A GENE RELATED TO MIGRAINE IN MAN

Abstract: Genes for familial hemeplegic migraine (FHM), episodic ataxia type-2 (EA-2), common forms of migraine, and other episodic neurological disorders, such as epilepsy, have been mapped to chromosome 19p13 and chromosome 10p12. A brain-specific P/Q-type calcium channel subunit gene, covering 300 kb with 47 exons is provided. The exons and their surroundings reveal polymorphic variations and deleterious mutations that are linked to various types of calcium channel dysfunctions causing episodic neurological disorders in man or animals.

Description: Title: A gene related to migraine m man. Migraine is a frequent paroxysmal neuro-vascular disorder, characterized by recurrent attacks of disabling headache, vomiting, photo/phonophobia , malaise, and other general syτnptoms (migraine WJ thout aura) Up to 20% of patients may, in addition, experience transient neurological (aura) symptoms during attacks (migraine with aura) (HCC, 1988) . Up to 24% of females and 12% of males m the general population are affected, however with variable attack frequency, duration and severity (Russell et al , 1995) Knowledge about the mechanisms of the final common pathway of migraine attacks has increased substantially the last five years, resulting m improved, though still only symptomatic (and sub-optimal) acute treatment for the attack. There is, however, still very little knowledge about the etiology of migraine attacks, i.e. why and how attacks begin and recur. Accordingly, prophylactic treatment for migraine is nonspecific and has only limited efficacy. Family, twin and population-based studies suggest that genetic factors are involved in migraine, most likely as part of a multifactoπal mechanism (reviewed by Haan et al . , 1996) . The complex genetics has hampered identification of candidate genes for migraine. Familial Hemiplegic Migraine (FHM) is a rare, autosomal dominant, subtype of migraine with aura, associated with ictal he iparesis and, in some families cerebellar atrophy (HCC, 1988) . Otherwise, the symptoms of the headache and aura phase of FHM and "normal" migraine attacks are very similar and both types of attacks may alternate within subject and co-occur within families. FHM is thus part of the migraine spectrum and can be used as a model to study the complex genetics of the more common- forms of migraine (Haan et al . , 1996). A gene for FHM has been assigned to chromosome 19pl3 in about half of the families tested (Joutel et al . , 1993; Ophoff et al . , 1994; Joutel et al . , 1995) . Remarkably, cerebellar atrophy was found only in families with FHM linked to chromosome 19pl3, but not in unlinked families. Recently, we showed the 19pl3 FHM locus to be also involved in "normal" migraine (May et al . , 1995) . Episodic ataxia type 2 (EA-2) is another, autosomal dominant, paroxysmal neurological disorder, characterized by acetazolamide-responsive attacks of cerebellar ataxia and migraine- like symptoms, and mterictal nystagmus and cerebellar atrophy. Recently, a gene for EA-2 was assigned to chromosome 19pl3, within the same interval as for FHM (Kramer et al . , 1995) . This finding, as well as the clinical similarities, raise the possibility of EA-2 and FHM being allelic disorders. Since other hereditary episodic neurological disorders responding to acetazolamide (such as hypokalaemic and hyperkalaemic periodic paralysis), as well as EA type-1 (which, in contrast to EA-2, is associated with continuous myokyτnia and non-responsive to acetazolamide) have all been associated with mutations in genes encoding for ion channels (Ptacek et al . , 1991; Ptacek et al . , 1994; Brown et al . , 1994), we specifically looked for similar genes within the FHM and EA-2 candidate region. In view of the above, the FHM/EA-2 locus can, since FHM is part of the migraine spectrum, thus be used to study the genetic factors and biological mechanisms that are related to various episodic neurological disorders such as FHM, EA-2, common migraine and others such as epilepsy. Calcium channels are multisubunit complexes composed of at least an l, an α2δ, and a β subunit. The central αl subunit is functionally the most important component, acting as a voltage sensor and forming the ion-conducting pore. The other subunits have auxiliary regulatory roles. The membrane topology of the αl subunit consist of four hydrophobic motifs (I to IV) , each containing six transmembrane -helices (SI- S6) and one hairpin (P) between S5-S6 that spans only the outer part of the transmembrane region. The present invention provides an isolated and/or recombinant nucleic acid, or fragments thereof, encoding a Ca 2+ -channel αl subunit related to familial hemiplegic migraine and/or episodic ataxia type- 2, derived from a gene present on chromosome 19pl3.1-I9pl3.2 ; a gene encoding the αl (ion-conducting) subunit of a P/Q-type voltage gated calcium channel. The present invention also provides access to and methods to study the genetic background and identify other subunits of the calcium channel subunit complexes and the proteins related therewith that are associated with the genetic factors and biological mechanisms that are related to various episodic neurological disorders such as FHM, EA-2, common migraine and others such as epilepsy which are related to cation channel dysfunction. The sequence of the cDNA of the gene is highly related (_90%) to a bram-speciflc rabbit and rat voltage gated P/Q-type calcium channel αl subunit (Mori et al . , 1991; Starr et al . , 1991), and the open reading frame consists of 2261 ammo acid residues. Northern blot analysis showed a bram-specific expression, especially in the cerebellum. Primary study of a cosmid contig harbouring the gene already indicated an exon distribution over at least 300 kb of genomic DNA. Recently, a neuronal Ca 2+ αlA subunit gene was localized to chromosome 19pl3. l-pl3.2 by FISH analysis (Diriong et al , 1995) . The gene symbol is CACNL1A4 and the αl subunit is classified as a P/Q-type. No sequence data for the CACNL1A4 gene have been provided by Diriong or others, but the same localization (chromosome 19pl3.1) and the identical classification (P/Q-type) suggests that the Ca 2+ channel αl subunit we have identified is very similar to CACNL1A4. No relation with migraine has been disclosed for CACNL1A4. The genomic structures of three other human Ca 2+ channel αl subunit genes (CACNL1A1, CACNL1A2 and CACNL1A3) have been published to date (Hogan et al, 1994; Soldatov, 1994; Yamada et al, 1995). Both CACN 1A1 and CACNL1A2 span about 150 kb and consist of 50 and 49 exons, respectively. The smaller CACNL1A3 gene is composed of 44 exons, distributed over 90 kb. The present invention also provides an isolated and/or recombinant nucleic acid comprising alleles of the invented gene which contain mutations relevant to the occurence