Abstract:
Differences in the rate of kynurenine formation in the lysates of red blood cells of a patient suspected of having Tourette syndrome, Tourette syndrome associated disorders or Tourette spectrum disorders and of a control are used for the diagnosis of such disorders.

Description:
This application is a continuation-in-part of each of copending application Ser. No. 125,577 (now abandoned) filed Nov. 25, 1987, copending application Ser. No. 271,653 filed Nov. 16, 1988, copending application Ser. No. 410,831 (now abandoned) filed Sep. 22, 1989, and copending application Ser. No. 562,596 filed Aug. 3, 1990. 
    
    
     Each of these copending applications is incorporated into this application by reference. 
     BACKGROUND 
     Tourette syndrome (TS) is a common, hereditary, neurobehavioral disorder characterized by motor and vocal tics. In addition to the tics the applicant has shown that TS is associated with a wide range of other behavioral disorders in both the patients and their relatives. These include attention deficit disorder (ADD) with or without hyperactivity, autism (a trait of three sets of symptoms: (1) a profound failure to develop social relationships; (2) defective speech and language; and (3) ritualistic or compulsive behavior), obsessive-compulsive behaviors, unipolar or bipolar affective disorder, phobias, panic attacks, premenstrual syndrome (PMS), generalized anxiety disorder, pervasive developmental disorder, dyslexia, learning disabilities, dysgraphia, mental retardation, specific math disabilities, specific reading disabilities, specific spelling disabilities, borderline personality disorder, migraine headaches, exhibitionism, stuttering, delayed speech, schizophreniform disorder, schizoid disorder, drug or alcohol addiction or abuse, bulimia, compulsive eating with obesity, physical or sexual abuse of spouse or children, somatiform disorders including spastic colon, (irritable bowel syndrome), chronic fatigue syndrome, sleep disturbances, sleep apnea, sudden infant death syndrome (SIDS), narcolepsy, insomnia, short temper, and temper tantrums. 
     Hereinafter these abnormalities are collectively referenced as &#34;TS related disorders&#34; or &#34;TS spectrum of disorders.&#34; 
     The applicant has proposed that the symptoms of TS, and TS related disorders, fit a model in which the frontal lobe and limbic system in the brain are disinhibited by a relative deficiency in brain serotonin and tryptophan and that these chemical deficiencies are due to genetic defects in the two major genes that cause the breakdown of tryptophan--tryptophan 2,3-dioxygenase and indoleamine 2,3- dioxygenase and that tests for mutations in these genes will be an extremely useful adjunct in the diagnosis and treatment of TS and TS associated behaviors. 
     Tryptophan 2,3-dioxygenase (tryptophan oxygenase, tryptophan pyrrolase) and indoleamine 2,3 dioxygenase, are similar but separate enzymes. See Gal, E. M. and Sherman, A. D., &#34;DL-kynurenine: its synthesis and possible regulatory function in brain&#34;, Neurochem.Res. 5:223-239 (1980). 
     Table 1 depicts several apparent similarities and differences between the functions of these enzymes. See Hayaishi, O., &#34;Properties and function of indoleamine 2,3-dioxygenase,&#34; Biochem. 79:13p-21p (1976); Gal, E. M., &#34;Cerebral tryptophan-2,3-dioxygenase (pyrrolase) and its induction in rat brain&#34; Neurochem. 22:861-863 (1974); and Gal, E. M. and Sherman, A. D. &#34;DL-kynurenine: its synthesis and possible regulatory function in brain&#34;, Neurochem. Res. 5:223-239 (1980). 
