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Blood, 15 March 2004, Vol. 103, No. 6, pp. 2019-2026.
Prepublished online as a Blood First Edition Paper on October 30, 2003; DOI 10.1182/blood-2003-09-3360.

Submitted September 30, 2003
Accepted October 24, 2003
Acquired somatic ATRX mutations in myelodysplastic syndrome associated with thalassemia (ATMDS) convey a more severe hematological phenotype than germline ATRX mutations
David P Steensma*, Douglas R Higgs, Chris A Fisher, and Richard J Gibbons
MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom; Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
MRC Molecular Haematology Unit, Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
* Corresponding author; email: steensma.david{at}mayo.edu.
Acquired somatic mutations in ATRX, an X-linked gene encoding a chromatin-associated protein, were recently identified in four patients with the rare subtype of myelodysplastic syndrome (MDS) associated with thalassemia (ATMDS). Here we describe a series of novel point mutations in ATRX detected in archival DNA samples from marrow and/or blood of patients with ATMDS by use of denaturing high performance liquid chromatography (DHPLC), a technique sensitive to low-level mosaicism. Two of the new mutations result in changes in amino acids altered in previously described pedigrees with germline ATRX mutations (ATR-X syndrome), but the hematological abnormalities were much more severe in the ATMDS patients than in the corresponding constitutional cases. In one ATMDS case where DNA samples from several time points were available, the proportion of ATRX-mutant subclones correlated with changes in the amount of hemoglobin H. This study strengthens the link between acquired, somatic ATRX mutations and ATMDS, illustrates how molecular defects associated with MDS and other hematological malignancies masked by somatic mosaicism may be detected by DHPLC, and shows that additional factors increase the severity of the hematological phenotype of ATRX mutations in ATMDS.

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