Abstract:
A method for mutation analysis of the neurofibromatosis 1 (NF1) gene of a patient includes extracting DNA from peripheral blood lymphocytes of the patient, establishing an EBV transformed B-lymphoblastoid cell line using lymphocytes from the patient, treating the EBV transformed B-lymphoblastoid cell line culture with puromycin, extracting RNA from cultures of the cell line immediately, amplifying the RNA using suitable primers, and obtaining peptide fragments by means of in vitro transcription/translation of the amplified fragments. The invention also relates to the identification of new hotspots and specific NF1 mutations. The invention also includes diagnostic kits for the detection of described specific mutations and hotspot domains, compounds correcting the structure of specific mutated NF1 proteins and in vitro and in vivo systems that may be used to screen for these therapeutic compounds.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS  
         [0001]    This application claims priority to International Application Number PCT/EP00/10255 filed on Oct. 18, 2000, designating the United States of America, International Publication Number WO 01/29251 (Apr. 26, 2001), the contents of which are incorporated herein by reference. Which International Application claims priority to European Patent Application No. 99870216.1 filed Oct. 18, 1999, the contents of which are incorporated herein by reference.  
         BACKGROUND OF THE INVENTION  
         [0002]    1. Technical Field  
           [0003]    The present invention relates to the field of methods for genetic diagnosis of Neurofibromatosis type 1 (NF1). More particularly, the present invention relates to an optimized mutation analysis of the NF1 gene by a faster and more reliable protein truncation analysis leading to the identification of at least 83% of mutations in familial as well as sporadic NF1 patients fulfilling the N.I.H. diagnostic criteria. The current technology allows one to define the mutation profile of the NF1 gene.  
           [0004]    2. State of the Art  
           [0005]    Neurofibromatosis type 1 is one of the most common autosomal dominant disorders, affecting about 1:3500 individuals in all ethnic groups. The main characteristics are cutaneous and subcutaneous neurofibromas, café-au-lait (CAL) skin spots, iris Lisch nodules and freckling (Huson et al., 1994). Other features found in only a minority of patients include scoliosis, macrocephaly, pseudarthrosis, short stature, malignancies and learning disabilities. One of the most feared complications of NF1 is malignancy. The disorder shares some features common to heritable cancer syndromes due to mutations in a tumor suppressor gene. These are: i) a tissue-restricted occurrence of primary cancers in neural crest and myeloid lineage cells; ii) a decreased age of onset of malignancies compared to the general population; iii) the occurrence of multiple primary tumors in some patients.  
           [0006]    The NF1 gene has been mapped to 17q11.2 and was positional cloned (Cawthon et al, 1990; Viskochil et al., 1990; Wallace et al., 1990). The NF1 gene is approximately 350 kb in size, contains 60 exons and codes for an ubiquitously expressed 11- to 13-kb transcript with an open reading frame coding for 2818 amino acids (Marchuk et al. 1991). The central portion of the coding sequence exhibits homology to the GTPase activating proteins (GAPs) and the protein can down regulate the Ras pathway through this GAP-related domain (reviewed by Kim and Tamanoi, 1998).  
           [0007]    The mutation rate in the NF1 gene is one of the highest known for human genes (reviewed by Huson and Hughes, 1994) with approximately 50% of all NF1 patients presenting as sporadic cases expected to carry de novo germline mutations. For these patients, only identification of the pathogenic germline mutation allows for presymptomatic/prenatal testing in offspring. Mutation is located in one of both alleles resulting in the synthesis of a mutated form in addition to the WT protein. A decrease in the WT NF1 protein content results in a diseased state of the cell. Since NF1 is a dominant disorder, individuals that are heterozygous for a NF1 mutation may still express NF1 at 50% or reduced levels. In tumors, a second hit (loss of Heterozygosity or point mutation) in the remaining allele further reduces the neurofibromin content in the cells. Despite the high frequency of this disorder in all populations, relatively few mutations have been identified at the molecular level. Mutational analysis in NF1 patients has proven to be laborious and is hampered by the large size of the gene, the large number of exons, the presence of several pseudogenes (Cumming et al., 1993; Hulsebos et al., 1996) and the wide variety of mutations (i.e. nonsense, frameshift and missense mutations, small insertions or deletions, large deletions encompassing the total gene, translocations, etc). Many techniques have been applied for the study of NF1 mutations with detection rates varying from 10 to 65% (Abernathy et al, 1997, Fahsold et al., 2000, Ars et al., 2000).  
           [0008]    A limited number of mutational “hotspots” have been reported: R1947X (C5839T) in exon 31, the 4-bp region between nucleotides 6789 and 6792 in exon 37, both implicated in about 2% of the NF1 patients (reviewed by Upadhyaya and Cooper, 1998). Also exon 4b is considered to contain mutational hotspots by others (Toliat et al., 2000). Recently we found that another mutational hotspot resides in exon 10b and harbors a missense mutation associated with aberrant splicing (Messiaen et al., 1999).  
           [0009]    So far, no studies attempted to delineate the mutational spectrum in the NF1 gene by extensive analysis using a combined cascade of complementary techniques. A high mutation detection rate is especially important if genetic testing is requested for the offspring of sporadic patients in which only identification of the pathogenic mutation can allow for prenatal/predictive testing. Moreover, once a technology will be available that is able to find the mutation in the NF1 gene with high sensitivity; this will enable to help with the diagnosis of patients that do not fulfill to the N.I.H. diagnostic criteria yet.  
           [0010]    The protein truncation test (PTT) is a form of mutation detection first described in 1993 by Roest et al. The PTT allows one to analyze the total coding region of a gene by in vitro transcription and translation of RT-PCR fragments and will specifically detect mutations that result in a truncated protein due to the occurrence of a premature stop codon or due to f.i. an in frame skipping of exons or segments of exons.  
           [0011]    The protein truncation test (PTT) based on in vitro protein synthesis, was first applied by Heim et al. (1995) to the whole NF1 coding sequence in 21 unrelated patients and 14 mutations were identified at the cDNA level (66% detection rate). However, the authors were able to identify the mutation at the genomic level in only 11 of the patients, what brings us to a detection level at the genomic level of only 11/21 (52%). No reasons for this failure were discussed in the paper. Park et al. (1998) studied 14 unrelated patients and 10 mutations were disclosed (71%). Here too, one of the alterations seen in the cDNA could not be resolved at the genomic DNA level, what brings us to a detection level of 9/14 (64%). Whereas the experiments of Heim et al. (1995) started from either blood cells or lymphoblastoid cell lines, Park et al. (1998) exclusively used peripheral blood.  
           [0012]    In order to be able to implement high-throughput screening using PTT, major improvements of the procedures are required (Den Dunnen and Van Ommen, 1999). Especially, laboratory testing for NF1 mutations is difficult. A protein truncation test is commercially available, but its sensitivity, specificity and predictive value have not been established (Rasmussen and Friedman, 2000).  
         BRIEF SUMMARY OF THE INVENTION  
         [0013]    The present invention provides an optimized mutation analysis method for the NF1 gene which is faster and more reliable than presently known protein truncation analysis systems. This optimized system can be applied to develop a kit that can be used for fast genetic NF1 diagnosis.  
           [0014]    In addition, the invention also relates to the use of this optimized method to characterize new hotspot domains and specific mutations allowing the definition of the mutation profile of the NF1 gene.  
           [0015]    The present invention relates more particularly to a method for mutation analysis of the NF1 gene of a patient comprising the steps of (see FIG. 1 and  2 ):  
           [0016]    a) isolating peripheral blood lymphocytes of said patient,  
           [0017]    b) establishing an EBV transformed B-lymphoblastoid cell line with said peripheral blood lymphocytes of said patient, or short-term culturing of the blood lymphocytes by phytohaemaglutinin (PHA) stimulation  
           [0018]    c) treatment of the EBV transformed B-lymphoblastoid cell line or the short term cultures with a protein synthesis inhibitor,  
           [0019]    d) immediate extraction of RNA of cultures of said EBV transformed B-lymphoblastoid cell line,  
           [0020]    e) amplifying said RNA using suitable primers generating cDNA fragments covering the whole NF1 gene coding region (RT-PCR), and  
           [0021]    f) obtaining peptide fragments by means of in vitro transcription/translation of said amplified fragments of step e).  
           [0022]    According to a further embodiment, the present invention also relates to a method as described above wherein f) is followed by at least on of the following steps (see FIG. 1):  
           [0023]    g) separation of said peptide fragments;  
           [0024]    h) cycle sequencing of the cDNA fragments that resulted in a truncated peptide in the PTT assay. Cycle sequencing of cDNA prepared from EBV transformed B-lymphoblastoid cell lines that were treated with and without a protein synthesis inhibitor are compared. This allows, as explained below, to detect more easily the aberrant fragments and allows to give information on the stability of the mutant transcript in the affected cells.  
           [0025]    i) evaluation of the cycle sequencing chromatograms with respect to putative splice sites using “Splice Site Prediction using Neural Networks” (http://www-hgc.lbl.gov/projects/splice.html, Messiaen et al. (2000)) if internal cDNA deletions are seen to allow to determine the plausible site of the genomic alteration.  
           [0026]    j) Identification of the genomic mutation by cycle sequencing of the exons of interest.  
           [0027]    Genetic analysis creates the possibility of finding gene mutations at an early stage in the disease development so symptoms can be reduced or even stopped in its early phase, if treatment becomes available. The present invention provides a method for the genetic analysis of the neurofibromatosis type 1 (NF1) gene. The large size of the gene and relatively insensitive techniques has made detection of causative mutation difficult especially for this NF1 gene. As NF1 is one of the most common autosomal dominant disorders with a high mutation rate, it is of prime interest to medicine that an efficient and reliable method is available to diagnose this disease. Screening for NF1 mutations, particularly in neonates and young children who are often a/oligosymptomatic, is thus one of the major applications of the present invention. Since the NF1 gene is ubiquitously expressed, test samples of the subject can be obtained from a variety of tissues or blood. An NF1 test can also be included in panels of prenatal tests since NF1 DNA, RNA or protein can also be assessed in amniotic fluid and chorion villi. Further description of the invention will illustrate the technique starting from blood cells, nevertheless, explained principles can also be applied when starting from other cells.  
           [0028]    Analysis can be performed on blood sent from any location such as private doctor practices or hospitals. Peripheral blood lymphocytes can be cultured for a short time, using phytohaemaglutinin stimulation. Alternatively, EBV transformed cell lines also allow repetitive analyses in a controlled environment.  
           [0029]    Preferably, the present invention provides a method as defined above wherein said protein synthesis inhibitor might be chosen from a group comprising puromycin, actinomycinD, cycloheximide or a possible analogue thereof. All of these prevent nonsense mediated decay of the mutant transcript. Mutations can be missed starting from a culture without puromycin treatment, due to the instability of the mutant transcript and the “premature termination codon induced” mRNA decay. Puromycin is preferred in the proposed method. Puromycin is a tRNA analogue causing chain termination and blocks nonsense-mediated decay in cell lines as was demonstrated to be the case for the hMSH2 gene (Andreutti-Zaugg et al., 1997). The effect of puromycin on the stability of the NF1 mutant transcript was not experimentally investigated before. The present inventors proved for the first time that the addition of puromycin to cell cultures could also improve the analysis of mutant transcripts of the NF1 gene thereby increasing the efficiency of NF1 genetic diagnosis.  
           [0030]    Until now, for the NF1 mutation analysis no indication was available when RNA isolation should be started. The inventors point out that production of newly made NF1 messenger RNA in specific conditions is of prime importance. Indeed, according to present invention it is essential that RNA is extracted immediately from the cultures of said EBV transformed B-lymphoblastoid cell lines or short-term cultures of PHA stimulated blood lymphocytes once they are retrieved from the incubator. As shown by the inventors, incubation of cell cultures at room temperature will influence the splicing of the NF1 messenger creating alternatively spliced products which may influence the interpretation of the NF1 analysis. The inventors showed that a crucial parameter in the successful application of the PTT to find the disease causing mutation is the quality of the RNA that is used to start the procedure. It was noticed that starting from RNA extracted from peripheral blood cells, kept for a while at room temperature, very often “spurious” bands were present after RT-PCR as well as on the PTT SDS-PAGE. It is obvious for a skilled person in the art that this would also account for possible artifacts if one incubates said EBV transformed B-lymphoblastoid cell lines at room temperature. Therefore it is also suggested by the inventors that RNA should be immediately extracted from the cell lines once they are removed from the incubator. The incubator creates an optimized environment for cell growth with stable CO 2  pressure and temperature (37° C.). Consequently, if cells are immediately analyzed after removal, epigenetic factors will not have the time to influence the activation of cryptic splice sites leading to the occurrence of these deleted transcripts. The inventors showed that RNA extracted from “aged” blood samples leads to increased skipping of exons and hence mimics—in the absence of a genomic alternation—the presence of a mutation. This results in a wrong interpretation of the genomic background of the patient, which cannot be allowed in medical diagnosis. Although it was already observed that infidelity of the splicing process could occur in specific gene transcripts of TSG101 and FHIT (Gayther et al., 1997) when RNA was isolated from “aged” blood, it seemed that this infidelity is gene specific and not a generalized phenomenon. Indeed this does not occur in other transcripts of other tumor suppressor genes such as BRCA1, BRCA2, BRUSH1, hMSH2, IGF2 receptor, PGDβ and RB (Gayther et al, 1997). Therefore it was not evident to find this phenomenon for the NF1 gene.  
           [0031]    According to a preferred embodiment, the present invention also relates to a method as defined above wherein RNA is immediately extracted from immediately isolated peripheral blood lymphocytes of said patient for further analysis of the mutations present in the DNA of said patient (FIG. 1). Also in this case epigenetic factors would not have the time to influence the activation of cryptic sites. The term ‘immediately’ implies not longer than 2 hours after blood collection and preferably as soon as possible. Often RNA cannot be extracted immediately after prelevation of the blood, which is often the case in clinical practice when samples are sent from abroad, lymphocytes are revived by short term (48-168 hours) culture using phytohaemagglutinin (PHA) stimulation at 37° C. Short-term culture moreover allows to obtain a much larger cell population for the extraction of the RNA.  
           [0032]    Preferably, the methods according to the present invention involve a reverse transcriptase (RT) step followed by an amplification step, which is a polymerase chain reaction (PCR) (FIG. 1). This step allows the amplification of gene fragments covering the whole coding domain of the NF1 gene, which makes the analysis of a gene consisting of multiple exons more feasible.  
           [0033]    Preferably, the present invention provides a method as defined above wherein said RNA extracted in step d) is total RNA. Isolation of total RNA is less expensive compared to the isolation of mRNA and will still result in the amplification of specific gene products when amplification conditions and primers are chosen appropriate as described by the method. Amplification products can be used to verify the corresponding DNA sequence or used to produce corresponding proteins (FIGS. 1 and 2).  
           [0034]    The said PCR products can be used in an in vitro translation system, so NF1-peptide fragments can be made. In addition, the present invention preferably provides methods as defined above wherein step f) is followed by a separation of said peptide fragments. This separation can be done by any technique known in the art such as SDS PAGE (one or two dimensional). In previous experiments, as described by Heim et al. (1995) and Park et al. (1998), isotopic  35 S-Methionine is incorporated in the peptides so separated peptides can be easily visualized using radiography. Contrarily to the prior art, the inventors changed the label to  3 H-Leucine. Changing the label increases the sensitivity of the mutation analysis significantly. This increase can be explained by the fact that the NF1 protein is rich in Leucine residues compared to the number of Methionines present in this protein and allows therefore a higher incorporation of specific label thereby increasing the detection efficiency. Alternatively to SDS-PAGE, mass spectrometry or Malditoff can be used to analyse the peptide population obtained.  
           [0035]    The present invention also provides a method that is as sensitive that it is possible to identify the NF1 mutation in sporadic patients presenting as somatic mosaic. More precisely, the sensitivity of the test allows to detect the NF1 mutation if present in at least 10% of the cells that are under investigation (FIG. 17). Up to now, somatic mosaicism could only be detected via FISH analysis and only for patients carrying large deletions. Other studies failed to identify the mutation with equal efficiency in sporadic patients (Ars et al. (1995): 51% detection rate in sporadic patients; Fahsold et al. (2000): 53% detection rate without specification between sporadic versus familial; our data: 83% detection in sporadic cases by PTT alone). So, by increasing the detection efficiency we are able to detect this aberration even when a point mutation is present. This is of uttermost importance as for sporadic patients only the identification of the pathogenic mutation allows for presymptomatic/prenatal diagnosis in future generations.  
           [0036]    The present invention also provides a method as defined above wherein in case a truncated peptide is observed by means of protein separation, the amplified cDNA fragment obtained in step e) is analyzed by cycle sequencing allowing the characterization of the effect of the mutation at the mRNA level. It is not excluded that this amplified cDNA fragment can be analyzed without any hint given by such an in vitro PTT system. Moreover, comparison of the cDNA analysis from cells treated with and without puromycin allows to give information on the stability of the mutant mRNA in the affected cells. As stable mRNA may result in the production of a truncated neurofibromin, this information may point to novel putative functional domains in neurofibromin.  
           [0037]    Preferably said analysis may be performed by means of cycle sequencing of a suitable fragment by means of suitable primers. From the length of the peptide fragment, it is mostly known which primers will be suitable. Primers for amplification of each of these fragments are known or can be readily developed (see also table 2 and 3 or any given table). Primers that are used for fragment amplification can also be applied to sequence respective amplified fragment. In this latter case, primers are labeled as known by a person skilled in the art.  
           [0038]    Preferably such methods according to the present invention will employ as primers of step e) primers as represented in FIG. 2 or in any of the tables or in the Examples or figure legends.  
           [0039]    Prefered methods according to the present invention employ non-isotopically labeled primers. Said label is chosen from a group comprising fluorescein, biotin, Cy5, FAM6, TAMRA, ROX.  
           [0040]    The generated cDNA fragments may be further analyzed by means of ALF-sequencer (Pharmacia), ABI-370 (Perkin Elmer) or any other sensitive semi- or automatic sequencing system.  
           [0041]    Currently, no lab in the world performs routine NF1 mutation diagnostic assays for large numbers of patients. One of the reasons for this is the inability to find high sensitivity and high specificity methodology for routine diagnostic testing of NF1 gene mutations. It is therefore highly desirable to have an improved diagnostic methodfor the presence or absence of NF1 mutation.  
           [0042]    By the present optimized Protein Truncation Test &gt;83% of the germline mutations in NF1 patients fulfilling the N.I.H. diagnostic criteria can be identified. The spectrum of mutations that can be detected by PTT is limited to nonsense mutations, frameshift mutations, splice mutations, deletions not encompassing the region flanked by the used primers, all leading to a premature termination codon. Additional methods are needed to detect missense mutations, small (less than 80 nucleotides) in frame deletions and/or insertions, large deletions and cytogenetic abnormalities such as translocations.  
           [0043]    The method of the invention relates to a hierarchical system for effective molecular diagnosis of NF1 disease-associated mutations. The spectrum of mutations reveals the high incidence of unusual splice mutations. Many of these mutations will be missed using genomic scanning techniques as many splicing mutations are caused by intronic mutations outside the canonical splice donor/acceptor sequences. Moreover, some mutations called “silent” at the genomic level, create a novel splice donor or acceptor site and are proven to be pathogenic by the RNA-based mutation detection methods.  
           [0044]    In the hierarchical system, the second level of analysis for patients that score negative with the optimized PTT system includes methods to detect missense mutations and/or small in frame insertions and/or deletions. These analyses can be performed by means of heteroduplex analysis (HA) and/or single stranded conformation polymorphism (SSCP) analysis and/or denaturing gradient gelelectrophoresis (DGGE) and/or conformation sensitive gelelectrophoresis (CSGE) and/ or immediate cycle sequencing (with or without subcloning).  
           [0045]    Said HA or single stranded confirmation analysis is performed to detect aberrant migrating PCR fragments which are then further analyzed by cycle sequencing.  
           [0046]    A preferred combined approach for the characterization of an NF1 germline mutation according to the present invention involves a protein truncation test from EBV transformed cell lines as detailed above and in the examples and figure legends followed by direct cDNA and gDNA sequencing, heteroduplex analysis followed by direct gDNA sequencing, Southern blot analysis using probes GE2-FF13-FF1-FB5D-AE25-P5-B3A as described in Marchuk et al, 1991 (These clones were a kind gift of Francis Collins), FISH (fluorescence in situ hybridization) analysis using intragenic cosmid or PAC clones and cytogenetic analysis.  
           [0047]    Preferably, the present invention provides a method for mutation analysis of the NF1 gene of a patient as defined above wherein said primers are located flanking exon 4b, 7, 10a-10c, 13, 23.2, 27a, 29, 37 or 39 of the NF1 gene respectively, as represented on FIG. 7 and  8 . We have found that the mutation spectrum of NF1 and the identification of mutational hotspots as defined before was biased by the limitations of the technology that was used as well as by the fact that the total coding region of the NF1 gene was not screened in older studies. We describe as examples thereof several hotspot domains for mutations in the NF1 gene which were not identified before: i.e. exon 7, exon 10a-10b-10c, exon 13 (2033insC), exon 23.2 (R1362X), exon 27a (R1513X), exon 29 (R1849X), exon 39 (2266delNF). Assay kits for screening and diagnosis of mutations within these specific novel hotspots in accordance with the principles of the present invention are also provided. Focusing on these domains will improve the speed in which mutations can be diagnosed.  
           [0048]    The present invention also provides a method for detecting previously published mutations as well as the following novel specific frame shifts, nonsense or splice mutations (see table 1): K33K (99del105), C93Y (278G&gt;A), C187Y (560G&gt;A), R192X (574C&gt;T), 603-604insT (idem), Q209X (625C&gt;T), 819-821delCCT (idem), 889-454del474nt(888del174), 987-988insA (idem), 1261-19G&gt;A (1260insTTTGTTTTTCTCTAGTC (SEQ ID NO 1)), W425X (1275G&gt;A), R461X (1381C&gt;T), Y489C (1465del62), 1466insC (idem), 1527+5G&gt;A (1392del135), E524X (1570G&gt;T), 1605insA (idem), S536X (1607C&gt;A), 1642-3C&gt;G (1641del80), 2305insT (idem), 2585insA (idem), 2836insT (idem), 2850+2del6 (2617del233), 2851-6del4 (2850del140), Q959X (2875C&gt;T), Q963X (2887C&gt;T), 2990+3A&gt;C (2850del140), Y1044X (3132C&gt;A), 3193delC (idem), V1093M (3277G&gt;A/ 3274 del40), 3108-3C&gt;G (3314del182), E1123X (3367G&gt;T), 3457delCTCA (idem), Q1174X (3520C&gt;T), 3704delA (idem), 3708+1G&gt;C (3496del212), 4026delG (idem), 4299delC (idem), Q1494X (4480C&gt;T), 4515-2A&gt;T (4515-14ins14/4515-17ins17), 4773-2A&gt;T (4772del433/ 4772del293), 5033delG (idem), 5117delT (idem), R1849 (502del341/5205del544), S1755X (5264C&gt;G), S1765X (5215del90/5294C&gt;A), 5567delT (idem), 5798delC (idem), Q1966X (5896C&gt;T), 6577delGAGgta (6364del215), R2237X (6709C&gt;T), 6858G&gt;C (6756del102), 7127-12T&gt;A (7126del132/7127-10ins10), 7268delCA (idem), K2401X (7201A&gt;T), R2429X (7285C&gt;T), 7884-7885delGT (idem), 8016delA (idem). Nomenclature for the mutations found for the NF1 protein is as recommended by Antonarakis (1998). Effect of the mutation at the mRNA level is between parentheses. The letters and numbers refer to the mutation at the amino acid level which is mentioned first and the effect of said mutation at the mRNA level is mentioned in the parentheses or the genomic mutation t(14;17)(q32;q11.2) interrupting the NF1 gene. All mutations were verified to be present at the genomic DNA level. The novel balanced translocation t(14;17)(q32;q11.2) interrupted the NF1 gene: PAC928b9 was found on the der(17) and PAC1002g3 was found on der(14).  
           [0049]    The present invention identifies a number of regions in the NF1 gene that can be skipped “in frame” by specific mutations in the genomic DNA and result in the production of a stable mRNA. A number of missense mutations were also identified. As both types of mutations may lead to the production of a truncated/altered neurofibromin, these mutations may point to novel functional domains of neurofibromin.  
           [0050]    Thus far, only the central GAP-related domain has been well characterized (GRD in FIGS. 7 and 8). A region involved in cAMP-mediated signaling exists in Drosophila and probably in humans as well but its location in the NF1 gene is not yet defined. Neither has the region that mediates the association of neurofibromin to the microtubules been defined. Careful mutation analysis like the study presented here may point to the regions involved in these and other functions of the NF1 gene. Specifically the following regions may be important and are first described now: In frame skipping of the last 105 nt of exon 2 (mediated by K33K), C83Y (exon 3), C93Y (exon 4b), 274delL (exon 6), In frame skipping of exon 10b (mediated f.i. by 1527+5G&gt;A), In frame skipping of both exon 11 and 12a (mediated f.i. by IVS12a+1G&gt;T), L847P (exon 16), In frame skipping of the first 90 nt of exon 29 (mediated by f.i. S1765X), In frame skipping of exon 37 (mediated f.i. by 6792C&gt;A, 6792C&gt;G, K2286N), in frame skipping of exon 40 (mediated f.i. by IVS39-12T&gt;A). The established EBV-cell lines harboring these specific mutations are valuable tools to perform further protein research to define additional functional regions onto the NF1 protein, e.g., specific transcripts can be isolated from these EBV cell lines and used to setup two-hybrid screenings.  
           [0051]    The present invention also relates to a diagnostic kit for mutation analysis of the NF1 gene of a patient comprising primers specifically amplifying the gene domains containing the novel specific mutations or the novel mutation hotspot regions as mentioned above.  
           [0052]    The present invention also relates to a diagnostic kit for mutation analysis of the NF1 gene of a patient comprising probes specifically detecting the gene domains containing novel mutation hotspots regions or specific mutations as mentioned above.  
           [0053]    The term “nucleic acid” refers to a single stranded or double stranded nucleic acid sequence present in a biological sample, said nucleic acid may consist of deoxyribonucleotides or ribonucleotides or may be amplified cDNA or amplified genomic DNA.  
           [0054]    The term “probe” refers to single stranded oligonucleotides and may consist of deoxyribonucleotides or ribonucleotides, nucleotide analogues or modified nucleotides, or may be amplified cDNA or amplified genomic DNA.  
           [0055]    The probes used in the process of the invention can be produced by any method known in the art, such as cloning of recombinant plasmids containing inserts including the corresponding nucleotide sequences, if need be, by cleaving the latter out from the cloned plasmids upon using the appropriate nucleases and recovering them (e.g., by fractionation according to molecular weight). The probes can also be synthesized chemically, for instance, by the conventional phopho-triester method.  