of migraine and other neurological disorders which are related to cation channel dysfunction. Such mutations are for example a mutation at codon 192 resulting m the replacement of argmine by glutamme (R192Q) , and/or a mutation at codon 666 resulting in the replacement of threon e by methionine, and/or a mutation at codon 714 resulting in a replacement of val e by alan e and/or a mutation at codon 1811 resulting m a replacement of lsoleuc e by leuc e, but also other mutations of alleles of said gene which bear relationships with cation channnel dysfunction. The present invention also provides isolated and/or recombinant nucleic acid comprising alleles of said gene which contain a polymorphic CA-repeat sequence specific for various alleles of said gene. The present invention also provides isolated and/or recombinant nucleic acids comprising alleles of said gene which contain a CAG repeat. The present invention also provides methods and tests (such as PCR, but also other tests to detect or amplify nucleic acids are known in the art) to detect, identify and localize or distinguish genes and alleles of such genes, or fragments thereof, encoding for proteins or α, β or χ sub- units of specific cerebral ca tion channels, more specifically the invented gene and its various alleles encoding the αl subunit of a P/Q-type voltage gated calcium channel and the gene encoding the β2 sub-unit, which are involved in the primary pathogenesis of neurological disorders such as FHM, migraine, EA-2 and SCA6. With such methods and tests one can study abnormalities of said gene. The invention also provides recombinant expression vectors comprising isolated and/or recombinant nucleic acid comprising alleles of said genes or fragments therof, and provides host cells or animals that comprise such vectors or that are otherwise transformed with an isolated and/or recombinant nucleic acid according to the invention. The invention thus also provides a rationale and methods for the testing and the development of specific prophylactic medication for migraine and other episodic neurological, in particular brain, disorders, such as epilepsy, associated with cation channel dysfunction. The invention for example provides cells or animals that comprise recombinant vectors that comprise variants of said genes or cells or animals that are transformed with said variants. Also, the invention provides means to identify naturally occuring variants of experimental animals with changes said gene related to FHM, EA-2, ΞCA7 , migraine or other neurological disorders associated with cation channel dysfunction. An example of such an animal is the tottering mouse, and its variants called leaner and rolling, described in the experimental part of the invention. The invention also provides cells or animals in which changes such as deletions or mutations in said gene have been introduced by recombinant nucleic acid techniques. All such cells or animals provided by the invention can be used to study the pathophysiology of FHM, EA-2, migraine or other neurological disorders associated with cation channel dysfunction, for example to test or develop specific medication for the treatment of said disorders . The invention also provides proteins or peptides encoded by said genes, or fragments thereof, related with cation channel dysfunction, and detection of such proteins or peptides by antibodies directed against said proteins or peptides. Such antibodies can be of natural or synthetic origin, and can be produced by methods known in the art. Such proteins and antibodies and detection methods can be used to further in vi tro or in vivo studies towards the pathophysiology of FHM, EA-2, migraine or other neurological disorders associated with cation channel dysfunction, in addition such proteins, antibodies and detection methods can also be used to diagnose or identify such disorders in patients or in experimental animals. Experimental Procedures Subjects Sixteen FHM patients were selected, including eight individuals from four unrelated chromosome 19-linked FHM families (NL-A , UK-B, USA -C (Ophoff et al , 1994), and USA-P (Elliot et al . , 1995), two affected individuals from two small FHM families from Italy { Italy I & II) and six individuals with sporadic hemiplegic migraine (i.e. no other family member was shown to suffer from attacks of hemiplegic migraine) . In families NL-A and USA - P cerebellar ataxia and/or nystagmus is associated with FHM. An additional set of four subjects from four unrelated EA-2 families linked to chromosome 19, was also included (CAN-25, -45, -191, -197. Fifty randomly collected individuals from the Dutch population (Smith et al . , 1988) were used as a control to determine the allele frequencies of polymorphic sites. Patients with migraine with or without aura were diagnosed according to the international Headache Society (IHS) classi ication criteria. Patients attending the neurology outpatient clinic of Leiden University Medical Center, The Netherlands, and patients responding to calls m local newspapers or in the periodical of the Dutch Migraine Patients Association, were screened for a positive family history of migraine. Only families with migraine in at least two generations were asked to participate. Probands (n=36) and relatives (n=492) were personally examined and interviewed using semi -structured questionnaires. The questionnaire included questions about age at onset, frequency and duration of attacks, aura symtoms , premonitory signs and symptoms, triggers for attacks, medication, and additional headaches. When family memoers were not available for a personal interview, information on their migraine was collected by interviewing their relatives. Because of the low validity of diagnosing migraine auras through relatives, we only assessed the presence or absence of migraine headaches. Whenever possible, medical records were examined. Genomic structure Ten different cosmids from the contig extending the invented gene, were subcloned separately in either M13 or pBlueScript KS vector. From each cosmid library at least 3x96 random clones with an average insert size of about 2 kb, were picked. Positive clones were identified by hybridization techniques and subsequently sequenced with vector-specific primers; tron-exon boundary sequences were completed using cDNA-based primers. Mutation analysis, DHPLC and SSCP Genomic DNA was used as template to generate polymerase chain reaction (PCR) products for single-strand conformational polymorphism (SSCP) analysis and denaturing high-performance liquid chromatography (DHPLC) . Amplifications were performed in standard conditions with primer pairs as listed in Table 1 or listed below. Except for the 5 1 side of exon 6, primers were chosen to produce fragments that contained a single exon and at least 35 basepairs (including primer) of each flanking