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AR Thompson, SH Chen and KJ Smith
Department of Medicine, University of Washington, Seattle.
In hemophilia B, assays based on a monoclonal antifactor IX specific for
the Thr-148 variant of an exonic polymorphism have diagnosed carriers in
selected families by either establishing linkage or by indicating the
presence or absence of a given normal factor IX. The sensitivity of the
immunoassays for detecting heterozygous women was explored by comparing
results from immunoassays with solid-phase polyclonal v the monoclonal
antifactor IXs. Factor IX with the normal Ala-148 variant gave a flat
dilution curve, qualitatively distinct from factor IX with the Thr-148
variant in the monoclonal assay. The two were indistinguishable in the
polyclonal assay. Mixtures of equal amounts of the two types gave an
intermediate result, about half as reactive in the monoclonal as compared
with the polyclonal assay system. Whereas mixtures with 10% Ala-148 and 90%
Thr-148 factor IXs could not readily be distinguished from Thr-148 factor
IX plasma, as little as 1% of the Thr-148 protein was detected in Ala-148
factor IX plasma. The frequency of the Ala-148 variant varied in
individuals with different ethnic backgrounds; it was found in 29% of
white, 12% of black, and none of Asian blood donors' factor IX genes in
Seattle. Only 4% of samples from South African black men were nonreactive
(ie, Ala- 148). The Thr/Ala-148 dimorphism is in strong linkage
disequilibrium with Taql restriction fragment length polymorphisms (RFLPs).
Three recombinations were noted in normal white genes and one in a normal
black factor IX gene (less than 2% of those examined). In 34 white families
with at least one woman being a possible carrier, genetically, the
immunoassay results were informative in 18. RFLP analyses were informative
in eight of the 15 families tested. In five families each, assignment of
carrier status was made to a woman by only DNA or only immunoassay results,
whereas the other approach was noninformative. The immunoassays provide a
rapid, inexpensive screening test and complement DNA analysis in white
women who are potential carriers of hemophilia B.
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| Copyright © 1988 by American Society of Hematology Online ISSN: 1528-0020 | |||||||||