           [0056]    The probes of the invention can optionally be labelled using any conventional label. This may include the use of labelled nucleotides incorporated during the polymerase step of the amplification or by any other method known to the person skilled in the art.  
           [0057]    The term “primer” refers to a single stranded nucleotide sequence capable of acting as a point of initiation for synthesis of a primer extension product which is complementary to the nucleic acid strand to be copied. The length and the sequence of the primer must be such that they allow to prime the synthesis of the extension products. Preferably the primer is about 5-50 nucleotides. Specific length and sequence will depend on the complexity or the required DNA or RNA targets, as well as on the conditions of primer use such as temperature and ionic strength.  
           [0058]    The present invention also advantageously provides nucleic acid sequences of at least approximately 15 contiguous nucleotides of the NF1 gene or mutant versions thereof, preferably from 15 to 50 nucleotides. These sequences may, advantageously be used as probes to specifically hybridize to sequences of the invention as defined above or primers to initiate specific amplification or replication of sequences of the invention as defined above, or the like. They may also be used in diagnostic kits or the like for detecting the presence of a nucleic acid according to the invention. These tests generally comprise contacting the probe with the sample under hybridizing conditions and detecting the presence of any duplex or triplex formation between the probe and any nucleic acid in the sample.  
           [0059]    Identification of specific mutations in the NF1 gene also has therapeutic implications. A method for identifying a compound correcting the defective structure of the mutated NF1 protein is one of the examples. A mutated NF1 protein can result from a specific mutation of the NF1 coding region as described above. Modulation of NF1 function can be accomplished by the use of therapeutic agents or drugs. These can be designed to interact with different aspects of the NF1 protein structure or function; a drug can correct its defective structure or increase its affinity for a substrate or cofactor. Efficacy of a drug or agent can be identified by a screening program in which nodulation is monitored in vitro using cell systems in which a defective NF1 protein is expressed. Alternatively, drugs can be designed to modulate NF1 activity from knowledge of the structure correlation of the NF1 protein and from knowledge of the specific defect in the various NF1 mutant proteins (Capsey et al., 1988).  
           [0060]    This invention also relates to model systems comprising an NF1 gene mutation, as defined above, which can be used to screen for therapeutic agents. In both in vitro and in vivo models mutant NF1 proteins are expressed and used to screen for correction of the mutant NF1 activity. In the in vitro tests both purified NF1 protein or cell lines expressing the mutant NF1 protein can be used; in the in vivo models, transgenic animals expressing the mutant NF1 protein can be employed.  
           [0061]    Transgenic mice carrying a mutation in one of the NF1 genes show clear pathological symptoms. Vogel et al. (1999) described that cis-Nf1 ± :p53 ±  mice exhibit a significant incidence of soft tissue sarcomas. The presence of the heterozygous NF1 mutation accelerates tumorigenesis and alters the tumor spectrum in the content of the p53 ±  background. In addition, chimeric mice composed in part of Nf1 −/−  cells carrying homozygous NF1 alterations do develop neurofibromas (Cichowski et al., 1999). Consequently, both mouse models provide the means to test therapeutic strategies.  
           [0062]    The following examples merely serve to illustrate the invention and are by no way to be understood as limiting the present invention. 
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0063]    [0063]FIG. 1: Overview of the optimized NF1 genetic mutation analysis. Peripheral blood lymphocytes are taken from the patients and DNA is extracted from the lymphocytes. Concomitant an EBV-transformed lymphoblastoid cell line is initiated or a short term culture of PHA stimulated lymphocytes is started. Once the culture is well established, the culture is split and 1 culture (P+ culture; wherein puromycin is added) is incubated with 200 μg/ml puromycin for 16 hours, the second culture (P− culture; wherein no puromycin is added) is further incubated in the RPMI 1640 culture medium. In order to get a good signal to noise ratio for the cycle sequencing of cDNA, total RNA from the P+ culture is extracted. cDNA is prepared using random hexamers and the coding region is amplified in 5 overlapping fragments using a modified forward primer containing a T7 promotor sequence, the KOZAK sequence and a methionine start codon in frame with the sequence to be analyzed. Afterwards in vitro transcription/translation peptide fragments are separated by SDS-PAGE. If a truncated peptide is present, the RT-PCR fragment leading to this truncated peptide is analyzed by cycle sequencing. Once the cDNA sequence pattern has been interpreted we continue the analysis at the genomic level by cycle sequencing of the DNA extracted directly from the lymphocytes covering the whole coding domain of the NF1 gene. Hence, it can be excluded that the mutation that is identified was introduced due to the EBV transformation itself.  
         [0064]    [0064]FIG. 2: Schematic overview of the total coding region of the NF1 gene (60 exons drawn to scale) and position of the 5 overlapping RT-PCR fragments used for in vitro transcription/translation. The position of the 5 overlapping RT-PCR fragments is denoted. Exon numbers are indicated. Overlap between the neighboring fragments is indicated in amino acids (AA). Small vertical bars indicate the position of the sequencing primers that are used to perform direct cycle sequencing of the RT-PCR fragments. Underneath are pictures from the SDS-PAGE showing the normal peptides obtained after in vitro transcription/translation of the 5 fragments. On every gel a protein marker ( 14 C Methylated proteins CFA626, Amersham) is loaded. 69 kDa denotes the size of the largest peptide band from the protein marker. Smaller fragments of the protein marker are 46 kDa, 30 kDa and 14.3 kDa in size. GRD denotes the Gap-related domain, this is a domain with catalytic GTPase-stimulating activity (Kim and Tamanoi,1998). The GRD spans the amino acids 1172-1538 of the protein.  
         [0065]    [0065]FIG. 3: Influence of puromycin on the analysis of NF1 exon 20. RNA was extracted from an EBV transformed lymphoblastoid cell culture with and without incubation with 200 μg/ml puromycin for 15 hours.  
         [0066]    A. PTT from Pplus and Pmin EBV cultures from NF1 patient NF-039. Lane 1: protein markers (sizes in kDa). Lanes 2, 3, Pplus and Pmin cultures with and without puromycin treatment, the presence of a truncated peptide was discerned by PTT analysis. The intensity of the truncated peptide compared to the wild type peptide was greatly enhanced after puromycin treatment.  
         [0067]    B. Starting from the cultures that were not treated with puromycin, direct cycle sequencing of the cDNA exon 20 without subcloning was unable to identify unambiguously he presence of the nonsense mutation in exon 20, due to the nonsense-mediated mRNA decay.  
         [0068]    C. Starting from the puromycin treated cultures, direct cycle sequencing of the cDNA without subcloning gave unambiguous results leading to the clearcut identification of a mutation in Exon 20: 3367GtoT, E1123X.  
         [0069]    [0069]FIG. 4: Influence of puromycin on the analysis of NF1 exon 10c. PTT from Pmin and Pplus EBV cultures from a normal control and NF1 patient NF-033. Lane 1: protein markers (sizes in kDa). Lanes 2, 4, Pplus cultures. Lanes 3, 5,  
         [0070]    A. Pmin cultures. Lanes 2 and 3: normal control showing only wild-type (WT) NF1. Lanes 4 and 5: patient NF-033 showing truncated peptide due to the presence of NF1 stop codon mutation at amino acid 524.  
         [0071]    B. cDNA sequence chromatograms of patient NF-033 of Pmin (upper panel) and Pplus (lower panel) EBV cultures. Arrow, heterozygous peak:  G AA&gt; T AA at amino acid 524.  
         [0072]    Another example illustrating the PTT results obtained starting from RNA extracted from EBV transformed lymphoblastoid cell cultures immediately after removal from the incubator and treated with and without puromycin. Both with and without puromycin treatment, the presence of a truncated peptide was discerned. The intensity of the truncated peptide compared to the wild type peptide was greatly enhanced after puromycin treatment. Sequencing results are only shown for the fragments leading to the peptides shown in lanes 4 and 5. Here too, starting from the puromycin treated cultures, direct cycle sequencing of the cDNA without subcloning gave unambiguous results leading to the clearcut identification of a mutation in Exon 10c: 1570GtoT, E524X. The mutation would again have been missed if only direct cycle sequencing would be performed starting from the culture without puromycin treatment, due to the instability of the mutant transcript and the “premature termination codon induced” mRNA decay. Due to this decay the mutant messenger is only present in small quantities and relevant seuence information is lost as it does not peak above the background/noise peaks.  
         [0073]    [0073]FIG. 5: Automated Laser Fluorescence (ALF) based fragment analysis of NF1 exon 7-skipping that is present in “aged” blood and in EBV cell lines carrying a specific nonsense mutation in exon 7, but that is not present in fresh blood nor in EBV cell lines not carrying a NF1 mutation in exon 7. FIG. 5 illustrates the importance of extracting the RNA immediately after prelevation for unprocessed blood or after removal from the incubator for cell cultures. Total RNA was extracted from Pplus and Pmin EBV cultures and from peripheral blood lymphocytes either processed immediately (“fresh”), or kept at room temperature and processed 48 hours after prelevation (“aged”) and semi-quantitative RT-PCR analysis of E7 skipping using a 5′-fluorescein labelled forward primer in E6 (5′-TTGACTTGGTGGTGGTTT-3′ (SEQ ID NO 2)) and a reverse primer in E8 (5′-TTGAGAATGGCTTACTTGGA-3′ (SEQ ID NO 3)). Lane 1, fresh peripheral blood lymphocytes. Lane 2, “aged” peripheral blood lymphocytes. Lane 3 and 5, Pmin EBV culture from patient NF-027 (A) and NF-064 (B) both carrying the mutation R304X. Lane 4 and 6, Pplus EBV culture from patient NF-027 (A) and NF-064 (B) both carrying the mutation R304X. Lane 7 and 8, Pmin (lane 7) and Pplus (lane 8) EBV culture from patient NF-019 carrying the mutation R2264X.  
         [0074]    Fragment analysis of RT-PCR products using a 5′ fluorescein labeled forward primer located in exon 6 and a reverse primer located in exon 8. 20 cycles of amplification were performed, i.e. the exponential phase of the PCR well before a plateau is reached. Hence the experiments are semi-quantitative. RT-PCR fragments were separated on a 5% denaturing polyacrylamide gel on an ALF automated DNA sequencer (Pharmacia). Lengths of the fragments were evaluated with Fragment Manager software using internal and external markers (M). The quantity of each transcript was determined as the area under the curve, which was also sized by means of Fragment Manager software (Pharmacia) and normalized against the sum of all the fragments obtained for a particular sample. This is expressed as skip/total.  
         [0075]    The analysis showed that ˜9% of the transcripts in “aged” blood (48 hours at room temperature) did not contain the exon 7 (exon 7 skipping) (lane 2).  
         [0076]    Patient A and B, both carrying an identical nonsense mutation in the exon 7 showed a slightly higher level of exon 7 skipping in their transcripts (lane 3 to 6).  
         [0077]    Exon 7 skipping was not present (at least not in amounts that are detectable with the technology used) in fresh blood samples in which RNA was extracted immediately after prelevation lane 1), nor in EBV cell lines from patients that had no mutation in NF1 exon 7 (lanes 7 and 8) (patient C).  
         [0078]    P+ denotes with puromycin treatment, P− denotes without puromycin treatment. M denotes internal size markers.  
         [0079]    [0079]FIG. 6: ALF based fragment analysis of NF1 exon 37-skipping that is present in “aged” blood and in EBV cell lines carrying a specific nonsense mutation in exon 37, but that is not present in fresh blood nor in EBV cell lines carrying a NF1 mutation in another exon. FIG. 6 provides another illustration of the importance of extracting the RNA immediately after prelevation for unprocessed blood or after removal from the incubator for cell cultures. Fragment analysis of RT-PCR products using a 5′ fluorescein labeled forward primer located in exon 36 and a reverse primer located in exon 38. 20 cycles of amplification were performed. RT-PCR fragments were separated on a 5% denaturing polyacrylamide gel on an ALF automated DNA sequencer (Pharmacia). Lengths of the fragments were evaluated with Fragment Manager software using internal and external markers (M). The quantity of each transcript was determined as the area under the curve, which was also sized by means of Fragment Manager software (Pharmacia) and normalised against the sum of all the fragments obtained for a particular sample. This is expressed as skip/total.  
         [0080]    The analysis showed that ˜14% of the transcripts in aged blood (48 hours at room temperature) did not contain the exon 37 (exon 37 skipping). P+ denotes with puromycin treatment, P− denotes without puromycin treatment. M: denotes internal size markers. Patient C, carrying a nonsense mutation in the exon 37 showed a significantly higher level of exon 37 skipping in his transcripts.  
         [0081]    Exon 37 skipping was almost absent (˜2%) in fresh blood samples (lane 1) and not detectable in EBV cell lines from patients that had a mutation in another exon of NF1 (lanes 5 and 6).  
         [0082]    [0082]FIG. 7: Distribution of the mutations identified by the protein truncation test (PTT) of the total coding region of the NF1 gene by analyzing 105 patients. The figure gives a schematic representation of the total coding region of the NF1 gene drawn to scale. In 85 of the 105 patients a mutation in the NF1 gene could be visualised using PTT (see Table 1). Exon numbers are indicated as described by Viskochil D. (1998). A mutational hotspot is defined by the occurrence of at least 2 independently arisen mutations in 2 unrelated persons at the same nucleotide. Examples are R304X (exon 7), R440X (exon 10a), R461X (exon 10a), Y489C (exon 10b), 2033-2034insC (exon 13), R1362X (exon 23.2), R1513X (exon 27a), R1849Q (exon 29), 2366delNF (exon 39). Also the finding of two different mutations at the same spot (e.g. 1465-1466insC and 1466A&gt;G in exon 10b) is in itself indicative of a mutational hotspot (Cooper et al., 1998) Moreover, if the number of mutations identified in the number of patients analysed is weighted against the size of the exons, a number of mutation dense regions stand out: i.e. exon 7, 10a-10b-10c and exon 37. Exon 31 was previously described to contain a mutational hotspot, i.e. R1947X (Upadhyaya and Cooper, 1998). We only found this mutation once so far, but it was found already by several research groups and hence it is a recurrent mutation. The denomination of this mutation as a mutational hotspot may however be due to a bias, as till recently only limited portions of the gene were investigated by research groups and preferentially, groups searched in those regions where mutations were reported by others before.  
         [0083]    [0083]FIG. 8: Distribution of all mutations identified so far by us using the PTT for the total coding region of the NF1 gene in 105 patients, and heteroduplex analysis, FISH analysis, Southern blot analysis and cytogenetic analysis in patients in which no mutation was identified by PTT. The heteroduplex analysis has not yet been completed for all exons in all patients that were negative in the PTT assay. So far, 6 interesting missense mutations and/or in frame deletions were disclosed: C93Y (exon 3), C187Y (exon 4b), 274delL (exon 6), L847P (exon 16), 991delM (exon 17), 2366delNF (exon 39). Their distribution is given on top of the bar representing the total coding region of the NF1 gene. Besides, a deletion of the total gene was found in 4 patients and 1 translocation t(14;17)(q32;q11.2).  
         [0084]    All mutations identified so far by analysing all together 105 patients are summarized in Table 1.  
         [0085]    [0085]FIG. 9A: Overview of the “mutation rich” regions in the NF1 gene. In our study exons 7, 10a, 10b, 10c and 37 stand up as particularly mutation-rich regions. In order to define the percentage of the coding region of a certain exon, we made the ratio between the number of nucleotides of a given exon and the number of nucleotides of the total coding region (i.e. 8457 nt). In the denominator the total coding region from ATG to TGA was taken, with the exception of the alternatively spliced exons 9br, 23a and 48a, in which no mutations have ever been found.  
         [0086]    [0086]FIG. 9B: Overview of the recurrent mutations found in this study. Between parentheses is denoted: the exon that is prone to the recurrent mutation, number of patients found in this specific study with the specific mutation, whether the patients are sporadic (S) or familial (F). If 2 apparently unrelated patients with an identical mutation are found and patients are familial cases, haplotype analysis was performed to confirm that both patients are indeed unrelated and hence that the mutations arose independently.  
         [0087]    [0087]FIG. 10. Illustration of the power of the current methodology detecting 2 different cryptic splice acceptors in IVS26, activated by mutation IVS26-2A&gt;TT Genomic DNA, cDNA and subcloned cDNA sequence chromatograms of 4515-2A&gt;T (IVS26-2A&gt;T) in patient NF-044.  
         [0088]    A. genomic DNA sequencing chromatogram showing presence of mutation 4515-2A&gt;T.  
         [0089]    B. starting from puromycin treated EBV cell lines, direct cycle sequencing chromatograms of the exon 26 &amp; 27 region showed that besides normal transcipts containing exon 27 derived from the Wild Type allele, also 2 mutant transcript populations were present: a fraction contain an insertion of the last 14 nt of IVS26 (mutant transcripts) and another fraction contain an insertion of the last 17 nt of IVS26 (mutant transcripts). Mutant transcripts are formed due to use of two different cryptic splice acceptors in IVS26 (see Table 9).  
         [0090]    C. cDNA sequencing chromatograms of the 2 mutant transcript populations after subcloning formed in patient NF-044. A fraction contains an insertion of the last 14 nt of IVS26 (left panel) and another fraction contain an insertion of the last 17 nt of IVS26 (right panel).  
         [0091]    [0091]FIG. 11. Illustration of the power of the current methodology detecting 2 different misspliced transcripts that are formed due to presence of the mutation IVS39-12T&gt;A. PTT, cDNA and genomic DNA sequence chromatograms of IVS39-12T&gt;A in patient NF-005.  
         [0092]    A. PTT results. Lanes 1 and 2: peptides synthesized in vitro from normal control EBV cultures. Lane 3: peptides synthesized in vitro from a Pmin EBV culture of patient NF-005. Arrowheads indicate presence of 2 different truncated peptides: one derived from transcripts in which exon 40 is skipped, another derived from transcripts formed by use of a novel splice acceptor in IVS 39 leading to insertion of the last 10 nt of IVS39.  
         [0093]    B. cycle sequencing of the mutant cloned cDNA transcripts. Upper panel, transcripts with an insertion of the last 10 nucleotides of IVS39 due to use of the novel splice acceptor (gtttgtttgtttgttt a gtttutagtag (SEQ ID NO 4)) created by 7127-12T&gt;A. Transcripts lead to a truncated peptide of 209 amino acids after in vitro translation. Lower panel, transcripts with E40 skipping resulting in a peptide shortened by only 44 amino acids after in vitro translation.  
         [0094]    C. cycle sequencing of the splice acceptor site genomic region of E40. Arrow, heterozygous peak showing the 7127-12T&gt;A mutation.  
         [0095]    [0095]FIG. 12: genomic and cDNA analysis of a patient with the mutation Y489C or 1466A&gt;G in exon 10b resulting in the creation of a novel splice door site. Exon 10b of the NF1 gene: 1466A to G (Y489C) is a “missense mutation” masquerading a splicing mutation. The mutation creates a novel splice donor site that succesfully competes with the normal unaltered splice donor leading to skipping of the last 62 nt of exon 10b.  
         [0096]    A. Cycle sequencing without subcloning of the genomic region of exon 10b in patient NF-017 showing transition of A to G at nt 1466 resulting in the formation of a splice donor site CT/gtaag;  
         [0097]    B. Cycle sequencing of the mutant cloned cDNA allele in patient NF-017. The last 62-bp of exon 10b are skipped and immediately followed by exon 10c, resulting in the formation of a stop codon at amino acid 489;  
         [0098]    C. Schematic diagram of the genomic region surrounding exon 10b. Shaded boxes represent exons, normal and novel splice donor sequences are denoted. By the transition of A to G at nt 1466 a novel splice donor is formed.  
         [0099]    [0099]FIG. 13: genomic and cDNA analysis of a patient showing mutation V1093M or 3277G&gt;A in exon 19b resulting in the formation of a novel splice donor site that is used by the splicing machinery. Exon 19b of the NF1 gene: 3277GtoA (V1093M) is a “missense mutation” masquerading a splicing mutation. The mutation creates a novel splice donor site that competes with the normal unaltered splice donor leading to skipping of the last 40 nt of exon 19b. Novel information is obtained on splice preferences in the NF1 gene using Splice Site Prediction using Neural Networks (http://www-hgc.lbl.gov/projects/splice.html). Evaluation of the sequences using this in silico prediction shows that wild type exon 19b contains a very weak splice donor and can be inactivated even by creation of another weak splice donor upstream.  
         [0100]    A. Cycle sequencing without subcloning of the genomic region of exon 19b in patient NF-063 showing substitution of G to A at nt 3277 resulting in the formation of a weak splice donor site TG/gt a tg; see Table 9  
         [0101]    B. Direct cycle sequencing of the mutant cDNA alleles in patient NF-063. The last 40-bp of exon 19b are skipped and immediately followed by exon 20;  
         [0102]    C. Schematic diagram of the genomic region surrounding exon 19b. Shaded boxes represent exons, normal and novel splice donor sequences are denoted. By the substitution of G to A at nt 3277 a novel splice donor is formed.  
         [0103]    [0103]FIG. 14: 5294C&gt;A (S1765X) nonsense mutation. Exon 29 of the NF1 gene: 5294CtoA (S1765X is a “nonsense mutation” masquerading a splicing mutation. The mutation creates a novel weak splice acceptor site that competes with the normal unaltered splice acceptor leading to skipping of the first 90 nt of exon 29. Novel information is obtained on splice preferences in the NF1 gene using Splice Site Prediction using Neural Networks (http://www-hgc.lbl.gov/projects/splice.html). Exon 29 contains a strong splice acceptor that however already can be inactivated even by creation of a weak splice acceptor downstream.  
         [0104]    A. Cycle sequencing without subcloning of the genomic region of exon 29 in patient NF-009 showing substitution of C to A at nt 5294 resulting in the formation of a novel splice acceptor site; see Table 9  
         [0105]    B. Direct cycle sequencing of the mutant cDNA alleles in patient NF-009. The first 90-bp of exon 29 are;  
         [0106]    C. Schematic diagram of the genomic region surrounding exon 29. Shaded boxes represent exons, normal and novel splice acceptor sequences are denoted. By the substitution of C to A at nt 5294 a novel splice donor is formed.  
         [0107]    [0107]FIG. 15: effect of nonsense mutations on splicing. PTT, cDNA and gDNA sequencing results of patient NF-027 with mutation R304X and PTT results of patient NF-003 and NF-019 with mutation Y2264X.  
         [0108]    A. PTT results using primers encompassing NF1 exons 28-38. Lane 1 &amp; 2 normal and truncated peptides formed in patients NF-003 (lane 1) and in patient NF-019 (lane 2). We identified the first nonsense mutations causing skipping of an exon containing these specific nonsense mutations (6792C&gt;A and 6792C&gt;G; published in Messiaen et al., 1997). Hoffmeyer et al. (1998) subsequently claimed that other nonsense codons in the NF1 gene are disparate splice effectors. We show using our detailed mutation analysis technology that only few nonsense mutations in the NF1 gene are inducing exon skipping, i.e; the formerly described 6792C&gt;A and 6792C&gt;G. We disagree with Hoffmeyer et al that the predominant effect of R304X is skipping of exon 7, see FIG. 15 B and C. Our experiments showed that the predominant effect of presence of R304X is formation of a stopcodon, as clearly evidenced on PTT assay and by cycle sequencing of the cDNA.  
         [0109]    B. PTT results using primers encompasing NF1 exons 1-12a. Analysis of 2 patients with a truncated peptide using the abovementioned primers starting from EBV transformed lymphoblastoid cell cultures not treated with puromycin and immediate RNA extraction after removal from the incubator. Lane 2, 3, 4 are normal controls and show presence of the normally observed bands not further discussed or relevant in this figure. Lane 5 shows presence of a truncated peptide in another patient carrying a mutation in the region between exons 28-38. Lane 6 shows presence of a truncated peptide of approximately 33 kDa in patient NF-027. Lane 1: protein marker.  
         [0110]    C. cycle sequencing without subcloning of (a) gDNA of patient NF-027 showing presence of the 910C&gt;T substitution changing R304 into a stopcodon, (b) cDNA of patient NF-027 Pmin EBV culture. Arrow: presence of the  T GA allele in a minor fraction of the transcripts (unequal expression), (c) cDNA of patient NF-027 Pplus EBV culture. Arrow: presence of the TGA allele present in equal amounts due to the inhibition of the nonsense mediated mRNA decay. 33 kDa is the size expected in the PTT reaction when the nonsense codon is retained and the optimized PTT could correctly identify the major effect of R304X on transcription.  
         [0111]    [0111]FIG. 16: Use of the combined cascade of testing allows making distinction between (even very rare) polymorphism and bonafide pathological mutations. The evaluation of the pathological effect of missense mutations is very difficult in the absence of knowledge of all functional domains in a protein. Often missense mutations are reported as bona fide mutations although firm data underscoring these conclusions are missing (Lambert et al., 2000). We identified a missense mutation in exon 45 of the NF1 gene, R2616Q: this mutation was not found in 300 normal control chromosomes, the amino acid Arginine is conserved in Drosophila, mouse, rat and Fugu and change of arginine for glutamine is predicted to cause a dramatic change in the polypeptide chain . Still, the missense mutation did not segregate with the disorder in the family that was studied. By PTT of the total coding region the real pathogenic lesion was identified, i.e. R304X in exon 7, illustrating the strength of the technology. Efficient and correct molecular mutation analysis is extremely important, as the most immediate result of the current findings is the ability to provide presymptomatic and/or prenatal diagnosis.  
         [0112]    [0112]FIG. 17: Somatic mosaicism for R2429X in a sporadic NF1 patient NF-075. Patient NF-075 is a male patient born in 1989 and has 2 small CAL spots (&lt;5mm), subcutaneous neurofibromas supraclavicular and a plexiform neurofibroma surrounding the R atrium and septum and invading the pericard, and multiple internal neurofibromas in the mediastinum, freckling in left axilla and 2 isch noduli in left eye.  
         [0113]    A. schematic representation of fragment 5, small bars denote the presence of sequencing primers to study this fragment, asterisk denotes the position of the stopcodon found in patient NF-075.  
         [0114]    B. panel 1: PTT analysis from fragment 5 and separation of the peptides on a 15% SDS-PAGE and 20 hrs exposure of autoradiograms in 2 normal control cell lines treated with puromycin (lane 2, 3) , in patient NF-055 EBV cell lines treated with (lane 4) and without (lane 5) puromycin. This patient NF-055 carries the germline mutation R2429X. In patient NF-075 a weak truncated band at exactly the same position as the truncated peptide previously detected in another patient NF-055 was revealed. Only with an optimal signal to noise ratio it is possible to discern such a faint truncated band. PTT, starting from RNA extracted immediately after taking the EBV cell line from the incubator, and using the very sensitive  3 H-Leucine incorporation, can effectively pinpoint the region of interest for further molecular study.  
         [0115]    panel 2: PTT analysis from fragment 5 and separation of the peptides on a 10% SDS-PAGE and 20 hrs exposure of autoradiograms in cell lines from patient NF-055 (lanes 1 and 2) and patient NF-075 (lanes 2 and 4), treated with puromycin (lane 1 and 3) and without puromycin (lanes 2 and 4)  
         [0116]    panel 3: same gel as in panel 2 but with a longer exposure time (60 hrs instead of 20 hrs). Using the longer exposure time the truncated peptide in patient NF-075 can be more readily seen.  
         [0117]    C. (1) genomic DNA direct cycle sequencing chromatograms of NF-055 reveals presence of mutation R2429X in his blood lymphocytes. Equal quantity of mutant versus wild type allele is present, as can be expected for a germline mutation present on 1 NF1-copy in all cells; (2) genomic DNA direct cycle sequencing chromatograms of a normal control person; (3) Genomic DNA direct cycle sequencing of NF-075 reveals at that sequence the presence of a small signal that might indicate presence of a T nucleotide at position 7285 in a fraction of the cells. Cycle sequencing in itself is not sensitive enough to give any pathological significance to such a signal; (4) Further analysis of the genomic DNA of patient NF-075 by subcloning revealed presence of mutation R2429X in a fraction of his blood cells. This is the first sporadic patient that could be identified to be a “somatic mosaic” for a nonsense mutation in the NF1 gene. Fragment analysis (not shown) showed that the mutation is present in &lt;10% of the blood cells.  
       DETAILED DESCRIPTION OF THE INVENTION 
    