     
                       TABLE 1______________________________________        Tryptophan Indoleamine        2,3-dioxygenase                   2,3-dioxygenase______________________________________SimilaritiesSubstrate      L-tryptophan L-tryptophanOxygen         OxygenProduct        N-formyl     N-formylL-kynurenine   L-kynurenineCofactor       heme         hemeInduced by:    tryptophan   tryptophanDifferencesLocation       liver, red blood                       intestine, brain          cells, brain other organsType of oxygen used          O.sub.2      O--O.sup.-Other substrates          none         D-tryptophan                       5-hydroxy-                       tryptophan                       serotonin                       melantoinInducible by steroids          yes          noInducible by interferon          no           yes______________________________________ 
    
     The nucleotide sequence of human indoleamine 2,3-dioxygenase has been published. See Gupta S. L. and Dal, W. &#34;Molecular cloning, sequencing and expression of human interferon-gamma-inducible indoleamine 2.3-dioxygenase cDNA&#34; Biochem. Biophys. Res. Comm. 168:1-8 (1990). Comparison of this published sequence of indoleamine 2,3-dioxygenase with the sequence of tryptophan dioxygenase disclosed (See FIG. 8) indicates that the two enzymes are produced by different genes. Accordingly, the predominantly liver enzyme, tryptophan 2,3-dioxygenase is referred to herein as TD02, the brain-intestine enzyme, indoleamine 2,3-dioxygenase is referred to as ID02. Collectively, these two enzymes are labelled TD02-ID02 which means TD02 and/or ID02. 
     If TD02-ID02 activity were present only in the liver-intestine, then the level of tryptophan in the brain would be almost completely dependent on the blood level of tryptophan and of the other large amino acids that compete for its transport across the blood brain barrier. However, as FIG. 1 shows, TOD2-ID02 activity is present in the brain where it is effective to siphon off some of the tryptophan after entry into the brain and before it is converted to serotonin. In rats, under normal conditions 70% of the brain tryptophan is converted to serotonin and 30% to brain kynurenine. See Gal, E. M. and Sherman, A. D., &#34;DL-kynurenine: its synthesis and possible regulatory function in brain&#34;, Neurochem. Res. 5:223-239 (1980). 
     Thus, even a moderate increase in brain TD02-ID02 activity could markedly change this ratio and lower the level of brain serotonin. Significant changes in the breakdown of tryptophan in the brain may thus occur concurrently with only moderate changes in the blood tryptophan and serotonin. 
     In humans, serotonin and tryptophan levels are apparently interdependent, serotonin level abnormalities being a consequence of tryptophan level abnormalities. As FIG. 2 shows, peripheral tryptophan can take two major metabolic pathways, i.e., 90% conversion to kynurenine and 10% conversion to serotonin. TD02-ID02 activity is the rate limiting step in the degradation of tryptophan to kynurenine. 
     Mutations of the TD02-ID02 genes are implicated in TS and TS associated behaviors and changes in the level of these enzymes would be expected to significantly affect serotonin production. While it is anticipated that TS and most of the TS related disorders will be due to mutations that increase the level of TD02-ID02, since some TS or autistic children have either too low or too high levels of serotonin, the basic defect is both may be a &#34;dysregulation&#34; of serotonin usually a result of too much, but occasionally too little, TD02-ID02. 
     FIG. 3 indicates that genetic defects in TD02-ID02 that may occur in TS, and TS related disorders, and in autism. The applicant&#39;s studies show that children with autism often develop full blown symptoms of TS as they grow older. (See Comings, D. E. and Comings, B. G., &#34;Clinical and genetic relationships between autism-PDD and Tourette syndrome: A study of 19 cases.&#34; Amer. J. Med. Genetics 39:180-191 (1991). Thus many cases of autism may in fact be due to the same genetic defect that causes TS. 
     SUMMARY OF THE INVENTION 
     This invention includes any test that assays or determines the functional integrity of tryptophan oxygenase (tryptophan 2,3-dioxygenase, TD02 or indoleamine 2,3-dioxygenase, ID02) in relationship to Tourette syndrome and TS associated behaviors, or TS spectrum disorders, whether that test is to determine changes in the nucleotide sequence of any part of the gene, the expression of TD02-ID02 messenger RNA, the expression or activity of the TD02-ID02 protein or enzyme, or electrophoretic variants of the TD02-ID02 protein or enzyme in any tissue or bodily fluid. 
