Abstract:
The invention has disclosed a method for diagnosis of dentinogenesis imperfecta type II (DGI-II) and/or dentinogenesis imperfecta type II with deafness (DGI-II with deafness). Said method comprises the steps of detecting the DSPP gene, transcript and/or protein in said subject and comparing it with the normal DSPP gene, transcript and/or protein to determine whether there is any variation, wherein said variation indicates that the possibility of suffering DGI-II and/or DGI-II with deafness in said subject is higher than the normal population. The present invention also discloses the method and pharmaceutical composition for treating DGI-II and/or DGI-II with deafness.

Description:
FIELD OF INVENTION 
     This invention relates to both biological engineering and medical fields. In particular, it relates to a method of diagnosing and treating dentinogenesis imperfecta type II using human dentin sialophosphoprotein or DSPP gene and the coded product, and a pharmaceutical composition containing DSPP gene and/or protein. 
     TECHNICAL BACKGROUND 
     The odontoblasts produce the dentin, which consists in mature tooth or the tooth during tooth development phase. During dentinogenesis, the odontoblasts form dentinal tubules. Dentin cell processes in these tubules make dentin a living tissue. During the primary stage of dentinogenesis, the odontoblasts synthesize, secrete and re-absorb the dentin matrix components. Protein synthesis occurs within cells. Exocytosis and endocytosis occurs mainly in cell processes. The first material formed is unmineralized mantle dentin matrix, mainly including collagen secreted by cells and non-collagenous components. The fasciculata collagen fibers congregate to a ball structure. Due to the continual increase of new fibrils, collagen becomes closer and closer. As a result, these prophase collagen fibers change into collagen fibers. Thus predentin characterized by collagen matrix is formed. Later, the mineralization crystals gradually deposited to become dentin at some distance away from cells. 
     The mature dentin contains more inorganic minerals than the bone. 65 wt. % of dentin are minerals, mostly hydroxyapatite crystals. Organic materials are 20%, mainly collagenous proteins and non-collagenous proteins. These collagens offer braces to the deposition of hydroxyapatite plate like crystalline. 
     Type I collagen is predominant (about 97%) in dentin collagens, 10%-15% of which is type I collagen trimer. Different from other connective tissue, type III collagen is lacking in dentin. Moreover, there are types V and VI collagens in dentin, but the contents are small. Although the contents of non-collagenous proteins in dentin are small, there are various kinds. According to the source of proteins, the dentin noncollagenous proteins can be divided to four kinds: dentin specific protein, mineralized tissue specific protein, aspecific protein, and blood serum source protein (or dentin affinity protein). Dentin specific protein is the only one which is synthesized and secreted by odontoblasts and exists only in dentin. Mineralized tissue specific proteins means those that are found and exist not only in dentin but also in cementum and bone. They are synthesized and secreted by osteoblasts, odontoblasts and cementoblasts. The non-specific proteins exist both in dentin and other tissues, including parenchyma, and synthesized and secreted by odontoblasts and other kinds of cells. Blood serum source proteins are those which are synthesized by other cells in the body, mainly by liver cells, and secreted to serum. These proteins have a high affinity to dentin, though they are not synthesized by dentin. They can enter dentin by blood circulation, so they are also called dentin affinity proteins. Proteoglycans or PGS are other primary non-collagenous proteins in dentin. They are large covalent molecules formed by many anylose side chains and one core protein. These side chains are composed of repeating disaccharide chain units, each of which consists of one glycuronic acid and one N-acetamidoacetose. One function of PGS in dentinogenesis is to affect or even control the systematism of collagen skeleton in predentin. The dentin proteoglycans fixed on the solid bracket can induce the formation of hydroxyapatite in vivo and in physiologic pH and ionic condition in vitro. On the contrary, the liquid proteoglycans restrain the form of mineral components in vitro. The combination of PGS and Ca 2+  is the precondition of inducing the formation of hydroxyapatite. 
     Dentinogenesis imperfecta or DGI is an autosomal dominant dental genetic disease that has a prevalence of 1/8000. There are three types according to clinical taxonomy (1)  (The number in brackets shows the relative literature.). Dentinogenesis imperfecta Type I is also named DGI-I. Except for dentinogenesis imperfecta, patients usually have osteogenesis imperfecta The pathogeny is broad mutations in collagen type I gene (2) . Type II or DGI-II is also called hereditary opalescent dentin. DGI-II has a relationship with the improper mineralization of dentin and its penetrance is nearly 100% (3) . Type III or DGI-III is also called dentinogenesis imperfecta Brandywine type or isolate hereditary opalescent dentin. It is a special hereditary opalescent dentin, only found in three isolates in Washington, D.C., the State of Maryland, USA. Witkop first reported this illness in 1956 (4)  and there is no related report in China till now. DGI-III has an obviously genetic heterogeneity. Its pathogeny is related to malamineralization. Because the gene causing DGI-I has been found and DGI-III is only found in the isolates in the State of Maryland, USA, DGI-II becomes the focus of tooth endodontics. 
     The clinical symptoms and pathology changes of DGI-II are as follows. The malajustment and turbulence of mineralization result in embryonic layer dysplasia in dentin. Both the primary dentition and permanent dentition are affected, with a more serious damage in primary dentition. A predominant feature is a blue-gray or amber brown discoloration of the teeth. The improper mineralized dentin is soft and the crown is prone to be worn. Moreover, compensatory hyperplasia of matrix increases in improperly mineralized dentin, leading to small or obliterated pulp chambers. Radiographs reveal that the affected teeth have bulbous crowns, narrow roots and small or obliterated pulp chambers and root canals. The pathology shows that the enamel surface is normal, but hypoplasia and hypocalcification can be found in about ⅓ of the patients. The enamel dentin junction changes greatly. Some teeth have a non-obvious sector structure in the enamel dentin junction. However, others are especially obvious. Dentin is lamellar with nearly normal outerdentin and dentinal tubules having subdivisional branches. In other parts, the dentin is obviously abnormal. Some short tubules or tubules with abnormal form distribute in dentin matrix disorderly. The predentin zone is very wide. Along the plywood, the remaining embedded cell can be seen, similar to embedded odontoblast and bloods. Observation under electron microscope indicates that the form and size of hypoplastic dentin micro-crystal are unchanged, but the quantity is small. Uncalcified or partly calcified transverse collagen fasciculi and volumes of crystal space can be seen discontinuously. 
     For the mapping of DGI-II gene, in 1969, Bixler et al. (5)  tried to use some protein polymorphic markers, such as ABO, Rh, MNSs, Kell, Fy, JK, HP, ACP1, PGM1 and PTC, to perform a linkage analysis in DGI-II families, but they failed to get the linkage evidence. In 1977, Mikkelsen et al. (6)  mapped a group of specific components (GC) in Vitamin D conjugated protein to 4q11-q13. In the next year, Kühnl identified that GC included six phenotypes: GC2/2, 2/1+, 2/1−, 1+/1−, 1+/1+, and 1−/1−. Later, Ball. S. P. et al. (7)  analyzed the linkage in a DGI-II big family named Family MRC4000 with the polymorphic markers of GC and found that DGI-II had a close linkage with GC (Lod=+7.9, θ=0.13). In 1992, Crall et al. (8)  mapped DGI-II to interval defined by two protein polymorphic markers: GC and interferon-inducible cytokine INP-10. The relative chromosome location was 4q12-21. The results above only offered a gross orientation of disease gene of DGI-II. Under that condition, it was almost impossible to clone the disease gene in this region. 
     In 1995, Crosby A.H et al (9)  analyzed the linkage in two big DGI-II families with 9 short tandem repeat polymorphic markers (STRP) and mapped the disease gene to the 4q21-23 region defined by two STRPs of D4S2691 and D4S2692. Multipoints linkage analysis suggested that the disease gene might be in the region within about 3.2 cM around SPP1. Recently, Aplin H. M et al. (10)  genotyped two big families used by Crosby A. H with 5 hyperdense STRPs. The linkage analysis showed that the disease gene of DGIII located between two STRPs of GATA62A11 and D4S1563 with a genetic distance of 2 cM. Moreover, this research group established the YACs Contigs in this region. They also identified that DMP1, IBSP, SPP1 and DSPP are all in this candidate region by PCR technology. 
     However, the mechanism of dentinogenesis imperfecta type II is still unclear so far. Also the direct relationship between dentinogenesis imperfecta type II and some special kind of protein is not reported. 
     In addition, there is still no effective method to diagnose DGI-II early and/or antenatally and to cure DGI-II by non-operative treatment in the art. 
     Therefore, there is an urgent need to develop new and efficient methods to diagnose and cure DGI-II, the relative pharmaceuticals, and diagnostic technology and reagents. 
     SUMMARY OF INVENTION 
     One purpose of the invention is to provide a new diagnostic method and detection kit, especially for antenatal and/or early diagnosis of dentinogenesis imperfecta type II (DGI-II) and dentinogenesis imperfecta type II with deafness (DGI-II with deafness). 
     Another purpose is to provide a new method to treat DGI-II and DGI-II with deafness. 
     Still another purpose is to provide a pharmaceutical composition to treat DGI-II and DGI-II with deafness. 
     In the first aspect, the invention provides a method for determining the susceptibility of DGI-II and/or DGI-II with deafness in a subject comprising the steps of:
         detecting the DSPP gene, transcript and/or protein in said subject and comparing it with the normal DSPP gene, transcript and/or protein to determine whether there is any difference,   wherein said difference indicates that the possibility of suffering DGI-II and/or DGI-II with deafness in said subject is higher than the normal population.       