    
     EXAMPLES  
     Example 1  
     Patients  
       [0118]    From all patients EBV transformed B-lymphoblastoid cell lines and/or short-term phytohaemaglutinin stimulated blood lymphocyte culutes were established to allow for extensive RNA and DNA based studies. DNA was extracted directly from the lymphocytes as well. Patients were ascertained in the Center of Medical Genetics of Ghent, Brussels and Liege (Belgium). Before the analysis was initiated a detailed clinical evaluation was performed and the clinical features of all patients were documented using the “NNFF International NF1 Mutation analysis Consortium” form. Only patients that fulfilled the diagnostic criteria as proposed by the NIH Consensus Statement in 1988 (Stumpf et al.) and updated in 1997 (Gutmann et al.) were admitted to the study. The study was approved by the ethics committee of the University Hospital Ghent (Belgium).  
       Example 2  
     DNA Isolation, RNA Isolation and cDNA Synthesis.  
       [0119]    EBV-transformed cell lines were grown in RPMI 1640. Prior to RNA isolation, the EBV transformed cell culture was split. In order to prevent nonsense mediated mRNA decay, one subculture was maintained in the presence of puromycin (16 hours, 200 μg/ml puromycin (Sigma, p7255), further called Pplus culture), while in the other subculture no puromycin was added (further called Pmin culture). RNA was extracted from both types of cultures for all patients.  
         [0120]    Total cellular RNA was extracted with TRIzol LS Reagent (Gibco BRL, 10296-010) using the manufacturer&#39;s instructions.  
         [0121]    cDNA was synthesized with 2-3 ug total RNA using random hexamers (Amersham Pharmacia Biotech) and 200 U Superscript II Reverse transcriptase (Gibco BRL).  
       Example 3  
     Protein truncation test  
       [0122]    Primers used for the protein truncation test (PTT) assay have been described by Heim et al. (1995). PTT was performed using an optimized protocol (Claes et al., 1998). The sensitivity of the technique was further enhanced using puromycin treated EBV-transformed cell cultures and/or phytohaemaglutinin stimulated blood lymphocyte cultures and RNA extraction immediately after removal from the incubator. We analyzed all protein samples on a 10% and 15% SDS-PAGE gel in order to maximize the detection of the very large and small abnormal peptide fragments.  
       Example 4  
     Improved PTT Results  
       [0123]    As the vast majority of mutations reported so far are predicted to generate a premature stop codon, it was chosen to start with the protein truncation test (PTT) in the first step of a combined mutation approach consisting of a cascade of techniques applied in the mutation analysis of the NF1 gene. However, the efficiency to detect truncating mutations by PTT depends on the stability as well as on the purity of the mutant mRNA under investigation. As nonsense-mediated mRNA decay has been documented in mutant NF1 alleles (Hoffmeyer et al, 1995) it was decided to also develop an optimized PTT for the NF1 gene using puromycin-treated EBV cell lines. Puromycin is a tRNA analogue causing chain termination and blocks nonsense-mediated decay in cell lines as was demonstrated to be the case for the hMSH2 gene (Andreutti-Zaugg et al., 1997). The effect of puromycin on the stability of the NF1 mutant transcripts was not investigated before. 67 EBV cell lines from NF1 patients were established. Established cell lines were grown until a T25 culture flask contained approximately 100 clusters with a diameter of 0.2-0.3 mm/cm 2  and were then divided in two separate wells (10 cm 2 ): one well was treated for 15 hours with puromycin (200 μg/ml), the other well was further incubated in the RPMI-1640 tissue culture medium. Total RNA was extracted from both cultures and further analyzed by the protein truncation test. Although we did not miss a truncated peptide using RNA from the cultures without puromycin treatment—mainly due to the fact that a PTT system based on isotopic incorporation of  3 H-Leucine is very sensitive—the direct cycle sequencing of all fragments leading to a truncating peptide was surprisingly greatly facilitated starting from cDNA prepared from the puromycin treated cultures (FIG. 3, 4 and  15 ). By the optimized PTT analysis, the germline mutation at the cDNA and gDNA level in 83% of the patients studied was succesfully identified.  
         [0124]    Another crucial parameter in the successful application of the PTT to find the disease causing mutation is the quality of the RNA that is used to start the procedure. It was noticed that starting from RNA extracted from peripheral blood cells, very often “spurious” bands were present after RT-PCR as well as on the PTT SDS-PAGEs.  
         [0125]    The origin of these spurious bands was further explored by comparing the transcripts obtained when RNA is extracted from the peripheral blood lymphocytes directly after prelevation or after 48 hours incubation at room temperature. The rationale for these experiments were twofold: i) in the natural situation the blood sample often stays for some time in the doctor&#39;s room and is transported hereafter to the lab. The time needed for this transport depends on the place from where the sample is referred, but can take more than 24 hours; ii) it has been reported that some tumor suppressor genes such as TSG101 and FHIT often show deletions at the cDNA level for which no mutations in the DNA can be found. Especially in tumor tissues and in “aged” (means that the blood sample was kept at room temperature for 60 hours before RNA was extracted) blood samples it was seen that both genes exhibit infidelity of the splicing process. Noteworthy, the authors observed that the breakpoints of the deleted transcripts coincide with cryptic splice donor or acceptor sites or with the skipping of entire exons. The splicing infidelity was observed to be gene specific and did not occur in other gene transcripts that were analyzed, i.e. BRCA1, BRCA2, hMSH2, IGF2, RB amongst others. Epigenetic factors may influence the activation of these cryptic sites leading to the occurrence of these deleted transcripts. Therefore, semi-quantitative experiments on the ratio of transcripts skipping of exons 7 and 37 compared to transcripts that do contain exons 7 and 37 were carried out. RNA was extracted from different sources, including fresh blood, “aged” blood at room temperature for 48 hours, EBV cell lines from normal control persons, EBV cell lines from patients harboring specific mutations in exon 7 and 37 leading to increased skipping of the respective exons (FIGS. 5 and 6). These experiments clearly demonstrated that RNA extracted from “aged” blood samples leads to increased skipping of these exons and hence mimics—in the absence of a genomic alteration—the presence of a mutation. The NF1 gene has to be considered to be a gene that is prone to alterations in the RNA processing in response to epigenetic factors.  
         [0126]    As all missense mutations, small in frame insertions/deletions as well as large deletions and chromosomal rearrangements necessarily escape detection by the PTT analysis, all patients in which no mutation was identified in the first step were further analysed with a second battery of analyses. This second step included: DNA heteroduplex analysis of all 60 exons, FISH analysis using 3 intragenic cosmid/PAC clones, Southern blot analysis using 5 intragenic probes and finally karyotyping.  
         [0127]    The combined approach surprisingly led to identification of the germline mutation in 64 out of 67 patients (&gt;95%, Table 5). By PTT alone the germline mutation (after cDNA and genomic sequencing) could be identified in 56 out of the 67 patients analysed (83%). This is the highest detection rate reported so far.  
         [0128]    This study indicates that 29% of the germline mutations in the NF1 gene are associated with aberrant splicing, a frequency that is much higher than that reported in surveys of other human genetic disorders (Krawczak et al., 1992 and Ruttledge et al., 1996), but is reminiscent of the situation found in the ATM gene (Teraoka et al., 1999). Given the fact that splicing errors as the cause for Neurofibromatosis type 1 are particularly frequent in the NF1 gene it is of paramount importance to avoid the occurrence of spliced transcripts that arise due to epigenetic factors such as incubation at room temperature of the blood lymphocytes outside their natural habitat (the bloodstream).  
         [0129]    This can be obtained by working with EBV lymphoblastoid cell lines and extraction immediately after cultures are withdrawn from the incubator.  
       Example 6  
     Exon 10b of the NF1 gene represents a mutational hotspot and harbors a recurrent missense mutation Y489C associated with aberrant splicing  
       [0130]    With the current technology several novel mutational hotspots were identified. One such a mutational hotspot resides in exon 10b. This region harbors a missense mutation that masquerades a splicing mutation.  
         [0131]    Material and methods  
         [0132]    NF1 patients  
         [0133]    For all patients, the diagnosis of NF1 was based upon the presence of two or more of the diagnostic criteria proposed by the NIH Consensus Statement in 1988 (Stumpf et al., 1988) and updated in 1997 (Gutmann et al., 1997). The study was approved by the Institutional Ethical Committees and informed consent was obtained from the patients studied. Patients were recruited randomly without bias as they were seen for medical follow up and genetic advise. Patients were recruited as part of a general mutation study. 37 patients were contributed by the Dpt of Medical Genetics of Gent and by the Service de Genetique, Hopital Erasme Brussels.  
         [0134]    Nucleic acid extraction  
         [0135]    DNA and RNA samples were obtained from 37 unrelated NF1 patients by extraction from EBV-transformed lymphoblastoid cell lines. Total cellular RNA and genomic DNA was isolated as described (Messiaen et al., 1997).  
         [0136]    cDNA analysis and in vitro transcription/translation analysis  
         [0137]    First strand cDNA was synthesised by random priming (Messiaen et al., 1997) and cDNA was amplified using 5 primer pairs for amplification of the total coding region (10). 4 μl PCR product was used in an optimized in vitro transcription/translation reaction as described (Messiaen et al., 1997; Claes et al., 1998). An identical truncated peptide fragment of 55 kDa was observed in 2 out of 37 patients by in vitro transcription/translation of the fragment spanning exons 1 to 12a and the corresponding cDNA was analysed by cycle sequencing with and without subcloning using 0.15 μM fluorescein isothiocyanate (FITC) labeled primers, designated by nucleotide positions: 5′-CTTCGGAATTCTGCCTCT-3′ (SEQ ID NO 5) (400-418), 5′-CTGATATGGCTGAATGTG-3′ (SEQ ID NO 6) (719-736), 5′-GCCTGTGTCAAACTGTGT-3′ (SEQ ID NO 7) (967-984) and 5′- CACACCCAGCAATACGAA -3′ (SEQ ID NO 8) (1367-1384) and the Thermo Sequenase fluorescent labelled primer cycle sequencing kit (Amersham). Samples were loaded on a 6% LongRanger gel (FMC) containing 7M urea and analysed on an ALF automated DNA sequencer. In order to check for the presence of the missense mutation Y489C in a fraction of the cDNA, RT-PCR fragments were cloned using the pCR-TOPO cloning kit (Invitrogen) and 90 individual clones were further analysed by cycle sequencing.  
         [0138]    Genomic DNA analysis  
         [0139]    Exon 10b was amplified using the primer pair as described (Purandare et al., 1994) and PCR products were further analysed by cycle sequencing without subcloning (Messiaen et al., 1997). Mutations are reported according to the recommendations of the Nomenclature Working Group (Antonarakis, 1998), with the start site of translation denoted as nucleotide 1 both for cDNA and genomic alterations.  
         [0140]    Results  
         [0141]    The total coding region of the NF1 gene was analysed by the protein truncation test in 37 unrelated NF1 patients from which an EBV lymphoblastoid cell line was available (Heim et al., 1995). In 2 patients an identical shortened fragment of approximately 55 kDa was discerned in the region encompassing the exons 1 to 12a. In both patients in vitro transcription/translation for the other regions only showed normal sized fragments. By electrophoresis of the RT-PCR fragments from patient 1 two discrete bands were discerned on a 1.5% agarose gel, i.e. a normal sized band of 1868-bp and a band that was approximately 60-bp smaller. In patient 2 however only a normal sized band was seen, indicating that the truncated protein of identical size was formed in a different way in this patient. cDNA sequencing in this region indeed revealed a different mutation in both patients. In patient 2, an insertion of C at nt 1465-1466 in exon 10b was found, immediately resulting in the creation of a stop codon at this site. In patient 1, a deletion/skipping of the last 62 nucleotides of exon 10b was observed in RNA from both lymphocytes and the EBV-lymphoblastoid cells (FIG. 12B). Here too, the immediate result is formation of a stop codon at this site, explaining the identical picture seen by protein truncation analysis. Further analysis of exon 10b at the genomic level confirmed the presence of an insertion 1465insC in patient 2. In patient 1 however, a missense mutation was identified: A1466G, changing the codon for Tyr to Cys (Y489C) (FIG. 12A). Both parents of this sporadic patient did not carry this missense mutation. This missense mutation masquerades a splicing defect: indeed substitution of A to G at position 1466 of the genomic DNA creates a new splice donor site (CT/G T AAG) (FIG. 12C).  
         [0142]    Analysis of the normal and mutant sequence using the program for splice site prediction by neural network (http://www-hgc.lbl.gov/projects/splice.html) showed a 0.86 score for the normal exon 10b donor site (GCTTTGT/gtaagtat (SEQ ID NO 9)) and a higher 0.97 score for the new donor site created by the missense mutation Y489C (AGAAGCT/gtaagtat (SEQ ID NO 10)). RT-PCR fragments from an EBV lymphoblastoid cell line of patient 1 were cloned and 90 individual clones were further analysed by cycle sequencing in order to check for the presence of the missense mutation in a fraction of the cDNA. In 50 cDNA clones showing a normal sized band of 1868-bp on a 1.5% agarose gel, only the wild type sequence was found and in none of them the missense mutation was present. In 40 clones containing a slightly smaller insert (approximately 60-bp) as evidenced by agarose gel electrophoresis, the smaller size was due to the skipping of the last 62 nucleotides of exon 10b along with intron 10b in the mRNA (FIG. 12B). This indicates that the major outcome of the mutation Y489C at the cDNA level is skipping of the last 62 nucleotides of exon 10b. Although Y489C and 1465-1466insC are different mutations at the genomic DNA level, both result in the formation of a premature stop codon at exactly the same position well before the GAP domain of neurofibromin. As the finding of two different mutations at the same spot (i.e. 1465-1466insC and 1466A&gt;G) is in itself indicative of a mutational hotspot (Cooper et al., 1998) these findings prompted us to analyze exon 10b in a larger patient population. We now identified the mutation Y489C in 4 unrelated NF1 patients on a total number of investigated proven NF1 patients of 105, allowing to estimate prevalence of this mutation in the NF1 population to be about 4%.  
       Example 7  
     Exhaustive mutation analysis of the NF1 gene allows the identification of 95% of mutations and reveals a high frequency of unusual splicing defects.  
       [0143]    Patients, Materials and Methods  
         [0144]    Patient samples  
         [0145]    In this prospective study, 67 unrelated index patients seen at the Departments of Medical Genetics of Ghent University Hospital, Université de Liège, Vrije Universiteit Brussel and Université Libre de Bruxelles for clinical follow-up and genetic counseling were included. Clinical features of all patients were documented using the “NNFF International NF1 Mutation analysis Consortium” form. Only patients fulfilling the diagnostic criteria as proposed by the NIH Consensus Statement in 1988 (Stumpf et al., 1988) and updated in 1997 (Gutmann et al., 1997) were included. The ethics committee of the Ghent University Hospital approved the study. From all patients EBV transformed B-lymphoblastoid cell lines were established. 38 patients presented as de novo cases and 29 patients were familial. The familial or sporadic nature of the mutation was verified by analysis of family members. All mutations were verified on a second independent sample. The mutations were absent on 100 unrelated normal chromosomes.  
         [0146]    RNA Isolation and cDNA Synthesis  
         [0147]    Prior to RNA isolation, the EBV transformed cell culture was split. In order to prevent nonsense mediated mRNA decay, one subculture was maintained in the presence of puromycin (16 hours, 200 μg/ml puromycin (Sigma, p7255), further called Pplus culture), while in the other subculture no puromycin was added (further called Pmin culture). RNA was extracted from both types of cultures for all patients.  
         [0148]    Total cellular RNA was extracted with TRIzol LS Reagent (Gibco BRL, 10296-010) using the manufacturer&#39;s instructions.  
         [0149]    cDNA was synthesized with 2-3 μg total RNA using random hexamers (Amersham Pharmacia Biotech) and 200 U Superscript II Reverse transcriptase (Gibco BRL).  
         [0150]    RT-PCR and PTT  
         [0151]    Primers used for the amplification of the total NF1 cDNA in 5 overlapping fragments (F1-F5) were as previously described (Heim et al., 1995). 3-5 μl PCR product, 20 μM amino acid mix minus Leucine (Promega, L4610) and 1.6 μl  3 H Leucine (specific activity 1 mCi/mmol; Amersham) were added to the TNT™ Coupled Reticulocyte Lysate System (Promega). Reactions were performed as described (Claes et al., 1998). Samples were subjected to electrophoresis in a 10% and 15% SDS-polyacrylamide gel (Protean II Bio-rad, 20×24 cm gels) and run for 16 h at 30 mA (10% gels) and 40 mA (15% gels).  14 C methylated protein (Amersham Pharmacia Biotech CFA626) was used as a protein-weight marker. Synthesized polypeptides were visualized by autoradiography after 20 and 60 h exposure to X-ray film.  
         [0152]    Semi-quantitative analysis of splicing variants not associated with mutations  
         [0153]    cDNA was subjected to 20 cycles of PCR using the following primer pairs: 5′-FITC-TTGACTTGGTGGATGGTTT-3′ (SEQ ID NO 11) (cDNA 749-777) and 5′-TTGAGAATGGCTTACTTGGA-3′ (SEQ ID NO 12) (cDNA 1096-1077) for analysis of exon 7 (E7) skipping; 5′-FITC- GGGCAGATAAAGCAGATAAT-3′ (SEQ ID NO 13) (cDNA 6721-6740) and 5′-CCGGATTGCCATAAATAC-3′ (SEQ ID NO 14) (cDNA 7029-7012) for analysis of E37 skipping.  
         [0154]    Semi-quantitative analysis of the transcripts was performed on a 5% denaturing acrylamide gel on an ALF automated DNA sequencer (Amersham Pharmacia Biotech) as described (Lambert et al., 1998). The nature of shortened transcripts was verified after subcloning by direct cycle sequencing as described (Messiaen et al., 1997).  
         [0155]    Splice site scores  
         [0156]    The sequence environment of all splice mutations was analyzed using Splice Site Prediction by Neural Network (SSPNN) and a Splice Site Score (SSS) was obtained (URL adress: http://www.fruitfly.org/seq_tools/splice.html). For all 5′ and 3′ splice sites (ss) the consensus values (CV) were calculated as developed by Shapiro and Senepathy (1987).  
         [0157]    cDNA sequencing  
         [0158]    Autoradiograms from PTT gels allowed to predict the most plausible position of the mutations causing the specific truncated peptides and RT-PCR fragments were cycle sequenced in the corresponding regions with the Thermo Sequenase™ fluorescent labeled primer cycle sequencing kit (Amersham Pharmacia Biotech) using 5′-fluorescein or 5′-Cy5 labeled sequencing primers distributed along the coding sequence (sequences available upon request).  
         [0159]    Heteroduplex Analysis (HA)  
         [0160]    Exons were amplified from genomic DNA. For some exons PCR primers were developed using OLIGO V5 software (Table 6). For other exons PCR primers were as described (Purandare et al., 1994; Hoffmeyer et al., 1998, Maynard et al., 1997; Abernathy et al., 1997; Cawthon et al., 1990; Li et al., 1995). Exons 1 and 49 were not yet studied. For the larger exons 16, 21, 28, 29, 31, 33, 35, 37 and 38 the sensitivity of the HA was improved by digestion with a specific RE in order to obtain fragments with an optimal size between 200-300 nt. After amplification, fragments were denatured at 98° C. for 5′ and allowed to reanneal at 68° C. for 1 hour. 2-4 μl of the PCR product was mixed with 8 μl loading buffer (25% bromophenolblue, 25% xyleencyanol, 30% glycerol) and loaded on a 1 X MDE gel (FMC, Rockland, Me.) containing 10% glycerol. After electrophoresis, gels were stained with EtBr (0.5 μg/l) and evaluated under a transilluminator. Aberrant fragments were further analyzed by cycle sequencing using the forward amplification primer or a nested primer for sequencing.  
         [0161]    Cytogenetic analysis and fluorescence in situ hybridisation (FISH)  
         [0162]    Patients in whom no mutation was found by PTT and HA were analyzed by cytogenetic analysis and FISH. Cytogenetic analysis was performed on PHA stimulated G-banded metaphases according to standard procedures. To detect submicroscopic deletions dual color FISH was performed according to Van Roy et al (1994) using PAC clones 22 (926B9; 5′ NF1) and 13 (1002G3; 3′ NF1) described by Correa et al (1999).  
         [0163]    Southern Blot analysis  
         [0164]    6 μg of genomic DNA was digested with 30 U of EcoRI and BglII (both Gibco BRL) for 6 hours at 37° C. Digested DNA was electrophoresed in 0.8% agarose and transferred to positively charged Nylon membranes (Hybond N +  Amersham). Hybridisation was carried out using standard procedures (Sambrook et al., 1989) using cDNA probes GE2, FF13, FB5D, P5 and B3A as described (Marchuk et al., 1991).  
         [0165]    Results  
         [0166]    Mutation detection rate using the combined approach and mutational spectrum  
         [0167]    We identified a bona fide pathogenic mutation in 64 of 67 unrelated NF1 patients (95.5%) (Table 5), including all 29 familial cases and 35 of 38 sporadic patients.  
         [0168]    By the optimized PTT starting from puromycin-treated EBV-lymphoblastoid cell lines, the mutation was completely characterised both at the cDNA and gDNA level in 56 patients ( 56 / 67  patients; 83.5%): 25 were nonsense ( 25 / 67 ; 37%), 12 frameshift (12/67; 18%: 5 insertions and 7 deletions of one or a few basepairs) and 19 in-frame or out-of-frame splice mutations (19/67; 28%).  
         [0169]    Further investigation of the remaining patients by HA resulted in the identification of 6 missense mutations and/or deletions of single amino acids (9%): C93Y, C187Y, L847P, 2970-2972delAAT or 991delM and 7096-7101delAACTTT or 2266delNF.  
         [0170]    18 of the 44 (41%) single base-pair substitutions were due to a C&gt;T or G&gt;A transition at CpG dinucleotides, known to be prone to mutation if methylated.  
         [0171]    A deletion of the entire NF1 gene was found by FISH analysis as evidenced by the absence of the 5′ (926B9) and 3′ (1002G3) PAC clone. Cytogenetic and FISH analysis showed a balanced translocation in a large NF1 family: t(14;17)(q32;q11.2), interrupting the NF1 gene as PAC 926B9 was found on the der (17) and PAC 1002G3 on the der (14) (data not shown).  
         [0172]    32 of the mutations identified (including the translocation) are novel compared to the most recent data (International NF1 Mutation Analysis Consortium before, March 1999; URL address: http://www.nf.org/nflgene/nflgene.home.html), Ars et al, 2000, Fahsold et al., 2000 and most recent overview of published data by Upadhyaya and Cooper, 1998).  
         [0173]    Translation inhibition facilitates detection of Premature Termination Codons (PTCs) by PTT and direct cycle sequencing  
         [0174]    Nonsense mediated mRNA decay compromises most RNA-based mutation detection methods, but can be circumvented using puromycin (Andreutti-Zaugg et al., 1997). Starting from RNA extracted from Pmin EBV cultures, PTT detects truncated peptides even if mutant transcripts are highly unstable. However, direct cycle sequencing of cDNA fragments using fluorescent dyes is severely impaired by the nonsense mediated decay and the signal-to-noise ratio is far better starting from Pplus EBV cultures. Representative results are shown in FIG. 4B.  
         [0175]    We compared the sensitivity of PTT and direct cycle sequencing in 13 EBV lymphoblastoid cell cultures treated with and without puromycin (6, FIG. 3, 4,  15  and  17 ). By PTT all truncated peptides from both types of cultures were discerned after 60 h exposure of autoradiograms. However only in 7 of the Pmin EBV cultures the mutant transcript was unambiguously identified by direct cDNA sequencing. In the remaining 6 cultures, the expression of the mutant transcripts was highly reduced compared to the normal transcripts with the ratio of mutant to wild-type peak height in sequencing chromatograms being &lt;0.35. Direct cDNA cycle sequencing can not reveal unambiguously the pathogenic mutation in these cases. In contrast, in all Pplus EBV cultures the mutation was identified and the ratio between mutant and wild-type peak height in sequencing chromatograms varied between 0.8 and 1.00.  
         [0176]    Distribution of the mutations, mutational hot spots and recurrent mutations  
         [0177]    Mutations seem to be equally distributed along the gene. However, some exons may have a higher mutation density (FIG. 9A). In 15% of the patients studied, a mutation was found within the exons 10a-10b-10c, although this region comprises only 4.5% of the coding region. In this region 3 recurrent mutations (R440X, R461X and Y489C) were found. In E37, comprising only 1.2% of the coding region, a mutation was found in 5.9% of the patients. Ten recurrent mutations were identified in 20 unrelated patients and together account for 30% of the mutations found in this study (5): R304X, R440X, R461X, Y489C, 2033-2034insC, R1362X, R1513X, R1849Q, Y2264X and 7096-7101delAACTTT (FIG. 9B). As NF1 haplotypes were different in both families carrying the mutation R1849Q, recurrence can not be due to identity by descent.  
         [0178]    R304X, R440X, R461X, R1362X, R1513X, R1849Q are C&gt;T or G&gt;A substitutions at CpG dinucleotides, which may explain their recurrence. There is no clue to explain the recurrence of 1466A&gt;G (Y489C) looking at the sequences surrounding this mutational hotspot. We found this mutation in {fraction (5/232)}unrelated patients (Messiaen et al., 1999). The recurrence of 2033insC may be caused by slippage of the polymerase in a stretch of 7 cytosines. Mutation Y2264X (C6792A and C6792G) resides in a sequence environment containing direct AC-repeats as well as palindromic sequences. The recurrence of 7096delAACTTT may be caused by slipped mispairing between two AACTTT tandem repeat sequences.  
         [0179]    Missense mutations in the NF1 gene and their pathogenicity  
         [0180]    We identified 6 genuine missense mutations or deletions of single amino acids, i.e. C93Y, C187Y, L847P, 2970-2972delAAT and 7096-7101delAACTTT. These were absent on 300 normal control chromosomes, conserved during evolution in Rat (D45201), Mouse (L10370), Fugu (AF064564) and Drosophila (L26501), segregated with the disorder in 5 familial cases or verified to be de novo in 1 sporadic case. If the total coding region would be studied uniquely at the genomic level 4 more mutations could erroneously be considered to be missense mutations: Y489C (2X), V1093M (1X) and R2616Q (1X). Y489C was documented as a splice mutation (Messiaen et al., 1999). V1093M acts similarly as a splice mutation by creating a novel splice donor in the middle of E19b. R2616Q, found in a familial patient NF-027, was not found in 300 control normal chromosomes, is predicted to cause a dramatic change in the polypeptide chain and is conserved in Rat, Mouse, Fugu and Drosophila (FIG. 16). However, this alteration did not segregate with the disorder within the family (FIG. 16). The index patient was compound heterozygous for R2616Q and R304X, the latter identified by PTT. R304X is the genuine pathogenic mutation in this family as her healthy daughter inherited the R2616Q allele and the affected daughter the R304X mutation. This finding underscores the importance of the analysis of the total coding region for truncating mutations before firm conclusions can be made on the pathogenicity of missense mutations.  
