1 dr pupak derakhshandeh, phd ass prof of medical science of tehran university sma spinal muscular...
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Dr Pupak Derakhshandeh, PhD
Ass Prof of Medical Science of Tehran University
SMA SMA
SPINAL MUSCULAR SPINAL MUSCULAR ATROPHYATROPHY
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Mutation Detection &Mutation Detection &PNDPND
--ThalassemiaThalassemia// --ThalassemiaThalassemia••HaemophiliaHaemophilia (A / B)(A / B)••HbDHbD, G, E, S, G, E, S••DMD/BMDDMD/BMD••SMA(ISMA(I--III)III)••CF; CF; ……
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DELETION OF SMN AND NAIP GENES IN IRANIAN PATIENTS
WITH SPINAL MUSCULAR ATROPHY
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SMAGene: SMN (Survival Motor Neuron)Motor Neuron; Anterior Horn; Spinal CordSecond most common fatal autosomal recessive disorder after CFSecond most common pediatric neuromuscular disorder after DMDIncidence : 1 in 6000-10000 live birthsCarrier frequency : 1 in 40-60
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CLASSIFICATIONSMA TYPE I (Werdnig-Hoffmann)
SMA TYPE II (Classic)
SMA TYPE III (Kugelberg-Welander)
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SMA TYPE ISevere form of SMA
Onset : first 6 months
Death : < 2 year
Never raising the head or sitting
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SMA TYPE IILess sever
Clinical appearing : < 18 months
Able to sit unaid
Death : about 9 years
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SMA TYPE III
Mildest form of SMA
Onset : > 18 months
Walking without aid
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OTHER CLASSIFICATION
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DIAGNOSIS
EMG
Muscle Biopsy
Genetic Testing/PND
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GENETICS1990: The three types of SMA were mapped to 5q13
The SMA locus contain two inverted copies of a 500kb element
The two copies named telomeric and centromeric
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GENETIC MAP
Three candidate genes named SMN (Survival Motor Neuron), NAIP (Neuronal Apoptosis Inhibitory Protein) and P44 were identified in this locus
Up to 95% of SMA patients (SMNI-III) are homozygously deleted for two exons (7&8) of both telomeric copy of SMN gene (SMNt)
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DeletionsUp to 5% of SMA patients have frameshift mutations, gene conversions and point mutation
Exons 5 and 6 of NAIPt gene are deleted in approximately 50% of type I SMA and 18% of types II and III SMA
P44t is lacked or intrrupted in 73% of
SMA type I patients and 7% in types II and III
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The summery of normal alleles (N) , mutant alleles (M) and deletion types (D) of SMN
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MOLECULAR DIAGNOSIS & PND
PCR-SSCP or PCR-RFLP of SMN gene enables confirmation of a suspected clinical diagnosis of SMA or prenatal diagnosis
These two techniques based on nucleotide differences of both exon 7 and exon 8 of telomeric and centromeric copy of SMN
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Deletion Analysis of SMN gene
Exones 7 and 8 of SMN gene were amplified and cut by Dra I and Dde I , respectively. (only centromeric copy is cutted)
Absence of SMNt exone(s) 7 (and 8) confirm diagnosis of SMA
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188 bp
164 bp
188 bp
123 bp
65 bp
Exon 7, DraI
Exon 8, DdeI
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SMN Deletion AnalysisSMN Deletion Analysis
SMNt Exon 7 is deleted in affected child
Derakhshandeh-Peykar, et al. Annal Acad Med, 2007Derakhshandeh-Peykar, et al. Annal Acad Med, 2007(Depart Med Gen & NRCGEB)
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NAIP Gene Deletion Analysis
Exones 5 & 6 of NAIP gene were amplified with exon 13 which was the internal control
Absence of exon 5 and exon 6 ( which only exist within the telomeric functional copy of NAIP) was detected in ~50% of type I SMA and 18% of types II and III SMA
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NAIP Deletion analysis
Derakhshandeh-Peykar, et al. Annal Acad Med, 2007Derakhshandeh-Peykar, et al. Annal Acad Med, 2007(Depart Med Gen & NRCGEB)
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The objective of this study was to genetically characterize the childhood onset
spinal muscular atrophy in Iran.
SMN NAIPDeletion of exon 7 &
8Deletion of exon 5 &
6
SMA type I (n=70) 70(100%) 61(87%)SMA type II (n=3) 2(66%) 1(33%)
SMA type III (n=2) 1(50%) 0(0%)
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Various deletion haplotypes were constructed by using genotypes of SMN and NAIP genes.
Haplotype A, which has the deletions of all two involved genes, were deleted in approximately 83% of type I and II SMA but not in type III and was found predominantly in the severe group with an early onset at less than 6 month of age.we report Thirty four our experiences for prenatal diagnosis
Haplotypes (%)A B C
SMA type I (n=70)
87 100 0
SMA type II (n=3)
33 66 33
SMA type III (n=2)
0 50 50
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These studies suggested that the frequency of gene deletions of SMN1 and NAIP gene is a few higher than previous reports. It is may be due to high rate of consanguine marriage by Iranian Muslims (96 % in this families). Thus, the conformation of SMA related gene deletion will also be a useful tool for the pre and postnatal diagnostic. In addition to common PCR methods for SMN exon 7 and 8 and NAIP exons 4 and 5, we also conducted multiplex PCR of exon 5, 6 and 13 of the NAIP telomere in one reaction.
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Derakhshandeh Esmaiili Rahmani Babrzadeh Taeb Attaran Sajedifar Farhud