     Diagnostic tests are provided for, among other things, Tourette syndrome (TS), and TS associated behaviors including chronic motor and vocal tics, attention deficit disorder (ADD) with or without hyperactivity, autism, obsessive-compulsive behaviors, depression or mania (unipolar or bipolar affective disorder) disorder, phobias, panic attacks, premenstrual syndrome (PMS), generalized anxiety disorder, pervasive developmental disorder, dyslexia, learning disabilities, mental retardation, dysgraphia, specific math disabilities, specific reading disabilities, specific spelling disabilities, borderline personality disorder, migraine headaches, exhibitionism, stuttering, delayed speech, schizophreniform disorder, schizoid disorder, drug or alcohol addiction or abuse, bulimia, compulsive eating with obesity, physical or sexual abuse of spouse or children, somatiform disorders including spastic colon, (irritable bowel syndrome), chronic fatigue syndrome, sleep disturbances, sleep apnea, sudden infant death syndrome (SIDS), narcolepsy, insomnia, short temper, and temper tantrums. 
     All of these disorders have been noted to be present in TS patients and their relatives at a greater frequency than in the general population. All of these different disorders are controlled by the limbic system, frontal lobes and hypothalamus, which in turn are dependent upon a normal level of brain serotonin to function properly. When serotonin metabolism is defective, due to a mutation affecting the level of the enzyme tryptophan oxygenase, any or all of these disorders may occur. 
     The fact that TS is a wide-based, generalized behavioral disorder associated with the above list of abnormalities is documented in Comings, D. E. and Comings, B. G., &#34;A controlled study of Tourette syndrome. I. Attention deficient disorder, learning disorders and school problems&#34; Amer. J. Human Genetics 41:701-741 (1987); Comings, D. E. and Comings, B. G., &#34;A controlled study of Tourette syndrome. II. Conduct disorder&#34; Amer. J. Human Genetics 41:742-760 (1987); Comings, D. E. and Comings, B. G., &#34;A controlled study of Tourette syndrome. III. Phobias and panic attacks&#34; Amer. J. Human Genetics 41:761-781 (1987); Comings, D. E. and Comings, B. G., &#34;A controlled study of Tourette syndrome. IV. Obsessive compulsive and schizoid behavior&#34; Amer. J. Human Genetics 41:782-803 (1987); Comings, D. E. and Comings, B. G., &#34;A controlled study of Tourette syndrome. V. Depression and mania&#34; Amer. J. Human Genetics 41:804-821 (1987); Comings, D. E. and Comings, B. G., &#34;A controlled study of Tourette syndrome. VI. Early development, sleep problems, allergies and handedness&#34; Amer. J. Human Genetics 41:822-838 (1987); Comings, D. E. and Comings, B. G., &#34;A controlled family history study of Tourette syndrome, I. Attention deficit hyperactivity disorder, learning disorders and dyslexia&#34; J. Clin. Psychiatry 51:275-280, (1990); Comings, D. E. and Comings, B. G., &#34;A controlled family history study of Tourette syndrome, II. Alcoholism, drug abuse and obesity&#34; J. Clin. Psychiatry 51:281-287 (1980); Comings, D. E. and Comings, B. G., &#34;A controlled family history study of Tourette syndrome, III. Other psychiatric disorders&#34; J. Clin. Psychiatry 51:288-291, (1990); Comings, D. E., Tourette Syndrome and Human Behavior, Hope Press, Duarte, CA 91009-0188, 830 pages (1990). 
     This invention covers techniques for the diagnosis of TS and TS related disorders utilizing testing of abnormalities in TD02-ID02. The diagnosis is accomplished by genetic tests to identify mutations in the TD02-ID02 genes which may cause such psychiatric, behavioral and physical disorders. To that end, the invention includes the identification, chromosomal location, nucleotide sequence and encoded peptide sequence of the human TD02 gene, and the demonstration that TD02 is mutated such that its level of activity is increased (or altered) in Tourette syndrome and TS related disorders. 