         [0181]    Mutations resulting in splicing defects  
         [0182]    Splicing errors were detected in {fraction (19/67)} (28%) patients (Table 5 and 7).  
         [0183]    Only 4 splice mutations were at the canonical GT splice donor or AG splice acceptor, i.e. IVS12a+1G&gt;T, 6577delGAGgta, IVS26-2A&gt;T and IVS27b-2A&gt;T.  
         [0184]    6 mutations were at less conserved positions of the 5′ or 3′ splice site (ss): IVS16+3delaaagtg, R1849Q, K2286N, IVS16-6delcut, IVS19b-3C&gt;G and IVS39-12T&gt;A.  
         [0185]    One nonsense and 2 missense mutations create a novel 5′ or 3′ ss and are splice mutations, i.e. S1765X, Y489C and V1093M.  
         [0186]    Y2264X (C6792A and C6792G) result in E37 skipping and R304X results partially in E7 skipping besides retention of the nonsense codon (FIG. 5). Both mutations do not alter the existing normal ss nor create novel ones and may exert their effect by altered interaction between an exonic splice enhancer and mRNA splicing factors (Messiaen et al., 1997, Hoffmeyer et al., 1998). The remaining 25 nonsense mutations were not associated with splicing defects and hence nonsense mediated exon skipping is rather exceptional in NF1.  
         [0187]    Consensus values (CVs) according to Shapiro and Senepathy (1987) and splice site scores (SSSs) according to Splice Site Prediction by Neural Networks (SSPNN) were calculated for all splice sites involved in splicing mutations (Table 7).  
         [0188]    Simple skipping of an exon due to a mutation at the 5′ or 3′ consensus ss of that exon was observed in only 4 cases, i.e. 6577delGAGgta, K2286N, IVS16-6delcttt and IVS19b-3C&gt;G. Only K2286N results in a transcript that, if translated, would leave the reading frame intact. Remaining splice mutations had complex effects.  
         [0189]    IVS12a+1G&gt;T leads to skipping of both E11 and 12a. Noteworthy, CV and SSS for the normal 5′ and 3′ ss of E11a and for the 3′ ss of E12a are very weak which may explain the concerted skipping of both exons if a mutation affects the 5′ ss of E12a. R1849Q (5547G&gt;A) results in transcripts lacking E29 (ex29del) and transcripts lacking both E29+30 (ex{fraction (29/30)}del) in equal amounts. The same transcripts were found in a patient with mutation IVS29+1G&gt;C (Osborn et al., 1999). This region is involved in tissue-specific alternative splicing with ex29del expressed only in human brain tissues and ex29/30del detectable at low levels in all tissues (Park et al., 1998). Constitutive increase of the ex29del expression in non-brain tissues seems to be the pathogenic lesion causing NF1 in this family.  
         [0190]    Seven mutations induced—beside exon skipping in some cases—the activation of a cryptic ss or the use of a novel created ss, i.e. IVS16+3delaaagtg, Y489C, V1093M, IVS26-2A&gt;T (FIG. 10), IVS39-12T&gt;A (FIG. 11) and S1765X. For all mutations affecting the 5′ ss of NF1 exons, the CV and SSS of the mutated ss (M) were lower than the wild type ss (N) sequences but differences between the SSSs were more pronounced.  
         [0191]    Y489C (FIG. 12) and V1093M (FIG. 13) both create a novel 5′ ss with an almost identical CV compared to the wild type 5′ ss. Prediction of ss strength by SSPNN gives slightly better results (Table 7). The natural 5′ ss of E19b is unusual for primates (A A /gtaa a t, rare nucleotides underlined), which may explain why it is inactivated even by the weak donor ss created by V1093M.  
         [0192]    Mutations at the 3′ ss had a lower (⅗) or almost identical (⅖) CV and SSS compared to the wild type 3′ ss. Both the CVs or SSSs fail to predict whether the mutation will lead to exon skipping and/or activation of a cryptic 3′ ss.  
         [0193]    IVS16-6delcttt and IVS39-12T&gt;A both disrupt a tandem repeat, cttt and gttt respectively. For both mutations, the CV and SSS of the mutant sequence are identical compared to the wild type 3′ ss, yet missplicing occurs and the outcome of both mutations differs. IVS16-6delcttt leads to “simple” E17 skipping, although a strong cryptic 3′ ss resides 57 nt upstream (SSS 0.96) and—if activated—could result in the in frame insertion of 29 amino acids. For IVS39-12T&gt;A the mutant 3′ sequence (gtttgtt a gttgtag/ggtacag (SEQ ID NO 15)) still has a high SSS (0.99) yet apparently gets inactivated and a novel created 3′ ss at IVS39-12 (gtttgtttgtttgtttgtt a g/tttttgtaggg) is used partially leading to a transcript that retains the last 10 nucleotides of IVS39, forming a peptide of 209 amino acids after in vitro translation. The mutation further causes skipping of E40 leading to a peptide shortened by only 44 amino acids. Both truncated peptides were discerned by PTT (FIG. 11) illustrating the power of this technique to detect multiple mutant transcripts.  
         [0194]    The novel 3′ ss created by S1765X has a lower CV and SSS compared to the wild type ss, yet in frame skipping of the first 90 nucleotides of E29 is observed (FIG. 14). An intranuclear scanning mechanism capable of recognizing nonsense codons as proposed by Dietz and Kendzior (1994) and primarily concerned with the maintenance of an open reading frame may mediate this outcome.  
         [0195]    R304X and splicing  
         [0196]    R304X was shown by Hoffmeyer et al (1997) to result in in-frame E7 skipping without retention of the nonsense codon in the mutant transcripts. We studied 3 patients with mutation R304X from 2 unrelated families. Starting from RNA extracted from Pplus and Pmin EBV cultures, PTT clearly showed a truncated peptide of approximately 33 kDa, the size expected when the nonsense codon is retained in all patients (FIG. 15). Cycle sequencing of cDNA from the Pmin cultures showed unequal expression of the mutant transcript containing the nonsense codon (FIG. 15). Semi-quantitative RT-PCR analysis of the transcripts showed that E7 skipping was present in a minor fraction of the transcripts (6-13%; FIG. 5). Puromycin treatment did not alter the ratio of the E7-skipped versus full-length transcript (FIG. 5). In EBV lymphoblastoid cell lines, Ex7del transcripts were undetectable in normal control persons (data not shown) and in patients with the mutation Y2264X (FIG. 5). Our results indicate that at least in EBV cultures E7 skipping is not the major outcome of mutation R304X. We cannot exclude whether or not cell type dependent splicing differences may underly the apparent discrepancies between both studies.  
         [0197]    Variant splicing due to environmental factors and not associated with mutations.  
         [0198]    In specific tumor suppressor genes such as TSG101 and FHIT, some transcripts with internal deletions are not necessarily associated with a genomic mutation and can be found in the RNA from normal tissues as well, especially in lymphocytes not processed immediately after prelevation (“aged” blood) (Gayter et al., 1997). Initially PTT was developed starting from blood samples, but often spurious background bands were visible on autoradiograms, urging us to develop the technology starting from EBV transformed cell lines. Some blood samples are inevitably delayed in transit from the hospital to the laboratory and the background bands may be caused by misspliced NF1 transcripts in “aged” blood cells that lead to the formation of truncated peptides in the PTT. We analysed blood samples from 4 unrelated normal control persons for 2 regions in the NF1 transcript: the region where E7-skipping was observed to a low extent in patients with the mutation R304X and the region where equal expression of transcripts with E37-skipping was observed in patients with the mutation Y2264X (Messiaen et al., 1997). Semi-quantitative analysis showed that skipping of E7 and 37 was undetectable in all control samples processed immediately after prelevation of the blood. In all 4 “aged” blood samples however, a fraction of the transcripts showed skipping of E7 and E37. Typically the ratio of misspliced to full-length transcripts for E7 and E37 ranged between 0.09 and 0.14. Analyses starting from RNA that was not extracted immediately after prelevation of the blood samples can result in the occurrence of shorter transcripts in RT-PCR. This “noise” may in some cases obscure the real “signal” that is formed by the bona fide mutation.  
         [0199]    Discussion  
         [0200]    In this study 67 unrelated typical NF1 patients were analysed using a cascade of complemenatry techniques and the mutation was identified in 64 patients (&gt;95%). Hence a sensitive molecular diagnostic test for NF1 can be achieved if classical NF1 patients are studied with multiple complementary and optimized techniques.  
         [0201]    By PTT we identified mutations in 56/67 patients (83%). Missense mutations or small in frame insertions/deletions were found by HA in {fraction (6/67)} patients (9%). 18 out of 44 single base pair substitutions were due to a C&gt;T or G&gt;A transition at CpG dinucleotides. By cytogenetic and/or FISH analysis 1 deletion of the entire gene and 1 balanced translocation t(14; 17)(q32;q11.2) interrupting the NF1 gene was found.  
         [0202]    The mutations were evenly distributed along the NF1 coding sequence. However, exons 10a-10c and E37 seem to be more mutation-rich as would be expected if mutations were distributed at random. We did not find E4b to be a remarkably mutation-rich region, as indicated by Fahsold et al (in press). This may be due to our smaller patient cohort. Alternatively, some of the recurrent E4b mutations reported by Fahsold et al may be identical by descent as no data on sporadic versus familial status or haplotypes are available. If, for both studies, we consider the number of E4b mutations versus the number of patients that were studied instead of versus the number of mutations that were found, a similar pick-up rate for E4b is obtained (16 out of 521 patients by Fahsold et al and 2 out of 67 patients in this study; both ˜3%). Ten mutations were recurrent in our study and each account for ˜2.9% of the germline mutations. The high number of recurrent mutations was unexpected. Our results suggest that the exons 7, 10a-10c, 13, 23.2, 27a, 29, 37, 39 harbour recurrent mutations and that these exons, together with exons 4b, 22 and 31 reported by others to contain recurrent mutations (Fahsold et al., in press and Upadhyaya and Cooper, 1998), should be implemented with priority in NF1 mutation analysis.  
         [0203]    A mutation was identified in 36 out of 39 sporadic patients (92%). This study shows for the first time that also in sporadic NF1 patients the pathogenic mutation can be identified with high efficiency. The most immediate result of this effort is the ability to provide presymptomatic/prenatal testing in the offspring of sporadic patients. Moreover, a sensitive test can help to diagnose young children presenting with NF1-related symptoms, but not (yet) fulfilling the N.I.H. diagnostic criteria.  
         [0204]    The presence of somatic mosaicism in conditions with a high new mutation rate as in NF1 has been predicted (Hall, 1988). Comparisons between mutation detection rates after analyzing the total coding region in sporadic versus familial NF1 patients were not published so far. In our study the gDNA direct sequencing chromatograms of 2 patients suggest that the mutant and wild-type sequence are not present in equal amounts. This might reflect somatic mosaicism and is currently further investigated. All patients in whom we found no mutation are sporadic and low level somatic mosaicism may underly the failure to find a mutation. Alternatively, we may have missed the mutations as no technique is 100% sensitive or the mutations may reside in the exons 1 or 49 or in the 5′ or 3′ UTR that were not yet analysed.  
         [0205]    In the majority of cases the clinical features of NF1 are caused by haploinsufficiency due to a mutation leading to a PTC and rapid decay of the mutant RNA. In this study 6 missense mutations and/or small in frame deletions were identified that may exert their effect in a dominant-negative fashion. Another group of mutations that may produce some truncated neurofibromin are mutations that affect splicing. The frequency of splicing errors in the NF1 gene is very high (28%) compared to other genetic disorders or as can be expected by calculation of relative target sizes (Krawczak et al., 1992). Only a minority of splice mutations ({fraction (4/19)}) were found at the invariant AG/GT dinucleotides and mutations at 3′ ss were as frequent as at the 5′ ss. 8 splice mutations induce in frame skipping of total exons or part of an exon and have the potential to be “leaky”. As 4 of these splice mutations (S1765X, K2286N, C6792A and C6792G) form a stable mutant transcript it remains possible that a truncated neurofibromin is formed.  
         [0206]    The observed splicing defects provide an unusual opportunity to examine splice site competition and the sequence determinants of splice site selection.  
         [0207]    For some regions of the NF1 gene, we found exon-deleted transcripts in normal control persons. The presence of these transcripts was more pronounced in the RNA extracted from “aged” lymphocytes. Multiple alternatively spliced transcripts have been described for NF1 (Danglot et al., 1995; Suzuki et al., 1991; Cawthon et al., 1990; Park et al., 1998). The observation that other specific splice variants apparently are formed—albeit typically at low levels—if blood lymphocytes are not kept at physiological temperatures is intriguing. The results lend support to the hypothesis that epigenetic factors may contribute to the phenotypic variability in NF1 patients by altering the ratio of specific splice variants.  
         [0208]    The fact that exon-deleted products are easily detected in PTT assays indicates that caution is needed in the interpretation of a “positive” PTT result, until a credible underlying mutation in the genomic DNA is identified. In particular, it is ill advised to use the results of the PTT for diagnostic purposes if the mutation at the cDNA and genomic DNA can not be identified.  
         [0209]    Often clinical samples are delayed in transit and cDNA analysis of such samples may yield results that mimic splicing errors. We circumvented this problem by establishing EBV transformed cell cultures, however this is a time consuming and expensive step. Therefore, we are currently evaluating the efficiency and sensitivity of the PTT starting from short term cultures of phytohaemagglutinin stimulated lymphocytes. The combination of short term culture of stimulated lymphocytes and puromycin treatment may significantly decrease the time needed to identify in a reliable and sensitive way the mutations in the NF1 gene by PTT.  
         [0210]    The availability of a powerful mutation detection technology for the NF1 gene will allow to adress some longstanding questions such as i/ what is the contribution of the NF1 gene to segmental NF, gastrointestinal NF, familial spinal NF, familial café-au-lait spots, late-onset NF and to conditions related to NF1 but with additional features; ii/ do genotype-phenotype correlations in NF1 exist; iii/ what is the contribution of somatic mosaicism in sporadic NF1 cases.  
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                                                                   TABLE 1                        Mutations detected by analysis of the whole coding region of the NF1 gene by       PTT, HA, Cytogenetic and FISH analysis.                                    Genomic       Codon   Codon   Exon/       Patient   Mutation 1     Effect on cDNA   Change   Number   Intron               NF-018   t(14; 17)(q32; q11.2)   /   /    /    /       NF-096   Del total gene   /   /   /   /       NF-097   Del total gene   /   /   /   /       NF-098   Del total gene   /   /   /   /       NF-062   Del total gene   /   /   /   /       NF-077   99A &gt; G   99del105   K &gt; K    33    2       NF-004   247C &gt; T   247C &gt; T   Q &gt; X    83    3       NF-023   278G &gt; A   278G &gt; A   C &gt; Y    93    3       NF-036   560G &gt; A   560G &gt; A   C &gt; Y    187   4b       NF-080   574C &gt; T   574C &gt; T   R &gt; X    192   4b       NF-056   574C &gt; T   574C &gt; T   R &gt; X    192   4b       NF-029   603-604insT   603-604insT   frameshift    202   4c       NF-090   625C &gt; T   625C &gt; T   Q &gt; X    209   4c       NF-086   819-821delCCT   819-821delCCT   delL    274    6       NF-088   889-454del474   888del174   Del58aa   /   IVS6 en E7       NF-027   910C &gt; T   910C &gt; T;   R &gt; X    304    7               888del174       NF-064   910C &gt; T   910C &gt; T;   R &gt; X    304    7               888del174       NF-081   910C &gt; T   910C &gt; T;   R &gt; X    304    7               888del174       NF-024   987-988insA   987-988insA   frameshift    330    7       NF-066   1019delCT   1019delCT   Frameshift        7       NF-093   1261 − 19G &gt; A   1260insTTGTTTTTCTCTAGC   Frameshift   SEQ ID NO 16   IVS9       NF-048   1275G &gt; A   1275G &gt; A   W &gt; X    425   10a       NF-042   1318C &gt; T   1318C &gt; T   R &gt; X    440   10a       NF-057   1318C &gt; T   1318C &gt; T   R &gt; X    440   10a       NF-030   1381C &gt; T   1381C &gt; T   R &gt; X    461   10a       NF-026   1381C &gt; T   1381C &gt; T   R &gt; X    461   10a       NF-017   1466A &gt; G   1465del62   Y &gt; C    489   10b       NF-012   1466A &gt; G   1465del62   Y &gt; C    489   10b       NF-065   1466A &gt; G   1465del62   Y &gt; C    489   10b       NF-095   1466A &gt; G   1465del62   Y &gt; C    489   10b       NF-016   1465-1466insC   1466insC   Y &gt; X    489   10b       NF-068   1527 + 5G &gt; A   1392del135   NA   NA   IVS10b       NF-033   1570G &gt; T   1570G &gt; T   E &gt; X    524   10c       NF-073   1605insA   1605insA           10c       NF-052   1607C &gt; A   1607C &gt; A   S &gt; X    536   10c       NF-076   1642 − 3C &gt; G   1641del80   frameshift       IVS10c       NF-045   IVS12a + 1G &gt; T   1641del204   none   NA   IVS12a       NF-034   2033-2034insC   2033insC   frameshift    678   13       NF-035   2033-2034insC   2033insC   frameshift    678   13       NF-074   2305insT   2305insT   frameshift       14       NF-010   2540T &gt; C   2540T &gt; C   L &gt; P    847   16       NF-070   2585insA   2585insA   frameshift       16       NF-071   2836insT   2836insT   frameshift       16       NF-051   IVS16 + 2del6   2617del233   frameshift   NA   IVS16       NF-028   IVS16-6del4   2850del140   frameshift   NA   IVS16       NF-014   2875C &gt; T   2875C &gt; T   Q &gt; X    959   17       NF-011   2887C &gt; T   2887C &gt; T   Q &gt; X    963   17       NF-001   2970-2972delAAT   2970-2972delAAT   delM    991   17       NF-091   2990 + 3A &gt; C   2850del140   Frameshift   NA   IVS17       NF-072   3132C &gt; A   3132C &gt; A   Y &gt; X   1044   19a       NF-053   3194delC   3194delC   frameshift   1065   19a       NF-063   3277G &gt; A   3277G &gt; A, 3274del40   V &gt; M; frameshift   1093   19b       NF-025   IVS19b − 3C &gt; G   3314del182   frameshift   NA   IVS19b       NF-039   3367G &gt; T   3367G &gt; T   E &gt; X   1123   20       NF-089   3457delCTCA   3457delCTCA   Frameshift   NA   20       NF-046   3520C &gt; T   3520C &gt; T   Q &gt; X   1174   21       NF-083   3704delA   3704delA   Frameshift   NA   21       NF-085   3708 + 1G &gt; C   3496del212   frameshift   NA   IVS21       NF-078   3826C &gt; T   3826C &gt; T   R &gt; X   1276   22       NF-059   3826C &gt; T   3826C &gt; T   R &gt; X   1276   22       NF-094   3826C &gt; T   3826C &gt; T   R &gt; X   1276   22       NF-079   4026delG   4026delG   frameshift   NA   23.2       NF-041   4084C &gt; T   4084C &gt; T   R &gt; X   1362   23.2       NF-054   4084C &gt; T   4084C &gt; T   R &gt; X   1362   23.2       NF-082   4299delC   4299delC   Frameshift   NA   25       NF-067   4480C &gt; T   C &gt; T   Q &gt; X   1494   26       NF-044   IVS26 − 2A &gt; T   4515-14 ins14;   frameshift   NA   IVS26               4515-17ins17       NF-021   4537C &gt; T   4537C &gt; T   R &gt; X   1513   27a       NF-006   4537C &gt; T   4537C &gt; T   R &gt; X   1513   27a       NF-058   IVS27b − 2A &gt; T   4772del433; 4772del293   frameshift   NA   IVS27b       NF-049   5033delG   5033delG   frameshift   1678   28       NF-084   5717delT   5117delT   Frameshift       30       NF-009   5264C &gt; G   5264C &gt; G   S &gt; X   1755   29       NF-050   5294C &gt; A   5215del90 (5294C &gt; A???)   S &gt; X   1765   29       NF-037   5546G &gt; A   5205del341; 5205del544   R &gt; Q   1849   29       NF-038   5546G &gt; A   5205del341; 5205del544   R &gt; Q   1849   29       NF-069   5546 + 2T &gt; G   5205del341; 5205del544   frameshift   NA   29       NF-047   5567delT   5567delT   frameshift   1856   30       NF-031   5798delC   5798delC   frameshift   1933   31       NF-060   5839C &gt; T   5839C &gt; T   R &gt; X   1947   31       NF-043   5896C &gt; T   5896C &gt; T   Q &gt; X   1966   31       NF-015   6577delGAGgta   6364del215   frameshift   2193   34       NF-040   6709C &gt; T   6709C &gt; T   R &gt; X   2237   36       NF-008   6789-6792delTTAC   6789-6792delTTAC   frameshift   2263   37       NF-019   6792C &gt; A   6756del102   Y &gt; X   2264   37       NF-003   6792C &gt; G   6756del102   Y &gt; X   2264   37       NF-032   6858G &gt; C   6756del102   K &gt; N   2286   37       NF-013   7096-7101del6   7096-7101del6   delNF   2366   39       NF-022   7096-7101del6   7096-7101del6   delNF   2366   39       NF-005   IVS39 − 12T &gt; A   7126del132;   NA   NA   IVS39               7127-10ins 10       NF-002   7201A &gt; T   7201A &gt; T   K &gt; X   2401   40       NF-092   7268delCA   7268delCA   Frameshift   2423   41       NF-055   7285C &gt; T   7285C &gt; T   R &gt; X   2429   41       NF-075   7285C &gt; T   7285C &gt; T   R &gt; X   2429   41       NF-061   7486C &gt; T   7286C &gt; T   R &gt; X   2496   42       NF-020   7884-7885delGT   7884-7885delGT   frameshift   2628   45       NF-007   8016delA   8016delA   frameshift   2672   46                    Patient   Type/effect   PTT (frag) 2     CG 3     S/F 4     Previously described               NF-018   /   /   /   F   Novel       NF-096   /   /   /   S   /       NF-097   /   /   /   S   /       NF-098   /   /   /   F   /       NF-062   /   /   /   S   /       NF-077   Splice: creation of novel 5&#39;ss, IF skip 105 nt   +(F1)   no       Novel       NF-004   nonsense   +(F1)   no   F   Osborn et al., 1999       NF-023   missense   −(HA)   no   F   Novel       NF-036   missense   −(HA)   no   F   Novel       NF-080   nonsense   +(F1)   Yes       Fahsold et al, 2000       NF-056   nonsense   +(F1)   yes   S   Fahsold et al., 2000       NF-029   frameshift   +(F1)   NA   F   Novel       NF-090   nonsense   +(F1)       S   Novel       NF-086   Amino acid deletion   —           Novel       NF-088   Genomic microdeletion of 474 basepairs   +(F1)   NA   S   Novel       NF-027   nonsense: truncation due to stopcodon;   +(F1)   yes   S   Hoffmeyer et al., 1998           splice: intact 3&#39; and 5&#39;ss, no cryptic or novel ss, IF           skip E7       NF-064   identical as NF-027   +(F1)   yes   F   Hoffmeyer et al., 1998       NF-081   identical as NF-027   +(F1)   yes       Hoffmeyer et al., 1998       NF-024   frameshift   +(F1)   NA   F   Novel       NF-066   Frameshift   +(F1)   NA   fnyi   Fahsold et al., 2000       NF-093   frameshift   +(H1)   NA   F   Novel       NF-048   nonsense   +(F1)   no   S   Novel       NF-042   nonsense   +(F1)   yes   S   Heim et al., 1995       NF-057   nonsense   +(F1)   yes   S   Heim et al., 1995       NF-030   nonsense   +(F1)   yes   S   Fahsold et al., in press       NF-026   nonsense   +(F1)   yes   S   Fahsold et al., in press       NF-017   splice: intact WT 5&#39;ss, creation novel 5&#39;ss,   +(F1)   no   F   Messiaen et al., 1999           skip last 62 nt E10b forms immediate           stopcodon       NF-012   identical as NF-017   +(F1)   no   S   Messiaen et al., 1999       NF-065   identical as NF-017   +(F1)   no   S   Messiaen et al., 1999       NF-095   identical as NF-017   +(F1)   No   S   Messiaen et al., 1999       NF-016   nonsense   +(F1)   NA   F   Novel       NF-068   Splice: inactiv 5&#39;ss, IF skip E10b   +(F1)   no   F   Novel       NF-033   nonsense   +(F1)   no   S   Novel       NF-073   frameshift   +(F1)   NA   S   Novel (Wallace/Messiaen)       NF-052   nonsense   +(F1)   no   F   Novel       NF-076   Splice: inact 3&#39;ss, OOF skippinf E11   +(F1 + 2)           Novel       NF-045   splice: inactiv 5&#39;ss, IF skip E11 + 12a   +(F2)   no   S   Abernathy et al., 1997       NF-034   frameshift   +(F2)   NA   S   Heim et al., 1995       NF-035   frameshift   +(F2)   NA   S   Heim et al., 1995       NF-074   frameshift   +(F2)   NA       Novel       NF-010   missense   −(HA)   no   F   Messiaen et al., 1998       NF-070   frameshift   +(F2)   NA   F   Novel       NF-071   frameshift   +(F2)   NA   fnyi   Novel       NF-051   splice: inact 5&#39;ss, activ cryptic 5&#39;ss, skip last   +(F2)   NA   S   Novel           233 nt E16       NF-028   splice: inactiv 3&#39;ss, OOF skip E17   +(F2)   NA   F   Novel       NF-014   nonsense   +(F2)   no   F   Novel       NF-011   nonsense   +(F2)   no   F   Novel       NF-001   amino acid deletion   −(HA)   NA   F   Shen et al., 1993       NF-091   Splice: inactiv 5&#39;ss, OOF skip E17   +(F2)       S   Novel       NF-072   nonsense   +(F2)   no   fnyi   Novel       NF-053   frameshift   +(F2)   NA   S   Novel       NF-063   splice: intact WT 5&#39;ss, creation novel 5&#39;ss,   +(F2)   no   F   Novel           skip last 40 nt E19b       NF-025   splice: inactiv 3&#39;ss, OOF skip E20   +(F2)   no   F   Novel       NF-039   nonsense   +(F2)   no   S   Novel       NF-089   Frameshift   +(F2 + F3)   No   F   Novel       NF-046   nonsense   +(F2)   no   S   Novel: MOSAIC!!       NF-083   Frameshift   +(F3)           Novel       NF-085   frameshift   +(F3)           Novel       NF-078   nonsense   +(F2)   Yes       Heim et al., 1995       NF-059   nonsense   +(F3)   yes   S   Heim et al., 1995       NF-094   Nonsense   +(F3)   Yes   S   Heim et al., 2000       NF-079   frameshift   +(F3)           Novel       NF-041   nonsense   +(F3)   yes   S   Upadhyaya et al., 1997       NF-054   nonsense   +(F3)   yes   S   Upadhyaya et al., 1997       NF-082   Frameshift   +(F3)           Novel       NF-067   nonsense   +(F3)   no   fnyi   Novel       NF-044   splice: inactiv 3&#39;ss, activ 2 cryptic 3&#39;ss sites   +(F3)   no   S   Novel           leading to 2 different OOF insertions       NF-021   nonsense   +(F3)   yes   S   Side et al., 1995       NF-006   nonsense   +(F3)   yes   S   Side et al., 1995       NF-058   splice: inactv 3&#39;ss, activ cryptic 3&#39;ss, OOF   +(F3)   no   F   Novel           skip E28; OOF skip first 293 nt E28       NF-049   frameshift   +(F3)   NA   F   Novel       NF-084   frameshift   +(F4)           Novel       NF-009   nonsense   +(F4)   no   S   Novel       NF-050   splice: intact 3&#39;ss, creation novel 3&#39;ss, IF   +(F4)   yes   F   Novel           skip first 90 nt E29       NF-037   splice: inact 5&#39;ss, OOF skip E29 and E29 + 30   +(F4)   yes   F*   Fahsold et al., in press       NF-038   identical as NF-037   +(F4)   yes   F*   Fahsold et al., in press       NF-069   identical as NF-037   +(F4)   yes   S   Fahsold et al., in press       NF-047   frameshift   +(F4)   NA   S   Novel       NF-031   frameshift   +(F4)   NA   S   Novel       NF-060   nonsense   +(F4)   yes   F   Cawthon et al., 1990       NF-043   nonsense   +(F4)   no   F   novel       NF-015   splice: inactiv 5&#39;ss, OOF skip E34   +(F4)   NA   S   novel       NF-040   nonsense   +(F4)   yes   S   Fahsold et al., in press       NF-008   frameshift   +(F4)   NA   S   Robinson et al., 1995       NF-019   splice: intact 3&#39;and 5&#39;ss, no cryptic or novel   +(F4)   no   F   Messiaen et al., 1997           ss, IF skip E37       NF-003   identical as NF-019   +(F4)   no   F   Messiaen etal, 1997       NF-032   splice: inactiv 5&#39;ss, IF skip E37   +(F4)   no   F   novel       NF-013   amino acid deletion   −(HA)   NA   S   Abernathy et al., 1994       NF-022   amino acid deletion   −(HA)   NA   F   Abernathy et al,. 1994       NF-005   splice: inactiv 3&#39;ss, IF skip E40; activ cryptic   +(F5)   no   F   novel           3&#39;ss, OOF ins last 10 nt IVS39       NF-002   nonsense   +(F5)   no   S   novel       NF-092   Frameshift   +(F5)   No   S   novel       NF-055   nonsense   +(F5)   yes   S   Fahsold et al., in press       NF-075   nonsense   +(F5)   yes   S   Fahsold et al., in press, low                           level MOSAIC in the                           lymphocytes!!       NF-061   nonsense   +(F5)   yes   S   Purandare et al., 1994       NF-020   frameshift   +(F5)   NA   S   novel       NF-007   frameshift   +(F5)   NA   S   novel                                                                  
 