tron sequence. Amplification of exons 1 and 20 was performed producing two overlapping fragments and exon 19 was amplified into three overlapping fragments. In addition, the following markers ; D10S191 Primer sequence 1 CTT TAA TTG CCC TGT CTT C Primer sequence 2 TTA ATT CGA CCA CTT CCC D10S245 Primer sequence 1 AGT GAG ACT CGT CTC TAA TG Primer sequence 2 ACC TAC CTG AAT TCC TGA CC D10S89 Primer sequence 1 AAC ACT AGT GAC ATT ATT TTC A Primer sequence 2 AGC TAG GCC TGA AGG CTT CT DHPLC (Oefner et al . , 1995; Hayward et al . , 1996) was carried out on automated HPLC instrumentation. Crude PCR products, which had been subjected to an additional 3 -minute 95°C denaturing step followed by gradual reanneal g from 95-65°C over a period of 30 minutes prior to analysis, were eluted with a linear acetonitrile (9017-03, J.T. Baker, Phillipsburg, N.J., USA) gradient of 1.8% per minute at a flow-rate of 0.9 ml/mm. The start- and end-points of the gradient were adjusted according to the size of the PCR products (Huber et al . , 1995) . The temperature required for successful resolution of heteroduplex molecules was determined empirically by injecting one PCR product of each exon at increasing mobile phase temperatures until a significant decrease retention was observed. For SSCP analysis, primary PCR products were labeled by incorporation of [α- 32 P]dCTP m a second round of PCR. Samples were diluted and denatured formamide buffer before electrophoresis . SSCP was carried out according to published protocols (Oπta et al . , 1989; Glavac et al . , 1994). Digestion of several exons to yield products suitable for SSCP analysis. Sequencing of PCR products was performed with an ABI 377 automated sequencing apparatus with cycle sequencing according to the manufacturer Furthermore, PCR products were cloned in the TA vector (Invitrogen) and subjected to manual dideoxy sequence analysis (T7 Sequencing kit, Pharmacia Biotech. ) . A total of 481 blood samples were collected from patients with migraine. Genomic DNA was isolated as described by Miller et al . , 1988. The analyses of the highly informative microsatellite markers D19S391, D19S394, D19S221 and D19S226, D10S191, D10S245 and D10S89 were performed by PCR; primer sequences related to these markers are available through the human Genome Data Base (GDB) . The relative frequencies of marker alleles were estimated on the entire family material, with the relevant correction for genetic relationships between individuals (Boehnke, M, 1991) with the ILINK option of the I-INKAGE package, version 5.03 (Lathrop et al . , 1985). The following marker order and recombination frequencies were used in the multipoint sib-pair analysis: D19S391-5%-D19S394-3%-D19S221- 5%-D19S226. Affected-sib-pair analysis was performed using the MAPMAKER/SIBS software package, simultaneously including marker information for all four DNA markers (Kruglyak, 1995) . Separate analyses were performed for migraine with aura, migraine without aura, and a combination of both. Allowance was made for dominance variance. When more than two affected sibs occurred in a single sibship, weighted scores were computed according to Suarez and Hodge (1979) . In a sib-pair analysis, the occurrence of parental marker alleles is compared among sibs. Normally, 25% of sib pairs share their marker alleles from both parents, 50% share one marker allele from one of their parents, wnile the remaining 25% share no parental allele. Deviations from this pattern towards increased sharing, and consistent with the constraints of Holmans ' s (1993) possible triangle, are explained as linkage (expressed as the maximum lod score MLS) . Increased sharing of marker alleles thus indicate that the marker is located closely near a genetic risk factor. The relative-risk ratio for a sib (λ R ) , defined as the ratio of the prevalence of a disease in sibs of affected individuals, divided by the prevalence of a disease m the population, can be calcutated (May et al . , 1995) . In other words: Affected risk for sib of a proband λ R = Affection risk for an individual in the general population Results Genomic structure The combination of hybridization and PCR strategies resulted in a rapid assembly of the complete coding sequence of the human cDNA, with an open reading frame of 6783 nucleotides encoding 2261 ammo acid residues (figure 4). The spatial distribution of the human Ca 2+ channel expression was assayed in rhesus monkey tissues. Total RNA was isolated from several tissues, including various brain structures, and probed with a human cDNA fragment. The probe detected a major transcript of approximately 9.8 kb in cerebellum, cerebral cortex, thalamus and hypothalamus , whereas no transcript was detected in heart, kidney, liver or muscle. There was also no hybridization signal found RNA preparations from mouse skin tissue or from human peripheral lymphocytes. In addition, an attempt to amplify parts of the cDNA from human peripheral lymphocytes failed. Complete alignment between the cDNA and individual exon sequences was achieved, allowing the establishment of the exon- tron structure (Table 1) . The reconstruction of the exon- mtron structure of the CACNL1A4 gene revealed 47 exons ranging in s ze from 36 bp (exon 44) to 810 bp (exon 19) The exons are distributed over about 300 kb at genomic DNA level. The result shows that the first 10 exons are located in a region of about 150 kb covered by the first 5 cosmids of the contig indicating relatively large introns at 5 ' side of the gene. Sequences (Figure 1) were obtained of all exons including approximately 100 bp of flanking introns, except for mtron 5 adjacent to exon 6. The forward primer of exon 6 harbours the splice junction and 3 bp of exon 6 Splice sites around all exons are compatible with consensus sequence with the exception of splice donor and acceptor of the first mtron. The cosmid contig that yielded the initial Ca 2+ channel gene exons was extended to cover more than 300 kb. Hybridization experiments showed that the first and last cosmids of the contig were positive for 3 ' - and 5 ' -end cDNA sequences, respectively, indicating a genomic distribution of the gene over at least 300 kb (Figure 2) . The cosmid contig has been placed into the LLNL physical map of chromosome 19 at band pl3.1, between the markers D19S221 and D19S226 (Figure 2) . We identified a new polymorphic CA-repeat sequence (D19S1150) on the cosmid contig. Oligonucleotide primers (Table 1) flanking the repeat were synthesized and amplification was performed by PCR as described. Analysis of D19S1150 in 45 random individuals from the Dutch population revealed nine alleles with an observed heterozygosity of 0.82. This highly polymorphic marker is located within the gene and is therefore very useful in genetic analysis. Mutation analysis Exons and flanking mtron sequences, containing