     It is anticipated that the mutations causing hyperinducability or increased activity of the TD02-ID02 genes occur in or near the promoter regions of the 5&#39; regulatory sequences of the TD02-ID02 genes in or near glucocorticoid response elements (GRE) or other induction response elements, or in the expressed-translated portions of the gene, affecting heme, tryptophan, copper or 02 or O-binding at or near or the active catalytic site. 
     The diagnostic tests of the invention include detection of mutations or alterations of TD02-ID02 genes by any technique, including electrophoretic patterns of fragments produced by cutting portions of the TO or IO genes with restriction enzymes, including after amplification, e.g., by the polymerase chain reaction (PCR) or other related techniques, allele specific PCR, see Newton, C. R., et al., Analysis of any point mutation in DNA. The amplification refractory mutation system (ARMS), Nucleic Acids Research 17:2503-2516 (1989) and reverse allele specific testing, see Wallace, application Ser. No. 07/283,142, and its continuation-in-part, Ser. No. 07/678,448, or any other technique to detect changes in tbe nucleotide sequence of TD02-ID02, assay of TD02-ID02 activity in red blood cells, white blood cells or other cellular or fluid components, the electrophoresis of TD02-ID02 to show mutant forms of the enzymes, or testing for abnormalities in the sequence or amount of TD02-ID02 messenger RNA. 
    
    
     BRIEF DESCRIPTION OF THE FIGURES 
     FIG. 1 is a schematic illustration of TD02-ID02 activity present in the brain. 
     FIG. 2 is a schematic illustration of two metabolic pathways available to peripheral tryptophan. 
     FIG. 3 indicates genetic defects in TD02-ID02 that may occur in TS, TS related disorders and autism. 
     FIG. 4 depicts audioradiograms of duplicate filter lifts from a human liver cDNA library in gt 11 hybridized with rat liver superimposed and turned slightly to reveal human cDNA clones of human tryptophan oxygenase. 
     FIGS. 5-1, 5-2, 5A-1, 5A-2 and 5A-3 depict the sequence of the human HT03 (TD02) clone and the translation into the open reading frame. 
     FIG. 6 depicts the sequence of rat pcTOl and rat TD02. 
     FIG. 7 shows the region cf homology between the sequences depicted by FIGS. 5 and 5a and by FIG. 6. 
     FIGS. 8-1, 8-2 and 8-3 depicts the sequence of the entire expressed portion and regulatory sequences of the human TO gene (TD02). 
     FIG. 9 is a diagramatic comparison of the sequence of the rat versus the human TD02. 
     FIG. 10 is a comparison of the amino acid sequenc of the rat (Maezono, K., et al., Deduced primary structure of rat tryptophan-2,3-dioxygenase, Biochem. Biophys. Res. Comm. 176-181 (1990)) versus the human tryptophan oxygenase gene. 
     FIGS. 11-1, 11-2 and 11-3 depicts the sequence of some of the TD02 introns. 
     FIG. 12 depicts the results of hybridization studies to identify the chromosomal location of the human TDO gene. 
     FIG. 13 depicts the chromosomal location of the human TD02 gene to 4q31. 
     FIG. 14 depicts the results of an assay which compares the activity of tryptophan oxygenase in controls and in patients with TS. 
     FIG. 15A depicts the results of electrophoresis of the red blood cell lysate, in conjunction with assay in the gel, for TD02 activity of controls and TS patients. 
     FIG. 15B illustrates an interpretation of FIG. 15A. 
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     This invention provides genetic tests for TS and TS related disorders listed in &#34;Summary of the Invention&#34;. These tests entail the identification of deletions, duplications, nucleotide changes and other defective alleles of the TD02-ID02 gene(s). These genetic tests, per se, may be of conventional nature and involve, for example: 
     (a) Obtaining DNA from subjects to be tested (blood, skin, urine, buccal smear, hair follicles or any other source). 