         [0274]    [0274]                                     TABLE 2                           NF1 PRIMERS SEQUENCING c-DNA            Name + Label   AnnT°   Position   Sequence (5′-3′)   Origin               NF.1cy   60     1   atggccgcgcacaggccggt   own                   (SEQ ID NO 16)       NF1s1 cy   58    73   acaggacagcagaacaca   Rina Wu                   (SEQ ID NO 17)       NF1s2 cy   58    400   cttcggaattctgcctct   Rina Wu                   (SEQ ID NO 18)       NF1s3 cy   58    713   ctgatatggctgaatgtg   Rina Wu                   (SEQ ID NO 19)       NF2s1 fl, cy   58    967   gcctgtgtcaaactgtgt   Rina Wu                   (SEQ ID NO 20)       NF2s2 fl, cy   58   1367   cacacccagcaatacgaa   Rina Wu                   (SEQ ID NO 21)       NF2s3, on, fl, cy   58   1685   atcctgatgctcctgtag   Rina Wu                   (SEQ ID NO 22)       NF2s3b cy   55   1878   tttttacggggtaggatg   own                   (SEQ ID NO 23)       NF3s1, on, fl, cy   60   2035   atttgccgacaagcccag   Rina Wu                   (SEQ ID NO 24)       NF3s2, on, fl, cy   58   2308   actgcaggaaacactgag   Rina Wu                   (SEQ ID NO 25)       NF3s3, on, fl, cy   58   2689   ggctgttgtccttaatgg   Rina Wu                   (SEQ ID NO 26)       NF4s1, on, fl, cy   58   3001   tgcttgggaatatggtc   Rina Wu                   (SEQ ID NO 27)       NF4s1a, cy(H3b)   58   3229   gtttcacttctagctggtct   own                   (SEQ ID NO 28)       NF4s1b, on, cy   60   3376   caaacaggtggcaggaaacg   own                   (SEQ ID NO 29)       NF4s2 fl, cy   56   3558   ccttcaacaaggcacaga   Rina Wu                   (SEQ ID NO 30)       NF4s3 fl, cy   56   3756   actctaccaactgctctg   Rina Wu                   (SEQ ID NO 31)       NF5s1 fl, cy   55   4011   gaacctccttcagatgac   Rina Wu                   (SEQ ID NO 32)       NF5s3 fl, cy   55   4308   agaagaacatatgcggcc   Rina Wu                   (SEQ ID NO 33)       NF5s3b rev cy   58   4450   gcacattgccgtcacttatg   own                   (SEQ ID NO 34)       NF5s4 fl, cy   55   4658   ctaggcatcaggtacatg   Rina Wu                   (SEQ ID NO 35)       NF6s1 fl, cy   55   4957   gtctccgcagtctatatc   Rina Wu                   (SEQ ID NO 36)       NF6s1b cy   60   5071   cctgggaaactggctgagca   own                   (SEQ ID NO 37)       NF6s2 fl, cy   55   5382   ggagtgtgaagccattgt   Rina Wu                   (SEQ ID NO 38)       NF6s3 fl, cy   55   5670   tagtaagacgctggcagc   Rina Wu                   (SEQ ID NO 39)       NF6s4 fl, cy   55   5934   ccttgggcagattacaga   Rina Wu                   (SEQ ID NO 40)       NF7s1 fl, cy   55   6195   gatgctgtccttcaacaa   Rina Wu                   (SEQ ID NO 41)       NF7s2 fl, cy   52   6544   gaaacagtcacagaagct   Rina Wu                   (SEQ ID NO 42)       NF7s2b, cy   57   6576   ggaggcatgcatgagagata   own                   (SEQ ID NO 43)       NF7s3 fl, cy   54   6841   cagccacttcttaataagg   Rina Wu                   (SEQ ID NO 44)       NF7s4 fl, cy   58   7134   gcatccttcacctgctatt   Rina Wu                   (SEQ ID NO 45)       NF8s1 fl, cy   55   7375   catggtgacccttcctat   Rina Wu                   (SEQ ID NO 46)       NF8s2 fl, cy   52   7742   atgttctcttggatgaag   Rina Wu                   (SEQ ID NO 47)       NF8s3 fl, cy   50   8119   gctgagcttattgttaag   Rina Wu                   (SEQ ID NO 48)                    
         [0275]    [0275]                                                                                                                                                                       TABLE 3                           NF1           Primers g-DNA: Primers for amplification of all exons of the NF1 gene for HA            Name + la-                               bel   Program   PCR   Length   Sequence (5′-3′)   Sequence origin                    NFex1.1cy   does not work               cy-cccagcctccttgccaacgc   Shen et al                               (SEQ ID NO 49)                   NFex1.2                   gacccattccaccggcctgt                               (SEQ ID NO 50)                   NFex2x.1   95° 5′   100 ng   340   bp   tttcaatggcaagtaagt   own                           (SEQ ID NO 51)                   NFex2x.2   (95°45″-54°30″-   10 × CS           gttatatccaaagtccaca   own           72°30″) × 35               (SEQ ID NO 52)                   NFex2x.1cy   72°10′   1UPltaq                           NFex2.1fl   4°   25 μl           fluo-tttaaggataaactgtt   own       (nested)                   (SEQ ID NO 53)                   NFex3.1   HS   100 ng           tttcacttttcagatgtgtgttg   Purandare et al                           (SEQ ID NO 54)                   NFex3.2   (95°1′-60°1′-72°1′) × 35   5 × Dy   237   bp   tggtccacatctgtactttg                               (SEQ ID NO 55)                   NFex3.1cy   72° 10′   1UtaqBRL                           4°   TV = 25 μl                           NFex4Ax.1   95° 5′   100 ng   517   bp   ttaaatctaggtggtgtgt   own                           (SEQ ID NO 56)                   NFex4Ax.2   (95°45″-54°30″-   10 × Boeh           aaactcatttctctggag   own           72°30″) × 35               (SEQ ID NO 57)               72°10′   1UPltaq                           4°   25 μl                               NFex4B.1wal   95°5′   100 ng           ggcttcctgaagtgctgggat   Walace M., pers.                           (SEQ ID NO 58)   comm.               NFex4B.2wal   95°45″-63°25″-   10 × CS   305   bp   ccagtttggtgttctagttcagca   Walace M., pers.           72°25″) × 35               (SEQ ID NO 59)   comm.           72° 10′   1UPlTaq                       NFex4B.1Vfl   4°   TV = 25μl           fluo-gtgagataccacacctgtccc   Viskochil       (seq 60°)                   (SEQ ID NO 60)                   NFex4c.1   HS   100 ng           tttcctagcagacaactatcga   Purandare et al                           (SEQ ID NO 61)               NFex4c.2   (95°1′-60°1′-72°1′) × 45   5 × Dy   283   bp   catcaaaaaaaaaattttaataccag                               (SEQ ID NO 62)                   NFex4c.1fl   72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NFex5.1fl   HS   200 ng           fluo-catgtggttctttatttataggc   Hoffmeyer et al                           (SEQ ID NO 63)                   NFex5.2   (95°1′-52′1′-72°1′) × 35   10 × CS   113   bp   tcaatcgtatccttaccagcc                               (SEQ ID NO 64)               72° 10′   1UtaqBRL               (primers lay                               within                               exon)           4°   TV = 25 μl               NFex6.1   HS   100 ng           catgtttatcttttaaaaatgttgcc   Purandare et al                           (SEQ ID NO 65)                   NFex6.2   (95°1′-64°1′-72°1′) × 35   10 × Boeh   299   bp   ataatggaaataattttgccctcc                               (SEQ ID NO 66)               72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NFex7.1   HS   100 ng           tgctataatattagctacatctgg   Purandare et al                           (SEQ ID NO 67)                   NFex7.2   (95°1′-58°1′-72°1′) × 35   5 × Dy   373   bp   Cctatgaacttatcaacgaagag                               (SEQ ID NO 68)           NFex7.1cy   72° 10′   1UtaqBRL                           4°   TV = 25 μl                           NFex7 + 8.1   HS   100 ng           tgctataatattagctacatctgg   Purandare et al                           (SEQ ID NO 69)                   NFex7 + 8.2   (95°1′-55°1′-72°1′) × 35   10 × Boeh   880   bp   ctagtctttctgtttataaaggat                               (SEQ ID NO 70)           72° 10′   1UtaqBRL                   4°   TV = 25 μl                           NFex9.1br   HS   100 ng           tccgctgtggctcagaacac   Purandare et al                           (SEQ ID NO 71)                   NFex9.2br   (95°1′-63°1′-72°1′) × 40   10 × Boeh   335   bp   agtagaagaggatgcacagcc                               (SEQ ID NO 72)               72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NFex9.1   95°5′   100 ng           tttgacctcatttgtattactgag                               (SEQ ID NO 73)                   NFex9.2   (95°1′-60°1′-72°1′) × 35   10 × CS   249   bp   agaaccttttgaaaccaagagtg   Purandare et al                           (SEQ ID NO 74)               72°10′   1UPltaq                           4°   TV = 25 μl                               NFex10A.1   HS   100 ng           acgtaattttgtactttttcttcc   Purandare et al                           (SEQ ID NO 75)   1995               NFex10A.2   (95°1′-58°1′-72°1′) × 35   10 × Boeh   222   bp   caatagaaaggaggtgagattc                               (SEQ ID NO 76)                   NEex10A.1fl   72° 10′   1UtaqBRL                               NFex10A.2cy   4°   TV = 25 μl                               NFex10C.1   HS   100 ng           cttggtaccctttagcagtcac   Purandare et al                           (SEQ ID NO 77)                   NFex10C.2   (95°1′-59°1′-72°1′) × 35   5 × Dy   379   bp   ccttctttctccatggag                               (SEQ ID NO 78)                   NFex10C.1cy   72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NEex11.1   HS   100 ng           gtactccagtgttatgtttacc   Purandare et al                           (SEQ ID NO 79)   1995               NFex11.2   (95°1′-55°1′-72°1′) × 40   5 × Dy   190   bp   taaagttgaaatttaaaaattaaagtac                               (SEQ ID NO 80)                   NFex11.1cy   72° 10′   1UtaqBRL                               NFex11.2cy   4°   TV = 25 μl                               NFex12A.1   HS   100 ng           acttgtattcattatgggagaatg   MRC (Maynard)                           (SEQ ID NO 81)                   NFex12A.2   (95°1′-60°1′-72°1′) × 35   5 × Dy   284   bp   agtaatctctcaccattaccattc                               (SEQ ID NO 82)                   NFex12A.2cy   72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NFex12B.1   HS   100 ng           tttctagtgaatctccttcaagt   Purandare et al                           (SEQ ID NO 83)                   NFex12B.2   (95°1′-59°1′-72°1′) × 40   5 × Dy   382   bp   atgaaatttaccaaatttcattcag                               (SEQ ID NO 84)                   NFex12B.1cy   72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NFex13X.1cy   95°5′   100 ng           cy-gagttattgtatgcggagac   own                           (SEQ ID NO 85)                   NFex13X.2   (95°1′-55°1′-72°1′) × 30   10 × CS,B,D   494   bp   ttgaatttcccctgtaaac   own                           (SEQ ID NO 86)                   NFex13.1fl   72°10′   1UplTaq           fluo-cacagtttattgcattgttagat   Purandare et al       (seq bij°)                   (SEQ ID NO 87)               4°   TV = 25 μl                               NFex14.1   HS   100 ng           tccttttgggtggagcttatc   Purandare et al                           (SEQ ID NO 88)                   NFex14.2   (95°1′-59°1′-72°1′) × 35   10 × Boeh   286   bp   tatacttgtaatatgcacgtatc                               (SEQ ID NO 89)                   NFex14.1cy   72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NFex15.1fl   HS   100 ng           fluo-tgtgatcaggaatagcttttgaa   Purandare et al                           (SEQ ID NO 90)                   NFex15.2   (95°1′-57°1′-72°1′) × 40   5 × Dy   276   bp   ttaacagataaaagtcaactttac                               (SEQ ID NO 91)               72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NFex16.1   HS   100 ng           tggataaagcataatttgtcaagt   Purandare et al                           (SEQ ID NO 92)                   NFex16.2   (95°1′-58°1′-72°1′) × 35   5 × Dy   549   bp   tagagaaaggtgaaaaataagag                               (SEQ ID NO 93)                   NFex16.1cy   72° 10′   1UtaqBRL                               NFex16seq   4°   TV = 25 μl           cy-ccagtcagtgacgtaaggg   own       cy                   (SEQ ID NO 94)                   NFex17.1   HS   100 ng           ctctgtgtgtttagatcagtca   Purandare et al                           (SEQ ID NO 95)                   NFex17.2   (95°1′-55°1′-72°1′) × 35   10 × Boeh   319   bp   tttatcaattactaccagtatcag                               (SEQ ID NO 96)                   NFex17.1cy   72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NFex18.1   HS   200 ng           tagtaaggtagccagaagttgtgt   MRC (Maynard)                           (SEQ ID NO 97)                   NFex18.2   (95°1′-60°1′-72°1′) × 35   10 × Boeh   320   bp   atttacaaaaccctacattgctc                               (SEQ ID NO 98)                   NFex18.1cy   72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NFex19A.1   HS   100 ng           tcatgtcacttaggttatctgg   Purandare et al                           (SEQ ID NO 99)                   NFex19A.2   (95°1′-53°1′-72°1′) × 40   5 × Dy   272   bp   tgtaattaagtagttataactctc                               (SEQ ID NO 100)                   NFex19A.1cy   72° 10′   1UtaqBRL           cy-tcatgtcacttaggttatctgg                               (SEQ ID NO 101)               4°   TV = 25 μl                               NFex19B.1x   95°5′   100 ng           attaccttctccccatttga   own                           (SEQ ID NO 102)                   NFex19B.2x   (95°1′-55°1′-72°1′) × 30   10 × boeh   371   bp   ggctttatttgctttttgc                               (SEQ ID NO 103)                   NFex19B.1x   72°10′   1Upltaq                       cy               NFex19B.2x   4°   TV = 25 μl                       cy               NFex20.1   HS   100 ng           ccaccctggctgattatcg   Purandare et al                           (SEQ ID NO 104)                   NFex20.2   (95°1′-62°1′-72°1′) × 35   10 × Dy   402   bp   taatttttgcttctcttacatgc                               (SEQ ID NO 105)                   NFex20.1cy   72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NFex20-   95°5′   100 ng           ctatatcaggtaaaatcatgtccaac   Fahsold et al       21.1                   (SEQ ID NO 106)                   NFex20-   (95°1′-60°1′-72°1′)*35   10 × boeh           gatttgctatgtgccagggac           21.2                   (SEQ ID NO 107)               72°10′   1Upltaq                           4°   TV = 25 μl                               NFex21xx.1   95° 5′   100 ng           gtcaaacttactcaatgcc   own                           (SEQ ID NO 108)                   NFex21xx.2   (95°45″-54°30″-   10 × Boeh   542   bp   caaccacttccctacag   own           72°30″) × 31               (SEQ ID NO 109)                   NFex21xx.1   72°10′   1UPltaq                       cy               NFex21x1.cy   4°   25 μl           cy-aactggcatgtaagagaag   own                           (SEQ ID NO 110)                   NFex22.1   HS   100 ng           tgctactctttagcttcctac   Purandare et al                           (SEQ ID NO 111)                   NFex22.2   (95°1′-58°1′-72°1′) × 35   10 × CS   331   bp   ccttaaaagaagacaatcagcc                               (SEQ ID NO 112)                   NFex22.1cy   72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NFex23AN.1   95°5′   100 ng   382   bp   gattgggtctcaacatttc                               (SEQ ID NO 113)                   NFex23AN.2   (95°1′-57°1′-72°1′) × 35   10 × Dy           cy-aataggctgaagtgaagatantc   own?       cy                   (SEQ ID NO 114)               72°10′   1UplTaq                           4°   TV = 25 μl                               NFex23.1.1   HS   100 ng           tttgtatcattcattttgtgtgta   Purandare et al                           (SEQ ID NO 115)                   NFex23.1.2   (95°1′-60°1′-72°1′) × 35   5 × Dy   282   bp   aaaaacacggttctatgtgaaaag                               (SEQ ID NO 116)                   NFex23.1.   72° 10′   1UtaqBRL                       1cy   4°   TV = 25 μl                               NFex23.2.1   HS   100 ng           cttaatgtctgtataagagtctc   Purandare et al                           (SEQ ID NO 117)                   NFex23.2.2   (95°1′-52°1′-72°1′) × 35   10 × CS   268   bp   actttagattaataatggtaatctc                               (SEQ ID NO 118)                   NFex23.2.1   72° 10′   1UtaqBRL                       cy   4°   TV = 25 μl                               NFex24b.1   HS   100 ng           ttgaactctttgttttcatgtctt   Purandare et al                           (SEQ ID NO 119)                   NFex24b.2   (95°1′-57°1′-72°1′) × 35   5 × Dy   267   bp   ggaatttaagatagctagattatc                               (SEQ ID NO 120)                   NFex24MRC,   72° 10′   1UtaqBRL                       not ok   4°   TV = 25 μl                               NFex25b.1   HS   100 ng           aatataataattatatttgggaaggt   Purandare et al                           (SEQ ID NO 121)                   NFex25b.2   (95°1′-57°1′-72°1′) × 35   10 × Boeh   338   bp   gaaaatatttgattcaaacagagc                               (SEQ ID NO 122)                   NFex25b.1cy   72° 10′   1UtaqBRL           cy-aatataataattatatttgggaaggt                               (SEQ ID NO 123)               4°   TV = 25 μl                               NFex25L.1   HS   100 ng           cattttattatagcagatgtc   own                           (SEQ ID NO 124)                   NFex25L.2   (95°45″-57°45″-   5 × Dy   534   bp   acttacacaggaacttcat               72°45″) × 35               (SEQ ID NO 125)               72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NFex26.1fl   HS   100 ng           fluo-gctttgtctaatgtcaagtcac   Purandare et al                           (SEQ ID NO 126)                   NFex26.2   (95°1′-58°1′-72°1′) × 35   5 × Dy   342   bp   ttaaacggagagtgttcactatc                               (SEQ ID NO 127)               72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NFex27A.1   HS   100 ng           gttacaagttaaagaaatgtgtag   Purandare et al                           (SEQ ID NO 128)                   NFex27A.2   (95°30″-62°30″-   10 × Boeh   300   bp   ctaacaagtggcctggtggcaaac               72°30″) × 45               (SEQ ID NO 129)                   NFex27A.1fl   72° 5′   1UtaqBRL                           4°   TV = 25 μl                               NFex27B.1fl   does not work               fluo-tttattgtttatccaattatagactt   Purandare et al                           (SEQ ID NO 130)                   NFex27B.2                   tcctgttaagtcaactgggaaaaac                               (SEQ ID NO 131)                   NFex28 Aber   95°5′   200 ng           cactgctaataatctttgtcttttttgtc   Abernathy       .1                   (SEQ ID NO 132)                   NFex28 Aber   (95°1′-65°1′-72°1′) × 40   10 × Boeh   501   bp   cgtttacaaaacacagactggaactta           .2                   (SEQ ID NO 133)                   NFex28 Aber   72°10′   1UPltaq                       .1cy               NFex28 Aber   4°   TV = 25 μl                       .2cy               NFex28.1fl                   ttccttaggttcaaaactggtca   own       (nested)                   (SEQ ID NO 134)                   NFex29L1   H.S.   100 ng           tacaatggtgggaactc   own                           (SEQ ID NO 135)                   NFex29.L2   (95°1′-56°45″-   10 × CS   567   bp   atattaaggtagaggctgttt   own           72°45″) × 35               (SEQ ID NO 136)                   NFex29L1cy   72°10′   1UtaqBRL                               NFex29L2cy   4°   TV = 25 μl                               NFex29.1cy                   cy-attcttctccacttcaccc   MRC (Shen)       (nested)                   (SEQ ID NO 137)                   NFex29.2cy                   cy-cccaaatcaaactgaagaga   MRC       (nested)                   (SEQ ID NO 138)                   NFex30x.1   95°5′   100 ng   350   bp   tggaactataaggaaaaa   own                           (SEQ ID NO 139)                   NFex30x.2cy   (95°1′-50°1′-   10 × CS           cy-aaagtcttcactggaaa   own           72°1′30″) × 30               (SEQ ID NO 140)               72°10′   1UPITaq                               NFex30.2fl   4°   TV = 25 μl                       (3)(nested)               NFex31.1(4)   HS   100 ng           ataattgttgatgtgattttcattg   Cawthon                           (SEQ ID NO 141)                   NFex31.2f1   (93°1′-63°1′-   10 × Koh   424   bp   fluo-aattttgaaccagatgaagag       (4)   72°1′30″) × 31               (SEQ ID NO 142)                   NFex31.1cy   72° 5′   1UtaqBRL                           4°   TV = 25 μl                               NFex32.1   HS   100 ng           ggtagagtgattaaaacatg                               (SEQ ID NO 143)                   NFex32.2   (95°1′-51°1′-72°1′) × 35   10 × CS   220   bp   tatgctatagtacagaaggc   Rina Wu                           (SEQ ID NO 144)                   NFex32.1cy   72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NFex33.1fl   HS   100 ng           fluo-catatctgttttatcatcaggagg                               (SEQ ID NO 145)                   NFex33.2   (95°1′-61°1′-72°1′) × 35   5 × Dy   462   bp   aagtaaaatggagaaaggaactgg   Cawthon                           (SEQ ID NO 146)                   NFex33.2cy   72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NFex34.1fl   HS   100 ng           fluo-caaaatgaaacatggaactttaga                               (SEQ ID NO 147)                   NFex34.2   (95°1′-57°1′-72°1′) × 35   5 × Dy   400   bp   taagcattaagtacaaatagcaca   Cawthon                           (SEQ ID NO 148)               72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NFex35.1fl   HS   100 ng           fluo-agaagccaaaatgataagaa                               (SEQ ID NO 149)                   NFex35.2   (95°1′-52°1′-72°1′) × 35   10 × CS   495   bp   acccaaagacaacaagag                               (SEQ ID NO 150)               72° 10′   1UtaqBRL                           4°   TV=25 μl                               NFex36.1   HS   100 ng           ggaccagtggacagaac   own                           (SEQ ID NO 151)                   NFex36.2fl   (95°1′-55°1′-72°1′) × 35   10 × Boeh   345   bp   fluo-atatgctttacaacttgagaa                               (SEQ ID NO 152)           72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NFex37.1   HS   100 ng           tacattaagctagctaccaa   own                           (SEQ ID NO 153)                   NFex37.2fl   (95°1′-54°1′-72°1′) × 35   10 × Boeh   460   bp   fluo-cgcttgagaacatactatcc                               (SEQ ID NO 154)               72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NFex38.1fl   HS   100 ng           fluo-ccagctaacagtgtctt   own                           (SEQ ID NO 155)                   NFex38.2   (95°1′-50°1′-72°1′) × 35   10 × Boeh   474   bp   aaggaaatatactcacaataa                               (SEQ ID NO 156)               72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NFex39.1fl   HS   100 ng           fluo-gaacctaatcaaccatctc                               (SEQ ID NO 157)                   NFex39.2   (95°1′-52°1′-72°1′) × 35   5 × Dy   286   bp   ttgcatttaaagtaagacat                               (SEQ ID NO 158)               72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NFex40.1fl   HS   100 ng           fluo-cctttccttgcagagttgtta                               (SEQ ID NO 159)               NFex40.2   (95°1′-57°1′-72°1′) × 35   5 × Dy   371   bp   caccactaaaggactagactgt                               (SEQ ID NO 160)               72° 10′   1UtaqBRL                           4°   TV = 25 μl                               NFex41.1fl   HS   100 ng           fluo-ttcatcctgttttaagtcacacttg                               (SEQ ID NO 161)                   NFex41.2   (95°1′-61°1′-72°1′) × 40   10 × Boeh   273   bp   ttgcctccattagttggaaaattg   Abernathy et al                           (SEQ ID NO 162)                   NFex41.1   72° 10′   1UtaqBRL           ttcatcctgttttaagtcacacttg                               (SEQ ID NO 163)               4°   TV = 25 μl                               NFex42.1fl   HS   100 ng           fluo-cttggaaggagcaaacgatggttg                               (SEQ ID NO 164)                   NFex42.2   (95°1′-61°1′-72°1′) × 35   10 × Boeh   356   bp   caaaaactttgctacactgacatgg   Abernathy et al                           (SEQ ID NO 165)               72°10′   1UTaq BRL                           4°   TV = 25 μl                               NFex43.1fl   HS   100 ng           fluo-agacactgtagttaatgaacttgc                               (SEQ ID NO 166)                   NFex43.2   (95°1′-60°1′-72°1′) × 35   10 × Boeh   224   bp   catgtactctcccaccttattttc   Abernathy et al                           (SEQ ID NO 167)                   NFex43.1Cy   72° 5′   Taq ST           cy-agacactgtagttaatgaacttgc                   1/20           (SEQ ID NO 168)               4°   TV = 25 μl                               NFex44.1fl   HS   100 ng           fluo-cacgttaattccctatcttgctgc   F Shen et al                           (SEQ ID NO 169)                   NFex44.2   (95°1′-65°1′-72°1′) × 35   10 × Boeh   200   bp   taaaaatttgagggtgggggactc   R?                           (SEQ ID NO 170)               72° 5′   Taq ST                               1/20                           4°   TV = 25 μl                           NFex45.1fl   HS   100 ng           fluo-catgaataggatacagtcttctac                               (SEQ ID NO 171)                   NFex45.2   (95°1′-60°1′-72°1′) × 35   10 × Boeh   269   bp   cacattactgggtaagcatttaac   Abernathy                           (SEQ ID NO 172)                   NFex45.2fl   72° 5′   1UtaqBRL                               NFex45.1bio   4°   TV = 25 μl                               NFex46.1fl   HS   100 ng           fluo-gggaatgtatattatgttttccac                               (SEQ ID NO 173)                   NFex46.2   (95°1′-60°1′-72°1′) × 35   5 × Dy   275   bp   atgttaggaagttcatcaaccatc   Abernathy                           (SEQ ID NO 174)                   NFex46.2cy   72° 5′   1UtaqBRL                           4°   TV = 25 μl                               NFex47.1   HS   100 ng           ctgttacaattaaaagataccttgc   MRC (Upadhyaya)                           (SEQ ID NO 175)                   NFex47.2   (95°1′-60°1′-72°2′) × 35   5 × Dy   185   bp   tgtgtgttcttaaagcaggcatac   MRC (Upadhyaya)                           (SEQ ID NO 176)               72° 10′   1UtaqBRL                           4°   TV = 25 μl                           NFex48.1   HS   100 ng           ttttggcttcagatggggatttac   MRC (Upadhyaya)                           (SEQ ID NO 177)                   NFex48.2   (95°1′-65°1′-72°1′) × 35   5 × Dy   352   bp   aagggaattcctaatgttggtgtc   MRC (Upadhyaya)                           (SEQ ID NO 178)               72° 10′   1UtacBRL                           4°   TV = 25 μl                               NFex48A.1fl   HS   100 ng           fluo-atctagtatctaattgtatttcacc   Li et al                           (SEQ ID NO 179)                   NFex48A.2   (95°1′-60°1′-72°2′) × 40   5 × Dy           gcagactgagcttacagggac                               (SEQ ID NO 180)               72° 10′   1UtaqBRL                           4°   TV = 25 μl                    Legend                    Labels   fl   Fluoresceïn label                           cy   Cy5 label               bio   Biothine label           Buffers   Dy   Dynazyme buffer   5X buffer contains   50 mM Tris-                           HCl(pH8.8)                           250 mM KCl                           0.5% Triton X-                           100                           7.5 mM MgCl 2                 Boeh   Boehringer buffer   10X buffer contains   100 mM Tris HCl                           15 mM MgCl 2                             500 mM KCl                           pH 8.3 (20° C.)               Koh   Kohan buffer   10X buffer contains   166 mM                           (NH 4 ) 2 SO 4                             670 mM Tris-                           HCl(pH8.8)                           67 mM MgCl 2                             100 mM β-                           mercaptoethanol                           67 μM EDTA                           1700 μg BSA/ml                           5% DMSO               CS   AC-Syvänen buffer   10X buffer contains   200 mM Tris-                           HCl(pH8.8)                           15 mM MgCl 2                             150mM                           (NH 4 ) 2 SO 4                             1% Triton X-100                           0.1% gelatin           others   HS   Hot Start   95°C. 5 min, 80°C. 5 min while adding the                       polymerase                    1 UtaqBRL   1 unit of Taq Polymerase from BRL                   1UPltaq   1 unit of Platinum Taq from BRL                            references   Shen et al   Neurofibromatosis type 1 (NF1): the search for mutations                       by PCR-heteroduplex analysis on Hydrolink gels. Hum                   Mol Gen, 1993, Vol2, No 11, 1861-1864               Purandare et al   Identification of Neurofibromatosis 1 (NF1) Homologous                   Loci by Direct Sequencing, Fluorescence in Situ                   Hybridization, and PCR Amplification of Somatic Cell                   Hybrids. Genomics; 1995: 30, 476-485               Wallace et al   personal communication               Sawada et al   Identification of NF1 mutation in both alleles of a dermal                   neurofibroma. Nat Genet;1996 Sep:14(1):110-2               Hoffmeyer et al   An Rsal polymorphism in the transcribed region of the                   neurofibromatosis (NF1)-gene. Hum Genet; 1994:93:481-                   482               Fahsold et al   Minor Lesion Mutational Spectrum of the NF1 Gene Does                   Not Explain Its High Mutability but Points to a Functional                   Domain Upstream of the Gap-Related domain. Am J                   Hum Genet; 2000:66:790-818               Abernathy et al   NF1 mutation analysis using a combined                   heteroduplex/SSCP approach. Hum Mut 1997;9:548-554               Cawthon et al   A Major Segment of the Neurofibromatosis Type 1 Gene:                   cDNA, Genomic Stucture, and Point Mutations. Cell;                   1990:62:193-201               MRC   Medical Research Counsil, UK, HGMP primers database               Rina Wu et al   PhD dissertation KUL               Li et al   Genomic Organization of the Neurofibromatosis 1 Gene                   (NF1). Genomics 1995;25:9-18                        
         [0276]    [0276]                                                               TABLE 4                           HA-PCR primers and conditions                    primer sequences   Fragment               Exon   (5′ to 3′)   size   T a (° C.) 1                       2   TTTCAATGGCAAGTAAGT   340   54               GTTATATCCAAAGTCCACA                        4a   TTAAATCTAGGTGGTGTGT   517   54           AAACTCATTTCTCTGGAG                       13   GAGTTATTGTATGCGGAGAC   494   55           TTGAATTTCCCCTGTAAAC                       19b   ATTACCTTCTCCCCATTTGA   371   55           GGCTTTATTTGCTTTTTGC                       21   GTCAAACTTACTCAATGCC   542   54           CAACCACTTCCCTACAG                       23a   GATTGGGTCTCAACATTTC   382   57           AATAGGCTGAAGTGAAGATANTC                       29   TACAATGGTGGGAACTC   567   56           ATATTAAGGTAGAGGCTGTTT                       30   TGGAACTATAAGGAAAAA   350   50           AAAGTCTTCACTGGAAA                       32   GGTAGAGTGATTAAAACATG   220   51           TATGCTATAGTACAGAAGGC                       35   AGAAGCCAAAATGATAAGAA   495   52           ACCCAAAGACAACAAGAG                       36   GGACCAGTGGACAGAAC   345   55           ATATGCTTTACAACTTGAGAA                       37   TACATTAAGCTAGCTACCAA   460   54           CGCTTGAGAACATACTATCC                       38   CCAGCTAACAGTGTCTT   474   50           AAGGAAATATACTCACAATAA                       39   GAACCTAATCAACCATCTC   286   52           TTGCATTTAAAGTAAGACAT                       40   CCTTTCCTTGCAGAGTTGTTA   371   57           CACCACTAAAGGACTAGACTGT                       44   CACGTTAATTCCCTATCTTGCTGC   200   65           TAAAAATTTGAGGGTGGGGGACTC                            
         [0277]    [0277]                                                                   TABLE 5                       Mutations detected by analysis of the whole coding region of the NF1 gene by PTT and HA;       analysis of 67 unrelated NF1 patients.                                                Codon           Patient   Genomic Mutation 1     Effect on cDNA   Codon Change   Number   Exon/Intron               NF-004   247C &gt; T   247C &gt; T   Q &gt; X    83    3       NF-023   278G &gt; A   278G &gt; A   C &gt; Y    93    3       NF-036   560G &gt; A   560G &gt; A   C &gt; Y    187   4b       NF-056   574C &gt; T   574C &gt; T   R &gt; X    192   4b       NF-029   603-604insT   603-604insT   frameshift    202   4c       NF-027   910C &gt; T   910C &gt; T;   R &gt; X    304    7               888del174       NF-064   910C &gt; T   910C &gt; T;   R &gt; X    304    7               888del174       NF-024   987-988insA   987-988insA   frameshift    330    7       NF-048   1275G &gt; A   1275G &gt; A   W &gt; X    425   10a       NF-042   1318C &gt; T   1318C &gt; T   R &gt; X    440   10a       NF-057   1318C &gt; T   1318C &gt; T   R &gt; X    440   10a       NF-030   1381C &gt; T   1381C &gt; T   R &gt; X    461   10a       NF-026   1381C &gt; T   1381C &gt; T   R &gt; X    461   10a       NF-017   1466A &gt; G   1465del62   Y &gt; C    489   10b       NF-012   1466A &gt; G   1465del62   Y &gt; C    489   10b       NF-016   1465-1466insC   1466insC   Y &gt; X    489   10b       NF-033   1570G &gt; T   1570G &gt; T   E &gt; X    524   10c       NF-052   1607C &gt; A   1607C &gt; A   S &gt; X    536   10c       NF-045   IVS12a + 1G &gt; T   1641del204   none   NA   IVS12a       NF-034   2033-2034insC   2033insC   frameshift    678   13       NF-035   2033-2034insC   2033insC   frameshift    678   13       NF-010   2540T &gt; C   2540T &gt; C   L &gt; P    847   16       NF-051   IVS16 + 2del6   2617del233   frameshift   NA   IVS16       NF-028   IVS16 − 6del4   2850del140   frameshift   NA   IVS16       NF-014   2875C &gt; T   2875C &gt; T   Q &gt; X    959   17       NF-011   2887C &gt; T   2887C &gt; T   Q &gt; X    963   17       NF-001   2970-2972delAAT   2970-2972delAAT   delM    991   17       NF-053   3193delC   3193delC   frameshift   1065   19a       NF-063   3277G &gt; A   3277G &gt; A, 3274del40   V &gt; M;   1093   19b                   frameshift       NF-025   IVS19b − 3C &gt; G   3314del182   frameshift   NA   IVS19b       NF-039   3367G &gt; T   3367G &gt; T   E &gt; X   1123   20       NF-046   3520C &gt; T   3520C &gt; T   Q &gt; X   1174   21       NF-059   3826C &gt; T   3826C &gt; T   R &gt; X   1276   22       NF-041   4084C &gt; T   4084C &gt; T   R &gt; X   1362   23.2       NF-054   4084C &gt; T   4084C &gt; T   R &gt; X   1362   23.2       NF-044   IVS26 − 2A &gt; T   4515-14 ins 14;   frameshift   NA   IVS26               4515-17ins17       NF-021   4537C &gt; T   4537C &gt; T   R &gt; X   1513   27a       NF-006   4537C &gt; T   4537C &gt; T   R &gt; X   1513   27a       NF-058   IVS27b − 2A &gt; T   4772del433; 4772del293   frameshift   NA   IVS27b       NF-049   5033delG   5033delG   frameshift   1678   28       NF-009   5264C &gt; G   5264C &gt; G   S &gt; X   1755   29       NF-050   5294C &gt; A   5215del90 (5294C &gt; A???)   S &gt; X   1765   29       NF-037   5546G &gt; A   5205del341; 5205del544   R &gt; Q   1849   29       NF-038   5546G &gt; A   5205del341; 5205del544   R &gt; Q   1849   29       NF-047   5567delT   5567delT   frameshift   1856   30       NF-031   5798delC   5798delC   frameshift   1933   31       NF-060   5839C &gt; T   5839C &gt; T   R &gt; X   1947   31       NF-043   5896C &gt; T   5896C &gt; T   Q &gt; X   1966   31       NF-015   6577delGAGgta   6364del215   frameshift   2193   34       NF-040   6709C &gt; T   6709C &gt; T   R &gt; X   2237   36       NF-008   6789-6792delTTAC   6789-6792delTTAC   frameshift   2263   37       NF-019   6792C &gt; A   6756del102   Y &gt; X   2264   37       NF-003   6792C &gt; G   6756del102   Y &gt; X   2264   37       NF-032   6858G &gt; C   6756del102   K &gt; N   2286   37       NF-013   7096-7101del6   7096-7101del6   delNF   2366   39       NF-022   7096-7101del6   7096-7101del6   delNF   2366   39       NF-005   IVS39 − 12T &gt; A   7126del132;   NA   NA   IVS39               7127-10ins10       NF-002   7201A &gt; T   7201A &gt; T   K &gt; X   2401   40       NF-055   7285C &gt; T   7285C &gt; T   R &gt; X   2429   41       NF-061   7486C &gt; T   7486C &gt; T   R &gt; X   2496   42       NF-020   7884-7885delGT   7884-7885delGT   frameshift   2628   45       NF-007   8016delA   8016delA   frameshift   2672   46                            PTT                   Patient   Type/effect   (frag) 2     CG 3     S/F 4     Previously described               NF-004   nonsense   +(F1)   no   F   Osborn et al., 1999       NF-023   missense   −(HA)   no   F   Novel       NF-036   missense   −(HA)   no   F   Novel       NF-056   nonsense   +(F1)   yes   S   Fahsold et al., in press       NF-029   frameshift   +(F1)   NA   F   Novel       NF-027   nonsense: truncation due to stopcodon;   +(F1)   yes   S   Hoffmeyer et al., 1998           splice: intact 3&#39; and 5&#39;ss, no cryptic or           novel ss, IF skip E7       NF-064   identical as NF-027   +(F1)   yes   F   Hoffmeyer et al., 1998       NF-024   frameshift   +(F1)   NA   F   Novel       NF-048   nonsense   +(F1)   no   S   Novel       NF-042   nonsense   +(F1)   yes   S   Heim et al., 1995       NF-057   nonsense   +(F1)   yes   S   Heim et al., 1995       NF-030   nonsense   +(F1)   yes   S   Fahsold et al., in press       NF-026   nonsense   +(F1)   yes   S   Fahsold et al., in press       NF-017   splice: intact WT 5&#39;ss, creation novel   +(F1)   no   F   Messiaen et al., 1999           5&#39;ss, skip last 62 nt E10b forms           immediate stopcodon       NF-012   identical as NF-017   +(F1)   no   S   Messiaen et al., 1999       NF-016   nonsense   +(F1)   NA   F   Novel       NF-033   nonsense   +(F1)   no   S   Novel       NF-052   nonsense   +(F1)   no   F   Novel       NF-045   splice: inactive 5&#39;ss, IF skip E11 + 12a   +(F2)   no   S   Abernathy et al., 1997       NF-034   frameshift   +(F2)   NAo   S   Heim et al., 1995       NF-035   frameshift   +(F2)   NA   S   Heim et al., 1995       NF-010   missense   −(HA)   no   F   Messiaen et al., 1998       NF-051   splice: inact 5&#39;ss, activ cryptic 5&#39;ss skip   +(F2)   NA   S   Novel           last 233 nt E16       NF-028   splice: inactiv 3&#39;ss, OOF skip E17   +(F2)   NA   F   Novel       NF-014   nonsense   +(F2)   no   F   Novel       NF-011   nonsense   +(F2)   no   F   Novel       NF-001   amino acid deletion   −(HA)   NA   F   Shen et al., 1993       NF-053   frameshift   +(F2)   NA   S   Novel       NF-063   splice: intact WT 5&#39;ss, creation novel   +(F2)   no   F   Novel           5&#39;ss, skip last 40 nt E19b       NF-025   splice: inactiv 3&#39;ss, OOF skip E20   +(F2)   no   F   Novel       NF-039   nonsense   +(F2)   no   S   Novel       NF-046   nonsense   +(F2)   no   S   Novel       NF-059   nonsense   +(F3)   yes   S   Heim et al., 1995       NF-041   nonsense   +(F3)   yes   S   Upadhyaya et al., 1997       NF-054   nonsense   +(F3)   yes   S   Upadhyaya et al., 1997       NF-044   splice: inactiv 3&#39;ss, activ 2 cryptic 3&#39;ss   +(F3)   no   S   Novel           sites leading to 2 different OOF           insertions       NF-021   nonsense   +(F3)   yes   S   Side et al., 1995       NF-006   nonsense   +(F3)   yes   S   Side et al., 1995       NF-058   splice: inactiv 3&#39;ss, activ cryptic 3&#39;ss,   +(F3)   no   F   Novel           OOF skip E28; OOF skip first 293 nt           E28       NF-049   frameshift   +(F3)   NA   F   Novel       NF-009   nonsense   +(F4)   no   S   Novel       NF-050   splice: intact 3&#39;ss, creation novel 3&#39;ss, IF   +(F4)   yes   F   Novel           skip first 90 nt E29       NF-037   splice: inact 5&#39;ss, OOF skip E29 and   +(F4)   yes   F   Ars et al., 2000           E29 + 30       NF-038   identical as NF-037   +(F4)   yes   F   Ars et al., 2000       NF-047   frameshift   +(F4)   NA   S   Novel       NF-031   frameshift   +(F4)   NA   S   Novel       NF-060   nonsense   +(F4)   yes   F   Cawthon et al., 1990       NF-043   nonsense   +(F4)   no   F   novel       NF-015   splice: inactiv 5&#39;ss, OOF skip E34   +(F4)   NA   S   novel       NF-040   nonsense   +(F4)   yes   S   Fahsold et al., in press       NF-008   frameshift   +(F4)   NA   S   Robinson et al., 1995       NF-019   splice: intact 3&#39; and 5&#39;ss, no cryptic or   +(F4)   no   F   Messiaen et al., 1997           novel ss, IF skip E37       NF-003   identical as NF-019   +(F4)   no   F   Messiaen etal, 1997       NF-032   splice: inactiv 5&#39;ss, IF skip E37   +(F4)   no   F   novel       NF-013   amino acid deletion   −(HA)   NA   S   Abernathy et al., 1994       NF-022   amino acid deletion   −(HA)   NA   F   Abernathy et al., 1994       NF-005   splice: inactiv 3&#39;ss, IF skip E40; activ   +(F5)   no   F   novel           cryptic 3&#39;ss, OOF ins last 10 nt IVS39       NF-002   nonsense   +(F5)   no   S   novel       NF-055   nonsense   +(F5)   yes   S   Fahsold et al., in press       NF-061   nonsense   +(F5)   yes   S   Purandare et al., 1994       NF-020   frameshift   +(F5)   NA   S   novel       NF-007   frameshift   +(F5)   NA   S   novel                                                            
         [0278]    [0278]                                     TABLE 6                           Comparison of the sensitivity of detecting NF1 mutations by direct       cDNA cycle sequencing starting from Pmin and Pplus EBV cultures as       measured by the ratio between mutant/wild-type peak height on       sequencing chromatograms.                            With                   Without   puromycin                   puromycin   Ratio               Genomic   ratio   mutant/       Patient   Exon   Mutation   mutant/wild-type   wild-type               NF-056    4b   R192X   0.51   0.80       NF-064    7   R304X   0.34   1.00       NF-057   10a   R440X   0.60   1.00       NF-012   10b   Y489C   0.60   1.00       NF-016   10b   1466insC   0.65   1.00       NF-033   10c   E524X   0.35   1.00       NF-035   13   2033insC   0.35   0.76       NF-051   IVS16   2850 + 2deltaaagt   0.84   1.00       NF-063   19b   V1093M   0.58   0.92       NF-039   20   E1123X   0.55   1.00       NF-046   21   Q1174X   0.32   0.72       NF-002   40   K2401X   0.28   0.75       NF-020   42   7884delGT   0.29   0.91                    
         [0279]    [0279]                                                                                                                                                                                                                                                                                             TABLE 7                       Consensus values (CV) and Splice Site Scores (SSS) of splice sites (ss) involved       in splicing mutations in the NF1 gene                                    Consensus Values                   according to Shapiro   Splice Site Scores           and Senepathy   according to NNPSS                Splice site   CV   CV   CVc   SSS-   SSS-   SSS-               (Mutation)   N   M   ry   N   M   cry   Comment                    Mutations at 5&#39;ss            6577delGAGgta   TG(delGAGgta)tagaag   0.70   0.33   NA   0.41   /   NA   skipping E34       IVS12a + 1G &gt; T   AG(g &gt; t)taagc   0.94   0.76   NA   1.00   /   NA   skipping E11 + E12a       IVS16 + 2delaaagtg   AGgt(delaaagtg)ttct   0.81   0.64   0.82   0.92   0.12   0.95   activ. cryptic 5&#39;ss 233 nt                                       upst.       5546G &gt; A   C(G &gt; A)gtaggt   0.81   0.69   NA   0.97   0.10   NA   skipping E29/E29 + E30       (R1849Q)       6858G &gt; C   A(G &gt; C)gtaatt   0.86   0.72   NA   0.99   0.73   NA   skipping E37       (K2286N)            Mutations at 3&#39;ss            IVS26 − 2A &gt; T   tttgctgtatct(a &gt; t)gG   0.82   0.66   IVS2   0.49   /   IVS2   activ. cryptic 3&#39;ss 14 nt                       6-           6-   upst. and 17 nt upst.                       14:0.84           14:0.92                       IVS2           IVS2                       6-           6-17:/                       17:0.81       IVS27b − 2A &gt; T   gtcattttcctt(a &gt; t)gG   0.84   0.68   0.84   1.00   /   0.84   skipping E28 and activ.                                       cryptic 3&#39;ss 293 nt downst       IVS16-6delcttt   tatttgttcttt(delcttt)agG   0.89   0.89   NA   0.99   0.97   NA   skipping E17       IVS19bC &gt; G   tttttatttct(c &gt; g)agA   0.96   0.84   NA   0.96   0.04   NA   skipping E20       IVS39 − 12T &gt; A   tt(t &gt; a)gttttttgtagG   0.90   0.89   0.79   1.00   0.99   0.92   skipping E40 and use of                                       novel created 5&#39;ss 10 nt                                       downst.                        Splice site   CV   CV   CVn   SSS-   SSS-   SSS-   Comment           (Mutation)   N   M   ov   N   M   nov                    Creation of novel 5&#39;ss            Y489C   CT(a &gt; g)taagt   0.79   NA   0.79   0.86   NA   0.97   novel 5&#39;ss 62 nt upst.       V1093M   TGgt(g &gt; a)tgg   0.73   NA   0.76   0.13   NA   0.27   novel 5&#39;ss 40 nt upst.            Creation of novel 3&#39;ss            S1765X   aatgacatttattatgctt(c &gt; a)gGA   0.90   NA   0.83   0.81   NA   0.18   novel 3&#39;ss 90 nt downst.                                                                                            
         [0280]    [0280] 
     
