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Prepublished online as a Blood First Edition Paper on October 24, 2002; DOI 10.1182/blood-2002-03-0853.
HEMOSTASIS, THROMBOSIS, AND VASCULAR BIOLOGY
From the Division of Medical Genetics, University
Medical School and University Hospital, Geneva,
Switzerland, and the Division of Angiology and Hemostasis,
University Hospital, Geneva, Switzerland.
Congenital afibrinogenemia (Mendelian Inheritance in Man
#202400) is a rare, autosomal recessive disorder characterized by the
complete absence of circulating fibrinogen. Our recent studies on the
molecular basis of the disease showed that the most common genetic
defect is a donor splice mutation in fibrinogen alpha gene (FGA)
intron 4, IVS4+1G>T. Two other FGA donor splice
mutations, in intron 1 (IVS1+3A>G) and intron 3 (IVS3+1_+4delGTAA),
were identified in afibrinogenemia patients. Because it was impossible to directly study the effect of these mutations on mRNA splicing in
patient hepatocytes, we used a transfected cell approach, which previously allowed us to show that the common IVS4 mutation causes afibrinogenemia due to the activation of multiple cryptic donor splice
sites. In this study, analysis of the IVS3delGTAA mutation showed exon
3 skipping in 99% of transcripts and exons 2 and 3 skipping in 1% of
transcripts. The different outcomes of these donor splice mutations
appear to follow the model proposed in a study of fibrillar collagen
genes, where donor splice mutations occurring in a rapidly spliced
intron with respect to upstream introns lead in most cases to exon
skipping, while mutations in later-spliced introns lead to intron
inclusion or cryptic splice-site utilization. Indeed, we found that in
FGA intron 3 was preferentially spliced first, followed by
intron 2, intron 4, and intron 1.
(Blood. 2003;101:1851-1856) Mutations affecting splice sites are common
in human genetic disease. The majority of these are single-point
mutations affecting the conserved bases at the donor or acceptor splice
sites. A study of more than a hundred splice-site
mutations1,2 showed that point mutations affecting the 5'
donor splice site were more common than those at the 3' acceptor site
(62% vs 26%). At the 5' donor splice site, mutations affecting the G
residue at position +1 are the most common, followed by mutations at
position +5. Mutations at these 2 positions are thought to
significantly reduce the pairing of the donor splice site with the
complementary site in the small nuclear ribonucleoprotein particle
U1snRNP, which is one of the first steps in the complex process of mRNA
splicing.3,4 At the 3' acceptor site, mutations affecting
the conserved Congenital afibrinogenemia (Mendelian Inheritance in Man #202400;
http://www.ncbi.nlm.nih.gov/omim/), an autosomal recessive disorder
originally described in 1920,5 is characterized by the
complete absence of functional fibrinogen.6-8 Fibrinogen is produced predominantly in hepatocytes from 3 homologous polypeptide chains, A Control and mutant FGA genomic constructs
mRNA analysis
Order of intron removal
Analysis of nuclear RNA intermediates Actinomycin treatment and nuclear RNA extraction were performed according to Schwarze et al.16 COS-7 cells transfected with the FGA wild-type genomic construct were incubated with serum-free DMEM containing 5 µg/mL actinomycin D to halt transcription. Incubation was stopped after 5, 10, 20, 40, and 60 minutes by washing with ice-cold phosphate-buffered saline (PBS). Nuclear RNA was isolated using the RNeasy kit (Qiagen) after incubating scraped cell pellets in Triton X-100 buffer and centrifugation in order to eliminate cytoplasmic components. RT-PCR was performed with P32-end-labeled sense oligonucleotides
and products were separated on 6% denaturing polyacrylamide gels. PCR
products amplified from genomic DNA were used as size markers. Again,
controls without reverse transcription were included in each reaction.
In addition, RT-PCR amplification of exon 3 was performed as a control
for RNA quantity in each reaction and gel loading.
