplex 1.2 system, Promega Corp., Madison, WI) on an ABI Prism 310 Genetic Analyzer. For
genotyping of chromosome 2, we used the following markers: D2S319,
D2S162, D2S149, D2S165, D2S170, D2S367, D2S2259, D2S391, D2S123,
D2S337, D2S2368, D2S101, D2S286, D2S2333, D2S274, D2S2229, D2S2386,
D2S160, D2S347, D2S112, D2S142, D2S335,
D2S364, D2S202, D2S117, D2S325, D2S2382 and D2S126, see Fig. 2
. Two additional STR markers (D2S2216
and D2S113) were not informative. The sequences of the oligonucleotide
primers for the microsatellite markers were obtained from the Genome
Database (http://www.gdb.org). Forward primers were Cy5-labeled.
PCR reactions contained 30 ng of genomic DNA, 150 µM of
each dATP, dCTP, dGTP, dTTP, 0.32 µM of each primer and
0.3 U Taq polymerase (SuperTaq, HT Biotechnology Ltd.) in 15 µL of buffer consisting of 10
mM Tris-HCl pH 9.0, 1.5 mM
MgCl2, 50 mM KCl, 0.1%
Triton X-100, and 0.01% wt/vol gelatin. Thermal cycling consisted of 3
min denaturation at 94 C, followed by 30 cycles of 30 sec/94 C, 30
sec/55 C, 30 sec/72 C and a final incorporation at 72 C for 5 min. PCR
products were analyzed by electrophoresis on a 6% polyacrylamide
denaturing gel (Sequagel, National Diagnostics, Atlanta, GA) on
an ALFexpress automated DNA sequencer from
Amersham Pharmacia Biotech (Piscataway, NJ)
(8).
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The patient was a male Caucasian born to nonconsanguineous,
healthy parents; the family history is unremarkable. Mother was 31 yr
old at the time of delivery. The boy was small for gestational age:
birth weight was 1630 g at 38 weeks and 1 day. Fetal distress
urged a caesarian section. However the neonate was vigorous after birth
with Apgar scores of 8 and 9 after 1 and 5 min, respectively. Physical
examination was unremarkable except for a preauricular skin tag on the
left side. No preauricular skin tags were present in other family
members. The renal ultrasound in the patient was unremarkable. Serious
feeding problems in the first week of life prompted early assessment of
thyroid function. Very low plasma free T4 and T4 levels, extremely
elevated plasma TSH and elevated plasma Tg concentrations were found
(Table 1
). The radioiodide imaging study
(1 MBq 123I- iv, followed
by measurements of the uptake in the thyroid every 30 min, and
administration of 100 mg NaClO4 iv at 120 min)
documented a normally located thyroid gland with a high uptake (above
20%) and an immediate and complete release of the intrathyroidal
radioiodine after NaClO4 administration. The
expressed CH, elevated Tg concentrations, and complete release of
123I- after
NaClO4 administration were consistent with the
diagnosis of TIOD.
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| Results |
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T2512,
whereas in the TPO genes of the father and the sister this mutation was
absent, consistent with the DGGE results (Fig. 1B
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| Discussion |
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T2512 in exon 14 of the
patients TPO alleles. This frameshift mutation leads to a premature
termination signal in exon 14. Previous in vitro analysis of
a similar frameshift mutation in exon 14 (ins C 25052511) resulted in
an inactive enzyme (7). The inheritance pattern of mutated TPO alleles in this family was not autosomal recessive as usual. Heterozygosity for the mutation was only detected in the mother. Because STR markers confirmed paternity, the proband either had a maternal isodisomy for (part of) chromosome 2 or an unbalanced karyotype due to a paternal chromosome anomaly involving chromosome 2p, leading to hemizygosity for the TPO locus in the proband.
Both the patient and his parents had normal karyotypes, which excluded major structural chromosomal abnormalities. By means of deduction, we concluded that the patient had UPD for chromosome 2p. Dosage analysis on Southern blotting (9) confirmed the presence of two copies of the TPO gene (data not shown).
