title: Distinct phenotypes distinguish the molecular classes of Angelman syndrome.
abstract: BACKGROUND
  Angelman syndrome (AS) is a severe neurobehavioural disorder caused by defects in the maternally derived imprinted domain located on 15q11-q13. Most patients acquire AS by one of five mechanisms: (1) a large interstitial deletion of 15q11-q13; (2) paternal uniparental disomy (UPD) of chromosome 15; (3) an imprinting defect (ID); (4) a mutation in the E3 ubiquitin protein ligase gene (UBE3A); or (5) unidentified mechanism(s). All classical patients from these classes exhibit four cardinal features, including severe developmental delay and/or mental retardation, profound speech impairment, a movement and balance disorder, and AS specific behaviour typified by an easily excitable personality with an inappropriately happy affect. In addition, patients can display other characteristics, including microcephaly, hypopigmentation, and seizures.
  
  
  METHODS
  We restricted the present study to 104 patients (93 families) with a classical AS phenotype. All of our patients were evaluated for 22 clinical variables including growth parameters, acquisition of motor skills, and history of seizures. In addition, molecular and cytogenetic analyses were used to assign a molecular class (I-V) to each patient for genotype-phenotype correlations.
  
  
  RESULTS
  In our patient repository, 22% of our families had normal DNA methylation analyses along 15q11-q13. Of these, 44% of sporadic patients had mutations within UBE3A, the largest percentage found to date. Our data indicate that the five molecular classes can be divided into four phenotypic groups: deletions, UPD and ID patients, UBE3A mutation patients, and subjects with unknown aetiology. Deletion patients are the most severely affected, while UPD and ID patients are the least. Differences in body mass index, head circumference, and seizure activity are the most pronounced among the classes.
  
  
  CONCLUSIONS
  Clinically, we were unable to distinguish between UPD and ID patients, suggesting that 15q11-q13 contains the only significant maternally expressed imprinted genes on chromosome 15.
authors.affiliation: R C Philips Unit and Division of Genetics, Department of Pediatrics, University of Florida, Gainesville, FL 32610-0296, USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Lossie
authors.forename: M M
authors.initials: MM
authors.lastname: Whitney
authors.forename: D
authors.initials: D
authors.lastname: Amidon
authors.forename: H J
authors.initials: HJ
authors.lastname: Dong
authors.forename: P
authors.initials: P
authors.lastname: Chen
authors.forename: D
authors.initials: D
authors.lastname: Theriaque
authors.forename: A
authors.initials: A
authors.lastname: Hutson
authors.forename: R D
authors.initials: RD
authors.lastname: Nicholls
authors.forename: R T
authors.initials: RT
authors.lastname: Zori
authors.forename: C A
authors.initials: CA
authors.lastname: Williams
authors.forename: D J
authors.initials: DJ
authors.lastname: Driscoll
mesh_terms: D000328:Adult; D017204:Angelman Syndrome / Q000145:classification* / Q000209:etiology / Q000235:genetics* / Q000503:physiopathology; D015139:Blotting, Southern; D001827:Body Height / Q000235:genetics; D015992:Body Mass Index; D002675:Child, Preschool; D002884:Chromosomes, Human, Pair 15 / Q000235:genetics*; D019175:DNA Methylation; D004252:DNA Mutational Analysis; D005260:Female; D018392:Genomic Imprinting / Q000235:genetics; D005838:Genotype; D006130:Growth Disorders / Q000235:genetics / Q000503:physiopathology; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D007805:Language Development Disorders / Q000235:genetics / Q000503:physiopathology; D008025:Ligases / Q000235:genetics*; D008297:Male; D009154:Mutation / Q000235:genetics*; D010641:Phenotype; D011110:Polymorphism, Genetic / Q000235:genetics; D011597:Psychomotor Performance; D012640:Seizures / Q000235:genetics / Q000503:physiopathology; D044767:Ubiquitin-Protein Ligases
chemical_list: C471639:UBE3A protein, human; D044767:Ubiquitin-Protein Ligases; D008025:Ligases