We previously used the transfected COS-7 cell model to show that the common FGA IVS4+1G>T mutation led to afibrinogenemia through the activation of cryptic donor splice sites situated 4 bp downstream in intron 4 (85% of aberrant mRNAs) or upstream in FGA exon 4.14 No skipping of exon 4 was observed. The same approach was used to determine the effect of the IVS3+1_+4delGTAA mutation on mRNA splicing. Analysis of the IVS3+1_+4delGTAA mutation Agarose gel electrophoresis of the RT-PCR product issued from the expression of the mutant construct showed only one product. Direct sequencing of this product demonstrated that the 4-bp deletion at the donor splice site of exon 3 caused exon skipping (Figure 3). Thus, although Spliceview19 computer prediction (http://www.itba.mi.cnr.it/webgene/) of the region surrounding the IVS3 donor site detected several potential cryptic donor splice sites in intron 3, it appears that in COS cells none of them is activated. To verify whether other potential aberrant mRNAs were produced by the IVS3delGTAA mutation, the RT-PCR product was cloned and 149 individual inserts were analyzed by hybridization; approximately 99% of the transcripts showed skipping of exon 3, while 1% of transcripts showed skipping of both exon 2 and exon 3 (Figure 3C). In both cases, the exon skipping disrupts the original reading frame, leading to a premature stop codon.
Order of intron splicing in the FGA gene Two different outcomes were found for the IVS4 mutation (cryptic splice-site activation) and the IVS3 mutation (exon skipping). Because outcome of splice-site mutations in the fibrillar collagen genes COL1A1, COL1A2, COL3A1, and COL5A1 has been proposed to differ according to the order of intron removal,15-17 we determined the order of intron splicing in the FGA gene using an RT-PCR-based approach described by Kessler et al.18 In this experiment, it is the observation of the partially spliced intermediates that is instructive, since products containing all the introns may derive from the primary RNA transcript and are uninformative for the order of intron splicing. The data and the deduced preferential order of intron removal in the FGA gene are summarized in Table 2.
Intron 1 versus intron 2.
Figure 4 shows the strategy for intron 1 versus intron 2. Primer pair A, with a forward primer in FGA
exon 1 and a reverse primer in intron 2, amplified the nonspliced exon
1-intron 1-exon 2 pre-mRNA (1309 bp). In contrast, primer pair B,
with a forward primer in intron 1 and a reverse primer in exon 3, amplified the spliced intron 1-exon 2-exon 3 intermediate (360 bp),
with traces of the unspliced product (819 bp). These results allow us
to conclude that in the FGA gene, intron 2 is preferentially
spliced before intron 1 (Figure 4; Table 2).
Intron 2 versus intron 3.
Reaction C, with the intronic primer in intron 3, amplified
predominantly the unspliced product (905 bp), but the spliced exon
2-exon 3 intermediate (446 bp) was also observed (Figure 5). Reaction D, with the intronic primer
in intron 2, also amplified both unspliced and spliced forms (1463 bp
and 331 bp, respectively). The preferential order of splicing of these
2 introns could not be clearly determined solely by the analysis of
these reactions.
