deafness. Mutations in the COL4A5 gene encoding the Type IV collagen a5 chain ... a5 chain protein. Key Words: A/port syndrome. glomerular basement mem- brane. ...... in a5(N) collagen chain gene converting a conserved cysteine to serine in ... a4(IV) collagen genes in autosomal recessive. Alport syndrome. Nature.
Mutation in a5(IV) Collagen Nonfamilial Hematuria1
Chain
Kousaku
Kitagawa,
lijima,
Yoshikazu
Sado,
Koichi Hajime
Nakanishi,
Kazumoto
Nakamura,
and
Norishige
K. Kitagawa, K. Nakanishi, K. lijima, H. Nishio, K. Sano, H. Nakamura, N. Yoshikawa, Department of Pediatrics, Kobe University School of Medicine, Kobe, Japan V. Sado, Japan
Shigei
(J. Am.
Soc.
Medical
Nephrol.
Research 1995;
Institute,
Okayama.
ABSTRACT Alport syndrome is an inherited disorder characterized by progressive nephritis with ultrastructural baschanges
membrane the COL4A5
and neurosensory gene encoding
of
the
glomerular
basement
deafness. Mutations the Type IV collagen
chain have been reported to occur In patients X-linked Alport syndrome. A girl with hematuric phritis, characteristic basket-weave glomerular
codon
in
that would domain
229, amino tion
acid
enzyme
be expected with
AflIll
only
to result
209, instead
residues.
Gene
tracking
demonstrated
that
her
mother
base-
restnicwas
normal. These findings represent a new mutation of the X-linked Alport syndrome in this patient and demonstrate that a COL4A5 gene mutation causes the abnormal expression of Type IV collagen a5 chain protein. Key Words:
A/port
brane. COL4A5. ment gel
syndrome. deletion
glomerular
and
mutation
basement detection
ally
presents
Kimihiko
Sano,
syndrome is a familial disorder that generruns a progressive course ( 1 ). It usually as hematuria in childhood and is associated
neurosensory
deafness.
Characteristic
alter-
enclosing electron-lucent lacunae, which frequently contain small, dense particles. When diffuse, these changes are diagnostic of Alport syndrome (5). A widespread basket-weave pattern of the GBM has also been observed in patients with hematuria who have no family history of nephritis, and it has been suggested that such GBM changes in patients with nonfamilial hematuria may represent new mutations of
nal
normal
with
lport
with
ne-
in a noncolofthe
A
the
(C; nucleotide 4728 from the 5’ end) in exon 50. This novel mutation alters the frame and introduces a translation stop
lagenous
Nishio,
Yoshikawa2
a5 with
ment membrane changes, and abnormal expression of the Type IV collagen a5 chain immunohistochemically, but no family history of nephritis, was identified. Mutation detection enhancement gel electrophoresis of the polymerase chain reaction-amplified exons of COL4A5 from this patient revealed a sequence vanant in the exon 50 region. Sequence analysis of her polymerase chain reaction product demonstrated a single-base deletion reading
Hisahide
in
ations of the glomerular basement membrane (GBM) are observed on electron microscopy (2-4). The GBM shows irregular thickening with replication of the lamina densa, forming a “basket-weave” pattern and
6:264-268)
ket-weave
Gene
memenhance-
Alport
syndrome
disease.
and
(6-8).
syndrome
Alport
is a genetically
X-hinked
autosomal
heterogeneous
dominant,
recessive
autosomal
modes
re-
dominant,
of inheritance
have
been reported (9-1 1 ). However, the majority of published Alport pedigrees show X-linked dominant inheritance (10). The characteristic GBM alterations in patients with this syndrome suggest that the defect is expressed in
one of the abnormalities
structural in
components
of the
GBM,
and
Type IV collagen have been in its pathogenesls. This Type IV of six a chains ( 1 2). Mutations In
the
heavily implicated collagen is composed the Type IV collagen a5 chain gene (COL4A5) have been reported in patients with X-hinked Alport syndrome ( 13, 14), and our recent immunohistochemical study showed abnormal expression of the Type IV collagen a5 chain in such patients ( 15). In this study, we observed similar abnormal expression of the Type IV collagen ce5 chain in a girl with nonfamilial hematuna
and
Analysis
patient tion
tion
of
widespread the 3’
end
basket-weave of the COL4A5
GBM changes. gene in this
revealed a novel, single-base deletion mutain exon 50. However, gene tracking with restricenzyme AfilIl demonstrated that her mother was
normal. mutation demonstrate
abnormal protein.
