title: A microduplication of the long range SHH limb regulator (ZRS) is associated with triphalangeal thumb-polysyndactyly syndrome.
abstract: BACKGROUND
  Sonic hedgehog (SHH) plays an important role in defining the anterior-posterior axis in the developing limbs. A highly conserved non-coding sequence about approximately 1 Mb upstream from the sonic hedgehog gene (SHH) was shown to be a long range regulator for SHH expression in the limb bud. Point mutations within this non-coding regulatory region designated ZRS lead to ectopic expression of Shh in the anterior margin of the limb bud, as shown in mice, and cause the human triphalangeal thumb and polysyndactyly (TPT-PS) phenotype. Even though this association is well established, its molecular mechanism remains unclear.
  
  
  RESULTS
  We investigated a large pedigree with variable TPT-PS. A single nucleotide exchange within the SHH limb regulator sequence was excluded, but locus specific microsatellite marker analyses confirmed a linkage to this region. Subsequently, array comparative genomic hybridisation (array CGH) was carried out using a submegabase whole human genome tiling path bacterial artificial chromosome (BAC) array revealing a microduplication in 7q36.3 in affected individuals. A duplicated region of 588,819 bp comprising the ZRS was identified by quantitative real-time polymerase chain reaction (qPCR) and direct sequencing.
  
  
  CONCLUSIONS
  A novel microduplication in 7q36.3 results in a similar TPT-PS phenotype as caused by single nucleotide alterations in the ZRS, the limb specific SHH regulatory element. Duplications can be added to the growing list of mechanisms that cause abnormalities of long range transcriptional control.
authors.affiliation: Institut für Medizinische Genetik, Charité Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: E
authors.initials: E
authors.lastname: Klopocki
authors.forename: C-E
authors.initials: CE
authors.lastname: Ott
authors.forename: N
authors.initials: N
authors.lastname: Benatar
authors.forename: R
authors.initials: R
authors.lastname: Ullmann
authors.forename: S
authors.initials: S
authors.lastname: Mundlos
authors.forename: K
authors.initials: K
authors.lastname: Lehmann
mesh_terms: D000818:Animals; D020029:Base Pairing; D001483:Base Sequence; D019457:Chromosome Breakage; D020090:Chromosome Segregation; D002897:Chromosomes, Human, Pair 7 / Q000235:genetics; D004252:DNA Mutational Analysis; D005260:Female; D005385:Fingers / Q000002:abnormalities*; D020440:Gene Duplication; D020022:Genetic Predisposition to Disease; D053823:Hedgehog Proteins / Q000235:genetics*; D006801:Humans; D008297:Male; D051379:Mice; D008969:Molecular Sequence Data; D009693:Nucleic Acid Hybridization; D010375:Pedigree; D010641:Phenotype; D016133:Polymerase Chain Reaction; D012045:Regulatory Sequences, Nucleic Acid / Q000235:genetics*; D013576:Syndactyly / Q000235:genetics*; D013577:Syndrome
chemical_list: D053823:Hedgehog Proteins; C509239:SHH protein, human