Abstract
Tuberous sclerosis complex (TSC) is an autosomal dominant disorder characterized by the development of hamartomas localized in various tissues which can occur in the skin, brain, kidney and other organs. TSC is caused by mutations in the TSC1 and TSC2 genes. Here we report the results from the first molecular testing of 16 Bulgarian patients and one Romanian patient in whom we found six novel mutations: four in the TSC2 gene, of which one is nonsense, two frame shift and one large deletion of 16 exons; and two in the TSC1 gene, one nonsense and other frame shift. In addition, we detected 10 previously reported mutations; some of which are described only once in the literature. Our data is similar to the previous studies with exception of the larger number of TSC1 mutations than that reported in the literature data. In total, 40% (4/10) of the mutation in the TSC2 gene are located in the GTPase-activating protein domain, while 50% (3/6) are in the TSC1 gene and clustered in exon 15. All the cases represent the typical clinical symptoms and meet the clinical criteria for TSC diagnosis. In 35% of our cases the family history was positive. Our results add novel findings in the genetic heterogeneity and pathogenesis of TSC. The genetic heterogeneity might correlate to the clinical variability among the TSC-affected families, which makes the genetic counselling a real challenge.



Similar content being viewed by others
Explore related subjects
Discover the latest articles and news from researchers in related subjects, suggested using machine learning.References
Astrinidis A. and Henske E. P. 2005 Tuberous sclerosis complex: linking growth and energy signaling pathways with human disease. Oncogene 24, 7475–7481.
Astrinidis A., Cash T. P., Hunter D. S., Walker C. L., Chernoff J. and Henske E. P. 2002 Tuberin, the tuberous sclerosis complex 2 tumor suppressor gene product, regulates Rho activation, cell adhesion and migration. Oncogene 21, 8470–8476.
Au K. S., Williams A. T., Gambello M. J. and Northrup H. 2004 Molecular genetic basis of tuberous sclerosis complex: from bench to bedside. J. Child. Neurol. 19, 699–709.
Benvenuto G., Li S., Brown S. J., Braverman R., Vass W. C. and Cheadle J. P. 2000 The tuberous sclerosis-1 (TSC1) gene product hamartin suppresses cell growth and augments the expression of the TSC2 product tuberin by inhibiting its ubiquitination. Oncogene 19, 6306–6316.
Chong-Kopera H., Inoki K., Li Y., Zhu T., Garcia-Gonzalo F. R., Rosa J. L. et al. 2006 TSC1 stabilizes TSC2 by inhibiting the interaction between TSC2 and the HERC1 ubiquitin ligase. J. Biol. Chem. 281, 8313–8316.
Costa-Mattioli M. and Monteggia L. M. 2013 mTOR complexes in neurodevelopmental and neuropsychiatric disorders. Nat. Neurosci. 16, 1537–1543.
Crino P. B., Nathanson K. L. and Henske E. P. 2006 The tuberous sclerosis complex. N. Engl. J. Med. 355, 1345–1356.
Curatolo P., Bombardieri R. and Jozwiak S. 2008 Tuberous sclerosis. Lancet 372, 657–668.
Dabora S. L., Jozwiak S., Franz D. N., Roberts P. S., Nieto A., Chung J. et al. 2001 Mutational analysis in a cohort of 224 tuberous sclerosis patients indicates increased severity of TSC2, compared with TSC1, disease in multiple organs. Am. J. Hum. Genet. 68, 64–80.
European Chromosome 16 Tuberous Sclerosis Consortium. 1993 Identification and characterization of the tuberous sclerosis gene on chromosome-16. Cell 75, 1305–1315.
Hodges A. K., Li S., Maynard J., Parry L., Braverman R., Cheadle J. P. et al. 2001 Pathological mutations in TSC1 and TSC2 disrupt the interaction between hamartin and tuberin. Hum. Mol. Genet. 10, 2899–2905.
Huang J. and Manning B. D. 2008 The TSC1-TSC2 complex: a molecular switchboard controlling cell growth. Biochem. J. 412, 179–190.
Hug N., Longman D. and Cáceres J. F. 2016 Mechanism and regulation of the nonsense-mediated decay pathway. Nucleic Acids Res. 44, 1483–1495.
Jin F., Wienecke R., Xiao G. H., Maize Jr J. C., DeClue J. E. and Yeung R. S. 1996 Suppression of tumourigenicity by the wild-type tuberous sclerosis 2 (Tsc2) gene and its C-terminal region. Proc. Natl. Acad. Sci. USA 93, 9154–9159.
Jones A. C., Daniells C. E., Snell R. G., Tachataki M., Idziaszczyk S. A., Krawczak M. et al. 1997 Molecular genetic and phenotypic analysis reveals differences between TSC1 and TSC2 associated familial and sporadic tuberous sclerosis. Hum. Mol. Genet. 6, 2155–2161.
Jones A. C., Shyamsundar M. M., Thomas M. W., Maynard J., Idziaszczyk S., Tomkins S. et al. 1999 Comprehensive mutation analysis of TSC1 and TSC2-and phenotypic correlations in 150 families with tuberous sclerosis. Am. J. Hum. Genet. 64, 1305–1315.