     In a preferred embodiment, the DSPP gene or transcript is detected, and compared with the normal DSPP nucleotide sequence to determine the difference. More preferably, said difference is selected from the group consisting of: in position 1 of Exon 3, G1→T1; in position 1 of Intron 3, G1→A1. 
     In the second aspect, the invention provides a method for treating DGI-II and/or DGI-II with deafness comprising the step of administrating a safe and effective amount of normal DSPP and/or DSP protein to the patient in need of said treatment. Preferably, the DSPP and/or DSP protein are administrated topically to periodontal tissues. 
     In the third aspect, the invention provides a pharmaceutical composition comprising a safe and effective amount of DSPP and/or DSP protein and a pharmaceutically acceptable carrier. Preferably, said pharmaceutical composition is injection. 
     In the fourth aspect, the invention provides a kit for detecting DGI-II and/or DGI-II with deafness comprising the primers which specifically amplify the DSPP gene or transcript. Preferably, the kit further comprises a probe that binds to the site of mutation. 
     In view of the technical teaching of the invention, the other aspects of the invention will be apparent to the skilled in the art. 
    
    
     
       DESCRIPTION OF DRAWINGS 
         FIG. 1  shows the gene structure of DSPP. This gene contains 5 exons and 4 introns. The full length is 8210 bp. Exon 1 (7-98), Exon 2 (2359-2437), Exon 3 (3577-3660), Exon 4 (3794-4780) and Exon 5 (5257-8201) encode DSPP. Exons 1-4 and part of Exon 5 (5257-5520) encode DSP, while another part of Exon 5 (5521-7893) encodes DPP. 
         FIG. 2  shows the haplotype construction of STRP markers in 4q21 region in a dentinogenesis imperfecta type II family. 
         FIG. 3  shows the haplotype construction of STRP markers in 4q21 region in a DGI-II with deafness family. A square represents a male. A filled suuare represents a DGI-II or DGI-II with deafness male patient. An open square represent a normal male. A circle represents a female. A filled circle represents a DGI-II or DGI-II with deafness female patient. An open circle represents a normal female. A bracketed circle or square represents a person not affected by DGI-II or DGI-II with deafness but by other disease. A bracketed circle or sausre that is lined through represents a dead person. The long bars represent the same chromosome from different persons. The numbers adjacent to the bars represent markers. 
         FIG. 4A and 4B  show mutations in DSPP gene.  FIG. 4A  shows G1→T1 in position 1 of Exon 3, which causes codon GTT change into TTT, resulting in a corresponding amine acid change of Val→Phe. The change of splicing site is shown in SEQ ID NO: 45, wherein n is G or T. A part of DSPP amino acid sequence is shown in SEQ ID NO: 47.  FIG. 4B  shows G1→A1 in position 1 of Intron 3, which causes the mutation of splicing site. The change of splicing site is shown in SEQ ID NO: 46, wherein n is A or G. A part of DSPP amino acid sequence is shown in SEQ ID NO: 48. 
     