Intron 3 versus intron 4. Analysis of RT-PCR reactions E and F demonstrated splicing of intron 3 before intron 4, since the only partially spliced intermediate amplified (398-bp product in reaction E) contained intron 4 but not intron 3 (Figure 5). Intron 1 versus intron 3. Reaction G, with the intronic primer in intron 3, amplified several bands, including a product without intron 2 (1593 bp) and one without intron 1 and intron 2 (524 bp). The latter product may result from a minor alternative pathway of splicing involving intron 1 (see "Discussion"), since primer pair H amplified a single strong 402-bp band containing intron 1 but not introns 2 and 3, demonstrating preferential splicing of intron 3 (and intron 2) before intron 1. The relatively low intensities of the bands amplified in reaction G may reflect the low abundance of partially spliced intermediates containing intron 3 in the FGA gene, consistent with the hypothesis that intron 3 is rapidly removed from the primary transcript. Intron 2 versus intron 4. Primer pair I, with the intronic primer in intron 4, amplified only the spliced exon 2-exon 3-exon 4 product (524 bp), demonstrating, as expected, preferential splicing of intron 2 (and intron 3) before intron 4. Primer pair J amplified a product containing introns 2 and 4 but not intron 3 (1245 bp). Intron 1 versus intron 4. Reaction K amplified a 1671-bp band containing intron 4 but not introns 2 and 3 and a 603-bp band containing intron 4 but not introns 1, 2, and 3. Again, the latter product may result from a minor pathway in which intron 1 is spliced before intron 4, since reaction L amplified a single strong 731-bp band product containing intron 1 but not intron 4 (or introns 2 and 3). The results demonstrate a preferential order of intron removal in the FGA gene where introns 3 and 2 are removed before intron 4 and intron 1. In order to determine which of the 2 introns, intron 2 or intron 3 was preferentially spliced first, we analyzed nuclear RNA intermediates isolated after actinomycin treatment to halt transcription.16 When primers were placed in exon 2 and intron 3 (reaction C, Figure 5B), there was no transfer of radioactivity from the unspliced intermediate to the spliced exon 2-exon 3 fragment (446 bp). In fact, the majority of radioactivity disappeared during the actinomycin treatment, which is consistent with the removal of intron 3 before intron 2. On the contrary, when primers were placed in intron 2 and exon 4, (reaction D, Figure 5B) the unspliced intermediate disappeared over time while the total radioactivity remained constant, again consistent with preferential removal of intron 3 before intron 2. These data, in addition to those obtained for RT-PCR reaction J, which amplified a product containing introns 2 and 4 but not intron 3, allow us to conclude that the preferential order of splicing in the FGA gene is intron 3 before intron 2, followed by intron 4 and intron 1.
We studied the effects of donor splice-site mutations affecting 2 different introns in the FGA gene, identified in patients with congenital afibrinogenemia, using a transfected cell approach. Although it is not immediately possible to conclude from the
experiments in COS-7 cells that exactly the same aberrant mRNAs are
being produced in the patient's hepatocytes, since cell-specific mRNA splicing of numerous genes, including the fibrinogen Two different outcomes were found for the common IVS4+1G>T mutation (cryptic splice-site activation) and the IVS3+1_+4delGTAA mutation (exon 3 skipping). Outcome of splice-site mutations in the fibrillar collagen genes COL1A1, COL1A2, COL3A1, and COL5A1 has been proposed to differ according to the order of intron removal.15-17 For example, identical IVS+1G>A substitutions in intron 47 and intron 48 of the COL1A1 gene caused, respectively, a mild and a lethal form of osteogenesis imperfecta, due to exon skipping in one case and cryptic splice-site activation in the other. Subsequent analysis of up to 12 splice-site mutations showed that, in general, donor splice-site mutations occurring in a rapidly spliced intron with respect to upstream introns lead preferentially to exon skipping, while donor splice-site mutations in later-spliced introns lead to intron inclusion or cryptic splice-site utilization.15 In some cases, introns were spliced along 2 pathways ("major" and "minor" pathways), and the outcome of mutations in these introns reflected the relative frequencies of these pathways.16,17 We determined the order of intron splicing in the FGA gene
using an RT-PCR-based approach.18 We found that introns 3 and 2 were spliced early, followed by intron 4 and intron 1. This preferential order of splicing leads to an RNA intermediate containing intron 1 followed by a large "exon" comprising exons 2, 3, and 4, and then by intron 4 and exon 5 (Figure
6). In this situation, a donor
splice-site mutation occurring in intron 4 can only lead to intron 4 inclusion (if the intron is small) or cryptic donor splice-site
activation. This is exactly the outcome of the common afibrinogenemia
mutation IVS4+1G>T. In contrast, since intron 3 is the first intron to
be spliced, followed by intron 2, the most likely outcome for the
IVS3delGTAA mutation is exon 3 skipping due to utilization of the
intron 2 donor site (Figure 6). This is what we observed in close to
100% of transcripts produced by cells expressing the IVS3delGTAA
mutation. In summary, the results obtained for the FGA gene
appear to be consistent with the model proposed for the collagen genes.