     (b) Identifying mutations in this DNA by hybridization of specific DNA or RNA probes to various parts of the TD02-ID02 genes, or DNA surrounding the TD02-ID02 genes. The mutations may be partial or complete gene duplications, double or multiple gene duplications, partial or complete gene deletions, single or multiple nucleotide substitutions, insertions or deletions, or frame shift mutations. The probes may, for example, be oligonucleotide probes including allele specific synthetic oligonucleotides, cloned cDNA, genomic DNA fragments, or RNA. The test may include hybridization of DNA electrophoresed in gels, or spotted on a support media, or amplified by DNA polymerases. The invention includes cloned cDNA and genomic DNA probes for the human TD02-ID02 genes useful to conduct such genetic tests. The invention also includes an isolated or synthetic DNA sequence comprising at least a portion of the TD02-ID02 gene sequence, and isolated or synthetic proteins encoded by the TD02-ID02 gene sequence in whole or in part. 
     (c) Assays of TD02-ID02 enzyme activity in red blood cells, white blood cells, or other cells or bodily fluids, 
     (d) Electrophoresis of TD02-ID02 enzymes in red blood cells, white blood cells, or other cells or bodily fluids. 
     CLONING OF THE HUMAN TO GENE 
     Schmidt, et al. report the isolation of the rat liver tryptophan oxygenase gene. See EMBO Journal 1:1287 (1982). Two cDNA probes, pcTOI and pcT02 covering parts of the entire rat TO gene are described. To provide an appropriate human cDNA probe, the rat pcTO 570 base pair clone was labelled with 32p and hybridized to a Clonetech human liver cDNA library (Clonetech Laboratories, Inc., Human Liver cDNA, Library Catalogue No. HL101B, Lot No. 2102). 
     The Clonetech cDNA library to human liver messenger RNA, in XGT11, was plated on LB plates at a density of 30,000 pfu, using LE392 host E. coli. Plaques were lifted in duplicate on BA85 circles, washed in 0.5N NaOH, 1.5M NaCl, then 0.5M Tris, pH 8, 1.5M NaCl, then baked 2 hours at 80° C. The filters were then prehybridized 2 hours in 6X SSC, 1X Denhardts, 100 ug/ml salmon sperm DNA at 65.C, 0.2 ml/sq.cm. 
     The 565 base pair pcT01 insert DNA was labelled with 32p by nick translation and hybridized overnight in 6X SSC, 1X Denhardts, 0.1% SDS, 65.C, then washed in 2X SSC, 1X Denhardts at room temperature for 30 min, then twice in 0.3X SSC, 0.5% SDS, 65° C. for 1 hour. Seventeen of the plaques that were positive on both duplicate plaque lifts were identified and replated at low density, about 100 plaques per disk, and final single plaques grown up of each positive clone. 
     Non-specific artifacts were ruled out if a positive signal (dark spot on the autoradiogram) was obtained in the same position on each duplicate lift as determined by superimposing the two autoradiograms in a slightly shifted position and examination for double spots. 
     FIG. 4, from just one of nine different dishes, depicts autoradiograms of duplicate filter lifts superimposed and turned slightly. Double spots (duplicate hybridizations) each represent presumptive human cDNA clones of human tryptophan oxygenase. The +&#39;s are orientation markers. 
     To ascertain if these presumptive clones truly represent human TO, the rat pcTOl cDNA and one of the human cDNA clones (HT03) were sequenced, using the Sanger method. The sequence of human HT03 (TD02) clone and the translation into protein to the open reading frame are shown in FIGS. 5-1, 5-2, 5A-1, 5A-2 and 5A-3, the sequence of the rat pcTOI and rat TD02 is shown in FIG. 6, and the region of homology between the two is shown in FIG. 7. The fact that all base pairs of the rat were 80% homologous with the human HT03 sequence and that the amino acid sequence of the human TD02 and the rat TD02 match were 88% homologous indicates that the human TD02 cDNA was isolated. 