These findings of the X-linked
that expression
in this
patient
indicate
a new
Alport syndrome. The results a COL4A5 gene mutation causes of the Type IV collagen a5 chain
METHODS ReceIved October 10, 1994. Accepted 2 correspondence to Dr. N. Yoshikawa, 5chool
of Medicine,
7-Kusunlki-cho,
January 2, 1995. Departmentof Pediatrics,
chuo-ku,
Kobe,
650 Japan.
1046.6673/0602-0264$03.00/0 Journal of the American society of Nephrology copyright C 1995 by the American Society of Nephrology
264
Kobe
UnIversity
Patient Patient
Y.O.
was
an
1 1 -yr-old
Japanese
girl
referred
for
evaluation of hematuria and proteinuria. At the age of 1 .9 yr, she presented with macroscopic hematuria associated with
Volume
6
.
Number
2
.
1995
Kitagawa
upper respiratory and proteinuria maturia associated of 1 1 , her blood tigations
infection and fever. Microscopic hematuria had been persistent. and macroscopic hewith fever had been recurrent. At the age pressure was normal and laboratory inves-
showed
teinuria gram
(0.5 and
persistent
microscopic
g/day) and ophthalmologic
Percutaneous Light microscopy
renal
and revealed
normal skin
hematuria
and
pro-
renal function. Her audioexamination were normal.
biopsy specimens minor glomerular
were taken. abnormalities
with small foci of tubular atrophy. electron microscopy showed a widespread basket-weave pattern of the GBM (Figure 1 ), and immunofluorescence microscopy demonstrated negative ghomerular staining for immunoglobulin (Ig)G. IgA, IgM. Clq, C4, C3, and fibrinogen. The patient’s 14-yr-old brother, 40-yr-old father. and 36-yr-old mother had no signs of renal disease or deafness, and their urinalysis
was
normal.
There
disease on the paternal was no family history
was
no
apparent
or maternal of consanguinity.
history
sides
of the
of the
family.
Indirect Immunofluorescence. were snap-frozen in a dry ice and into
4-sm
5 mm, Kidney
There
air
and rinsed and skin
three tissue
dried,
fixed
and bath.
in 95%
skin
tissues
They
ethanol
were
cut
at 4#{176}C for
times with PBS at room temperature. sections for immunostaining with primary antibody against the Type IV collagen aS chain were denatured in 6 M urea-0. 1 M glycine HC1 buffer (pH 3.5) at 4#{176}C for 1 h ( 18) and then washed three times with PBS before reacting with primary antibody. The sections were stained by an Indirect method with the primary antibodies against the cr3, cr4, and cr5 chains. After reaction for 45 mm at room temperature, secondary antibodies, fluorescein isothlocyanate-conjugated goat IF(ab’)21 anti-rat IgG, and fluorescein isothiocyanate-conjugated goat IF(ab’)21 anti-mouse IgG (Organon
ondary The
renal
sections,
Kidney acetone
et al
Teknika-Cappel,
antibodies sections were
flecting
DNA
Durham,
were diluted viewed with (Olympus
microscope
NC)
were
added.
to 1 :60 with PBS before an Olympus BH2-RFCA Optical Co. , Tokyo. Japan).
Sec-
use. re-
Analysis
Pathology Electron
Microscopy.
The
portion
of
tissue
for
electron
microscopy was fixed in phosphate-buffered 5% ghutaraldehyde for 2 h and postflxed for 1 h in 2% osmium tetroxide. It was subsequently processed through graded alcohol and embedded in Epon 8 1 2 resin. Ultrathin sections were cut on a LKB ultramicrotome, stained with uranyl acetate and lead citrate, and examined with a JEM- 100S electron microscope (JEOL, Tokyo. Japan). Two glomeruhi were examined. Antibodies. Mouse monoclonal antibody against the Type IV collagen a3 chain NC 1 (mAb 1 7) ( 1 6) was kindly provided by Dr. J. Wieslander (Statens Seruminstitut, Copenhagen, Denmark). Monoclonal antibody against the Type IV collagen cr4 chain
vided
NC 1 (mAb85)
by Dr.