    
    
     DETAILED DESCRIPTION OF INVENTION 
     After studying for several years, the inventors of the invention have, for the first time found and proved dentin sialophosphoprotein (DSPP) and/or dentin sialoprotein (DSP) have a close relationship with dentinogenesis imperfecta type II (DGI-II). In addition, the new function of DSPP/DSP was found, i.e., the changes of DSPP or DSP will cause DGI-II directly. Based on this discovery, the inventors accomplished the invention. 
     Firstly, the inventors collected two genetic families affected by dentinogenesis imperfecta or dentinogenesis imperfecta with progressive hearing loss in China. Then they localized the disease gene of dentinogenesis imperfecta to the 4q21-22 region in Chromosome 4 by genotyping and linkage analysis with microsatellite markers Then, the inventors identified the candidate genes by the following steps: 
     (1) Finding all of the genes mapped in 4q21-22 region, i.e., making the transcription map in 4q21-22 region; 
     (2) Checking the expression situation of all of the genes in 4q21-22 region; 
     (3) Determining the genes mapped in 4q21-22 region and expressed in dental pulp as the candidates for dentinogenesis imperfecta. 
     The results showed that the candidate genes included DMP1, IBSP, SPP1, DSP, DPP and DSPP. 
     Further, the inventors used PCR-SSCP technique to screen all candidate genes for mutation and found that the mutations in DSPP have a direct causality with dentinogenesis imperfecta, while other genes do not. 
     Finally, the mode and site of DSPP mutation in two genetic families were identified by sequence analysis. In DGI-II family, sequencing revealed a G1→T1 mutation at position 1 of Exon 3 (position 3577 in SEQ ID NO:1). The mutation results in not only an amino acid change, but also a splicing site change which may cause the expression of intron, termination of translation in advance or frame shifting ( FIG. 4A ). Therefore, the normal DSPP (or DSP) protein is unable to be expressed. 
     In another DGI-II with deafness family, the mutation is a G1→A1 mutation in position 1 of Intron 3 (position 3661 of SEQ ID NO:1). The mutation was predicted to result in splicing site change, which may cause the expression of intron, termination of translation in advance or frame shifting ( FIG. 4B ). Therefore, the normal DSPP (or DSP) protein is unable to be expressed. Further, it may influence the translation of signal peptide so that DSPP can not be correctly localized. Surprisingly, this mutation causes the patient affected with both DGI-II and deafness, suggesting that DSPP mutation is associated with deafness. It is possible to diagnose deafness, especially DGI-II with deafness, by detecting whether DSPP is normal or not. 
     On the basis of this invention, one can design and exploit new drugs based on DSPP gene and its products (e.g., transcripts and proteins) as well as the interacting molecule. In addition, one can use DSPP gene in vitro to reconstruct teeth or remodel some tooth structure, such as dentin. 
     Human DSPP mutation causes human dentinogenesis imperfecta type II. Based on the DSPP gene and its expression products, one can develop new drugs and diagnosis/treatment techniques for detecting and treating human DGI-II. 
     Human DSPP Gene and Protein 
     The detailed sequences of human DSPP gene and protein are available in Genbank (The accession number is AF163151) and some references, such as Gu, K., Chang, S., Ritchie, H. H., Clarkson, B. H. and Rutherford, R. B., Eur. J. Oral Sci. 2000 Feb: 108 (1):35-42. In Sequence Listing, human DSPP nucleotide sequence and amino acid sequence are shown in SEQ ID NO:1 and SEQ ID NO: 2, respectively.  FIG. 1  shows the introns and exons of human DSPP. 
     
       
         
               
               
             
           
               
                   
               
             
             
               
                 Exon 1 
                 7-98 
               
               
                 mRNA 
                 join (7-98, 2359-2437, 3577-3660, 3794-4780, 
               
               
                   
                 5257-8201) 
               
               
                 Exon 2 
                 2359-2437 
               
               
                 CDS 
                 join (2387-2437, 3577-3660, 3794-4780, 5257-7896) 
               
               
                 sig_peptide 
                 2387-2431 
               
               
                 mat_peptide 
                 join (2432-2437, 3577-3660, 3794-4780, 5257-7893)/ 
               
               
                   
                 Product “DSPP” 
               
               
                 mat_peptide 
                 join (2432-2437, 3577-3660, 3794-4780, 5257-5520)/ 
               
               
                   
                 Product “DSP” 
               
               
                 Exon 3 
                 3577-3660 
               
               
                 Exon 4 
                 3794-4780 
               
               
                 Exon 5 
                 5257-8201 
               
               
                 mat_peptide 
                 5521-7893 
               
               
                 misc_feature 
                 5596-5604 /note = “Region: cell binding domain” 
               
               
                 PolyA_signal 
                 7988-7993 
               
               
                 PolyA_signal 
                 8171-8176 
               
               
                   
               
             
          
         
       
     
