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Prepublished online as a Blood First Edition Paper on August 29, 2002; DOI 10.1182/blood-2002-05-1399.

Submitted May 23, 2002
Accepted July 15, 2002
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
Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
* Corresponding author; email: Akiko_Shimamura{at}dfci.harvard.edu.
Fanconi anemia (FA) is an autosomal recessive chromosomal instability syndrome characterized by congenital abnormalities, progressive bone marrow failure, and cancer predisposition. Although FA patients are candidates for bone marrow transplant 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 for 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 FA patients, 37 patients referred for possible FA, and 29 normal controls. 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 newly diagnosed FA patients. These new FA screening assays would allow efficient testing of broad populations at risk.

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