The T4-binding globulin (TBG) gene is a single copy located on the X-chromosome. Previous studies have failed to elucidate the molecular defect in individuals with complete TBG deficiency (TBG-CD). Indeed, no major deletions, insertions, or other rearrangements were observed in the TBG gene of six unrelated males with this defect. To clarify the molecular basis of TBG-CD, we have cloned and sequenced the TBG gene of an affected male (CD5) of French Canadian origin. The sequence of the exons encoding the mature protein, adjacent introns, and the promoter region revealed two nucleotide substitutions: CTA(Leu)----CCA(Pro) at codon 227 and TTG(Leu)----TTT(Phe) at codon 283. The Leu----Phe substitution, a relatively conservative replacement, is a TBG polymorphism present in 16% (3 of 19) of French Canadian males. It has no effect on the serum concentration or properties of the common type TBG (TBG-C). The new Leu----Pro substitution, which is predicted to alter the higher order of TBG structure, is probably responsible for the TBG-CD phenotype of the individual studied and two other families with TBG-CD. It possibly impairs TBG biosynthesis or secretion or perhaps alters TBG structure to such a degree that the molecule is not recognized by antibodies against native or denatured TBG and does not bind T4.

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T4-binding globulin (TBG) is a glycoprotein of hepatic origin which transports thyroid hormone in serum. Inherited TBG defects in man are X-chromosome linked and are expressed in hemizygotes as complete deficiency, partial deficiency, or excess. Since TBG is not necessary for thyroid hormone action, affected subjects are healthy. Using DNA probes for human TBG, we searched for restriction fragment length polymorphisms in six affected males belonging to 6 unrelated families with inherited complete TBG deficiency and an equal number of normal males. TBG could not be detected in the serum of any of the TBG-deficient males by a specific and sensitive RIA capable of detecting as little as 5 micrograms TBG/L or 0.031% of the average normal serum TBG concentration. DNA isolated from white blood cells was digested with 11 restriction endonucleases, and the digests were submitted to DNA blot analysis using two cloned TBG-DNA probes which together covered the entire protein coding and the 5'-flanking sequences of the TBG gene. A total of 26 different bands were detected on DNA blots, identifying 18 restriction sites located within the 4.2-kilobase TBG gene, which includes intronic, exonic, and 5'-flanking sequences. This analysis, which sampled 2.3% of the total TBG genome, failed to reveal differences in fragment size among the 6 TBG-deficient and 6 normal males examined. One restriction endonuclease (NcoI) identified normal sequences at the putative promoter region of the gene, and four other endonucleases (TaqI, SstII, MspI, and HpaII) recognized the cytosine-guanine dinucleotide phosphate sequences representing potential mutation hot spots. Although C was methylated at these sites, no C to T (thymidine) transitions were found. These data suggest that large deletions, insertions, or rearrangements of the TBG gene, or mutations at sites of methylated cytosine-guanine dinucleotide phosphate dimers are not common mechanisms for inherited complete TBG deficiency in man.

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