title: Phenotypic variation in a large Swedish pedigree due to SNCA duplication and triplication.
abstract: BACKGROUND
  The "Lister family complex," an extensive Swedish family with autosomal dominant Parkinson disease, was first described by Henry Mjönes in 1949. On the basis of clinical, molecular, and genealogic findings on a Swedish and an American family branch, we provide genetic evidence that explains the parkinsonism in this extended pedigree.
  
  
  METHODS
  Clinical methods included a detailed neurologic exam of the proband of the Swedish family branch, MRI, and ([123]I)-beta-CIT SPECT imaging. Genomic analysis included alpha-synuclein sequencing, SNCA real-time PCR dosage, chromosome 4q21 microsatellite analysis, and high-resolution microarray genotyping. The geographic origin and ancestral genealogy of each pedigree were researched in the medical literature and Swedish Parish records.
  
  
  RESULTS
  The proband of the Swedish family branch presented with early dysautonomia followed by progressive parkinsonism suggestive of multiple system atrophy. Molecular analysis identified a genomic duplication of <0.9 Mb encompassing alpha-synuclein and multimerin 1 (SNCA-MMRN1), flanked by long interspersed repeat sequences (LINE L1). Microsatellite variability within the genomic interval was identical to that previously described for a Swedish American family with an alpha-synuclein triplication. Subsequent genealogic investigation suggested that both kindreds are ancestrally related to the Lister family complex.
  
  
  CONCLUSIONS
  Our findings extend clinical, genetic, and genealogical research on the Lister family complex. The genetic basis for familial parkinsonism is an SNCA-MMRN11 multiplication, but whereas SNCA-MMRN1 duplication in the Swedish proband (Branch J) leads to late-onset autonomic dysfunction and parkinsonism, SNCA-MMRN1 triplication in the Swedish American family (Branch I) leads to early-onset Parkinson disease and dementia.
authors.affiliation: Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, Center for Neurology, University of Tübingen, Tübingen, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Fuchs
authors.forename: C
authors.initials: C
authors.lastname: Nilsson
authors.forename: J
authors.initials: J
authors.lastname: Kachergus
authors.forename: M
authors.initials: M
authors.lastname: Munz
authors.forename: E-M
authors.initials: EM
authors.lastname: Larsson
authors.forename: B
authors.initials: B
authors.lastname: Schüle
authors.forename: J W
authors.initials: JW
authors.lastname: Langston
authors.forename: F A
authors.initials: FA
authors.lastname: Middleton
authors.forename: O A
authors.initials: OA
authors.lastname: Ross
authors.forename: M
authors.initials: M
authors.lastname: Hulihan
authors.forename: T
authors.initials: T
authors.lastname: Gasser
authors.forename: M J
authors.initials: MJ
authors.lastname: Farrer
mesh_terms: D000328:Adult; D000368:Aged; D000569:Americas; D001342:Autonomic Nervous System Diseases / Q000235:genetics / Q000503:physiopathology; D001798:Blood Proteins / Q000235:genetics*; D002894:Chromosomes, Human, Pair 4 / Q000235:genetics; D004252:DNA Mutational Analysis; D003704:Dementia / Q000235:genetics* / Q000503:physiopathology; D005260:Female; D018628:Gene Dosage; D005789:Genealogy and Heraldry; D020022:Genetic Predisposition to Disease / Q000235:genetics*; D005820:Genetic Testing; D006801:Humans; D008297:Male; D018895:Microsatellite Repeats / Q000235:genetics; D008875:Middle Aged; D009154:Mutation / Q000235:genetics*; D020411:Oligonucleotide Array Sequence Analysis; D020734:Parkinsonian Disorders / Q000175:diagnosis / Q000235:genetics* / Q000503:physiopathology; D010375:Pedigree; D010641:Phenotype; D013548:Sweden; D015899:Tomography, Emission-Computed, Single-Photon; D051844:alpha-Synuclein / Q000235:genetics*
chemical_list: D001798:Blood Proteins; D051844:alpha-Synuclein; C069282:multimerin