Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Analysis of rearrangements of the CFTR gene in patients from Turkey with CFTR-related disorders: frequent exon 2 deletion

Abstract

Cystic fibrosis is a hereditary disease that mostly affects the sweat glands, respiratory system, digestive system, and reproductive system. Many and various types of mutations have been reported in CFTR in different ethnicities and countries/regions. Analysis of CFTR gene rearrangements is recommended in patients with unidentified mutated alleles in CFTR sequencing analysis. We collected MLPA analyses of 527 patients from Turkey who had at least one unidentified mutation in CFTR sequence analysis. Heterozygous/homozygous deletions were detected in the CFTR gene in 49 individuals (9.2%) from 35 families. Twelve different single/multi exon deletions were demonstrated, two of which were not previously reported in the literature. Mutations have previously reported in patients from various regions including Asia, Europe, and Africa, and Turkey is located at a crossroads between them. The most frequent mutation was the exon 2 deletion, accounting for 60%. Moreover, patients with exon 2 deletions, were especially originated from northern Turkey. This finding is valuable in leading and shaping planned screening programs in Turkey. Our study, the most comprehensive study for rearrangement analysis in patients from Tukey, revealed a candidate hotspot region of patients suspected of having CFTR-related disorders from Turkey.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bombieri C, Claustres M, De Boeck K, Derichs N, Dodge J, Girodon E, et al. Recommendations for the classification of diseases as CFTR-related disorders. J Cyst Fibros. 2011;10:S86–102.

    Article  CAS  Google Scholar 

  2. Hamosh A, FitzSimmons SC, Macek M, Knowles MR, Rosenstein BJ, Cutting GR. Comparison of the clinical manifestations of cystic fibrosis in black and white patients. J Pediatr. 1998;132:255–9.

    Article  CAS  Google Scholar 

  3. Mak V, Zielenski J, Tsui LC, Durie P, Zini A, Martin S, et al. Proportion of cystic fibrosis gene mutations not detected by routine testing in men with obstructive azoospermia. JAMA. 1999;281:2217–24.

    Article  CAS  Google Scholar 

  4. Alper OM, Wong LJ, Young S, Pearl M, Graham S, Sherwin J, et al. Identification of novel and rare mutations in California Hispanic and African American cystic fibrosis patients. Hum Mutat. 2004;24:353.

    Article  Google Scholar 

  5. Moskowitz SM, Chmiel JF, Sternen DL, Cheng E, Gibson RL, Marshall SG, et al. Clinical practice and genetic counseling for cystic fibrosis and CFTR-related disorders. Genet Med. 2008;10:851–68.

    Article  Google Scholar 

  6. Derksen RH, Bouma BN, Kater L. The prevalence and clinical associations of the lupus anticoagulant in systemic lupus erythematosus. Scand J Rheumatol. 1987;16:185–92.

    Article  CAS  Google Scholar 

  7. Ong T, Marshall SG, Karczeski BA, et al. Cystic Fibrosis and Congenital Absence of the Vas Deferens. 2001 Mar 26 [Updated 2017 Feb 2]. GeneReviews® [Internet].

  8. Owczarzy R, Tataurov AV, Wu Y, Manthey JA, McQuisten KA, Almabrazi HG, et al. IDT SciTools: a suite for analysis and design of nucleic acid oligomers. Nucleic Acids Res. 2008;36:W163–9.

    Article  CAS  Google Scholar 

  9. Livak KJ, Schmittgen TD. Analysis of relative gene expression data using real-time quantitative PCR and the 2(-Delta Delta C(T)) method. Methods. 2001;25:402–8.

    Article  CAS  Google Scholar 

  10. Dörk T, Macek M, Mekus F, Tümmler B, Tzountzouris J, Casals T, et al. Characterization of a novel 21-kb deletion, CFTRdele2,3(21 kb), in the CFTR gene: a cystic fibrosis mutation of Slavic origin common in Central and East Europe. Hum Genet. 2000;106:259–68.

    Article  Google Scholar 

  11. Kilinç MO, Ninis VN, Dağli E, Demirkol M, Ozkinay F, Arikan Z, et al. Highest heterogeneity for cystic fibrosis: 36 mutations account for 75% of all CF chromosomes in Turkish patients. Am J Med Genet. 2002;113:250–7.

    Article  Google Scholar 

  12. Lakeman P, Gille JJ, Dankert-Roelse JE, Heijerman HG, Munck A, Iron A, et al. CFTR mutations in Turkish and North African cystic fibrosis patients in Europe: implications for screening. Genet Test. 2008;12:25–35.

    Article  CAS  Google Scholar 

  13. Onay T, Topaloglu O, Zielenski J, Gokgoz N, Kayserili H, Camcioglu Y, et al. Analysis of the CFTR gene in Turkish cystic fibrosis patients: identification of three novel mutations (3172delAC, P1013L and M1028I). Hum Genet. 1998;102:224–30.

    Article  CAS  Google Scholar 

  14. Férec C, Casals T, Chuzhanova N, Macek M, Bienvenu T, Holubova A, et al. Gross genomic rearrangements involving deletions in the CFTR gene: characterization of six new events from a large cohort of hitherto unidentified cystic fibrosis chromosomes and meta-analysis of the underlying mechanisms. Eur J Hum Genet. 2006;14:567–76.