     To sequence the regulatory region and some of the introns of the human TD02 gene required the isolation of genomic clones. Table 2 lists the cDNA and genomic clones used and the method of their isolation. 
     
                       TABLE 2______________________________________Human TDO2 cDNA and Genomic Clones                          SizeClone  Source        Vector    (kb) Probe______________________________________HT03   Clontech HL10016                gt11      1.7  Rat pCT01  human liver cDNATGH-01 Human Genomic Charon 4A 20.0 HTO3  Library.sup.33TGH-031  Human Genomic Charon 4A 1.7  HTO3  Library.sup.33TGH-041  Human Genomic Charon 4A 1.45 HTO3  LibraryTGH-07 Chrom 4 Library                EMBL 3    1.5  HTO3  LA04NS02TGH-09 Chrom 4 Library                EMBL 3    2.0  HTO13.12  LA04NS01______________________________________ 1. Subclones of TGH01. 2. Clone containing only the 5&#39; portion of TO cDNA. 
    
     The various lambda libraries were screened by plating approximately 30,000 plaques on LB agar on 150 mm petri dishes. Duplicate lifts were made on Nitrocellulose BA-85. The membranes were screened by labeling with the probes listed, labeled with 32P by nick translation. Areas of coincident positive signal were scraped from the plate and re-screened at a lower plaque density. The lambda inserts were subcloned into Bluescript. 
     The entire expressed portion and regulatory sequences of the human TO gene (TD02) has also been sequenced using the Sanger method. The sequence is depicted by FIGS. 8-1, 8-2 and 8-3. The numbering starts at -1,652 bases from the start site of the transcribed portion of the TD02 gene and then extends from +1. There is a promoter CATAA (TATA) box at -24 and a second minor TATA box at -213. There is a promoter homologous to the CAAT box at -74. The sequence is CTAAG, identical to the sequence in the rat trytophan oxygenase gene. In comparison to the rat sequence there is an insert of DNA starting at -293 and extending to -1,957. There is a glucocorticoid response element (GRE) at -1,510 homologous to the second rat GRE. 
     Within the insert there are a series of GTT repeats starting at -823. Since part of the GRE consensus sequence is GTTCTT, this GTTGTT repeat may serve as a GRE-like element. 
     FIG. 9 is a diagramatic comparison of the sequence of the rat versus the human TD02. The regions of homology are shaded. The site of the DNA insert is clearly shown. 
     FIG. 10 is a comparison of the amino acid sequence of the rat (Maezono, K., et al., Deduced primary structure of rat tryptophan-2,3-dioxygenase, Biochem. Biophys. Res. Comm. 170:176-181 (1990)) versus the human tryptophan oxygenase gene. This comparison shows that there is an 88% homology between the two sequences and clearly identifies the human sequence as tryptophan oxygenase. 
     In addition to the expressed and regulatory regions, some of the TD02 introns have also been sequenced. These are shown by FIGS. 11-1, 11-2 and 11-3 which also illustrates some of the synthetic oligomers (shown by lines through the sequence) used for the PCR amplification of specific regions of TD02 and are useful for the diagnosis of disease producing mutations of the TD02 gene. The numbers indicate the name of the synthetic oligomer. The position of the number indicates the direction the oligomer is pointing (i.e., 3&#39; or 5&#39;). 
     The HT03 clone was used in the hybridization of rodent-human cell hybrids and for in situ hybridization studies to identify the chromosomal location of the human TD02 gene (see FIGS. 12 and 13). These studies indicated the human TD02 gene is in chromosome band 4q31 (see Comings, D. E., Muhleman, D., Dietz, G. W. and Donlon, T. &#34;Human tryptophan oxygenase localized to 4q31: Possible implications for human behavioral disorders. Genomics 9:301-308 (1991)). 
