Compound Heterozygosity for a Recessive Glycine Substitution and a Splice Site Mutation in the COL7A1 Gene Causes an Unusually Mild Form of Localized.

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Compound Heterozygosity for a Recessive Glycine Substitution and a Splice Site Mutation in the COL7A1 Gene Causes an Unusually Mild Form of Localized Recessive Dystrophic Epidermolysis Bullosa  Michela Terracina, Patrizia Posteraro, Giovanna Zambruno, Daniele Castiglia  Journal of Investigative Dermatology  Volume 111, Issue 5, Pages 744-750 (November 1998) DOI: 10.1046/j.1523-1747.1998.00397.x Copyright © 1998 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 1 Pedigree of the localized RDEB family. The segregation of the glycine substitution G1347R (half black symbols) and the splice site mutation 5820G→A (half gray symbols) is shown. Journal of Investigative Dermatology 1998 111, 744-750DOI: (10.1046/j.1523-1747.1998.00397.x) Copyright © 1998 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 2 Clinical, ultrastructural, and immunofluorescence features of the localized RDEB family. Patient II.3 exhibits several small blisters, erosions, crusts, and scars on the hand palmar (A) and, to a lesser extent, dorsal (B) surfaces; mild dystrophy of fingernails is also present (B). Electron microscopy of the dermal–epidermal junction (DEJ) of uninvolved RDEB skin (C) reveals the presence of numerous, cross-banded anchoring fibrils (arrows), which appear similar to those detected in normal control skin (D) (k, basal keratinocyte, d, dermis; asterisk, lamina densa). By immunofluorescence microscopy, the linear labeling of the DEJ with monoclonal antibody LH7:2 against collagen VII is similar in control (F) and RDEB skin (E), where it is localized along the roof of an initial blister (asterisk). Scale bars: (C, D) 0.5 μm; (E) 16 μm; (F) 20 μm. Journal of Investigative Dermatology 1998 111, 744-750DOI: (10.1046/j.1523-1747.1998.00397.x) Copyright © 1998 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 3 Northern blot and immunoblot analysis of collagen VII mRNA and protein levels in localized RDEB keratinocyte cultures. (A) Northern blot analysis of total RNA shows a signal of similar intensity for the collagen VII probe in patient II.3 (lane 1) and control keratinocytes (lane 2); GAPDH, glyceraldehyde-3-phosphate dehydrogenase probe used for loading control. (B) Cell extracts were subjected to sodium dodecyl sulfate-polyacrylamide gel electrophoresis under denaturing conditions followed by immunoblotting with antibodies to collagen VII. Control keratinocyte extracts revealed a strong band of procollagen VII (white arrowhead; lane 1), similarly to extracts of proband II.3 (lane 2), the mother I.2 (lane 3), and a healthy unrelated control (lane 4). The keratinocyte extracts were subjected to limited pepsin treatment, and the digestion products were reacted with antibodies recognizing the triple-helical and the carboxy-terminal NC-2 domains of procollagen VII. The digestion removed the globular domains of procollagen VII and resulted in the appearance of three bands on the immunoblots: the intact triple helical domain and its amino-terminal half, the P2 fragment, as well as its carboxy-terminal half, the P1 fragment (black arrowheads, from top to bottom, respectively). In the extracts of probands II.3 (lane 6), the mother I.2 (lane 7), and a healthy unrelated control (lane 8), bands of similar intensity were observed, indicating that the mutations did not result in significant destabilization of collagen VII triple-helix. The 17 amino acid deletion caused by the splice site mutation in exon 70 is located amino-terminally adjacent to the COL7A1 central hinge region, the main pepsin cleavage site that generates the P1 and P2 fragments. The glycine substitution G1347R resides well within the long triple helical fragment P2, more than 90 amino acid residues from the putative amino-terminal pepsin cleavage site of this fragment. Lane 5 shows molecular weight standards, from top to bottom: 200, 120, 80, and 50 kDa. Journal of Investigative Dermatology 1998 111, 744-750DOI: (10.1046/j.1523-1747.1998.00397.x) Copyright © 1998 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 4 Identification of the heterozygous missense mutation G1347R in COL7A1 gene of patient II.3 and inheritance in the kindred. (A) Total genomic DNA was subjected to PCR reaction using primers which amplify a 445 bp fragment spanning exons 34–35 of COL7A1. In comparison with the DNA of a normal control, sequencing of the patient’s DNA reveals a G→C transversion at nucleotide position 4039 of exon 34 that changes a glycine codon to an arginine codon at amino acid residue 1347. The mutation is designated G1347R. (B) ASO analysis: hybridization of the 445 bp PCR product with a wild type (WT) and mutated (M) ASO shows the heterozygous state of the mutation in the three affected siblings (II.2, II.3, II.5), the patients’ mother (I.2), and a healthy member (II.1) of the kindred. C, unaffected control individual. Journal of Investigative Dermatology 1998 111, 744-750DOI: (10.1046/j.1523-1747.1998.00397.x) Copyright © 1998 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 5 Identification of the heterozygous splice site mutation 5820G→A in COL7A1 gene of patient II.3 and inheritance in the kindred. (A) Total genomic DNA was subjected to PCR reaction using primers that amplify a 433 bp fragment encompassing COL7A1 exons 69–70. As compared with the DNA of a normal control, sequencing of the patient’s DNA reveals a G→A substitution at the last nucleotide of exon 70 (nt position 5820). The mutation is designated 5820G→A. (B) Verification of mutation 5820G→A with HphI restriction endonuclease digestion of the 433 bp PCR product. Five fragments (a 150 bp doublet, and 58, 40, 35 bp bands) are visible in the mother and an healthy unrelated control (C), and an additional 300 bp fragment (from the 150 bp doublet) is detected in the three affected siblings (II.2, II.3, II.5), their father (I.1), and two healthy family members (III.1, III.2), which is indicative of a heterozygous state for mutation 5820G→A. The markers for molecular size (100 bp DNA ladder, from 2000 to 100 bp) are in lane M. (C) Schematic representation of the localization of HphI sites within the 433 bp amplified fragment, an arrow denotes the site abolished by mutation 5820G→A. Journal of Investigative Dermatology 1998 111, 744-750DOI: (10.1046/j.1523-1747.1998.00397.x) Copyright © 1998 The Society for Investigative Dermatology, Inc Terms and Conditions

Figure 6 RT-PCR and cloning analysis of the effects of splice site mutation 5820G→A at the mRNA level. (A) The mRNA from cultured keratinocytes was analyzed by RT-PCR using oligonucleotide primers that amplify nt 5702–5916 of COL7A1 cDNA. In addition to the expected major 215 bp band present in the controls (C1, C2, C3), analysis of the amplification product reveals a smaller band in patient II.3. The inset shows the electrophoretic pattern of the two amplified bands in relation to the number of PCR cycles. The markers for molecular size (100 bp DNA ladder, from 2000 to 100 bp) are in lane M. (B) As compared with a normal control, sequence analysis of a clone obtained from the 215 bp band (mutant cDNA 1) reveals a G→A substitution at the last nucleotide of exon 70. Isolation and cloning of the smaller band reveals an aberrant mRNA bearing an in-frame skipping of the entire exon 70 (48 bp) (mutant cDNA 2). Journal of Investigative Dermatology 1998 111, 744-750DOI: (10.1046/j.1523-1747.1998.00397.x) Copyright © 1998 The Society for Investigative Dermatology, Inc Terms and Conditions