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Prepublished online as a Blood First Edition Paper on August 29, 2002; DOI 10.1182/blood-2002-05-1399.
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Blood, 15 December 2002, Vol. 100, No. 13, pp. 4649-4654
RED CELLS
A novel diagnostic screen for defects in the Fanconi anemia
pathway
Akiko Shimamura,
Rocio Montes de Oca,
John L. Svenson,
Nicholas Haining,
Lisa A. Moreau,
David G. Nathan, and
Alan D. D'Andrea
From the Department of Pediatric Oncology, Dana-Farber
Cancer Institute, Boston, MA.
Fanconi anemia (FA) is an autosomal recessive chromosomal
instability syndrome characterized by congenital abnormalities, progressive bone marrow failure, and cancer predisposition. Although patients with FA are candidates for bone marrow transplantation or gene
therapy, their phenotypic heterogeneity can delay or obscure diagnosis.
The current diagnostic test for FA consists of cytogenetic quantitation
of chromosomal breakage in response to diepoxybutane (DEB) or mitomycin
C (MMC). Recent studies have elucidated a biochemical pathway for
Fanconi anemia that culminates in the monoubiquitination of the FANCD2
protein. In the current study, we develop a new rapid diagnostic and
subtyping FA assay amenable for screening broad populations at risk of
FA. Primary lymphocytes were assayed for FANCD2 monoubiquitination
by immunoblot. The absence of the monoubiquitinated FANCD2 isoform
correlated with the diagnosis of FA by DEB testing in 11 known patients
with FA, 37 patients referred for possible FA, and 29 healthy control
subjects. Monoubiquitination of FANCD2 was normal in other bone
marrow failure syndromes and chromosomal breakage syndromes. A
combination of retroviral gene transfer and FANCD2 immunoblotting
provides a rapid subtyping assay for patients newly diagnosed with FA.
These new FA screening assays would allow efficient testing of broad
populations at risk.

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