R. J. Butkowski
( 1 6). Monoclonal chain
antibody
NC 1 peptide
a derived SKPQSE) buffered
obtained
(H5
from
(University
against
1 ) was
made
the by
mice
was
kindly
of Minnesota, Type IV collagen immunizing
rats
pro-
MN) cr5
with
nonconsensus amino acid sequence (VDVSDMF( 1 7). mAb85 was diluted to 1 :20 with phosphatesaline (PBS) immunohistochemlcal study. The other
antibodies
were
not
diluted
for
immunohistochemical
study.
DNA Extraction and Polymerase Chain Reaction. Genomic DNA was extracted from peripheral blood leukocytes, as described by Sambrook et al. ( 19). The concentration of the extracted DNA was adjusted to 50 ng/.cL and used as template for polymerase chain reaction (PCR) amphification of the exon 47, 48, 49, 50, and 5 1 regions of COL4A5. The following oligonucleoticie primers were synthesized for the intron sequence adjacent to the exon. according to published sequence data (20-22). Exon 47. F;(5’-GTCCAGATGGATFGCAAGGTC-3’) R;(5’-Tl’CGAATFCCAGTAGGAAATFAGATAT-3’) Exon
48.
F;(5’-CTFTACTGT’ITFCTCTCC-3’) R;(5’-GTCACAGCTAAATCAATGCC-3’)
Exon
49.
F;(5’-GACTCTAGAAAGGCCATTGCACTGGTF-3’) R;(5’-GACAAATGCAAGGAAGAGTG-3’)
Exon
50.
F;(5’-GCGGCACATTTTTCCTFGTC-3’) R;(5’-GGACCTGAATTAAAGCTATAAGCA-3’) Exon 51. F;(5’-TGTCTTATTTCTTATTTCCC-3’)
R;(5’-CAATGAGACACTGCATCCTAGGA-3’) Amplification
5pm
.
Figure 1 Electron micrograph of renal biopsy specimen Patient Y.O. A widespread basket-weave pattern ofthe was present (original magnification, x5,000).
Journal
of the American
Society
of Nephrology
from GBM
was
performed
with
50
ng
of genomic
DNA
template, 25 pmol of each primer, 10 nmol of each deoxyribonucleoside 5’-triphosphate (Takara Shuzo Co. , Otsu, Japan), and 0.5 U of AmpliTaq DNA polymerase (Perkin-Elmer Cetus, Norwalk, CT) under buffered conditions ( 10 mM TrisHC1IpH 8.31, 50 mM KC1, 2.0 mM MgCl2, 0.01% gelatin) in a total volume of25 pL. Forty cycles of94#{176}Cfor 1 mm, 45#{176}C for 2 mm, and 72#{176}C for 3 mm were carried out. Heteroduplex Analysis in Mutation Detection Enhancement Gel. The PCR products from the patient and from five normal control subjects (males) were combined to form heteroduphexes, heated to 95#{176}C,and slowly cooled to room temperature. Electrophoresis of the PCR products of exon 50 in mutation detection enhancement (MDE) gel (AT Biochem Inc., Malvern, PA) (40 cm long and 1 mm thick) was performed for 24 to 30 h at 800 V. and the DNA fragments were visualized under ultraviolet illumination after staining with ethidium bromide. DNA Sequence. The fragment from Patient Y.O. was separated on a 1% agarose gel, purified with Gene Clean II Kit (BIO 101 Inc., CA), and ligated into pT7Blue Vector (NOVA-
265
Mutation
COL4A5
GEN,
Madison,
in Nonfamilial
WI), and
transformation
Hematuria
the ligation
of competent were isolated
taming clones ALF DNA Sequencer II (Pharmacia den) with an AutoRead Sequencing and the sequences were analyzed software
(International
product
was
used
for the
XL 1 -Blue cells. Six insert-conand sequenced on an automated
Biotechnologies
Biotech, Uppsala, SweKit (Pharmacia Blotech), with MacVector Ver.4. 1.4 Inc. , New Haven, CT).
Family Tracking. For family tracking, PCR-amphified DNA from the patient and her mother were digested with restriction enzyme AflIII (Gibco BRL, Galthersburg, MD) and electrophoresed on a 3% agarose gel.
