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Copyright is owned by the Author of the thesis. Permission is given for a copy to be downloaded by an individual for the purpose of research and private study only. The thesis may not be reproduced elsewhere without the permission of the Author. Molecular Genetic Analysis for Malignant Hyperthermia A presented to Massey University in partial fulfilment of the requirements for the degree of Master of Science in Biochemistry Keisaku Sato 2004 ACKNOWLEDGEMENTS I especially would like to thank my supervisor, Dr. Kathryn Stowell for her help, advise and patience during my project. M s. Robyn MaL ton helped me for some sample preparations and I obtained many ideas and protocols for experimen tal designs from Dr. Rosemary Brown, although I have never seen her yet ... I would also like 10 thank all members al the Twilight Zone. I have never had any di fficulties or problems in the relationship with them. When I was having trouble and hard time. they were very kind and welcomed me warmly. I love the warm-hearted atmosphere in this laboratory. Finally. I have to than k my mother who always understands and accepts me. ABSTRACT M alignant hyperthermia (MH) is a rare pharmacogenetic disorder in humans caused by inhalational general anaesthetics and depolarising muscle relaxants. An MH reaction shows abnormal calcium homeostasis in skeletal muscle lead ing to a hypermetabolic state and increased muscle contracture. A mutation w ithin the calcium release channel ryanodine receptor of. keletal muscle (RYR I) is one of the causes of MH leading to the abnormally high release of calcium ions into the cytosol during MH reactions. The MH reaction can also be triggered by excess exercise. hea t and stress. A New Zealand male. identified as M 8 I 8, showed a fulminant MH reac tion which resu lted in death. The reaction was caused by exerci. e. and he did not have a family history of MH. As this individual did not have any of the mutations within RYR I found 10 date in New Zealand families. the entire RYRI cDNA was screened for a novel mutation that may result in susceptibility to exercise- induced MH. This patien t may have had a novel RYR I mutation because exercise- induced MH is quite rare. Screening of this gene. however did not identify any mutations within RYR I, suggesting that the M 8 18 patient may have a mutation in another gene because Ml-I is a heterogeneous disorder w ith 40-50% of fam ilies showing linkage to alternati ve loci. Heterogeneity of M H can re. ult in discordance between genotype and phenotype. So me Ml-I susceptible patients do not have a RYR I mutation that is found in other individuals w ith the same kindred. One or more other genes could be associated with M H for these individuals al though alternati ve loci have not been studied in New Zealand fami lies . A genome-wide scan was performed to search for other candidate loc i using a large M l-I kindred known as the CH family w ithin which discordance has been observed. Non-parametric linkage analysis across all chromosomes identified five weak linkages from one branch, and two strong linkages from another branch of the CH family. Secondary linkage analysis was performed on one candidate locus identified in the genome-wide scan, and a weak linkage and recombination was observed within the shorter region. No candidate genes with obvious relevance to calcium homeostasis or signalling were identified w ithin this region. The existence of alternative causative loci in this fami ly cannot be ruled out however, because the loci identified from the genome-w ide scan are very large and contain many genes of unknown function. ABBREVIATIONS A absorbance ATP adenosine triphosphate bp base pair CCD central core di sease cDNA co mpl ementary DNA cM centimorga n 4-CmC 4-chloro-m-cresol C-terminal carboxy terminal DEPC diethyl pyrocarbonate DHPR dihydropyridine receptor DNase deoxyribonuclease DMSO dimethyl su lphox ide d TPs dinucleotide triphosphate EC excitation-co ntraction EDTA ethylene diamine tetra-acetate HEPES -l2-hydroxyethyl]piperazine-N' -[ 4-butanesulphonic acid] IVCT in vitro contracture test kb kilobase MH mali gnant hyperthermia MHE malignant hyperthermia equivocal (European protocol) MHN malignant hyperthermia negative (European protocol) MHS malignant hyperthermia susceptible (European protocol) MH+ malignant hyperthermia positive (North American protocol) MH malignant hyperthermia negative (North American protocol) mRNA messenger