UPD represents an imbalance in the distribution of paternal and maternal chromosomes in the offspring. It is defined as the presence (in a diploid individual) of two homologs of a specific chromosome pair inherited from only one parent (10). This condition can be complete or partial. Uniparental heterodisomy is the condition where both chromosome homologs in the offspring originate from one parent but are different from each other. If two identical copies of one single parental homolog are present, the condition is called uniparental isodisomy. The first case of UPD was described by Engel (11), who stated that the consequences on the phenotype may result from three potentially harmful effects: interference with genomic imprinting, (occasionally) vestigial aneuploidy (unbalanced karyotype) from which UPD initially may have originated, and isodisomy. In isodisomy, there is not only the risk for a disturbance due to imprinting, but the two pairs of homologs are identical creating homozygosity for a large region of a certain chromosome, with an associated increased risk for recessive disorders (11). The latter is the cause for the TIOD in the patient presented.
UPD of chromosome 2 has been described five times thus far, all were
maternal in origin, and two out of five cases involved isodisomy
(12). Clinical features are listed in Table 2
; it is of note that our patient has so
few clinical features while patients of other authors are often more
severely affected.
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To the best of our knowledge, partial isodisomy for chromosome 2p as described in this report, has not been described before. This finding has important consequences for genetic counseling of these parents: usually parents of a child with a TIOD will be given a 25% recurrence risk, and in certain cases prenatal diagnostics through molecular studies will be offered. Because the recurrence risk for partial UPD is very low, the risk for TIOD in further offspring for this couple is negligible. With regard to this family, there is no need to perform prenatal studies during future pregnancies.
The pathogenesis of the prenatal growth retardation and preauricular skin tag in the proband remains uncertain. Intrauterine growth retardation is usually not present in children born with CH including the ones with TIOD. We have analyzed a group of 45 newborns with TIOD, and their birth weight is not different from the rest of the population (17A ). Explanations for the intrauterine growth retardation in this patient are homozygosity for other genes on chromosome 2p or an imprinting effect.
An imprinting map of the human genome suggested that chromosome 2 might have imprinting effects (14, 18). This is based on the homology of human chromosome 2 with mouse chromosomes 2 and 12, which have shown to be imprinted. However, genes imprinted in mice are not necessarily imprinted in humans (12).
One case report describing a newborn with UPD2mat, ascertained through trisomy mosaicism in amniotic fluid, also showing intra uterine growth retardation, hypothyroidism (etiology not mentioned) and hyaline membrane disease/bronchopulmonary problems (19), might be an indication of genomic imprinting for chromosome 2 (14). However, another patient with maternal isodisomy and two isochromosomes [i(2p) and i(2q)] was completely normal (20), which argues against maternally imprinted gene(s) on chromosome 2.
According to McKusicks "Mendelian Inheritance in Man" (http://www.ncbi.nlm.nih.gov/Omim), there is no condition on chromosome 2p associated with skin tags. In the cytogenetic literature, a duplication of 2p2521 has been described in a patient with among others preauricular skin tags (21), indicating that genes on 2p can give rise to tag formation once disturbed in their function. However, the patient described in the cytogenetic literature had many other pathological conditions, a big contrast to our patient with one minor dysmorphic feature.
These patients with (partial) duplication or (partial) deletion of 2p show in general growth retardation, mental retardation, and many dysmorphic features. Some of these patients also have low-set, malformed ears, but no preauricular skin tags (Human Cytogenetics Database 1992).
Regarding our patient homozygosity for other genes on 2p, or genomic imprinting of 2p as an explanation for the unilateral preauricular ear tag cannot be excluded.
In conclusion: The patient described has severe congenital hypothyroidism caused by the dyshormonogenesis TIOD, which in turn is caused by a mutation in the TPO gene. Due to partial maternal isodisomy of the short arm of chromosome 2, the TPO gene mutation was reduced to homozygosity. In patients with these autosomal recessive thyroid disorders, it remains important to confirm heterozygosity for the causative mutation in both parents because this has a significant effect on genetic counseling. A role for genomic imprinting of chromosome 2p cannot be discarded by this study. However, these data show that partial maternal isodisomy of chromosome 2p (2pter2p12) is compatible with a minimal influence on normal development.
| Acknowledgments |
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| Footnotes |
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Received April 8, 2000.
Accepted November 1, 2000.
| References |
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