RESULTS Indirect lagen cr3, the
immunofluorescence study of Type IV colin the patient showed segmental distributions of cr4, and cr5 chains in the GBM (Figure 2A) and of cr5 chain in the epidermal basement membrane
(Figure 3A). Examination from the patient’s mother
of a skin revealed
tion of the a5 chain brane (Figure 3B). The PCR products
epidermal
in the
biopsy a diffuse basement
specimen distribumem-
flanking exons 47 to 5 1 obtained from the patient and five healthy male controls were analyzed by 3% agarose gel electrophoresis, which showed that the apparent sizes of the amplified products of each exon were the same In all six subjects (data not shown). These results demonstrated that the putative mutations probably did not involve large
deletions mutations,
These further
or
Insertions, or
changes
PCR products by screening
but
small
inversions,
of only a few nucleotides. of each exon were
for
mutations
by
point analyzed
heteroduplex
5Otm 3. Skin biopsy specimens stained with anti-a5(IV) antibody, from Patient V.0. (A) and her mother (B). Segmental binding of anti-a5(lV) antibody to the epidermal basement membrane of the patient’s skin (A) was observed. Note the normal binding areas (black arrow) and the areas with no binding (white arrow) in the epidermal basement membrane. Diffuse linear binding of the anti-a5(lV) antibody to Figure
the epidermal mother’s skin
basement (B) was
membrane
observed
(black
(original
arrow)
of the
magnification,
x410).
in the MDE gel. For exons 47, 48, 49, and 51, the heteroduplex DNA samples from the controls and patient yielded single bands of the same size (data not shown). Analysis ofexon 50 suggested the presence of a mutation in the patient (Figure 4). The five controls showed single bands of 228 base pairs (bp), but Patient Y.O. showed two bands. The band intensity of analysis
the slower moving heteroduplex DNA caused by the conformational difference was approximately onethird that of the faster moving homoduplex DNA. The PCR product from the patient was characterized further by DNA sequencing, which showed a singlebase (C; nucleotide 4728) deletion in the 3’ end of exon 50. This deletion changes the reading frame and introduces a premature stop codon (TGA) 29 bp downstream of the mutation, resulting in a message for a truncated Type IV collagen cr5 molecule lacking part of the NC domain (Figure 5). Of six clones isolated, two showed the wild-type and four showed the mutanttype sequence, indicating that the patient was heterozygous for the mutation in exon 50.
Yo
Figure 2. Glomerulus, stained with anti-cr5(lV) antibody, of Patient V.0. (A) and a differential interference micrograph of the same section (B) for spatial clarity. Glomerulus, stained with anti-cr5(IV) antibody, ofa normal control (C). Segmental linear binding of anti-cr5(lV) antibody to the patient’s GBM (A) was observed. Diffuse linear binding of the anti-a5(IV) antibody to the GBM ofthe normal control (C) was observed (original magnification, x250).
266
M
1
2
3
4
5
Figure 4. MDE gel analysis of exon 50 regIon PCR products. Lane YO, DNA derived from Patient V.0.; Lanes 1 to 5, DNA from normal controls. Patient V.0. showed two bands, whereas the five controls showed single bands.
Volume
#{243}Number ‘
2
.
1995
Kitagawa
et al
V Wild type
Mutant type
4714
GTA
GAT
GTG
TCA
GAC
ATG
TTC
AGT
AAA
CCT
CAG
TCA
GAA
ACG
CTG
AAA
GCA
GGA
1572
V
D
V
S
D
M
F
S
K
P
Q
S
E
T
L
K
A
C
4768
GAC
TTG
AGG
ACA
CGA
ATT
AGC
CGA
TGT
CAA
GTG
TGC
ATG
AAG
AGG
ACT
TAA
1590
D
L
R
T
R
I
S
R
C
Q
V
C
M
K
R
T
4714
GTA
CAT
CTC
TCA
GAA
TGT
TCA
CTA
AAC
CTC
ACT
CAC
AAA
CCC
TGA
1572
V
D
V
S
E
C
S
V
N
L
S
Q
K
R
Figure 5. Nucleotide sequence of the COL4A5 gene and the deduced amino acid sequence of the Type IV collagen cr5 chain of Patient V.0. *The TGA stop codon introduced by the frameshift. The monoclonal antibody against the Type IV collagen cr5 chain recognized the underlined amino acid sequence. The single-base deletion (C; nucleotide 4728) is indicated by an arrowhead.