The factors controlling the order of intron removal are not known. The "quality" of the donor/acceptor sites; the presence of cryptic sites, splice enhancers or suppressors, or RNA secondary structures; or the size of introns and exons may all contribute.22-27 For the FGA gene, however, as for the aprt gene,18 the strength of the donor and acceptor sites as estimated by Spliceview19 scores is not sufficient to determine the order of intron splicing. Indeed, FGA intron 4 has the highest donor and acceptor scores (91 and 95, respectively) followed by intron 2 (84 and 91) and intron 3 (83 and 82). For intron 1, the donor score was 80, while the acceptor site was undetected by the analysis, reflecting poor agreement with acceptor consensus sequences. Splicing of the "poor" intron 1 may be dependent on prior splicing of the downstream introns, with the exon 1-intron 1-exon 2-exon 3-exon 4-exon 5 intermediate a better substrate for the spliceosome. If the order of intron splicing determines the outcome of donor
splice-site mutations in the majority of genes, if not all, it should
be possible to predict the order of intron splicing based on studies of
splice-site mutations. For congenital afibrinogenemia, other than the
FGA mutations described here, 2 mutations affecting FGG splice sites have been identified and their effect on
mRNA splicing characterized. Asselta and coworkers28
studied a Pakistani patient with afibrinogenemia who was homozygous for
a mutation in FGG intron 1: IVS1+5G>A. Expression of the
IVS1+5G>A mutant in transfected HeLa cells followed by RT-PCR and
sequencing revealed that the mutation led to retention of intron 1 in
the mRNA. Using a similar experimental approach, Margaglione et
al29 identified a homozygous FGG intron 3 mutation affecting the same conserved +5 donor splice-site position,
IVS3+5G>A, in an Italian patient. Expression of the mutant
FGG sequence in HEK 293 cells showed skipping of exon 3, resulting in a deletion of the corresponding 60 amino acid residues
encoded by this exon and a frame shift leading to premature
We thank Prof Laurent Roux for the COS-7 cell line. We thank the reviewers of this article for their useful comments and suggestions.
Submitted March 19, 2002; accepted October 15, 2002.
Prepublished online as Blood First Edition Paper, October 24, 2002; DOI 10.1182/blood-2002-03-0853.
Supported by Swiss National Science Foundation (SNF) grant 31-64987.01 and by the Dr Henri Dubois Ferrière-Dinu Lipatti Foundation. M.N.-A. is the recipient of an SNF Professorship.
C.A. and A.D. contributed equally.
The publication costs of this article were defrayed in part by page charge payment. Therefore, and solely to indicate this fact, this article is hereby marked "advertisement" in accordance with 18 U.S.C. section 1734.
Reprints: Marguerite Neerman-Arbez, Centre Médical Universitaire, 1 rue Michel Servet, CH-1211 Geneva, Switzerland; e-mail: marguerite.arbez{at}medecine.unige.ch.
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© 2003 by The American Society of Hematology.
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M Failly, L Bartoloni, A Letourneau, A Munoz, E Falconnet, C Rossier, M M de Santi, F Santamaria, O Sacco, C D DeLozier-Blanchet, et al. Mutations in DNAH5 account for only 15% of a non-preselected cohort of patients with primary ciliary dyskinesia J. Med. Genet., April 1, 2009; 46(4): 281 - 286. [Abstract] [Full Text] [PDF] |
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P. D. James, L. A. O'Brien, C. A. Hegadorn, C. R. P. Notley, G. D. Sinclair, C. Hough, M.-C. Poon, and D. Lillicrap A novel type 2A von Willebrand factor mutation located at the last nucleotide of exon 26 (3538G>A) causes skipping of 2 nonadjacent exons Blood, November 1, 2004; 104(9): 2739 - 2745. [Abstract] [Full Text] [PDF] |
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