     The DSPP and/or DSP protein or polypeptide have various uses including but not limited to: curing disorders caused by low or no activity of DSPP and/or DSP protein (using directly as a medicine), and screening out antibodies, polypeptides or ligands which promote the function of DSPP and/or DSP. The expressed recombinant DSPP and/or DSP protein can be used to screen polypeptide library to find therapeutically valuable polypeptide molecules which activate the function of DSPP and/or DSP protein. 
     In another aspect, the invention also includes polyclonal and monoclonal antibodies, preferably monoclonal antibodies, which are specific for polypeptides encoded by human DSPP DNA or fragments thereof. By “specificity”, it is meant an antibody that binds to the human DSPP gene products or fragments thereof. Preferably, the antibody binds to the human DSPP gene products or fragments thereof and does not substantially recognize nor bind to other antigenically unrelated molecules. Antibodies that bind to human DSPP and block human DSPP protein and those which do not affect the human DSPP function are included in the invention. 
     The present invention includes not only intact monoclonal or polyclonal antibodies, but also immunologically-active antibody fragments, e.g., a Fab′ or (Fab) 2  fragment, an antibody heavy chain, an antibody light chain, a genetically engineered single chain Fv molecule (Lander, et al., U.S. Pat. No. 4,946,778), or a chimeric antibody, e.g., an antibody which contains the binding specificity of a murine antibody, but the remaining portion of which is of human origin. 
     The antibodies in the present invention can be prepared by various techniques known to those skilled in the art. For example, purified human DSPP gene products, or its antigenic fragments can be administrated to animals to induce the production of polyclonal antibodies. Similarly, cells expressing human DSPP or its antigenic fragments can be used to immunize animals to produce antibodies. The antibodies of the invention can be monoclonal antibodies which can be prepared by using hybridoma technique (See Kohler, et al., Nature, 256; 495,1975; Kohler, et al., Eur. J. Immunol. 6: 511,1976; Kohler, et al., Eur. J. Immunol 6: 292, 1976; Hammerling, et al., In Monoclonal Antibodies and T Cell Hybridomas, Elsevier, N.Y., 1981). Antibodies of the invention comprise those which block human DSPP function and those which do not affect human DSPP function. Antibodies in the invention can be produced by routine immunology techniques and using fragments or functional regions of human DSPP gene product. These fragments and functional regions can be prepared by recombinant methods or synthesized by a polypeptide synthesizer. The antibodies binding to unmodified human DSPP gene product can be produced by immunizing animals with gene products produced by prokaryotic cells (e.g.,  E. coli ), and the antibodies binding to post translationally modified forms thereof (e.g., glycosylated or phosphorylated polypeptide) can be acquired by immunizing animals with gene products produced by eukaryotic cells (e.g., yeast or insect cells). 
     The antibody against human DSPP and/or DSP protein can be used in immunohistochemical method to detect the presence of DSPP and/or DSP protein in the biopsy specimen. 
     The polyclonal antibodies can be prepared by immunizing animals, such as rabbit, mouse, and rat, with human DSPP and/or DSP protein. Various adjuvants, e.g., Freund&#39;s adjuvant, can be used to enhance the immunization. 
     The substances that act with DSPP and/or DSP protein, e.g., inhibitors, agonists and antagonists, can be screened out by various conventional techniques, using the protein of the invention. 
     The protein, antibody, inhibitor, agonist or antagonist of the invention provides different effects when administrated in therapy. Usually, these substances are formulated with a non-toxic, inert and pharmaceutically acceptable aqueous carrier. The pH typically ranges from 5 to 8, preferably from about 6 to 8, although pH may alter according to the property of the formulated substances and the diseases to be treated. The formulated pharmaceutical composition is administrated in conventional routine including, but not limited to, intramuscular, intravenous, subcutaneous, or topical administration. The topical administration at periodontal tissues is preferred. 
     The normal DSPP and/or DSP can be directly used for curing disorders, e.g., DGI-II. The DSPP and/or DSP protein of the invention can be administrated in combination with other medicaments for DGI-II. 
     The invention also provides a pharmaceutical composition comprising safe and effective amount of DSPP and/or DSP protein in combination with a suitable pharmaceutical carrier. Such a carrier includes but is not limited to saline, buffer solution, glucose, water, glycerin, ethanol, or the combination thereof. The pharmaceutical formulation should be suitable for the delivery method. The pharmaceutical composition of the invention may be in the form of injections which are made by conventional methods, using physiological saline or other aqueous solution containing glucose or auxiliary substances. The pharmaceutical compositions in the form of tablet or capsule may be prepared by routine methods. The pharmaceutical compositions, e.g., injections, solutions, tablets, and capsules, should be manufactured under sterile conditions. The active ingredient is administrated in therapeutically effective amount, e.g., from about  1 ug to 5 mg per kg body weight per day. Moreover, the polypeptide of the invention can be administrated together with other therapeutic agents. 
     When using pharmaceutical composition, the safe and effective amount of the DSPP and/or DSP protein or its antagonist or agonist is administrated to mammals. Typically, the safe and effective amount is at least about 0.1 ug/kg body weight and less than about 10 mg/kg body weight in most cases, and preferably about 0.1-100 ug/kg body weight. Of course, the precise amount will depend upon various factors, such as delivery methods, the subject health, and the like, and is within the judgment of the skilled clinician. 
     The human DSPP and/or DSP polynucleotides also have many therapeutic applications. Gene therapy technology can be used in the therapy of abnormal cell proliferation, development or metabolism, which is caused by the loss of DSPP and/or DSP expression or the expression of abnormal or non-active DSPP and/or DSP. The methods for constructing a recombinant virus vector harboring DSPP and/or DSP gene are described in the literature (Sambrook, et al.). In addition, the recombinant DSPP and/or DSP gene can be packed into liposome and then transferred into the cells. 
     The methods for introducing the polynucleotides into tissues or cells include: directly injecting the polynucleotides into tissue in the body, in vitro introducing the polynucleotides into cells with vectors, such as virus, phage, or plasmid, and then transplanting the cells into the body. 
     The invention further provides diagnostic assays for quantitative and in situ measurement of DSPP and/or DSP protein level. These assays are well known in the art and include FISH assay and radioimmunoassay. The level of DSPP and/or DSP protein detected in the assay can be used to illustrate the importance of DSPP and/or DSP protein in diseases and to determine the diseases associated with DSPP and/or DSP protein. 
     A method of detecting the presence of DSPP and/or DSP protein in a sample by utilizing the antibody specifically against DSPP and/or DSP protein comprises the steps of: contacting the sample with the antibody specifically against DSPP and/or DSP protein; observing the formation of antibody complex which indicates the presence of DSPP and/or DSP protein in a sample. 
     The polynucleotide encoding DSPP and/or DSP protein can be used in the diagnosis and treatment of DSPP and/or DSP protein related diseases. In respect of diagnosis, the polynucleotide encoding DSPP and/or DSP can be used to detect whether DSPP and/or DSP is expressed or not, and whether the expression of DSPP and/or DSP is normal or abnormal, e.g., in the case of diseases. DSPP DNA sequences can be used in the hybridization with biopsy samples to determine the expression of DSPP. The hybridization methods include Southern blotting, Northern blotting and in situ blotting, etc., which are public and sophisticated techniques. The corresponding kits are commercially available. A part of or all of the polynucleotides of the invention can be used as probe and fixed on a microarray or DNA chip for analyzing the differential expression of genes in tissues and for the diagnosis of genes. The DSPP and/or DSP specific primers can be used in RNA-polymerase chain reaction and in vitro amplification to detect the transcripts of DSPP and/or DSP. 
     Further, detection of the mutation of DSPP and/or DSP gene is useful for the diagnosis of DSPP and/or DSP protein related diseases. The mutation forms of DSPP and/or DSP include site mutation, translocation, deletion, rearrangement and any other mutations compared with the normal wild-type DSPP and/or DSP DNA sequence. The conventional methods, such as Southern blotting, DNA sequencing, PCR and in situ blotting, can be used to detect mutation. Moreover, mutation sometimes affects the expression of protein. Therefore, Northern blotting and Western blotting can be used to indirectly determine whether the gene is mutated or not. 
     The invention is further illustrated by the following examples. It is appreciated that these examples are only intended to illustrate the invention, but not to limit the scope of the invention. For the experimental methods in the following examples, they are performed under routine conditions, e.g., those described by Sambrook et al., in Molecule Clone: A Laboratory Manual, New York: Cold Spring Harbor Laboratory Press, 1989, or as instructed by the manufacturers, unless otherwise specified. 
     EXAMPLE 1 
     DGI-II family had 42 members, and DGI-II with deafness family had 14 members. All individuals were subjected to careful clinical examination and recorded in details by experienced dentists. The patients with deafness were examined carefully by otologists and identified by pure tone audiogram and brain stem evoked potential. 5 ml blood samples in the families were collected by standard venipuncture and stocked by ACD solution. DNA was extracted using the following method: 
     Preparation of Blood DNA Sample 
     Blood DNA samples were extracted by Qiagen kit according to manufacturer&#39;s instructions. The steps were as follows: 
     a. Add 20 ul Proteinase K, 200 ul blood sample and 200 ul Buffer AL into a 1.5 ml microcentrifuge tube. Mix by pulse-vortexing for 15 seconds. 
     b. Incubate for digestion at 56° C. for 10 minutes. Add 210 ul 100% ethanol to the sample, and briefly centrifuge for 10 seconds. 
     c. Carefully apply the mixture onto a QIAamp spin column and centrifuge at 8000 rpm for 1 minute. 
     d. Discard the filtrate and transfer the QIAamp spin column in another 2 ml collection tube. 
     e. Add 500 ul Buffer AW1 into QIAamp spin column, centrifuge at 8000 rpm for 1 minute. 
     f. Discard the filtrate and add 500 ul Buffer AW2 into QIAamp spin column, centrifuge at 14000 rpm for 3 minutes.
         g. Discard the filtrate and place the QIAamp spin column in a new 1.5 ml microcentrifuge tube.   h. Add 200 ul Buffer AE into QIAamp spin column, incubate at room temperature for 5 minutes, and centrifuge at 8000 rpm for 1 minute. The filtrate collected in the tube was DNA solution from blood sample.   i. DNA quality was determined by 1% agarose gel electrophoresis. The DNA quantity was determined by UV spectrophotometer. The DNA samples were stored at −20° C.       