RNA II MOPS 3-[N-morpholino]propanesulphonic acid NPL non-parametric linkage N-terminal amino terminal oligo(dT) oli godeoxythymidine pC02 carbon dioxide pressure PCR polymerase chain reaction PCr phos phocreati ne Pi in orga ni c phosphorus 3 1PNMR phos phorus-3 1 nucl ear magnetic resonance RFLP res tri ction fragment length pol ymorphi sm R ase ribonuclease RT reverse transcri ptase RT-PCR reverse transc riptase-polymerase chain reaction RYR rya nod ine receptor SIDS sudden infant death syndrome SR sarco pl as mi c reti culum SSCP sin gle stranded co nformational polymorphi sm TAE Tris-acetate-EDTA buffer Taq Therm,us aquaticus TBE Tri s-borate-EDTA buffer TE Tris-EDTA buffer Tm melting temperature Tris tris (hydroxymethyl ) ami nomethane T-tubule transverse tubule UV ultraviolet li ght VNTR variable number of tandem repeat pol ymorphism Ill LIST OF FIGURES Page Figure 1- 1 The excitation-contraction pathway of skeletal muscle 5 Figure 1-2 Proposed mechanism for induction of malignant hyperthermia 7 Figure 1-3 A linear representation of location of RYRI mutations 14 Figure 2- 1 Typical PCR amplification curves 29 Figure 2-2 Concepts of quantificati on using external standard samples 30 Fi gure 3- 1 Quality check of genomic D A 4 1 Figure 3-2 Detection of CACNA IS mutations 42 Figure 3-3 R A electrophoresis -+-+ Figure 3-4 Strategy for the amplification of RYR I cDNA 45 Figure 3-5 PCR products for RYR I screening 47 Figure 3-6 Detection of the Tyrl 006 polymorphism 49 Figure 3-7 The position of polymorphisms found in M8 I 8 cDNA 49 Fi gure 3-8 Detection of the sequencing error A 1832G 50 Fi gure 3-9 A lignment of sequences from severa l species 5 1 Figu re -+- I Principle of linkage analys is 5-+ Figure -+-2 The CH family members selected for the genome-wide scan 60 Figure 4-3 A standard curve used for real-time quantification PCR 6 1 Figure 4-4 DNA quantification using a standard curve 62 Figure 4-5 M elting curve analy is 62 Figure 4-6 A genome-wide scan for the CH fam ily 69 Figure 4-7 Candidate loci iclenti fied from the EA branch 7 1 Figure 4-8 A candidate gene on chromosome 16 71 Figure 4-9 Candidate loci on chromosome 6 and 12 73 Figure 5-1 The EA family used for secondary linkage analysis 76 Figure 5-2 Amplification of microsatellite marker loci 79 Figure 5-3 Genotyping using GeneMapper Software 80 IV Fi gure 5-4 Secondary linkage anal ys is on chromosome 16p1 2 82 Figure 5-5 Haplotype of the EA fa mil y on chro mosome 16pl 2 83 LIST OF TABLES Page Tabl e 1-1 Selected RYRJ and CACNA 1S mutati ons 13 Table 2- 1 Typical co nditi ons of PCR therm al cycl es 2 1 Tabl e 2-2 Typical reacti on components fo r PCR 22 Tab le 2-3 The reacti on components fo r Li ghtCycler quantifica ti on 31 Tab le 2-4 The th erm al cyc les fo r Li ghtCycler qu antifi cati on 32 Tab le 2-5 The therm al cycles fo r mi crosatelli te marker analysis 35 Table 2-6 Settin gs fo r linkage analys is 38 Table 3-1 Concent ra ti ons and th e A2601180 ra ti os of ex trac ted RNA samples 44 Table 3-2 PCR and seq uencin g primers fo r screenin g of RYR I cDNA 46 Tabl e 3-3 Polymorphi sms fo un d from RYR 1 cDN A of M8 I 8 48 Table 4-1 Algorithm s and res tricti ons of linkage analys is progra mmes 57 Table 4-2 Factors influencin g co mputati on time 57 Tab le 4-3 The A26011so rat ios and concent rations of 26 indi vid uals 63 Table 4-4 An example of genotyping data 64 Tabl e 4-5 An example of haplotype and all ele frequency 65 Tabl e 4-6 Statu s of indi viduals of the EA branch 70 Table 4-7 Statu s of indi vidu als of the ES branch 72 Tabl e 4-8 Statu s of indi viduals of the TAME branch 74 Tabl e 5-1 Statu s of indi viduals used fo r th e secondary linkage analys is 77 Table 5-2 Microsatellite markers used fo r the second ary linkage analys is 78 Tabl e 5-3 The A26012 so rati os and concentrati ons of additional indi viduals 79 Table 5-4 Primers for CACNG3 screenin g 85 V Table 6-1 The IVCT result of the CH family 92 Table 6-2 Numbers of each disease status in three branches 93 TABLE OF CONTENTS Page Abstract l Abb revi ati011s ll List o/j1gures /l' List o/tables CHAPTER ONE : INTRODUCTION 1.1 Overview of Malignant Hyperthermia 1 I. I. I Introduction 1 1.1.2 Historr 1 1.1.3 Clinical srn1ptoms 2 1.1.4 Triggering agents 2 1.1.5 Mmwgement and treatment 3 1.2 Pathophysiology of MH 3 1.2.J Introduction 3 1.2.2 Excitation-contraction coupling 4 1.2.3 Dihydropyridine receptor 4 1.2.4 Ryanodine receptor 6 1.2.5 The proposed mechanisrn <~f'MH reactions 6 VI 1.3 Diagnosis of MH 7 1.3.