the complete coding region of CACNL1A4 and part of untranslated sequences, were screened for the presence of mutations by SSCP and DHPLC analysis in 20 individuals with either FHM or EA-2. Several synonymous nucleotide substitutions and polymorphisms were identified including a highly polymorphic (CAG) n-repeat in the 3' untranslated region of exon 47 (Table 2) . Of all polymorphisms only one was identified predicting an ammo acid change, an alanme to threonme substitution at codon 454 (A454T) . Four different πussense mutations were found in FHM patients of which one mutation was observed in two unrelated FHM affected individuals (Table 3) . The mutations were shown to segregate with the disease within the families, and were not present about 100 control chromosomes. A G-to-A transition was identified m family Italy-II at codon 192, resulting m a substitution of arginme to glutamme (R192Q) within the first voltage sensor domain (IS4) . A second missense mutation occurs at codon 666, within the P-segment of the second repeat replacing a threonme residue for methione (T666M) m family USA-P. Two other mutations are located in the 6th transmembrane spanning segment of respectively repeat II and IV. The IIS6 mutation is a T-to-C transition at codon 714, resulting in a substitution of val e to alanme (V714A) , identified FHM family UK-B . The mutation in domain IVS6 is an A-to-C transversion at codon 1811 resulting in a substitution of lsoleuc e to leucme (I1811L) . This I1811L mutation is found in family NL-A and family USA-C, two unrelated FHM families. Comparison of haplotypes in this region, including mtragenic markers, did not reveal any evidence for a common founder of family NL-A and USA- C (data not shown) . No mutation was found m FHM family Italy- I nor in the six sporadic hemiplegic migraine patients. In addition to missense mutations FHM families, we also identified mutations in two out of four EA-2 families (Table 3) . In EA-2 family CAN- 191 , a basepair deletion occurs exxon 22 at nucleotide position 4073 causing a fra eshift and a premature stop. The second EA-2 mutation is a transition of G-to-A of the first nucleotide of mtron 24, predicted to leading to an aberrant splicing in family CAN-26. The invented gene also contains a CAG repeat, of which expansions have been found patients with autosomal dominant cerebellar ataxia (SCA6) . Hence FHM, EA-2 and SCA6 are allelic ion channel disorders and different mutations are associated with different clinical symptomatologies . Our study patients with common migraine (with or without aura) included 36 independent multigenerational Dutch families. At least some data were available on 937 family members and 212 persons who "married- m" (spouses) . Of these, 442 family members (247 affected) and 86 spouses (7 affected) were personally interviewed. The distribution of the different types of migraine among the 247 affected family members are as follows: 132 family members showed migraine without aura, 93 showed migraine with aura and 22 showed months -migraine, not fulfilling all critera by IHS . Among the 7 affected spouses these figures were 4, 1 and 2, respectively. We scored the parental transmission of migraine in the 36 families (Tabel 4) to investigate if an additional X-linked dominant or mitachondrial gene was involved. An approximately 2.5:1 preponderance of females among the migraine sufferers was noted, which remained m the affected offspring. Affected fathers were found to transmit migraine to their sons 21 cases, making X-linked dominant or mitochondπal inheritance highly unlikely. The genetic analysis included 204 potentially affected sib pairs; after correction for more than one sib pair a single sibship the total number of sib pairs was 108. Affected-sib-pair analysis was performed for sib pairs who were both affected with any form of migraine and, in separate analyses, for sib pairs who where both suffering from either migraine with aura or migraine without aura. The mformativeness of the region between the markers D19S391, D19S394, D19S221 and D19S226 varied between 82% and 96%. The combined analysis of migraine with and without aura resulted in a maximum multipoint lod score of 1.69 (p»0.005) with marker D19S226. For migraine with aura the maximum multipoint lod score was 1.29 corresponding with p=sθ.013 with marker D19S394. The maximum lod score for migraine without aura was not significant (MLS <0.25) (data not shown). The relative risk ratio for a sib to suffer from migraine with aura (λ R ) , defined as the increase in risk of the trait attributable to the 19pl3 locus, varied between λ„=1.5 (for marker D19S394) and λ R =2.4 (for marker D19S226) . When combining migraine with and without aura, λ R was 1.25. In a selected portion of 36 Dutch families with migraine with aura and without aura, affected sib-pair analysis was performed for sib pairs who were affected with any form of migraine. The following markers, flanking the β2(CACNB2) calcium channel subunit gene on chromosome 10pl2, were tested: D108191, D10S246 and D10S89. For the combined phenotype (migraine with and without aura) a maximum pultipoint lod score of 0,95 (p<0,01) was obtained with marker; D10S191. This result gives independent evidence for a role of the P/Q type Ca 2* channel in migraine and other neurological disorders. Discussion The genomic structure of the exemplified invented gene revealed 47 exons distributed over about 300 kb (Table 1; Figure 1) . A comparison of the gene structure to already known Ca 2+ channel αl subunit genes (CACNL1A1, CACNL1A2 , and CACNL1A3) (Soldatov, 1994; Ya ada et al . , 1995; Hogan et al . , 1995) , reveals a similar number of exons (50, 49, and 44 respectively) but a larger genomic span (300 kb vs 90-150 kb) . Remarkebly, all splice sites are according to consensus sequence except for mtron 1. Splice donor as well as splice acceptor of the first mtron do not contain the expected gt ... ag mtron sequence. An incorrect cDNA sequence is unlikely because the cDNA sequence containing the junction of the first two exons is identical to rabbit and rat sequence. Sequences corresponding to splice donor and acceptor are present exon 1 and 2, suggesting an additional (yet unidentified) exon m the first mtron encompassing part of sequences of exon 1 and exon 2. To test the possible involvement of the invented gene relating to the CA 2* -channel sub-unit in migraine FHM, SCA6 and EA-2, we performed a mutation analysis by DHPLC and SSCP and found several alterations (For example Table 2 & 3) . Only one missense variation was observed also present in 2% of the normal controls (Table 2) . This polymorphism is a alanme to threonme substitution at codon 454 (A454T) , located in the intracellular loop between IS6 and IIS1 (Figure 2) . This region contains a conserved alpha interaction domain (AID) that binds