     EXAMPLE 2 
     1 Genotyping: 
     The sequences of high polymorphic STR markers in region 4q21 were obtained from Genome Database and markers A-G were D4S2691, D4S1534, GATA62 μl 1, DSP, DMP1, SPP1, D4S451, respectively. PCR amplifications were carried out following LI-COR company manual for the touchdown program and using PTC-225 DNA Engine Tetrad (MJ-Research Inc.). PCR reactions were in 10 ul system containing 20 ng genomic DNA template, 2.0 mM dNTP, 1.0 pmol M13-tailed forward primer and reverse primer, 1.0 pmol fluorescent M13 primer, 1.5 mM MgCl 2 , 10 mM Tris-HCl, and 1U AmpliTaq Gold Taq Polymerase (Perkin-Elmer Corp.). The reaction system was initially denatured at 95° C. for 8 minutes, followed by 4 cycles of denaturing at 95° C. for 45 seconds, annealing at 68° C. for 2 minutes with a drop of 2° C. per cycle until 60° C., and extending at 72° C. for 1 minute, and by a second set of 2-4 cycles of denaturing at 95° C. for 45 seconds, annealing at 58° C. for 1 minute with a drop of 2° C. per cycle until 50-54° C., and extending at 72° C. for 1 minute, and then by 20-30 cycles of denaturing at 95° C. for 30 seconds, annealing at 50-54° C. for 30 seconds and extending at 72° C. for 30 seconds. Finally the samples were extended at 72° C. for 15 minutes. PCR products and fluorescent-labeled standard size DNA markers were electrophoresed on a LI-COR automated sequencer on a polyacrylamide gel. Data were collected and analyzed by Base Image 4.1 and Gene Image 3.12 software, while linkage ready pedigree files were generated. These files were used for linkage analysis and haplotype analysis. 
     2. Linkage Analysis and Haplotype Analysis 
     DGI-II hereditary locus was modeled as an autosomal dominant inheritance with 100% penetrance in a two-allele system. The frequency of disease gene was set to 0.0001, the frequencies of STRs were assumed to be uniformly distributed. Two-point linkage analysis was performed by using MLINK and ILINK program from the LINKAGE version 5.10 software package. Haplotype construction was performed using SIMWALK2 version 2.31 and Cyrillic version 2.02 software. 
     The pedigree data are shown in Tables 1-2 and  FIGS. 2-3 . 
     
       
         
               
             
               
               
             
               
               
               
             
               
               
               
               
               
               
               
               
               
               
             
               
               
               
               
               
               
               
               
               
               
             
           
               
                 TABLE 1 
               
             
             
               
                   
               
               
                 Disease locus in DGI-II pedigree and STRP two-point linkage analysis in 
               
               
                 4q21 region 
               
             
          
           
               
                 Loca- 
                   
               
             
          
           
               
                 tion 
                 Lod score at θ 
                 Maximum 
               
             
          
           
               
                 marker 
                 0.0 
                 0.01 
                 0.05 
                 0.1 
                 0.2 
                 0.3 
                 0.4 
                 Lod 
                 θ 
               
               
                   
               
             
          
           
               
                 A 
                 −∞ 
                 −0.11 
                 2.19 
                 2.76 
                 2.59 
                 1.81 
                 0.83 
                 2.76 
                 0.1 
               
               
                 B 
                 1.65 
                 1.62 
                 1.51 
                 1.37 
                 1.09 
                 0.78 
                 0.42 
                 1.65 
                 0.0 
               
               
                 C 
                 7.63 
                 7.50 
                 6.96 
                 6.25 
                 4.74 
                 3.09 
                 1.36 
                 7.63 
                 0.0 
               
               
                 D 
                 6.06 
                 5.96 
                 5.53 
                 4.98 
                 3.82 
                 2.57 
                 1.24 
                 6.06 
                 0.0 
               
