Multiple endocrine neoplasia type 1 (MEN1) is a familial cancer syndrome inherited as an autosomal dominant trait. Various heterozygous germline mutations of the responsible gene, MEN1, have been identified within its exons in many, but not all, affected individuals. We here demonstrate, by DNA polymorphism analysis and gene dosage analysis with polymerase chain reaction (PCR), a large heterozygous germline MEN1 deletion in a kindred with MEN1, in whom no mutation could be detected in the PCR-amplified exons. The deletion spanned an at least 7 kb region containing the entire MEN1 gene. These findings indicate that a large germline deletion of the MEN1 gene, which escapes detection in PCR-based sequence analysis, should be considered as a potential cause of MEN1.Key words: Multiple endocrine neoplasia type 1 -MEN1 -Tumor suppressor gene -Gene dosage -DNA testing Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant familial cancer syndrome characterized by parathyroid, enteropancreatic and pituitary tumors.1, 2) The responsible gene, MEN1, was recently identified on chromosome 11q13 by positional cloning.
3)A heterozygous MEN1 germline mutation underlies an inherited predisposition to the development of MEN1-related tumors. Although the molecular function of the encoded protein, menin, is unknown, 3) MEN1 is considered to be a tumor suppressor gene because loss of heterozygosity of the MEN1 locus frequently occurs in the MEN1-related tumors.
4)Previous studies have identified various MEN1 germline mutations within its exons in many affected individuals with MEN1.3, 5-8) Although several missense mutations and in-frame deletions have been identified, the detected germline mutations were mostly nonsense or frameshift mutations, which cause truncation of menin and, presumably, loss of function of the gene. These findings are consistent with a tumor suppressor function of this gene.The previous studies also revealed that some individuals affected with MEN1 had no detectable MEN1 germline mutation.3, 5-7) Because these studies analyzed only proteincoding exons that were amplified by polymerase chain reaction (PCR), a mutation in another region of the gene or a large heterozygous deletion could have been missed. Alternatively, some of these mutation-negative individuals could have had a distinct syndrome caused by some other gene(s) that meets the formal definition of MEN1 as suggested previously, 5) or could have had multiple independent tumors by chance in two or more MEN1-related endocrine tissues. Because identification of a MEN1 germline mutation enables presymptomatic recognition or early exclusion of this disease in individuals at risk, it is important to characterize MEN1 germline mutations which escape detection by PCRbased mutation screening.We encountered a case of familial MEN1 with three affected individuals, two of whom (Fig. 1, patients a and c) were previously analyzed and exhibited no detectable MEN1 germline mutation in the protein-coding exons.
7)We analyzed blood cell DNA of the third ...