subumts (De Waard et al . , 1996). However, A454T is located outside the AID consensus sequence and is not likely to be involved. The identification of two mutations that disrupt the predicted translation product of the invented gene in two unrelated EA-2 patients and the segregation of these mutations with the episodic ataxia phenotype m their families provide strong evidence that the invented gene is the EA-2 gene. A basepair deletion leads to a frame-shift in the putative translation product and encounters a stop codon in the next exon. The frame-shift in this EA-2 family is predicted to yield a calcium channel αl subunit polypeptide consisting of repeat I and II, and a small portion of repeat III (IIIS1) . The G-to-A transition of the first nucleotide of mtron 24 is affecting the nearly invariant GT dinucleotide of the intronic 5' splice junction. The bram-specifIC expression of the exemplified invented gene makes it extremely difficult to test the hypothesis that this mutation produces aberrantly spliced RNAs by retaining the mtron or utilizing other cryptic 5' splice sites. The frameshift and splice site mutations in EA-2 may suggest a dominant negative effect of the truncated proteins by overruling the (corresponding) intact αl subunits. No mutations were found in the remaining EA-2 families (CAN-25 and -197) The use of two independent techniques for mutation screening (DHPLC and SSCP) makes it unlikely that we missed a heterozygote PCR product Mutations in the promoter region or m mtron sequences, resulting in aberrant splicing, may have been the cause of EA-2 m these families. We could also have missed a mutation around the splice acceptor site of mtron 5, covered by the forward primer of exon 6. However, larger deletions of e . g . complete exons with flanking mtron sequence will disturb the predicted translation product, like the ΔC 4073 and splice site mutation do, but this is not detectable by a PCR-based screening method but can be seen Southern blot analysis instead. Four different missense mutations were identified in five unrelated FHM families. These mutations all segregate with FHM within a family and are not observed in over 100 normal chromosomes. The first missense mutation that we describe in the exemplified invented gene occurs in the IS4 domain of the αl subunit (Table 3; Figure 3) . The S4 domains are postulated to be voltage sensors because they have an unusual pattern of positively charged residues at every third or fourth position separated by hydrophobic residues (Tanabe et al . , 1987). In calcium channels the positively charged ammo acid is an arginine residue (Stea et al . , 1995). The mutation in FHM family Italy-II predicts a substitution of the first arginine in the IS4 segment with a neutral, non- polar glutamme (R192Q) . The change of the net positive charge of this conserved region of the protein may influence correct functioning of the voltage sensor. The second missense mutation in FHM family USA -P occurs in the P-segment of the second transmembrane repeat. A C-to-T transition predicts substitution of a threon e residue with methionme at codon 666 (T666M) . Various observations have shown that P-segments, the hairpin between S5 and S6 that spans only the outer part of the transmembrane region, form the ion-selectivity filter of the pore and binding sites for toxins (Guy and Durell (1996) . Alignment of protein sequence of different P-segments indicating that some residues occur m many different channel genes (Guy and Durell, 1996) . The T666M substitution alters one of the conserved residues in the P-segment. It is conceivable that an alteration of a P- segment affects the ion-selectivity or toxin binding of a channel gene. The remaining two missense mutations identified m FHM families alter the S6 segment of the second and the fourth repeat . A valme to alanme substitution in FHM family UK-B is found in domain IIS6 at codon 714 (V714A) . Domain IVS6 is mutated in two unrelated FHM families (NL-A and USA-C) , predicting a isoleucme to leuc e substitution at codon 1811 (I1811L) . The V714A and I1811L missense mutations do not really change the neutral -polar nature of the ammo acid residues. However, both S6 mutations are located nearly at the same residue at the mtracellular site of the segment and are conserved in all calcium channel αl subunit genes. In addition, the A-to-C transversion leading the I1811L substitution occurred m two unrelated FHM families on different haplotypes indicating recurrent mutations rather than a founder effect. Although the exact function of the S6 domains are not known, these data strongly suggest that mutations in IIS6 and IVS6 result FHM. The I1811L mutation is present two FHM families of which one (NL-A) also displays a cerebellar atrophy m (some) affected family members. The presence of cerebellar atrophy in FHM families has been reported in about 40% of chromosome 19- linked FHM families, whereas none of the unlinked families was found to nave cerebellar atrophy (Terwmdt et al . , 1996) . The I1811L mutation excludes the possibility of allelic mutations in FHM and FHM with cerebellar atrophy. However, it is likely that FHM or FHM with cerebellar atrophy are the result of pleiotropic expression of a single defective gene. No mutation was found in a small Italian FHM family ( Italy-I) . Apart from the possibilities discussed for EA-2, it should be noted that linkage to 19pl3 was only suggested but never proved with significant lod scores (M. Ferrari, personal knowledge) . The four missense mutations identified indicate a mechanism for FHM in which both alleles of the αl subunit are expressed, one harbouring an amino acid substitution which affects the function of this calcium channel αl subunit by reducing or enhancing the electrical excitability. The relationship of FHM and other types of migraine makes it highly rewarding to investigate the involvement of the only missense variant observed (A454T) (Table 2), and to continue the search for other variants of the exemplified invented gene specific for common types of migraine. The mutations in EA-2 and FHM demonstrate among others that the brain specific calcium channel gene CACNL1A4 is responsible for both EA-2 and FHM, and is also involved m the primary pathogenesis of the more common forms of migraine. We conducted the common migraine study m an independent sample of 36 extended Dutch families, with migraine with aura and migraine without aura. We found significant increased sharing of the marker alleles in sibs with migraine with aura (MLS=1.29 corresponding with p«0.013) . Although no such increased sharing was found for migraine without aura, a combined analysis for both migraine types resulted in an even more significant increased sharing (MLS=1.69 corresponding with p«0.005). These results clearly indicate the involvement of the calcium