               
                 E 
                 8.24 
                 8.11 
                 7.54 
                 6.80 
                 5.22 
                 3.49 
                 1.67 
                 8.24 
                 0.0 
               
               
                 F 
                 8.38 
                 8.24 
                 7.67 
                 6.93 
                 5.32 
                 3.55 
                 1.64 
                 8.38 
                 0.0 
               
               
                 G 
                 7.34 
                 7.23 
                 6.77 
                 6.16 
                 4.87 
                 3.44 
                 1.84 
                 7.34 
                 0.0 
               
               
                   
               
             
          
         
       
     
     
       
         
               
             
               
               
             
               
               
               
             
               
               
               
               
               
               
               
               
               
               
             
               
               
               
               
               
               
               
               
               
               
             
           
               
                 TABLE 2 
               
             
             
               
                   
               
               
                 Disease locus in DGI-II with deafness pedigree and Lod score in 4q21 
               
               
                 region 
               
             
          
           
               
                 Loca- 
                   
               
             
          
           
               
                 tion 
                 Lod score at θ 
                 Maximum 
               
             
          
           
               
                 marker 
                 0.0 
                 0.01 
                 0.05 
                 0.1 
                 0.2 
                 0.3 
                 0.4 
                 Lod 
                 θ 
               
               
                   
               
             
          
           
               
                 A 
                 −∞ 
                 −2.86 
                 −1.48 
                 −0.92 
                 −0.42 
                 −0.18 
                 −0.05 
                 −0.05 
                 0.4 
               
               
                 B 
                 −∞ 
                 0.67 
                 1.19 
                 1.25 
                 1.04 
                 0.65 
                 0.21 
                 1.25 
                 0.1 
               
               
                 C 
                 1.20 
                 1.8 
                 1.07 
                 0.93 
                 0.63 
                 0.33 
                 0.08 
                 1.20 
                 0.0 
               
               
                 D 
                 −0.14 
                 −0.09 
                 −0.05 
                 −0.02 
                 −0.00 
                 −0.00 
                 −0.00 
                 −0.00 
                 0.2 
               
               
                 E 
                 0.91 
                 0.92 
                 0.91 
                 0.86 
                 0.67 
                 0.41 
                 0.14 
                 0.92 
                 0.01 
               
               
                 F 
                 2.71 
                 2.66 
                 2.46 
                 2.21 
                 1.65 
                 1.02 
                 0.37 
                 2.71 
                 0.0 
               
               
                 G 
                 2.11 
                 2.07 
                 1.91 
                 1.70 
                 1.24 
                 0.73 
                 0.23 
                 2.07 
                 0.0 
               
               
                   
               
             
          
         
       
     
     The results suggested that the disease genes in DGI-II and DGI-II with deafness pedigrees were linked with STRP markers in 4q21 region. 
     EXAMPLE 3 
     Mutation Screening of Candidate Genes 
     Using Primer 5.0 software, we designed primers to amplify exons and the splice junctions between exons and introns of DSP gene (Table 3). PCR-SSCP technique was used to screen DSP gene for mutation. PCR products were electrophoresed on 10% polyacrylamide gel and 9.3% polyacrylamide gel with 4% glycerol. Then, the gels were silver stained according to standard protocol. 
     Primers were as follows: 
     
       
         
               
               
             
               
               
               
               
               
             
           
               
                 TABLE 3 
               
             
             
               
                   
               
               
                 Primer Sequences in DSPP Coding Region 
                   
               
             
          
           
               
                 Primer 
                   
                   
                   
                   
               
               
                 Name 
                 Sequence 
                 No. 
                 bp 
               
               
                   
               
               
                 DSPP-E1 F 
                 5′-TGCAAAAGTCCATGACAGTG-3′ 
                 SEQ ID 
                 128 
                   
               
               
                   
                   
                 NO:3 
               
               
                   
               
               
                 DSPP-E1 R 
                 5′-TCAGTTGGTTCTGAGTAAAAAGGA-3′ 
                 SEQ ID 
               
               
                   
                   
                 NO:4 
               
               
                   
               
               
                 DSPP-E2 F 
                 5′-AAGTAATTTTGTGCTGTTCCTTT-3′ 
                 SEQ ID 
                 149 
               
               
                   
                   
                 NO:5 
               
               
                   
               
               
                 DSPP-E2 R 
                 5′-AACAAAGTGAAGAGGTTTTCT-3′ 
                 SEQ ID 
               
               
                   
                   
                 NO:6 
               
               
                   
               
               
                 DSPP-E3 F 
                 5′-AAGAACCTTTTCAATTGCTAGT-3′ 
                 SEQ ID 
                 189 
               
               
                   
                   
                 NO:7 
               
               
                   
               
               
                 DSPP-E3 R 
                 5′-TGGAGAAGTTAATGGAATGTAGCA-3′ 
                 SEQ ID 
               
               
                   
                   
                 NO:8 
               
               
                   
               
               
                 DSPP-E4 F 
                 5′-TGCAATTTGCTTTCCTTCAA-3′ 
                 SEQ ID 
                 205 
               
               
                   
                   
                 NO:9 
               
               
                   
               
               
                 DSPP-E4 R 
                 5′-CCTCTTCGTTTGCTAATGTGG-3′ 
                 SEQ ID 
               
               
                   
                   
                 NO:10 
               
               
                   
               
               
                 DSPP-E5 F 
                 5′-TCACAAGGTAGAAGGGAATG-3′ 
                 SEQ ID 
                 226 
               
               
                   
                   
                 NO:11 
               
               
                   
               
               
                 DSPP-E5 R 
                 5′-GTTTGTGGCTCCAGCATTGT-3′ 
                 SEQ ID 
               
               
                   
                   
                 NO:12 
               
               
                   
               
               
                 DSPP-E6 F 
                 5′-GGGACACAGGAAAAGCAGAA-3′ 
                 SEQ ID 
                 243 
               
               
                   
                   
                 NO:13 
               
               
                   
               
               
                 DSPP-E6 R 
                 5′-TGTTATTGCTTCCAGCTACTTGAG-3′ 
                 SEQ ID 
               
               
                   
                   
                 NO:14 
               
               
                   
               
               
                 DSPP-E7 F 
                 5′-CAATGAGGATGTCGCTGTTG-3′ 
                 SEQ ID 
                 206 
               
               
                   
