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浙江大学学报(医学版)  2020, Vol. 49 Issue (5): 586-590    DOI: 10.3785/j.issn.1008-9292.2020.10.06
专题报道     
一例TSC2基因低比例突变嵌合体基因学分析
金筱筱(),金鹏珍,严恺,钱叶青,董旻岳*()
浙江大学医学院附属妇产科医院生殖遗传科 生殖遗传教育部重点实验室, 浙江 杭州 310006
Genetic analysis of a mosaic case with low proportion mutation of TSC2 gene
JIN Xiaoxiao(),JIN Pengzhen,YAN Kai,QIAN Yeqing,DONG Minyue*()
Department of Reproductive Genetics, Women's Hospital, Zhejiang University School of Medicine, Key Laboratory of Reproductive Genetics, Ministry of Education, Hangzhou 310006, China
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摘要:

目的: 对一例临床表现不典型的结节性硬化症(TSC)患者进行基因突变分析以明确诊断。方法: 收集一例临床上拟诊TSC的患者及其父母的外周血,通过全外显子组测序技术对先证者TSC1TSC2基因的全部外显子及其侧翼序列进行测序,确定候选致病突变位点,同时对先证者及其父母的外周血DNA进行Sanger测序验证,并用液滴数字PCR技术确定先证者体细胞中该突变嵌合比例。结果: 先证者的TSC2基因第11号外显子存在c.1096G>T(p.E366*)杂合无义突变,为微小突变峰,突变比例未高于其突变阈值,不排除嵌合体的可能。液滴数字PCR结果提示,先证者为c.1096G>T点突变嵌合体,嵌合比例为14%。结论: 先证者TSC2基因发生体细胞镶嵌突变,c.1096G>T可能是该TSC患者的致病原因。液滴数字PCR有助于体细胞镶嵌突变嵌合体的确诊。

关键词: 结节性硬化症TSC2诊断全外显子组测序Sanger测序镶嵌现象液滴数字PCR    
Abstract:

Objective: To perform gene mutation analysis in a patient with atypical clinical manifestations of tuberous sclerosis (TSC) for definite diagnosis. Methods: Peripheral blood DNA was obtained from a patient with clinically suspected TSC and her parents, and all exons and their flanking sequences of TSC1 and TSC2 genes in the proband were sequenced by whole exome sequencing to determine the candidate pathogenic mutations. At the same time, Sanger sequencing was performed to verify the peripheral blood DNA of the patient and her parents. And the mosaic percentage of the mutation in the proband's somatic cells was detected by the droplet digital PCR method. Results: A heterozygous nonsense mutation c.1096G>T (p.E366*) was identified in the exon 11 of the TSC2 gene, which only had a small mutation peak. A lower percentage of the mutation was found in the DNA of the patient than that in the public database, therefore the possibility of mosaicism might not be excluded. In addition, the droplet digital PCR method demonstrated that the proband was a c.1096G>T mutant mosaicism, and the mosaic percentage was 14%. Conclusions: The somatic mosaic mutation c.1096G>T (p.e366*) may be responsible for the phenotype of TSC in this patient. And the drop digital PCR is expected to be a diagnostic method for somatic cells mosaicism.

Key words: Tuberous sclerosis    TSC2    Diagnosis    Whole exome sequencing    Sanger sequencing    Mosaicism    Droplet digital PCR
收稿日期: 2020-07-05 出版日期: 2020-11-19
:  R394.3  
基金资助: 浙江省重点研发计划(2019C03025)
通讯作者: 董旻岳     E-mail: jxx@enzemed.com;dongmy@zju.edu.cn
作者简介: 金筱筱(1979-), 女, 硕士研究生, 主任医师, 主要从事妇产科临床工作; E-mail:jxx@enzemed.com; https://orcid.org/0000-0002-7982-2626
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引用本文:

金筱筱,金鹏珍,严恺,钱叶青,董旻岳. 一例TSC2基因低比例突变嵌合体基因学分析[J]. 浙江大学学报(医学版), 2020, 49(5): 586-590.

JIN Xiaoxiao,JIN Pengzhen,YAN Kai,QIAN Yeqing,DONG Minyue. Genetic analysis of a mosaic case with low proportion mutation of TSC2 gene. J Zhejiang Univ (Med Sci), 2020, 49(5): 586-590.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2020.10.06        http://www.zjujournals.com/med/CN/Y2020/V49/I5/586

探针及引物 序列
TSC2-F GGTGGTGGCGTGGGACATTCT
TSC2-R CGAGCCTGCCTGTCTGGGTT
TSC2-P-Wt FAM-CATCATCGAACGGCT-MGB
TSC2-P-mut VIC-AACATCATCTAACGGCTC-MGB
TSC2-P ROX-TCAGCAGCTCCAGgtg-MGB
表 1  扩增所需的上下游引物及数字PCR所需探针
图 1  先证者及父母TSC2 c.1096位点Sanger测序结果
图 2  先证者及父母TSC2基因突变率分析结果
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