α 1A -subunιt gene region on 19pl3 in both migraine with and without aura, the contribution to migraine with aura, however, seems strongest. The positive findings in our study clearly demonstrate an involvement of the FHM locus region in non-hemiplegic familial migraine, notably in migraine with aura. The P/Q-type calcium channel α 1A -subunit gene on chromosome 19pl3 may be an "aura-gene" and is involved n both FHM and migraine with aura, but not in migraine without aura. This however, seems unlikely since an increased sharing of marker alleles was also found when we combined the results for migraine with and without aura. Furthermore, the increase m sharing was stronger than expected to be only due to the contribution of migraine with aura. An alternative explanation is that the gene is involved in both types of migraine, but in migraine without aura there is an additional strong effect of other, possibly environmental factors, thereby reducing the penetrance . The latter view is also supported by the results obtained from calculating the relative risk ratios (λ R ) for sibs from affected individuals to also have migraine. The relative risk ratio for a sib to suffer from migraine with aura was λ R =2.4. When combining migraine with and without aura, λ R was 1.25. In a population-based study the relative risk for first degree relatives of probands with migraine with aura to also have migraine with aura was λ p =3.8. Because of the female preponderance among migraine patients, X- linked dominant or mitochondrial inheritance has been suggested to be involved in familial migraine. Although a predominant maternal inheritance pattern was noted our families, X- lmked dominant or mitochondrial inheritance were found to be highly unlikely because affected fathers transmit migraine to their sons. Furthermore, the predominant maternal inheritance can be explained by the female preponderance among the migraine patients. We conclude that the well-established genetic contribution to the etiology of migraine is partly, but not entirely, due to genetic factors located m the chromosomal region of the P/Q-type calcium channel α 1A -subunιt gene. Further analysis of the cerebral distribution and function of this calcium channel, as well as of the "mutated channels", will help to unravel the pathogenetic pathway of migraine. It may also contribute to a better understanding of the mechanisms involved m related disorders such as episodic ataxia type-2, autosomal dominant cerebellar ataxia (SCA6), cerebral atrophy, and epilepsy, which all have been found to be associated with mutations in this gene. Study of FHM, EA-2 mutants and variants such as the A454T variant expressed in vitro or m mouse or other experimental animal models will ultimately lead to better understanding of the diseases, their cellular mechanisms, and the clinical relationship between FHM, EA-2, migraine, and other episodic neurological disorders such as epilepsy, and will provide rationales for the development of prophylactic therapy. Localization and identification of the mouse gene related to the neurological mouse mutations tottering, leaning and rolling. The tottering (tg) mutation arose spontaneously in the DBA inbred strain, and has been back-crossed into a C57BL/6J (B6) inbred strain for at least 30 generations. The genome of the tg mouse therefore is of B6 origin except for a small region around the tg gene on chromosome 8. Interestingly, the chromosome 8 region in mouse has synteny with the human chromosome 19pl3.1, m which the human calcium channel alphal subunit has been identified. We therefore consider the tg locus as a possible site of the mouse homologue of the human calcium channel gene. To determine the exact localization of the mouse homologue, PCR was carried out with primers based on human cDNA sequence selected from Figure 1 and mouse genomic DNA as template. In human, primers were known to be located m different flanking exons. PCR amplification on human DNA yielded a 1.5kb fragment. Forward primer : 5'- caa cat cat get ttc ctg cc-3' Reversed primer: 5 1 - atg atg acg gcg aca aag ag-3' Amplification on mouse DNA yielded a 750-bp fragment The fragment mainly consists of mtronic sequences SSCP analysis revealed several polymorphisms m the different inbred strains (each strain a specific pattern) . Analysis of amplified product of the tg/tg (homozygote) and tg/+ (heterozygote) mice demonstrated a DBA specific signal in the tg/tg mouse, and a heterozygous pattern of DBA and B6 inbred strains in the heterozygous tg/+ mouse. These results show that the mouse homologue of the human calcium channel alphal subunit is located within the mouse tottering interval on chromosome 8 In conclusion: the phenotypic characteristics of the tg mouse (tg/tg and tg/+) suggest involvement of ion-channels in the tg-etiology. The localization of the mouse homologue of the human calcium gene within the tottering interval show that a tottering phenotype in mouse is caused by a mutation in the mouse homologue of the CACNL1A4 gene . W th various variants of the tottering mouse (the Jackson Laboratory, Bar Habor, ME, USA) , such as the leaner and rolling varieties, such mutations in the mouse homologue of the CACNL1A4 gene can be found, clearly demonstrating that the gene is related to a variety of episodic neurologic disorders and using this genetic information one can engage a variety of pathofysiological studies, as for example indicated below. The tg mutation arose spontaneously in the DBA/2 inbred strain, tg/tg homozygotes are characterized by a wobbly gait affecting the hindquarters m particular, which begins at about 3 to 4 weeks of age, and by intermittent spontaneous seizures which resemble human epileptic absence seizures. The central nervous system of the mice appears normal by light microscopy. There is no discernible cerebellar hypoplasia In fluorescent histochemistry studies tg/tg mice show a marked increase in number of noradrenergic fibers in the terminal fields innervated by locus ceruleus axons , the hippocampus, cerebellum, and dorsal lateral geniculate . Treatment of neonatal tg/tg mice with 6-hydroxydopamme, which selectively causes degeneration of distal noradrenergic axons from the locus ceruleus, almost completely abolishes the ataxic and seizure symptoms. The leaner mutation of the tottering mouse arose spontaneously the AKR/J strain. Homozygotes are recognized at 8 to 10 days of age by ataxia, stiffness, and retarded motor activity. Adults are characterized by instability of the trunk, and hypertonia of trunk and limb muscles. The cerebellum is reduced size, particularly in the anterior region, tg<la>/tg<la> mice, as is the case with a certaim number of FHM patients. There is loss of granule cells beginning at 10 days of age and loss of Purkm e and Golgi cells beginning after 1 month. Cell loss later