When controls (restriction
the was
amplified
DNA
digested site;
(228
with
bp)
from
restriction
A/CATGT),
two
the
five
enzyme
fragments
AflIll
( 189
and
39 bp) were produced, and the 189-bp fragments were detected by 3% agarose gel electrophoresis. When the patient’s amplified DNA was subjected to this treatment. an undigested 227-bp band appeared, as a result of the missing MLIII restriction site caused by the change from ACATGT to AATGT at the deletion point, in addition to the normal 189-bp fragment. The patient’s mother had only the normal 189-bp fragment;
DNA
could
not
samples
from
other
members
of the
family
be obtained.
DISCUSSION We have hematuria basket-weave
reported the cases of several who were characterized by
nephritis,
a tendency
course,
pattern frequent
ness,
and
suspected tions of
of the
GBM,
to show
that Alport
of
severe
born
infants
new may
mutants occur
in
deaf-
boys
(8).
We
these patients represented syndrome. GrUnfeld (9) with GBM changes suggestive
genetic transmission the basis of population
Kallen
disease
neurosensory
prognosis
10-yr-old girl syndrome, although she had of renal disease. Eleven years an infant girl with hematuria, developed renal failure. This
and
a progressive
occurrence
a more
no
children with a widespread family history of
(23)
example
of
nephritls dynamic
suggested
that
with
in
new mutadescribed a of Alport a negative family history later, she gave birth to and 2 yr after that, she
the
Alport
suggests occurred.
had calculations,
up
to 18%
Shaw
of all
genotype may cases of Alport
and isolated the absence
of
other
that On
affected
new-
represent
syndrome family
Patient
IV
normal
and
examination widespread Is characteristic abnormal
did not appear to have Alport syndrome of her family had nephritis. However, of her renal biopsy specimen revealed a basket-weave pattern of the GBM, which of this syndrome (8). She also showed
expression
was
identical
served In patients with The Type IV collagen
of the American
of the
to the
Type IV collagen cr5 chain, abnormal expression ob-
X-linked
Aiport
syndrome
cr5 chain-producing
Society
of Nephrology
(15).
cells
in
with
active
have cr5
a mixture chains.
which
syndrome may active abnormal X chromosome
Consequently,
such
is female Type
of normal and abnormal Our patient’s mother showed
of the we
Alport or an
on (24).
expression
therefore,
X-hinked normal
depending
inactivated
collagen
Type
IV collagen
cr5 chain,
represent a Alport syndrome. The reconfirmed this possibility.
suspected
that
this
may
mutation of X-linked sults obtained in this study Analysis of the 3’ end of her COL4A5 new
gene identified a novel single-base deletion mutation in exon 50. Gene tracking with restriction enzyme AflIII revealed that her mother was normal. The patient was a heterozygote of the mutant and wild-type alleles. We were unable to examine her father’s DNA, but his urinalysis results were normal, and It is, therefore, unlikely that he has the COL4A5 gene mutation. Mutations have been described in four patients without any family history of Alport syndrome (25-27). We identified a single-base (C; nucleotide 4728) deletion in exon 50 of Patient Y.O. This mutation, which has not been reported before, can be considered causal for the disease in this patient. This mutation alters the reading frame, introduces a translation stop codon TGA (nucleotides 4756 to 4758) after amino
acid
1585, and would be expected to result in a shortened translated sequence, leading to the formation of a Type IV collagen cr5 chain containing only 1585 amino acids instead of 1605 (Figure 5). This
would mean an NC domain the normal 229, amino acid study
Y.O. none
gene,
randomly patients
Y.O.
because
Journal
COL4A5
postulate
members.
which
female patients have either an
is
provided
with
a monoclonal
showed
abnormal
by
with
only
residues. the
209,
Support
instead of for this
immunohistochemical
antibody, Type
in which Patient collagen cr5 chain anti-Type IV collagen cr5 IV
expression. This monoclonal chain antibody was raised by immunizing rats with a peptide containing a nonconsensus amino acid sequence, VDVSDMFSKPQSE ( 1572 to 1584) (Figure 5). Our results demonstrate that a COL4A5 gene mutation
causes
gen
cr5 chain
would defects
abnormal expression of the Type IV collaprotein. This abnormally short cr5 chain be expected to cause structural and functional in the Type N collagen molecule and, there-
267
Mutation
COL4A5
fore,
In the
essential
for
helix
before
in Nonfamilial
GBM the
network. correct
formation
molecular the Type
cross-links IV collagen COL4A5 gene mutation Ding et at. (29).