       
       
         1 
         
           
             264  
           
           
             1  
             17  
             DNA  
             Homo sapiens  
           
            1 

tttgtttttc tctagtc                                                    17 

 
           
             2  
             18  
             DNA  
             Homo sapiens  
           
            2 

ttgacttggt ggtggttt                                                   18 

 
           
             3  
             20  
             DNA  
             Homo sapiens  
           
            3 

ttgagaatgg cttacttgga                                                 20 

 
           
             4  
             31  
             DNA  
             Homo sapiens  
           
            4 

gtttgtttgt ttgtttgtta gttttttgta g                                    31 

 
           
             5  
             18  
             DNA  
             Homo sapiens  
           
            5 

cttcggaatt ctgcctct                                                   18 

 
           
             6  
             18  
             DNA  
             Homo sapiens  
           
            6 

ctgatatggc tgaatgtg                                                   18 

 
           
             7  
             18  
             DNA  
             Homo sapiens  
           
            7 

gcctgtgtca aactgtgt                                                   18 

 
           
             8  
             18  
             DNA  
             Homo sapiens  
           
            8 

cacacccagc aatacgaa                                                   18 

 
           
             9  
             15  
             DNA  
             Homo sapiens  
           
            9 

gctttgtgta agtat                                                      15 

 
           
             10  
             15  
             DNA  
             Homo sapiens  
           
            10 

agaagctgta agtat                                                      15 

 
           
             11  
             19  
             DNA  
             Homo sapiens  
           
            11 

ttgacttggt ggatggttt                                                  19 

 
           
             12  
             20  
             DNA  
             Homo sapiens  
           
            12 

gggcagataa agcagataat                                                 20 

 
           
             13  
             18  
             DNA  
             Homo sapiens  
           
            13 

ccggattgcc ataaatac                                                   18 

 
           
             14  
             26  
             DNA  
             Homo sapiens  
           
            14 

gtttgttagt tttttgtagg gtacag                                          26 

 
           
             15  
             15  
             DNA  
             Homo sapiens  
           
            15 

ttgtttttct ctagc                                                      15 

 
           
             16  
             20  
             DNA  
             Homo sapiens  
           
            16 

atggccgcgc acaggccggt                                                 20 

 
           
             17  
             18  
             DNA  
             Homo sapiens  
           
            17 

acaggacagc agaacaca                                                   18 

 
           
             18  
             18  
             DNA  
             Homo sapiens  
           
            18 

cttcggaatt ctgcctct                                                   18 

 
           
             19  
             18  
             DNA  
             Homo sapiens  
           
            19 

ctgatatggc tgaatgtg                                                   18 

 
           
             20  
             18  
             DNA  
             Homo sapiens  
           
            20 

gcctgtgtca aactgtgt                                                   18 

 
           
             21  
             18  
             DNA  
             Homo sapiens  
           
            21 

cacacccagc aatacgaa                                                   18 

 
           
             22  
             18  
             DNA  
             Homo sapiens  
           
            22 

atcctgatgc tcctgtag                                                   18 

 
           
             23  
             18  
             DNA  
             Homo sapiens  
           
            23 

tttttacggg gtaggatg                                                   18 

 
           
             24  
             18  
             DNA  
             Homo sapiens  
           
            24 

atttgccgac aagcccag                                                   18 

 
           
             25  
             18  
             DNA  
             Homo sapiens  
           
            25 

actgcaggaa acactgag                                                   18 

 
           
             26  
             18  
             DNA  
             Homo sapiens  
           
            26 

ggctgttgtc cttaatgg                                                   18 

 
           
             27  
             17  
             DNA  
             Homo sapiens  
           
            27 

tgcttgggaa tatggtc                                                    17 

 
           
             28  
             20  
             DNA  
             Homo sapiens  
           
            28 

gtttcacttc tagctggtct                                                 20 

 
           
             29  
             20  
             DNA  
             Homo sapiens  
           
            29 

caaacaggtg gcaggaaacg                                                 20 

 
           
             30  
             18  
             DNA  
             Homo sapiens  
           
            30 

ccttcaacaa ggcacaga                                                   18 

 
           
             31  
             18  
             DNA  
             Homo sapiens  
           
            31 

actctaccaa ctgctctg                                                   18 

 
           
             32  
             18  
             DNA  
             Homo sapiens  
           
            32 

gaacctcctt cagatgac                                                   18 

 
           
             33  
             18  
             DNA  
             Homo sapiens  
           
            33 

agaagaacat atgcggcc                                                   18 

 
           
             34  
             20  
             DNA  
             Homo sapiens  
           
            34 

gcacattgcc gtcacttatg                                                 20 

 
           
             35  
             18  
             DNA  
             Homo sapiens  
           
            35 

ctaggcatca ggtacatg                                                   18 

 
           
             36  
             18  
             DNA  
             Homo sapiens  
           
            36 

gtctccgcag tctatatc                                                   18 

 
           
             37  
             20  
             DNA  
             Homo sapiens  
           
            37 

cctgggaaac tggctgagca                                                 20 

 
           
             38  
             18  
             DNA  
             Homo sapiens  
           
            38 

ggagtgtgaa gccattgt                                                   18 

 
           
             39  
             18  
             DNA  
             Homo sapiens  
           
            39 

tagtaagacg ctggcagc                                                   18 

 
           
             40  
             18  
             DNA  
             Homo sapiens  
           
            40 

ccttgggcag attacaga                                                   18 

 
           
             41  
             18  
             DNA  
             Homo sapiens  
           
            41 

gatgctgtcc ttcaacaa                                                   18 

 
           
             42  
             18  
             DNA  
             Homo sapiens  
           
            42 

gaaacagtca cagaagct                                                   18 

 
           
             43  
             20  
             DNA  
             Homo sapiens  
           
            43 

ggaggcatgc atgagagata                                                 20 

 
           
             44  
             19  
             DNA  
             Homo sapiens  
           
            44 

cagccacttc ttaataagg                                                  19 

 
           
             45  
             19  
             DNA  
             Homo sapiens  
           
            45 

gcatccttca cctgctatt                                                  19 

 
           
             46  
             18  
             DNA  
             Homo sapiens  
           
            46 

catggtgacc cttcctat                                                   18 

 
           
             47  
             18  
             DNA  
             Homo sapiens  
           
            47 

atgttctctt ggatgaag                                                   18 

 
           
             48  
             18  
             DNA  
             Homo sapiens  
           
            48 

gctgagctta ttgttaag                                                   18 

 
           
             49  
             20  
             DNA  
             Homo sapiens  
           
            49 

cccagcctcc ttgccaacgc                                                 20 

 
           
             50  
             20  
             DNA  
             Homo sapiens  
           
            50 

gacccattcc accggcctgt                                                 20 

 
           
             51  
             18  
             DNA  
             Homo sapiens  
           
            51 

tttcaatggc aagtaagt                                                   18 

 
           
             52  
             19  
             DNA  
             Homo sapiens  
           
            52 

gttatatcca aagtccaca                                                  19 

 
           
             53  
             23  
             DNA  
             Homo sapiens  
           
            53 

tttaaggata aactgtttac gtg                                             23 

 
           
             54  
             23  
             DNA  
             Homo sapiens  
           
            54 

tttcactttt cagatgtgtg ttg                                             23 

 
           
             55  
             20  
             DNA  
             Homo sapiens  
           
            55 

tggtccacat ctgtactttg                                                 20 

 
           
             56  
             19  
             DNA  
             Homo sapiens  
           
            56 

ttaaatctag gtggtgtgt                                                  19 

 
           
             57  
             18  
             DNA  
             Homo sapiens  
           
            57 

aaactcattt ctctggag                                                   18 

 
           
             58  
             21  
             DNA  
             Homo sapiens  
           
            58 

ggcttcctga agtgctggga t                                               21 

 
           
             59  
             24  
             DNA  
             Homo sapiens  
           
            59 

ccagtttggt gttctagttc agca                                            24 

 
           
             60  
             21  
             DNA  
             Homo sapiens  
           
            60 

gtgagatacc acacctgtcc c                                               21 

 
           
             61  
             22  
             DNA  
             Homo sapiens  
           
            61 

tttcctagca gacaactatc ga                                              22 

 
           
             62  
             26  
             DNA  
             Homo sapiens  
           
            62 

catcaaaaaa aaaattttaa taccag                                          26 

 
           
             63  
             23  
             DNA  
             Homo sapiens  
           
            63 

catgtggttc tttatttata ggc                                             23 

 
           
             64  
             21  
             DNA  
             Homo sapiens  
           
            64 

tcaatcgtat ccttaccagc c                                               21 

 
           
             65  
             26  
             DNA  
             Homo sapiens  
           
            65 

catgtttatc ttttaaaaat gttgcc                                          26 

 
           
             66  
             24  
             DNA  
             Homo sapiens  
           
            66 

ataatggaaa taattttgcc ctcc                                            24 

 
           
             67  
             24  
             DNA  
             Homo sapiens  
           
            67 

tgctataata ttagctacat ctgg                                            24 

 
           
             68  
             23  
             DNA  
             Homo sapiens  
           
            68 

cctatgaact tatcaacgaa gag                                             23 

 
           
             69  
             24  
             DNA  
             Homo sapiens  
           
            69 

tgctataata ttagctacat ctgg                                            24 

 
           
             70  
             24  
             DNA  
             Homo sapiens  
           
            70 

ctagtctttc tgtttataaa ggat                                            24 

 
           
             71  
             20  
             DNA  
             Homo sapiens  
           
            71 

tccgctgtgg ctcagaacac                                                 20 

 
           
             72  
             21  
             DNA  
             Homo sapiens  
           
            72 

agtagaagag gatgcacagc c                                               21 

 
           
             73  
             24  
             DNA  
             Homo sapiens  
           
            73 

tttgacctca tttgtattac tgag                                            24 

 
           
             74  
             23  
             DNA  
             Homo sapiens  
           
            74 

agaacctttt gaaaccaaga gtg                                             23 

 
           
             75  
             24  
             DNA  
             Homo sapiens  
           
            75 

acgtaatttt gtactttttc ttcc                                            24 

 
           
             76  
             22  
             DNA  
             Homo sapiens  
           
            76 

caatagaaag gaggtgagat tc                                              22 

 
           
             77  
             22  
             DNA  
             Homo sapiens  
           
            77 

cttggtaccc tttagcagtc ac                                              22 

 
           
             78  
             18  
             DNA  
             Homo sapiens  
           
            78 

ccttctttct ccatggag                                                   18 

 
           
             79  
             22  
             DNA  
             Homo sapiens  
           
            79 

gtactccagt gttatgttta cc                                              22 

 
           
             80  
             28  
             DNA  
             Homo sapiens  
           
            80 

taaagttgaa atttaaaaat taaagtac                                        28 

 
           
             81  
             24  
             DNA  
             Homo sapiens  
           
            81 

acttgtattc attatgggag aatg                                            24 

 
           
             82  
             24  
             DNA  
             Homo sapiens  
           
            82 

agtaatctct caccattacc attc                                            24 

 
           
             83  
             23  
             DNA  
             Homo sapiens  
           
            83 

tttctagtga atctccttca agt                                             23 

 
           
             84  
             25  
             DNA  
             Homo sapiens  
           
            84 

atgaaattta ccaaatttca ttcag                                           25 

 
           
             85  
             20  
             DNA  
             Homo sapiens  
           
            85 

gagttattgt atgcggagac                                                 20 

 
           