     PROOF THAT MUTATIONS OF TD02 CAUSE TS AND TS RELATED BEHAVIORS 
     The connection between mutations affecting the structural integrity of tryptophan oxygenase and Tourette syndrome has been proven by an assay of tryptophan oxygenase in lysates of red blood cells from controls and patients with Tourette syndrome (TS), using tryptophan, heme and oxygen as substrates. This assay is performed by detecting the rate of production of kynurenine in a double beam recording U.V. spectrophotometer, over time. The rate is determined using the linear portion of the curve. The mean rate of production of kynurenine in controls can thus be compared to the rate of production in patients with TS. The results are shown in FIG. 14. Twenty-five TS patients were assayed and all had TD02 enzyme levels in the range of 150% of normal. Thirteen control patients were assayed. One of 13 controls had elevated TD02 levels, verifying the high carrier frequency of the mutant TD02 gene, as proposed by the applicant. See, Comings, D. E., Himes, J. and Comings, B. G. &#34;An epidemiological study of Tourette syndrome in a single school district&#34;, J. Clin. Psychiatry 51:463-469 (1990). 
     ELECTROPHORESIS OF MUTANT TD02 IN TS 
     Electrophoresis of the red blood cell lysate, in conjunction with assay in the gel for the TD02 enzyme activity, showed that the increase in TD02 activity was due to a mutation of the TD02 gene, and not due to indirect causes such as an increase in blood steroid levels. The controls (with a normal range of enzyme activity) had a single band with low levels of activity (FIG. 15). Since TD02 is a tetrameric protein, this is interpreted as all four monomeric units being normal. 
     Twenty of the twenty five patients were heterozygotes for the TD02 mutation and had three bands (FIG. 15). This is interpreted as a pair of normal dimers for the normal enzyme, a set of mutated dimers and normal dimers, and a set of mutated dimers. 
     Five of twenty-five TS patients were homozygous for the mutant TD02 had a single band (FIG. 15). This is interpreted as a pair of mutant dimers. 
     In TD02 two subunits or monomers are bound to a single heme forming dimer. The organization of TD02 into two dimers accounts for presence of three and only three bands by electrophoresis. 
     The heterozygous TS patients had the TS spectrum of psychiatric disorders on either the maternal or paternal side of the family. The homozygous TS patients had the spectrum of TS related behaviors on both sides of the family. 
     These results teach that mutations of the TD02 gene result in elevated activity of TD02 and are causative of TS in either heterozygous or homozygous dosage and establish the claimed relationship between genetic mutations of this gene and TS and TS associated behaviors. 
     This discovery is unique in its demonstration that mutations of TD02 are causative in TS and its TS associated disorders or TS spectrum disorders. Prior suggestions of a link between tryptophan oxygenase (tryptophan pyrrolase) and a single specific psychiatric disorder, depression (Mangoni et al) assumed the increased levels of TD02 were due to a nongenetic cause, i.e., the well known inducibility of TD02 by steroids (hydrocortisone and others). Thus this old proposal was: 
     stress→increased adrenal steroids→increased TD02→depression. No mention of genetic mutations, the important and unique aspect of this invention, was made. 
     Our unique claim and demonstration is that: 
     genetic mutations→increased TD02 activity→defective serotonin metabolism→many psychiatric disorders (TS and TS spectrum disorders). 
     The distinction is critical. If, as previously proposed, increases in the activity of TD02 in depression were secondary to elevated adrenal steroid levels, there would be no need to attempt to identify mutations of the TD02 gene since the basic cause of depression would lie elsewhere. The present invention, demonstration and teaching that genetic mutations of the TD02 gene are the primary and basic cause of TS and TS associated behaviors, is new and unique, and allows specific tests to be performed to aid in the rapid diagnosis and treatment of TS and TS associated behaviors.