                   
                 NO:15 
               
               
                   
               
               
                 DSPP-E7 R 
                 5′-TATCCAGGCCAGCATCTTCT-3′ 
                 SEQ ID 
               
               
                   
                   
                 NO:16 
               
               
                   
               
               
                 DSPP-E8 F 
                 5′-CACCTCAGATCAACAGCAAGAG-3′ 
                 SEQ ID 
                 226 
               
               
                   
                   
                 NO:17 
               
               
                   
               
               
                 DSPP-E8 R 
                 5′-TCTTCTTTCCCATGGTCCTG-3′ 
                 SEQ ID 
               
               
                   
                   
                 NO:18 
               
               
                   
               
               
                 DSPP-E9 F 
                 5′-ATGAAGAAGCAGGGAATGGA-3′ 
                 SEQ ID 
                 232 
               
               
                   
                   
                 NO:19 
               
               
                   
               
               
                 DSPP-E9 R 
                 5′-ATTCTTTGGCTGCCATTGTC-3′ 
                 SEQ ID 
               
               
                   
                   
                 NO:20 
               
               
                   
               
               
                 DSPP-E10 F 
                 5′-TGATGGAGACAAGACCTCCAA-3′ 
                 SEQ ID 
                 205 
               
               
                   
                   
                 NO:21 
               
               
                   
               
               
                 DSPP-E10 R 
                 5′-TGCCATTGAAAGAAATCAGC-3′ 
                 SEQ ID 
               
               
                   
                   
                 NO:22 
               
               
                   
               
               
                 DSPP-E11 F 
                 5′-TTCTTTCCTCCATCCTTCCA-3′ 
                 SEQ ID 
                 194 
               
               
                   
                   
                 NO:23 
               
               
                   
               
               
                 DSPP-E11 R 
                 5′-TTCTGATTTTTGGCCAGGTC-3′ 
                 SEQ ID 
               
               
                   
                   
                 NO:24 
               
               
                   
               
               
                 DSPP-E12 F 
                 5′-GGCAATGTCAAGACACAAGG-3′ 
                 SEQ ID 
                 236 
               
               
                   
                   
                 NO:25 
               
               
                   
               
               
                 DSPP-E12 R 
                 5′-TCTCCTCGGCTACTGCTGTT-3′ 
                 SEQ ID 
               
               
                   
                   
                 NO:26 
               
               
                   
               
               
                 DSPP-E13 F 
                 5′-TGCAAGGAGATGATCCCAAT-3′ 
                 SEQ ID 
                 231 
               
               
                   
                   
                 NO:27 
               
               
                   
               
               
                 DSPP-E13 R 
                 5′-TGTCATCATTCCCATTGTTACC-3′ 
                 SEQ ID 
               
               
                   
                   
                 NO:28 
               
               
                   
               
               
                 DSPP-E14 F 
                 5′-CAAAAGGAGCAGAAGATGATGA-3′ 
                 SEQ ID 
                 243 
               
               
                   
                   
                 NO:29 
               
               
                   
               
               
                 DSPP-E14 R 
                 5′-TGCTGTCACTGTCACTGCTG-3′ 
                 SEQ ID 
               
               
                   
                   
                 NO:30 
               
               
                   
               
               
                 DSPP-E15 F 
                 5′-GCAGTGATAGTAGTGACAGCAGTG-3′ 
                 SEQ ID 
                 205 
               
               
                   
                   
                 NO:31 
               
               
                   
               
               
                 DSPP-E15 R 
                 5′-TTGCTGCTGTCTGACTTGCT-3′ 
                 SEQ ID 
               
               
                   
                   
                 NO:32 
               
               
                   
               
               
                 DSPP-E16 F 
                 5′-CAAATCAGACAGTGGCAAAGG-3′ 
                 SEQ ID 
                 508 
               
               
                   
                   
                 NO:33 
               
               
                   
               
               
                 DSPP-E16 R 
                 5′-GCTCTCACTGCTATTGCTGCT-3′ 
                 SEQ ID 
               
               
                   
                   
                 NO:34 
               
               
                   
               
               
                 DSPP-E17 F 
                 5′-GCAAGTCAGACAGCAGCAAA-3′ 
                 SEQ ID 
                 598 
               
               
                   
                   
                 NO:35 
               
               
                   
               
               
                 DSPP-E17 R 
                 5′-CTGCTGTCGCTATCACTGCT-3′ 
                 SEQ ID 
               
               
                   
                   
                 NO:36 
               
               
                   
               
               
                 DSPP-E18 F 
                 5′-ATAGCAACGACAGCAGCAAT-3′ 
                 SEQ ID 
                 583 
               
               
                   
                   
                 NO:37 
               
               
                   
               
               
                 DSPP-E18 R 
                 5′-TCGCTGCTATTGCTATCACTG-3′ 
                 SEQ ID 
               
               
                   
                   
                 NO:38 
               
               
                   
               
               
                 DSPP-E19 F 
                 5′-GCAACAGCAGTGATAGTGACA-3′ 
                 SEQ ID 
                 598 
               
               
                   
                   
                 NO:39 
               
               
                   
               
               
                 DSPP-E19 R 
                 5′-CTGCTGTCGCTGCTTTCA-3′ 
                 SEQ ID 
               
               
                   
                   
                 NO:40 
               
               
                   
               
               
                 DSPP-E20 F 
                 5′-AGCAGCGACAGCAGTGATAT-3′ 
                 SEQ ID 
                 500 
               
               
                   
                   
                 NO:41 
               
               
                   
               
               
                 DSPP-E20 R 
                 5′-TTGTTACCGTTACCAGACTTGC-3′ 
                 SEQ ID 
               
               
                   
                   
                 NO:42 
               
               
                   
               
               
                 DSPP-E21 F 
                 5′-TGACAGCACATCTGACAGCA-3′ 
                 SEQ ID 
                 261 
               
               
                   
                   
                 NO:43 
               
               
                   
               
               
                 DSPP-E21 R 
                 5′-TCCCCCAGTTGTTTTTGTTT-3′ 
                 SEQ ID 
               
               
                   
                   
                 NO:44 
               
               
                   
               
             
          
         
       
     
     PCR products were sequenced to determine the type and location of mutations. 
     1. The DNA fragments that showed a changed electrophoresis pattern in SSCP analysis were amplified by standard PCR. 
     2. PCR products were purified with Millipore spin column. 
     3. Sequencing Reaction: 
     