             86  
             19  
             DNA  
             Homo sapiens  
           
            86 

ttgaatttcc cctgtaaac                                                  19 

 
           
             87  
             23  
             DNA  
             Homo sapiens  
           
            87 

cacagtttat tgcattgtta gat                                             23 

 
           
             88  
             21  
             DNA  
             Homo sapiens  
           
            88 

tccttttggg tggagcttat c                                               21 

 
           
             89  
             23  
             DNA  
             Homo sapiens  
           
            89 

tatacttgta atatgcacgt atc                                             23 

 
           
             90  
             23  
             DNA  
             Homo sapiens  
           
            90 

tgtgatcagg aatagctttt gaa                                             23 

 
           
             91  
             24  
             DNA  
             Homo sapiens  
           
            91 

ttaacagata aaagtcaact ttac                                            24 

 
           
             92  
             24  
             DNA  
             Homo sapiens  
           
            92 

tggataaagc ataatttgtc aagt                                            24 

 
           
             93  
             23  
             DNA  
             Homo sapiens  
           
            93 

tagagaaagg tgaaaaataa gag                                             23 

 
           
             94  
             20  
             DNA  
             Homo sapiens  
           
            94 

ccagtcagtg aacgtaaggg                                                 20 

 
           
             95  
             22  
             DNA  
             Homo sapiens  
           
            95 

ctctgtgtgt ttagatcagt ca                                              22 

 
           
             96  
             24  
             DNA  
             Homo sapiens  
           
            96 

tttatcaatt actaccagta tcag                                            24 

 
           
             97  
             24  
             DNA  
             Homo sapiens  
           
            97 

tagtaaggta gccagaagtt gtgt                                            24 

 
           
             98  
             23  
             DNA  
             Homo sapiens  
           
            98 

atttacaaaa ccctacattg ctc                                             23 

 
           
             99  
             22  
             DNA  
             Homo sapiens  
           
            99 

tcatgtcact taggttatct gg                                              22 

 
           
             100  
             24  
             DNA  
             Homo sapiens  
           
            100 

tgtaattaag tagttataac tctc                                            24 

 
           
             101  
             22  
             DNA  
             Homo sapiens  
           
            101 

tcatgtcact taggttatct gg                                              22 

 
           
             102  
             20  
             DNA  
             Homo sapiens  
           
            102 

attaccttct ccccatttga                                                 20 

 
           
             103  
             19  
             DNA  
             Homo sapiens  
           
            103 

ggctttattt gctttttgc                                                  19 

 
           
             104  
             19  
             DNA  
             Homo sapiens  
           
            104 

ccaccctggc tgattatcg                                                  19 

 
           
             105  
             23  
             DNA  
             Homo sapiens  
           
            105 

taatttttgc ttctcttaca tgc                                             23 

 
           
             106  
             26  
             DNA  
             Homo sapiens  
           
            106 

ctatatcagg taaaatcatg tccaac                                          26 

 
           
             107  
             21  
             DNA  
             Homo sapiens  
           
            107 

gatttgctat gtgccaggga c                                               21 

 
           
             108  
             19  
             DNA  
             Homo sapiens  
           
            108 

gtcaaactta ctcaatgcc                                                  19 

 
           
             109  
             17  
             DNA  
             Homo sapiens  
           
            109 

caaccacttc cctacag                                                    17 

 
           
             110  
             19  
             DNA  
             Homo sapiens  
           
            110 

aactggcatg taagagaag                                                  19 

 
           
             111  
             21  
             DNA  
             Homo sapiens  
           
            111 

tgctactctt tagcttccta c                                               21 

 
           
             112  
             22  
             DNA  
             Homo sapiens  
           
            112 

ccttaaaaga agacaatcag cc                                              22 

 
           
             113  
             19  
             DNA  
             Homo sapiens  
           
            113 

gattgggtct caacatttc                                                  19 

 
           
             114  
             23  
             DNA  
             Homo sapiens  
             
               (21)..(21)  
               N is any nucleotide  
             
           
            114 

aataggctga agtgaagata ntc                                             23 

 
           
             115  
             24  
             DNA  
             Homo sapiens  
           
            115 

tttgtatcat tcattttgtg tgta                                            24 

 
           
             116  
             24  
             DNA  
             Homo sapiens  
           
            116 

aaaaacacgg ttctatgtga aaag                                            24 

 
           
             117  
             23  
             DNA  
             Homo sapiens  
           
            117 

cttaatgtct gtataagagt ctc                                             23 

 
           
             118  
             25  
             DNA  
             Homo sapiens  
           
            118 

actttagatt aataatggta atctc                                           25 

 
           
             119  
             24  
             DNA  
             Homo sapiens  
           
            119 

ttgaactctt tgttttcatg tctt                                            24 

 
           
             120  
             24  
             DNA  
             Homo sapiens  
           
            120 

ggaatttaag atagctagat tatc                                            24 

 
           
             121  
             26  
             DNA  
             Homo sapiens  
           
            121 

aatataataa ttatatttgg gaaggt                                          26 

 
           
             122  
             24  
             DNA  
             Homo sapiens  
           
            122 

gaaaatattt gattcaaaca gagc                                            24 

 
           
             123  
             26  
             DNA  
             Homo sapiens  
           
            123 

aatataataa ttatatttgg gaaggt                                          26 

 
           
             124  
             21  
             DNA  
             Homo sapiens  
           
            124 

cattttatta tagcagatgt c                                               21 

 
           
             125  
             19  
             DNA  
             Homo sapiens  
           
            125 

acttacacag gaacttcat                                                  19 

 
           
             126  
             22  
             DNA  
             Homo sapiens  
           
            126 

gctttgtcta atgtcaagtc ac                                              22 

 
           
             127  
             23  
             DNA  
             Homo sapiens  
           
            127 

ttaaacggag agtgttcact atc                                             23 

 
           
             128  
             24  
             DNA  
             Homo sapiens  
           
            128 

gttacaagtt aaagaaatgt gtag                                            24 

 
           
             129  
             24  
             DNA  
             Homo sapiens  
           
            129 

ctaacaagtg gcctggtggc aaac                                            24 

 
           
             130  
             26  
             DNA  
             Homo sapiens  
           
            130 

tttattgttt atccaattat agactt                                          26 

 
           
             131  
             25  
             DNA  
             Homo sapiens  
           
            131 

tcctgttaag tcaactggga aaaac                                           25 

 
           
             132  
             29  
             DNA  
             Homo sapiens  
           
            132 

cactgctaat aatctttgtc ttttttgtc                                       29 

 
           
             133  
             27  
             DNA  
             Homo sapiens  
           
            133 

cgtttacaaa acacagactg gaactta                                         27 

 
           
             134  
             23  
             DNA  
             Homo sapiens  
           
            134 

ttccttaggt tcaaaactgg tca                                             23 

 
           
             135  
             17  
             DNA  
             Homo sapiens  
           
            135 

tacaatggtg ggaactc                                                    17 

 
           
             136  
             21  
             DNA  
             Homo sapiens  
           
            136 

atattaaggt agaggctgtt t                                               21 

 
           
             137  
             19  
             DNA  
             Homo sapiens  
           
            137 

attcttctcc acttcaccc                                                  19 

 
           
             138  
             20  
             DNA  
             Homo sapiens  
           
            138 

cccaaatcaa actgaagaga                                                 20 

 
           
             139  
             18  
             DNA  
             Homo sapiens  
           
            139 

tggaactata aggaaaaa                                                   18 

 
           
             140  
             17  
             DNA  
             Homo sapiens  
           
            140 

aaagtcttca ctggaaa                                                    17 

 
           
             141  
             25  
             DNA  
             Homo sapiens  
           
            141 

ataattgttg atgtgatttt cattg                                           25 

 
           
             142  
             21  
             DNA  
             Homo sapiens  
           
            142 

aattttgaac cagatgaaga g                                               21 

 
           
             143  
             20  
             DNA  
             Homo sapiens  
           
            143 

ggtagagtga ttaaaacatg                                                 20 

 
           
             144  
             20  
             DNA  
             Homo sapiens  
           
            144 

tatgctatag tacagaaggc                                                 20 

 
           
             145  
             24  
             DNA  
             Homo sapiens  
           
            145 

catatctgtt ttatcatcag gagg                                            24 

 
           
             146  
             24  
             DNA  
             Homo sapiens  
           
            146 

aagtaaaatg gagaaaggaa ctgg                                            24 

 
           
             147  
             24  
             DNA  
             Homo sapiens  
           
            147 

caaaatgaaa catggaactt taga                                            24 

 
           
             148  
             24  
             DNA  
             Homo sapiens  
           
            148 

taagcattaa gtacaaatag caca                                            24 

 
           
             149  
             20  
             DNA  
             Homo sapiens  
           
            149 

agaagccaaa atgataagaa                                                 20 

 
           
             150  
             18  
             DNA  
             Homo sapiens  
           
            150 

acccaaagac aacaagag                                                   18 

 
           
             151  
             17  
             DNA  
             Homo sapiens  
           
            151 

ggaccagtgg acagaac                                                    17 

 
           
             152  
             21  
             DNA  
             Homo sapiens  
           
            152 

atatgcttta caacttgaga a                                               21 

 
           
             153  
             20  
             DNA  
             Homo sapiens  
           
            153 

tacattaagc tagctaccaa                                                 20 

 
           
             154  
             20  
             DNA  
             Homo sapiens  
           
            154 

cgcttgagaa catactatcc                                                 20 

 
           
             155  
             17  
             DNA  
             Homo sapiens  
           
            155 

ccagctaaca gtgtctt                                                    17 

 
           
             156  
             21  
             DNA  
             Homo sapiens  
           
            156 

aaggaaatat actcacaata a                                               21 

 
           
             157  
             19  
             DNA  
             Homo sapiens  
           
            157 

gaacctaatc aaccatctc                                                  19 

 
           
             158  
             20  
             DNA  
             Homo sapiens  
           
            158 

ttgcatttaa agtaagacat                                                 20 

 
           
             159  
             21  
             DNA  
             Homo sapiens  
           
            159 

cctttccttg cagagttgtt a                                               21 

 
           
             160  
             22  
             DNA  
             Homo sapiens  
           
            160 

caccactaaa ggactagact gt                                              22 

 
           
             161  
             25  
             DNA  
             Homo sapiens  
           
            161 

ttcatcctgt tttaagtcac acttg                                           25 

 
           
             162  
             24  
             DNA  
             Homo sapiens  
           
            162 

ttgcctccat tagttggaaa attg                                            24 

 
           
             163  
             25  
             DNA  
             Homo sapiens  
           
            163 

ttcatcctgt tttaagtcac acttg                                           25 

 
           
             164  
             24  
             DNA  
             Homo sapiens  
           
            164 

cttggaagga gcaaacgatg gttg                                            24 

 
           
             165  
             25  
             DNA  
             Homo sapiens  
           
            165 

caaaaacttt gctacactga catgg                                           25 

 
           
             166  
             24  
             DNA  
             Homo sapiens  
           
            166 

agacactgta gttaatgaac ttgc                                            24 

 
           
             167  
             24  
             DNA  
             Homo sapiens  
           
            167 

catgtactct cccaccttat tttc                                            24 

 
           
             168  
             24  
             DNA  
             Homo sapiens  
           
            168 

agacactgta gttaatgaac ttgc                                            24 

 
           
             169  
             24  
             DNA  
             Homo sapiens  
           
            169 

cacgttaatt ccctatcttg ctgc                                            24 

 
           
             170  
             24  
             DNA  
             Homo sapiens  
           
            170 

taaaaatttg agggtggggg actc                                            24 

 
           
             171  
             24  
             DNA  
             Homo sapiens  
           
            171 

catgaatagg atacagtctt ctac                                            24 

 
           
             172  
             24  
             DNA  
             Homo sapiens  
           
            172 

cacattactg ggtaagcatt taac                                            24 

 
           
             173  
             24  
             DNA  
             Homo sapiens  
           
            173 

gggaatgtat attatgtttt ccac                                            24 

 
           
             174  
             24  
             DNA  
             Homo sapiens  
           
            174 

atgttaggaa gttcatcaac catc                                            24 

 
           
             175  
             25  
             DNA  
             Homo sapiens  
           
            175 

ctgttacaat taaaagatac cttgc                                           25 

 
           
             176  
             24  
             DNA  
             Homo sapiens  
           
            176 

tgtgtgttct taaagcaggc atac                                            24 

 
           
             177  
             24  
             DNA  
             Homo sapiens  
           
            177 

ttttggcttc agatggggat ttac                                            24 

 
           
             178  
             24  
             DNA  
             Homo sapiens  
           
            178 

aagggaattc ctaatgttgg tgtc                                            24 

 
           
             179  
             25  
             DNA  
             Homo sapiens  
           
            179 

atctagtatc taattgtatt tcacc                                           25 

 
           
             180  
             21  
             DNA  
             Homo sapiens  
           
            180 

gcagactgag cttacaggga c                                               21 

 
           
             181  
             18  
             DNA  
             Homo sapiens  
           
            181 

tttcaatggc aagtaagt                                                   18 

 
           
             182  
             19  
             DNA  
             Homo sapiens  
           
            182 

gttatatcca aagtccaca                                                  19 

 
           
             183  
             19  
             DNA  
             Homo sapiens  
           
            183 

ttaaatctag gtggtgtgt                                                  19 

 
           
             184  
             18  
             DNA  
             Homo sapiens  
           
            184 

aaactcattt ctctggag                                                   18 

 
           
             185  
             20  
             DNA  
             Homo sapiens  
           
            185 

gagttattgt atgcggagac                                                 20 

 
           
             186  
             19  
             DNA  
             Homo sapiens  
           
            186 

ttgaatttcc cctgtaaac                                                  19 

 
           
             187  
             20  
             DNA  
             Homo sapiens  
           
            187 

attaccttct ccccatttga                                                 20 

 
           
             188  
             19  
             DNA  
             Homo sapiens  
           
            188 

ggctttattt gctttttgc                                                  19 

 
           
             189  
             19  
             DNA  
             Homo sapiens  
           
            189 

gtcaaactta ctcaatgcc                                                  19 

 
           
             190  
             17  
             DNA  
             Homo sapiens  
           
            190 

caaccacttc cctacag                                                    17 

 
           
             191  
             19  
             DNA  
             Homo sapiens  
           
            191 

gattgggtct caacatttc                                                  19 

 
           
             192  
             23  
             DNA  
             Homo sapiens  
             
               (21)..(21)  
               N is any nucleotide  
             
           
            192 

aataggctga agtgaagata ntc                                             23 

 
           
             193  
             17  
             DNA  
             Homo sapiens  
           
            193 

tacaatggtg ggaactc                                                    17 

 
           
             194  
             21  
             DNA  
             Homo sapiens  
           
            194 

atattaaggt agaggctgtt t                                               21 

 
           
             195  
             18  
             DNA  
             Homo sapiens  
           
            195 

tggaactata aggaaaaa                                                   18 

 
           
             196  
             17  
             DNA  
             Homo sapiens  
           
            196 

aaagtcttca ctggaaa                                                    17 

 
           
             197  
             20  
             DNA  
             Homo sapiens  
           
            197 

ggtagagtga ttaaaacatg                                                 20 

 
           
             198  
             20  
             DNA  
             Homo sapiens  
           
            198 

tatgctatag tacagaaggc                                                 20 

 
           
             199  
             20  
             DNA  
             Homo sapiens  
           
            199 

agaagccaaa atgataagaa                                                 20 

 
           
             200  
             18  
             DNA  
             Homo sapiens  
           
            200 

acccaaagac aacaagag                                                   18 

 
           
             201  
             17  
             DNA  
             Homo sapiens  
           
            201 

ggaccagtgg acagaac                                                    17 

 
           
             202  
             21  
             DNA  
             Homo sapiens  
           
            202 

atatgcttta caacttgaga a                                               21 

 
           
             203  
             20  
             DNA  
             Homo sapiens  
           
            203 

tacattaagc tagctaccaa                                                 20 

 
           
             204  
             20  
             DNA  
             Homo sapiens  
           
            204 

cgcttgagaa catactatcc                                                 20 

 
           
             205  
             17  
             DNA  
             Homo sapiens  
           
            205 

ccagctaaca gtgtctt                                                    17 

 
           
             206  
             21  
             DNA  
             Homo sapiens  
           
            206 

aaggaaatat actcacaata a                                               21 

 
           
             207  
             19  
             DNA  
             Homo sapiens  
           
            207 

gaacctaatc aaccatctc                                                  19 

 
           
             208  
             20  
             DNA  
             Homo sapiens  
           
            208 

ttgcatttaa agtaagacat                                                 20 

 
           
             209  
             21  
             DNA  
             Homo sapiens  
           
            209 

cctttccttg cagagttgtt a                                               21 

 
           
             210  
             22  
             DNA  
             Homo sapiens  
           
            210 

caccactaaa ggactagact gt                                              22 

 
           
             211  
             24  
             DNA  
             Homo sapiens  
           
            211 

cacgttaatt ccctatcttg ctgc                                            24 

 
           
             212  
             24  
             DNA  
             Homo sapiens  
           
            212 

taaaaatttg agggtggggg actc                                            24 

 
           
             213  
             8  
             DNA  
             Homo sapiens  
           
            213 

tgtagaag                                                              8 

 
           
             214  
             8  
             DNA  
             Homo sapiens  
           
            214 

agttaagc                                                              8 

 
           
             215  
             8  
             DNA  
             Homo sapiens  
           
            215 

aggtttct                                                              8 

 
           
             216  
             8  
             DNA  
             Homo sapiens  
           
            216 

cagtaggt                                                              8 

 
           
             217  
             8  
             DNA  
             Homo sapiens  
           
            217 

acgtaatt                                                              8 

 
           
             218  
             15  
             DNA  
             Homo sapiens  
           
            218 

tttgctgtat cttgg                                                      15 

 
           
             219  
             15  
             DNA  
             Homo sapiens  
           
            219 

gtcattttcc tttgg                                                      15 

 
           
             220  
             15  
             DNA  
             Homo sapiens  
           
            220 

tatttgttct ttagg                                                      15 

 
           
             221  
             15  
             DNA  
             Homo sapiens  
           
            221 

tttttatttc tgaga                                                      15 

 
           
             222  
             15  
             DNA  
             Homo sapiens  
           
            222 

ttagtttttt gtagg                                                      15 

 
           
             223  
             8  
             DNA  
             Homo sapiens  
           
            223 

ctgtaagt                                                              8 

 
           
             224  
             8  
             DNA  
             Homo sapiens  
           
            224 

tggtatgg                                                              8 

 
           
             225  
             23  
             DNA  
             Homo sapiens  
           
            225 

aatgacattt attatgctta gga                                             23 

 
           
             226  
             21  
             DNA  
             Homo sapiens  
           
            226 

agttgaagat gaaagtgcgc a                                               21 

 
           
             227  
             21  
             DNA  
             Homo sapiens  
           
            227 

agttgaagat kaaagtgcgc a                                               21 

 
           
             228  
             20  
             DNA  
             Homo sapiens  
           
            228 

cagtacagca gaattaatta                                                 20 

 
           
             229  
             20  
             DNA  
             Homo sapiens  
           
            229 

cagtacagca kaattaatta                                                 20 

 
           
             230  
             14  
             DNA  
             Homo sapiens  
           
            230 

tatctwggga tcat                                                       14 

 
           
             231  
             20  
             DNA  
             Homo sapiens  
           
            231 

ccagcaacag kgwkcwkaar                                                 20 

 
           
             232  
             22  
             DNA  
             Homo sapiens  
           
            232 

acagtttgct gtatcttggg at                                              22 

 
           
             233  
             25  
             DNA  
             Homo sapiens  
           
            233 

acagtagttt gctgtatctt gggat                                           25 

 
           
             234  
             20  
             DNA  
             Homo sapiens  
           
            234 

aaaagttttt tgtagggtac                                                 20 

 
           
             235  
             20  
             DNA  
             Homo sapiens  
           
            235 

aaaagcttta cttacagtgt                                                 20 

 
           
             236  
             36  
             DNA  
             Homo sapiens  
           
            236 

gtttgtttgt ttgtttgttw gttttttgta gggtac                               36 

 
           
             237  
             18  
             DNA  
             Homo sapiens  
           
            237 

agaagctrta agtatctt                                                   18 

 
           
             238  
             18  
             DNA  
             Homo sapiens  
           
            238 

agaagctaat ccaagaaa                                                   18 

 
           
             239  
             11  
             DNA  
             Homo sapiens  
           
            239 

agctataagt a                                                          11 

 
           
             240  
             15  
             DNA  
             Homo sapiens  
           
            240 

gctttgtgta agtat                                                      15 

 
           
             241  
             11  
             DNA  
             Homo sapiens  
           
            241 

agctgtaagt a                                                          11 

 
           
             242  
             15  
             DNA  
             Homo sapiens  
           
            242 

gctttgtgta agtat                                                      15 

 
           
             243  
             20  
             DNA  
             Homo sapiens  
           
            243 

ggagatggtr tggaattgat                                                 20 

 
           
             244  
             21  
             DNA  
             Homo sapiens  
           
            244 

aggagatgrt rykkmaywkw w                                               21 

 
           
             245  
             21  
             DNA  
             Homo sapiens  
           
            245 

aggagatggt gtggaattga t                                               21 

 
           
             246  
             21  
             DNA  
             Homo sapiens  
           
            246 

aggagatgat acttcacatt a                                               21 

 
           
             247  
             12  
             DNA  
             Homo sapiens  
           
            247 

gatggtgtgg aa                                                         12 

 
           
             248  
             11  
             DNA  
             Homo sapiens  
           
            248 

cttaagtaaa t                                                          11 

 
           
             249  
             12  
             DNA  
             Homo sapiens  
           
            249 

gatggtatgg aa                                                         12 

 
           
             250  
             12  
             DNA  
             Homo sapiens  
           
            250 

cttaagtaaa tt                                                         12 

 
           
             251  
             20  
             DNA  
             Homo sapiens  
           
            251 

attatgcttm ggaaattgaa                                                 20 

 
           
             252  
             19  
             DNA  
             Homo sapiens  
           
            252 

attaaagwwr ktkmwrmwr                                                  19 

 
           
             253  
             25  
             DNA  
             Homo sapiens  
           
            253 

ccaccacttt ccaggttggt tctac                                           25 

 
           
             254  
             20  
             DNA  
             Homo sapiens  
           
            254 

tttattatgc ttcggaaatt                                                 20 

 
           
             255  
             25  
             DNA  
             Homo sapiens  
           
            255 

ccaccacttt ccaggttggt tctac                                           25 

 
           
             256  
             20  
             DNA  
             Homo sapiens  
           
            256 

tttattatgc ttaggaaatt                                                 20 

 
           
             257  
             11  
             DNA  
             Homo sapiens  
           
            257 

agtctaygaa a                                                          11 

 
           
             258  
             11  
             DNA  
             Homo sapiens  
           
            258 

agtctacgaa a                                                          11 

 
           
             259  
             11  
             DNA  
             Homo sapiens  
           
            259 

agtctaygaa a                                                          11 

 
           
             260  
             19  
             PRT  
             Homo sapiens  
           
            260 

Lys Tyr Thr Thr Asp Glu Phe Asp Gln Arg Ile Leu Tyr Glu Tyr Leu 
  1               5                  10                  15 

Ala Glu Ala 

 
           
             261  
             19  
             PRT  
             Rattus sp.  
           
            261 

Lys Tyr Thr Thr Asp Glu Phe Asp Gln Arg Ile Leu Tyr Glu Tyr Leu 
  1               5                  10                  15 

Ala Glu Ala 

 
           
             262  
             19  
             PRT  
             Mus musculus  
           
            262 

Lys Tyr Thr Thr Asp Glu Phe Asp Gln Arg Ile Leu Tyr Glu Tyr Leu 
  1               5                  10                  15 

Ala Glu Ala 

 
           
             263  
             19  
             PRT  
             Fugu rubripes  
           
            263 

Lys Tyr Ser Thr Asp Asp Phe Asp Gln Arg Ile Leu Tyr Glu Tyr Leu 
  1               5                  10                  15 

Ala Glu Ala 

 
           
             264  
             19  
             PRT  
             Drosophila melanogaster  
           
            264 

Lys Tyr Ser Ser Asp Arg Gly Glu Thr Arg Val Leu Tyr Gln Tyr Leu 
  1               5                  10                  15 

Ala Glu Gly