slows but continues throughout life. Granule and Purkmje cells are more severely affected than Golgi cells and the anterior folia more severely affected than other parts of the cerebellum. The cerebellum of tg<la>/tg mice shows shrinkage and degenerative changes of the Purkmje cells. The loss in cerebellar volume in tg<la>/tg and in tg/tg mice is specific to the molecular layer, with no change m volume of the granule cell layer or the white matter layer. Allelism of leaner with tottering was shown m complementation and linkage tests. A third variety of the tottering mouse is (tg<rol>) called the rolling Nagoya . Found among descendants of a cross between the SIII and C57BL/6 strains, the tg<rol> mutation apparently occurred in the SIII strain. Homozygotes show poor motor coordination of hindlimbs that may lead to falling and rolling, and sometimes show stiffness of the hindlimbs and tail. No seizures have been observed. Symptoms are recognizable at 10 to 14 days old. They appear a little earlier than those of tg/tg mice and are somewhat more severe. The cerebellum is grossly normal until 10 days of age, but after that grows more slowly than normal. The size of the anterior part of the central lobe of the cerebellum is reduced with reduction in the numbers of granule, basket, and stellate cells but normal numbers of Purkmje cells. There is a reduced concentration of glutamate and an mcreasd concentration of glycme and taurme in the cerebellum and decreased activity of tyrosine hydroxylase in the cerebellum and other areas. Legends to figures Figure 1 Nucleic acid sequences of 47 exons and flanking mtron sequences containing the complete coding region of the invented gene and part of untranslated sequences. Figure 2 Genetic map, cosmid contig and global exon distribution of the invented gene om chromosome 19pl3.1. The cosmid contog is shown with EcoRI restriction sites, available via Lawrence Livermore National Laboratory; exon positions are indicated schematically, regardless of exon or mtron sizes (Table 1) . D19S1150 is a highly polyτnorpmic mtragenic (Ca) n-repeat . Figure 3 Membrane topology of αl subunit of the P/Q-type Ca 2+ - channel The location and ammo acid substitutions are indicated for mutations that cause FHM or EA-2 Figure 4 The coding sequence of human cDNA of the invented gene with an open reading frame encoding 2261 ammo acid residues. References 1. Browne, D.L., Gancher S.T, Nutt, J.G., Brunt, E.R., Smith E.A., Kramer P., and Litt M. (1994). Episodic ataxia/myokymia syndrome is associated with point mutations m the human potassium cnannel gene, KCNA1. Nat . Genet . 8: 136-140. 2. Diriong S., Lory P., Williams M.E., Ellis S.B., Harpold M.M., and Taviaux S. (1995) . Chromosomal localization of the humangenesfor αlA, αlB, and αlE voltage-dependent Ca 2+ channel subunits. Geno ics 30: 605-609. . Headache Classification Committee (HCC) of the International Headache Society (1988). Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 8: 19-28. 4. Hogan, K. , Powers, P.A., and Gregg, R.G. (1994). Cloning of the human skeletal muscle alpha 1 subunit of the dihydropyridme- sensitive L-type calcium channel (CACNL1A3) . Genomi cs 24: 608-609. 5. Joutel A., Bousser M-G., Biousse V., Labauge P., Chabriat H., Nibbio A.,Macιazek J., Meyer B., Bach M-A. , Weissenoach J., Lathrop G.M., and Tournier-Lasserve E. (1993) . A gene for familial hemiplegic migraine maps to chromosome 19. Nature Genet. 5: 40-45. 6. Joutel A., Ducros A., Vahedi K. , Labauge P., Delrieu 0., Pmsard N., Mancim J., Ponsat G., Gaoftiere F., Gasant J.L., Maziaceck J, Weissenbach J., Bousser M.G., and Tournier- Lasserve E. (1994) . Genetic heterogeneity of familial hemiplegic migraine. Am. J. Hum . Genet . 55: 1166-1172. 7. Hayward-Lester, A., Chilton, B.S., Underhill, P.A., Oefner, P.J., Doris, P.A. (1996). Quantification of specific nucleic acids, regulated RNA processing and genomic polymorphisms using reversed-phase HPLC. In: F. Ferr (Ed.), Gene Quantification, Birkhuser Verlag, Basel, Switzerland. 8. Huber, C.G., Oefner, P.J., Bonn, G.K. (1995) Rapid and accurate sizing of DNA fragments by ion-pair chromatography on alkylated nonporous poly (styrene-div ylbenzene) particles. Anal . Chew . , 67, 578-585. 9. Kramer P.L., Yue Q. , Gancher S.T., Nutt J.G., Baloh R. , Smith E., Browne D., Bussey K. , Lovrien E., Nelson S, and Litt M. (1995) A locus for the nystagmus-associated form of episodic ataxia maps to an 11-cM region on chromosome 19p. Am. J. Hum . Genet . 57. 182-185. 10. May A, Ophoff R.A. , Terwmdt G.M., Urban C, Van Ei k R., Haan J., Diener H.C., Lmdhout D., Frants R.R., Sandkuiji L.A., and Ferrari M.D. (1995) . Familial hemiplegic migraine locus on 19pl3 is involved in the common forms of migraine with and without aura. Hum. Genet. 96: 604-608. 11. Mori Y, Friedπch T. , Kim M.S., Mikami A., Nakai J. , Ruth P., Bosse E., Hofmann F., Flockerzi V., Furuichi T., Mikoshiba K. Imoto K. , Tanabe T., and Numa S. (1991). Primary structure and functional expression from complementary DNA of a brain calcium channel. Nature 350: 398-402. 12. Oefner, P.J., Underhill, P.A. (1995) Comparative DNA sequencing by denaturing high-performance liquid chromatograpny (DHPLC) Am. J. Hum . Genet . 57 [Suppl.], A266. 13. Ophoff R.A., Van Eijk R., Sandkuiji L.A., Terwmdt G.M., Grubben C.P.M., Haan J. , Lindhout D., Ferrari M.D., and Frants R.R. (1994). Genetic heterogeneity of familial hemiplegic migraine. Genomics 22: 21-26. 14. Oπta, M., Suzuki, Y., Sekiya, T., and Hayashi, K. (1989) . Rapid and sensitive detection of point mutations and DNA polymorphisms using the polymerase chain reaction. Genomics 5: 874-879. 15. Ptacek L.J., George A.L., Griggs R.C., Tawil R., Kallen R.G., Barchi R.L., Robertson M., and Leppert M.F. (1991). Identification of a mutation in the gene causing hyperkalemic periodic paralysis. Cell 67: 1021-1027. 16. Ptacek L.J., Tawil R. , Griggs R.C., Engel A.G., Layzer R.B., Kwiec ski H., McManis P.G., Santiago L., Moore M., Fouad G., Bradley P., and Leppert M.F. (1994) Dihydropyridme receptor mutations cause hypokalemic periodic paralysis. Cell 77: 863-868. 17. Ravnik-Glavac, M., Glavac D., and Dean, M. (1994). Sensitivity of single- strand conformation polymorphism and heteroduplex method for mutation detection in the cystic fibrosis gene. Hum. Mol . Genet . 3: 801-807. 18. Russell, M.B., Rasmussen B K. , Thorvaldsen P., and Olesen J.. (1995). Prevalence and sex-ratio of the subtypes of migraine. Int. J Epidemiol . 24: 612-618. 19. Starr T.V.B., Prystay W., and Snutch T. (1991). Primary structure of a calcium channel that is highly expressed in the rat cerebellum. Proc . Na tl . Acad. Sci . 88: 5621-5625. 20. Soldatov N.M. (1994) Genomic structure of Human L-type Ca 2+ channel. Genomics 22: 77-87. 