Kozlowski P., Roberts P., Dabora S., Franz D., Bissler J., Northrup H. et al. 2007 Identification of 54 large deletions/duplications in TSC1 and TSC2 using MLPA, and genotype-phenotype correlations. Hum. Genet. 121, 389–400.
Kwiatkowski D. J., Whittemore V. H. and Thiele E. A. 2010 Tuberous sclerosis complex: genes, clinical features, and therapeutics, Wiley-Blackwell. Weinheim.
Lamb R. F., Roy C., Diefenbach T. J., Vinters H. V., Johnson M. W., Jay D. G. et al. 2000 The TSC1 tumour suppressor hamartin regulates cell adhesion through ERM proteins and the GTPase Rho. Nat. Cell. Biol. 2, 281–287.
Langkau N., Martin N., Brandt R., Zugge K., Quast S., Wiegele G. et al. 2002 TSC1 and TSC2 mutations in tuberous sclerosis, the associated phenotypes and a model to explain observed TSC1/TSC2 frequency ratios. Eur. J. Pediatr. 161, 393–402.
Luo R., Cai Q. and Mu D. 2015 A Chinese tuberous sclerosis complex family and a novel tuberous sclerosis complex-2 mutation. Chin. Med. J. (Engl). 128, 128–130.
Mayer K., Goedbloed M., van Zijl K., Nellist M. and Rott H. D. 2004 Characterisation of a novel TSC2 missense mutation in the GAP related domain associated with minimal clinical manifestations of tuberous sclerosis. J. Med. Genet. 41, e64.
Nellist M., Verhaaf B., Goedbloed M. A., Reuser A. J., van den Ouweland A. M. and Halley D. J. 2001 TSC2 missense mutations inhibit tuberin phosphorylation and prevent formation of the tuberin–hamartin complex. Hum. Mol. Genet. 10, 2889–2898.
Nellist M., Sancak O., Goedbloed M. A., Rohe C., van Netten D., Mayer K. et al. 2005 Distinct effects of single amino-acid changes to tuberin on the function of the tuberin-hamartin complex. Eur. J. Hum. Genet. 13, 59–68.
Northrup H. and Krueger D. A. 2013 International tuberous sclerosis complex consensus group. Tuberous sclerosis complex diagnostic criteria update: recommendations of the 2012 International tuberous sclerosis complex consensus conference. Pediatr. Neurol. 49, 243–254.
O’Callaghan F., Shiell A., Osborne J. and Martyn C. 1998 Prevalence of tuberous sclerosis estimated by capture-recapture analysis. Lancet 352, 318–319.
Plank T. L., Yeung R. S. and Henske E. P. 1998 Hamartin, the product of the tuberous sclerosis 1 (TSC1) gene, interacts with tuberin and appears to be localized to cytoplasmic vesicles. Cancer Res. 58, 4766–4770.
Qin J., Wang Z., Hoogeveen-Westerveld M., Shen G., Gong W., Nellist M. et al. 2016 Structural basis of the interaction between tuberous sclerosis complex 1 (TSC1) and Tre2-Bub2-Cdc16 domain family member 7 (TBC1D7). J. Biol. Chem. 291, 8591–8601.
Sampson J., Scahill S., Stephenson J., Mann L. and Connor J. 1989 Genetic aspects of tuberous sclerosis in the west of Scotland. J. Med. Genet. 26, 28–31.
Sancak O., Nellist M., Goedbloed M., Elfferich P., Wouters C., Maat-Kievit A. et al. 2005 Mutational analysis of the TSC1 and TSC2 genes in a diagnostic setting: genotype–phenotype correlations and comparison of diagnostic DNA techniques in tuberous sclerosis complex. Eur. J. Hum. Genet. 13, 731–741.
Santiago Lima A. J., Hoogeveen-Westerveld M., Nakashima A., Maat-Kievit A., van den Ouweland A., Halley D. et al. 2014 Identification of regions critical for the integrity of the TSC1-TSC2-TBC1D7 complex. PLoS One 9, e93940.
Tee A. R., Sampson J. R., Pal D. K. and Bateman J. M. 2016 The role of mTOR signalling in neurogenesis, insights from tuberous sclerosis complex. Semin. Cell Dev. Biol. 52, 12–20.
Van Slegtenhorst M., de Hoogt R., Hermans C., Nellist M., Janssen B., Verhoef S. et al. 1997 Identification of the tuberous sclerosis gene TSC1 on chromosome 9q34. Science 277, 805–808.
Acknowledgements
The authors thank the following foundations for financial support by the Medical University Sofia, Bulgaria (grant no. D-131/ 2017).
Author information
Authors and Affiliations
Corresponding author
Additional information
Corresponding editor: S. Ganesh
Rights and permissions
About this article
Cite this article
Glushkova, M., Bojinova, V., Koleva, M. et al. Molecular genetic diagnostics of tuberous sclerosis complex in Bulgaria: six novel mutations in the TSC1 and TSC2 genes. J Genet 97, 419–427 (2018). https://doi.org/10.1007/s12041-018-0927-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12041-018-0927-7