Hematuria
The NC domain is probably alignment of three a chains and for the formation of inter(28). Abnormal expression of cr5 chain in a patient with a has also been reported by
Patient Y.O. showed abnormal expression of the Type IV collagen cr3 and cr4 chains. A defect ofthe Type Iv collagen cr5 chain leads to defects of the a3 and cr4 chains in the GBM. Ding et al. (29) and Antignac et al. (25) also documented abnormal expression ofthe Type IV collagen cr3 and cr4 chains in patients with COL4A5 gene mutations. The mechanism responsible for the Type IV collagen cr3 and cr4 chain defects in patients with the COL4A5 gene mutation has been discussed by Kashtan et al. (30) and Reeders (3 1), but remains to be established. Mutation in the Type IV collagen cr5 chain may result In defective molecular assembly with subsequent proteolysis of the cr3 and cr4 chains or in defective synthesis through some unknown effects on
transcription
translation (31). et a!. (32) reported mutations in the Type IV collagen cr3 and cr4 chain genes in autosomal recessive Alport syndrome. In autosomal recessive Alport syndrome, patients’ parents were Mochizuki
asymptomatic of X-linked
and their phenotype was similar to that Alport syndrome. The significant differences between autosomal recessive and X-linked Alport syndrome are the presence of consanguinity and
of disease
decade
of life
in
affected
In autosomal
females
recessive
in
Alport
the
by a grant and
for
WeLfare
Progressive project
research
first
syndrome.
Renal for
Dlsease Specially
REFERENCES 1 . Alport AC: Hereditary familial congenital haemorrhagic nephritls. BMJ 1927; 1:504-506. 2. Hinglais N, Gr#{252}nfeld JP, Bois E: Characteristic ultrastructural
lesion
of the
glomerular
basement
membrane
hereditary nephritls (Alport’s syndrome). Lab Invest 1972;27:473-487. 3. Spear GS, Slusser RJ: Alport’s syndrome. Emphasizing electron microscopic studies of the glomerulus. Am In
progressive
Pathol
J
1972;69:213-224.
4. Churg J. Sherman RI: Pathologic characteristics of hereditary nephritis. Arch Pathol 1973;95:374-379. 5. Yoshikawa N, Cameron AR, White RH: The glomerular basal hamina in hereditary nephritis. J Pathol 1981; 135: 199-209. 6. Yoshikawa N, White RH, Cameron MI: Familial hematuna; chinico-pathologlcal correlations. Chin Nephrol 1982;
17:172-182.
7. Habib drome:
R, Gubler Experience
2lISuppl
MC, Hinglais at Hospital
N, et Necker.
at.: Alport’s Kidney Int
Pediatr
1987;!
14.
15.
16.
17.
18.
spectrum Kidney Int
H, Matsuo glomerular of herednephritis. J
of hereditary 1985;27:83-92.
nephri-
JP:
smooth Barker
E. Chompret
Genetic
A, Broyer
heterogeneity
muscle tumors. DF, Hostikka
M, Gubler
of Alport
MC,
syndrome.
hereditary Kleppel Michael
nephritis. MM, Santi A!: Human
20.
SL,
1993;26
1:1167-1169.
J,
Kidney Int PA, Cameron
1994;46: JD,
1413-1421. Wieslander
J,
tissue distribution of novel basement membrane collagen. Am J Pathol 1989; 134:813-825. Yoshioka K, Hino S, Takemura T, et al.: Type N collagen cr5 chain: Normal distribution and abnormalities in X-llnked Alport syndrome revealed by monoclonal antibody. Am J Pathol 1994;144:986-996. Yoshioka K, Michael AF, Velosa J, Fish AJ: Detection of renal 1985;
19.
Science Zhou
et aL: Identification of mutations in the COL4A5 collagen gene in Alport syndrome. Science 1990;248: 1224-1227. Tryggvason K, Zhou J, Hostikka SL, Shows TB: Molecular genetics of Alport syndrome. Kidney Int 1993;43: 38-44. Nakanishi K, Yoshikawa N, lijima K, et at.: Immunohistochemical study of al-5 chains of type IV collagen In
hidden
nephrltogenic
antigen
and nonrenal 121: 156-165.