21. Teh B.T., Silburn P., Lindblad K. , Betz R., Boyle R. , Schalling M., and Larsson C. (1995) . Familial periodic cerebellar ataxia without myokymia maps to a 19-cM region on 19pl3. Am. J. Hum. Genet. 56: 1443-1449. 22. Terwmdt G.M., Ophoff R.A., Haan J. , Frants R.R., and Ferrari M.D. (1996). Familial hemiplegic migraine: a clinical comparison of families linked and unlinked to chromosome 19. Cephalagia 16: 153-155. 23. Von Brederlow, B., Hahn, A.F., Koopman, W.J., Ebers, G.C., and Bulman, D. (1995). Mapping the gene for acetozolamide responsive hereditary paroxysmal cerebellar ataxia to chromosome 19p. Hum. Mol . Genet . 2: 279-284. 24. Ya ada Y., Masuda K. , Li Q., Ihara Y, Kubota A., Miura T., Nakamura K. , Fujn Y., Seino S., and Seino Y. (1995) The structures of the Human Calcium channel αl subunit (CACNL1A2) and β- subunit (CACNLB3) genes. Genomics 27: 312-319. Exon/intron organization of the human invented gene and exon-specif ic primer pairs Table 1 Note. Sizes of exons and PCR products are given in basepairs; domains of protein are indicated according to Stea et al. , 1995. Table 2 Polymorphisms in coding sequence of the invented gene Note. Freαuency as observeα in 100 control cnromosomes. = Seven aileies of (CAG) n were oDserveα in tne range between n=4 to n=! 4 witn a neterozvgositv value of 0.75 Table 3 Mutations of the invented gene in families with FHM or EA-2 Tabl e 4 . Parental transmission of migraine for 36 unrelated Dutch families. * ratio of proportion affected sons/proportion affected daughters

Claims: CLAIMS 1. An isolated and/or recombinant nucleic acid encoding a Ca 2+ -channel αl subunit related to (familial hemiplegic) migraine and/or episodic ataxia type- 2 derived from, related to or associated with a gene which in humans is present on chromosome 19pl3.1-I9pl3.2 or a specific fragment or homolog or derivative thereof. 2. A nucleic acid according to claim 1 which is a cDNA molecule . 3. A cDNA molecule according to claim 2 comprising a 6800 bp coding region. 4. A nucleic acid according to claim 1, 2 or 3 which is of human origin. 5. A nucleic acid according to claim 4 and showing at least 70% homology with the nucleic acid sequence as listed in figure 1. 6. A nucleic acid according to any of claims 1-5 and showing at least 90% homology with the nucleic acid sequence as listed m figure 1. 7. A nucleic acid according to any of claims 1-6 and showing a mutation at codon 192 resulting m the replacement of arginine by glutamme. 8. A nucleic acid according to any of claims 1-7 and showing a mutation at codon 666 resulting in the replacement of threonme by methionme. 9. A nucleic acid according to any of claims 1-8 and showing a mutation at codon 714 resulting in the replacement of valme by alan e. 10. A nucleic acid according to any of claims 1-9 and showing a mutation at codon 1811 resulting in the replacement of lsoleucme by leucine. 11. A nucleic acid according to any of claims 1-10 and comprising a CA-repeat sequence as shown figure 2. 12. A nucleic acid according to any of claims 1-11 and comprising a (CAG)n repeat sequence as shown in figure 2. 13. A nucleic acid according to any of claims 1-12 and comprising a polymorphism in the coding sequence. 14. A nucleic acid according to claim 13 and comprising a polymorphism the coding sequence as shown in table 2. 15. A nucleic acid according to claim 13 or 14 and comprising a mutation at codon 454 resulting in a replacement of alanme by threonme. 16. A nucleic acid according to any of claims 1-15 and comprising a deletion. 17. A nucleic acid according to any of claims 1-16 and comprising a frameshift at codon 1266. 18. A nucleic acid according to any of claims 1-17 and comprising a mutation resulting m abberant splicing. 19. A nucleic acid according to any of claims 1-18 and comprising a mutation resulting in abberant splicing of mtron 28. 20. An isolated and/or recombinant nucleic acid encoding a CA 2* channel subunit or a functional fragment thereof related to (familial hemiplegic) migraine and/or episodic ataxia type 2. 21. An isolated and/or recombinant nucleic acid encoding a CA 2* channel β2 subunit related to (familial hemiplegic) migraine and/or episodic ataxia type 2, derived from, related to or associated with a gene which m humans is present on chromosome 10pl2 or a specific fragment thereof. 22. A method for localising or identifying a gene using a nucleic acid molecule or a fragment of fragments thereof according to any of claims 1-21. 23. A method according to claim 22 wherein the gene is related to episodic neurological disorders. 24. A method according to claim 22 or 23 wherein the gene is related to migraine. 25. A method according to claim 22, 23 or 24 wherein the gene is related to FHM and/or EA-2 and/or autosomal dominant cerebellar ataxia. 26. A method distinguishing between alleles of a gene using a nucleic acid molecule or a fragment of fragments thereof according to any of claims 1-21. 27. A method according to any of claims 23-26 which the gene is of human origin. 28. A method according to any of claims 23-27 which comprises selecting a cell or an animal. 29. A recombinant expression vector comprising a nucleic acid molecule or a fragment of fragments thereof according to any of claims 1-21. 30. A cell or an animal comprising a vector according to claim 29. 31. A cell or an animal comprising a nucleic acid molecule or a fragment of fragments thereof according to any of claims 1-21. 32. A cell or an animal selected by a method according to claim 28. 33. A cell or an animal comprising a genome m which nucleic acid sequences corresponding to nucleic acid molecules according to any of claims 1-21 have been modified. 34. Use of a cell or an animal according to any of claim 30-33 to test or develop specific medication for the treatment of FHM, EA-2, SCA6 , migraine or other neurological disorders associated with cation channel dysfunction. 35. A protein or peptide comprising an ammo acid sequence encoded by a nucleic acid molecule, or a fragment or fragments thereof, according to any of claims 1-21. 36. A natural or synthetic antibody directed against a protein or peptide according to claim 35. 37. Use of a protein or peptide or antibody according to claim 35 or 36 to detect or diagnose FHM, EA-2, SCA6 , migraine or other neurological disorders associated with cation channel dysfunction.

Inventors: FERRARI MICHEL DOMINIQUE, FRANTS RUNE ROBERT ISAK ERIK, OPHOFF ROEL ANDRE, TERWINDT GISELA MARIE, FERRARI, MICHEL, DOMINIQUE, FRANTS, RUNE, ROBERT, ISAK, ERIK, OPHOFF, ROEL, ANDRE, TERWINDT, GISELA, MARIE
Applicants: FERRARI MICHEL DOMINIQUE, FRANTS RUNE ROBERT ISAK ERIK, OPHOFF ROEL ANDRE, TERWINDT GISELA MARIE, UNIV LEIDEN, FERRARI, MICHEL, DOMINIQUE, FRANTS, RUNE, ROBERT, ISAK, ERIK, OPHOFF, ROEL, ANDRE, RIJKSUNIVERSITEIT TE LEIDEN, TERWINDT, GISELA, MARIE
Application year: 1997
Main classification: C12N15
IPC codes: A01K67, C07K14, C07K16, C12N1, C12N5, C12N15, C12Q1