    Article  Google Scholar 

  15. Niel F, Martin J, Dastot-Le Moal F, Costes B, Boissier B, Delattre V, et al. Rapid detection of CFTR gene rearrangements impacts on genetic counselling in cystic fibrosis. J Med Genet. 2004;41:e118.

    Article  CAS  Google Scholar 

  16. http://www.genet.sickkids.on.ca/ 2020.

  17. Indika NLR, Vidanapathirana DM, Dilanthi HW, Kularatnam GAM, Chandrasiri NDPD, Jasinge E. Phenotypic spectrum and genetic heterogeneity of cystic fibrosis in Sri Lanka. BMC Med Genet. 2019;20:89.

    Article  Google Scholar 

  18. Neocleous V, Yiallouros PK, Tanteles GA, Costi C, Moutafi M, Ioannou P, et al. Apparent homozygosity of p.Phe508del in CFTR due to a large gene deletion of exons 4-11. Case Rep Genet. 2014;2014:613863.

    PubMed  PubMed Central  Google Scholar 

  19. Chevalier-Porst F, Bonardot AM, Chazalette JP, Mathieu M, Bozon D. 40 kilobase deletion (CF 40 kb del 4-10) removes exons 4 to 10 of the cystic fibrosis transmembrane conductance regulator gene. Hum Mutat. 1998;S291-4.

  20. Alibakhshi R, Kianishirazi R, Cassiman JJ, Zamani M, Cuppens H. Analysis of the CFTR gene in Iranian cystic fibrosis patients: identification of eight novel mutations. J Cyst Fibros. 2008;7:102–9.

    Article  CAS  Google Scholar 

  21. Audrézet MP, Chen JM, Raguénès O, Chuzhanova N, Giteau K, Le Maréchal C, et al. Genomic rearrangements in the CFTR gene: extensive allelic heterogeneity and diverse mutational mechanisms. Hum Mutat. 2004;23:343–57.

    Article  Google Scholar 

  22. Atag E, Bas Ikizoglu N, Ergenekon AP, Gokdemir Y, Eralp EE, Ata P, et al. Novel mutations and deletions in cystic fibrosis in a tertiary cystic fibrosis center in Istanbul. Pediatr Pulmonol. 2019;54:743–50.

    Article  Google Scholar 

  23. Wakabayashi-Nakao K, Yu Y, Nakakuki M, Hwang TC, Ishiguro H, Sohma Y. Characterization of Δ(G970-T1122)-CFTR, the most frequent CFTR mutant identified in Japanese cystic fibrosis patients. J Physiol Sci. 2019;69:103–12.

    Article  CAS  Google Scholar 

  24. Sohn YB, Ko JM, Jang JY, Seong MW, Park SS, Suh DI, et al. Deletion of exons 16-17b of CFTR is frequently identified in Korean patients with cystic fibrosis. Eur J Med Genet. 2019;62:103681.

    Article  Google Scholar 

  25. Lerer I, Laufer-Cahana A, Rivlin JR, Augarten A, Abeliovich D. A large deletion mutation in the CFTR gene (3120+1Kbdel8.6Kb): a founder mutation in the Palestinian Arabs. Mutation in brief no. 231. Online. Hum Mutat. 1999;13:337.

    Article  CAS  Google Scholar 

  26. Faà V, Bettoli PP, Demurtas M, Zanda M, Ferri V, Cao A, et al. A new insertion/deletion of the cystic fibrosis transmembrane conductance regulator gene accounts for 3.4% of cystic fibrosis mutations in Sardinia: implications for population screening. J Mol Diagn. 2006;8:499–503.

    Article  Google Scholar 

  27. Kaplan S, Pinar G, Kaplan B, Aslantekin F, Karabulut E, Ayar B, et al. The prevalence of consanguineous marriages and affecting factors in Turkey: a national survey. J Biosoc Sci. 2016;48:616–30.

    Article  Google Scholar 

  28. Claustres M, Thèze C. des Georges M, Baux D, Girodon E, Bienvenu T, et al. CFTR-France, a national relational patient database for sharing genetic and phenotypic data associated with rare CFTR variants. Hum Mutat. 2017;38:1297–315.

    Article  CAS  Google Scholar 

  29. Chiang CWK, Marcus JH, Sidore C, Biddanda A, Al-Asadi H, Zoledziewska M, et al. Genomic history of the Sardinian population. Nat Genet. 2018;50:1426–34.

    Article  CAS  Google Scholar 

  30. Elborn JS. Cystic fibrosis. Lancet. 2016;388:2519–31.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank the staff of the Genetic Diagnostic Center of Haseki Training and Research Hospital for their collaboration and Esranur Kucuktepe for her efforts in the validation of the experiments.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

Authors

Contributions

MBD: Investigation, Formal analysis, Writing – original draft, Writing - review & editing, Project administration, Resources, and Supervision, POC: Investigation, Formal analysis, Methodology, and Writing.

Corresponding author

Correspondence to Mehmet Bugrahan Duz.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was conducted in accordance with the Declaration of Helsinki (1964) and was approved by ethics committee of Haseki Training and Research Hospital (ID:2020-76). Consent forms were obtained from all patients.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Duz, M.B., Ozyavuz Cubuk, P. Analysis of rearrangements of the CFTR gene in patients from Turkey with CFTR-related disorders: frequent exon 2 deletion. J Hum Genet 66, 315–320 (2021). https://doi.org/10.1038/s10038-020-00859-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s10038-020-00859-w

Search

Quick links