Sambrook J, In: A Laboratory
determinants
basement
Fntsch
EF,
in
membranes.
Maniatis
human
Am J Pathol
T: Molecular
Cloning.
Manual 2nd Ed. New York: Cold Spring Harbor Laboratory; 1989:9.16-9.19. Zhou J, Hostikka SL, Chow LT, Tryggvason K: Characterization of the 3’ half of the human type N collagen aS gene that Is affected in the Alport syndrome. Genomics ;9: 1-9.
2 1 . Zhou J, Barker DF, Hostikka SL, Gregory MC, Atkin CL, Tryggvason K: Single base mutation in a5(N) collagen chain gene converting a conserved cysteine to serine in Alport syndrome. Genomics 199 1 9:10-18. 22. Nomura 5, Osawa G, Sal T, Harano T, Harano K: A splicing mutation In the a5(N) collagen gene of a family with Alport’s syndrome. Kidney Int 1993;43: 1116-1124. 23. Shaw RS, Kallen RJ: Population genetics of Alport’s syndrome. Hypothesis ofabnormal segregation and the necessary existence of mutation. Nephron 1976; 16:427-432. 24. Kashtan CE, Fish AJ. Kieppel MM, Yoshioka K, Michael AF: Nephrltogenic antigen determinants in epidermal and renal basement membranes of kindreds with Alporttype familial nephritis. J Chin Invest 1986;78: 10351044. 25. Antignac C, KnebeLmann B, Drouot L, et at: Deletions in the COL4A5 collagen gene in X-linked Alport syndrome. J Clin Invest 1994;93: 119S-1207. 26. Netzer KO, Renders L, Zhou J, Pullig 0, Tryggvason K, Weber M: Deletions of the COL4A5 gene in patients with iMport syndrome. Kidney Int 1992;42: 1336-1344. 27. RenieriA, Sen M, Myers JC, et aL: De novo mutation in the COL4A5 gene converting glycine-325 to glutamic acid in Alport syndrome. Hum Mol Genet 1992; 1:127-129. 28. Hudson BG, Reeders ST. Tryggvason K: Type N collagen: Structure, gene organization and role in human disease. Molecular basis of Goodpasture and Alport syndromes and diffuse lelomyomatosis. J Biol Chem 1993;268:26033-26036. 29. Ding J, Zhou J, Tryggavason K, Kashtan CE: COL4A5 deletions in three patients with Alport syndrome and posttransplant antiglomerular basement membrane ne-
syn-
1982;
11:519-524.
9. Grunfeld JP: The clinical tis [clinical conferencel.
268
13.
phritls.
30.
111:520-528.
8. Yoshlkawa N, Matsuyama 5, Ito H, Hajikano T: Nonfamihial hematuria associated with basement membrane alterations characteristic itary nephritis: Comparison with hereditary
J, Bois
Grfinfeld
1991
ACKNOWLEDGMENTS This work was supported from the Ministry of Health selected diseases.
Feingold
Kidney Int 1985;27:672-677. 1 1 . Atkin CL, Gregory MC, Border WA: Alport syndrome. In: Schrier RW, Gottschalk CW, Eds. Diseases of the Kidney. 4th Ed. Boston: Little Brown; 1988:617-641. 12. Zhou J, Mochizuki T, Smeets H, et at.: Deletion of the paired a5(IV) and cr6(IV) collagen genes in inherited
and/or
Recently,
severity
10.
Kashtan Fish AJ: collagen.
3 1 . Reeders 32.
J Am CE,
Soc Nephrol Kieppel MM,
Alport
syndrome,
Pediatr
Nephrol
ST:
1994;5: Butkowski
16 1-168. RJ,
basement
Michael
AF.
membranes
and
1990;4:523-532.
Molecular
genetics of hereditary nephritls [clinical conferencel. Kidney Int 1992;42:783-792. Mochizuki T, Lemmink HH, Mariyama M, et at.: Identification of mutations in the cr3(N) and a4(IV) collagen genes in autosomal recessive Alport syndrome. Nature Genet 1994;8:77-82.
Volume
6
-
Number
2
1995
#{149}