       
         
               
               
               
               
             
           
               
                   
                   
               
             
             
               
                   
                 (1) 
                 Reaction system 
                   
               
               
                   
                   
                 Reaction mixture 
                 2 ul 
               
               
                   
                   
                 Primers (0.8 mM) 
                 2 ul 
               
               
                   
                   
                 Purified PCR products 
                 3 ul 
               
               
                   
                 (2) 
                 Reaction conditions: 
               
               
                   
                   
                 96° C. 
                 30 sec 
               
               
                   
                   
                 96° C. 
                 30 sec 
               
               
                   
                   
                 50° C. 
                  5 sec 
               
               
                   
                   
                 60° C. 
                  4 min 
               
               
                   
                   
                 60° C. 
                  4 min 
               
               
                   
                   
               
             
          
         
       
     
     Total 35 cycles 
     (3) Precipitation of the Product of Sequencing Reaction 
     Add 9 volumes of 70% ethanol into the sequencing product, incubate at 4° C. for 3 minutes. 
     Centrifuge at 4° C. at 4000 rpm for 30 minutes. 
     Place the centrifuge tube upside down and continue to centrifuge until the speed reaches 1300 rpm at 4° C. 
     (4) Loading and Sequencing Samples 
     Add 2 ul Loading Dye buffer into precipitated products of sequencing reaction. 
     Incubate at 90° C. for 2 minutes and place it on ice immediately. 
     Load samples into ABI PRISM automated DNA sequencer to sequence. 
     The sequencing results were shown in  FIGS. 4A and 4B . In DGI-II family, sequencing revealed a G1→T1 mutation at position 1 of Exon 3 (position 3577 in SEQ ID NO:1). This mutation resulted in not only an amino acid change, but also a splicing site change that might cause the expression of intron, termination of translation in advance or frame shifting ( FIG. 4A ). Therefore, the normal DSPP (or DSP) protein was unable to be expressed. 
     In another DGI-II with deafness family, the mutation was a G1→A1 mutation in position 1 of Intron 3 (position 3661 of SEQ ID NO:1). This mutation was predicted to result in splicing site change which may cause the expression of intron, termination of translation in advance or frame shifting ( FIG. 4B ). Therefore, the normal DSPP (or DSP) protein was unable to be expressed. Further, it might influence the translation of signal peptide so that DSPP could not be correctly localized. Surprisingly, this mutation caused the patient affected with both DGI-II and deafness, suggesting that DSPP mutation was associated with deafness. It is possible to diagnose deafness, especially DGI-II with deafness, by detecting whether DSPP is normal or not. 
     Discussion 
     1. Linkage and Haplotype Analysis 
     We used seven STR markers in 4q21 region to genotype DGI-II and DGI-II with deafness families. Linkage and haplotype construction showed that the disease gene in DGI-II family was linked with 4q21 and the maximum LOD score was 8.38 at SPP1 locus (θ=0.00) (Table 1,  FIG. 2 ) and the disease gene in DGI-II with deafness was also linked with STR markers in 4q21 region and the maximum LOD score was 2.71 (0=0.00) (Table 2,  FIG. 3 ). 
     2. Mutation Screening of Candidate Genes and Confirmation by Sequencing 
     We designed 22 primers overlapping the DSPP gene to screen for mutations and identify mutations by sequencing. We found the disease gene in DGI-II family was linked with the STR markers in 4q21 region, while the disease gene in DGI-II with deafness was also linked with STR markers in this region. These mutations were not observed in 100 normal and unaffected individuals. It suggests that these mutations should be the cause of DGI-II disease. 
     DPP and DSP are two small polypeptides which have specific chemical properties and are cleaved from a single transcripts of DSPP gene. Both of them are expressed specifically in dental pulp tissue and may also be expressed in cochleae. DSP is a Glu-, Ser- and Gly-rich protein with many phosphorylation sites, which are predicted to be involved in dentin mineralization. DPP affects mineralization in two ways. Low concentration of DPP protein is able to bind to interspace of collagen I and initiate formation of phosphorum apatite crystals, while high concentration of DPP protein binds to the growing crystals, affects the size and form of crystals, and decreases the growth of crystals. It is necessary to further study the mechanism that the mutations in DSPP gene cause dentinogenesis imperfecta and deafness. 
     All the documents cited herein are incorporated into the invention as reference, as if each of them is individually incorporated. Further, it would be appreciated that, in the above teaching of the invention, the skilled in the art could make certain changes or modifications to the invention, and these equivalents would still be within the scope of the invention defined by the appended claims of the present application. 
     REFERENCES 
     
         
         1. Witkop C J et al. Hereditary defects in enamel and dentin. Acta Genet 1957;7:236˜239 
         2. Cetta G et al. Third international conference on osteogenesis imperfecta. Ann NY Avad Sci, 1998 
         3. Takagi Y et al. Matrix protein difference between human normal and dentinogenesis imperfecta dentin. In the chemistry and biology of mineralized connective tissues. Veis A, editor, New York: Elsevier/North-Holand. 1981 
         4. Witkop C J, et al. Medical and dental findings in the Brandywine isolate. AL J Med Sci 1966;3:382˜403 
         5. Bixler D, et al. Dentinogenesis imperfecta: genetic variation in a six-generation family. J. Dent. Res. 1968;48:1196˜1199 
         6. Mikkelsen, M et al. Possible localization of Gc-system on chromosome 4. Loss of long arm 4 material associated with father-child incompatibility within the Gc-system. Hum. Hered. 1988;27: 105˜107 
         7. Ball. S P, et al. Linkage between dentinogenesis imperfecta and Gc. Ann. Hum. Genet. 1982;46:35˜40 
         8. Crall M G. Genetic marker study of dentinogenesis imperfecta. Proc Finn Dent Soc. 1992;88:285˜293 
         9. Crodby A H, et al. Genetic mapping of dentinogenesis imperfecta type II Locus. Am. J. Hm. Genet. 1995;57:832˜839 
         10. Aplin H. M, et al. Refinement of the dentinogenesis imperfecta type II locus to an interval of less than 2 centimorgans at chromosome 4q21 and the creation of a yeast artificial chromosome contig of the critical region. J. Dent. Res. 1999;78(6):1270˜1276