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Hemophilia Hemophilia A is an X-linked, recessive, bleeding disorder caused by a deficiency in the activity of coagulation factor VIII. Factor VIII (F8) is the protein product of the HEMA gene, located at map position Xq28. Affected individuals have internal bleeding in joints and muscles, easy bruising, and prolonged bleeding from wounds. It affects approximately 1 in 10,000 males in most populations (a similar number of females are carriers). There are about 17,000 people presently living with hemophilia in the United States. There are no national, regional or ethnic groups known to have increased incidence. Hemophilia A is caused by hundreds of different heterogeneous mutations in the HEMA gene (base changes, insertions, deletions, inversions). This gene seems to be a hotspot for mutation. Approximately 1 out of 5 cases of hemophilia A is the result of a new mutation, rather than a mutant gene inherited from the parents. The disease shows a range of severity, which may be linked to the specific type of mutation inherited and its effect on the function of the factor VIII protein. Carrier detection and prenatal diagnosis can be done by sequencing of the entire HEMA gene, or by detection of specific mutations known to exist in a family. Therapy for the disease requires replacement of factor VIII by injection of purified protein derived from human plasma or recombinant techniques. Question: Hemophilia A is famous as a disease of the Royal families of Europe in the 19th and 20th centuries. Since hemophilia A is on the X chromosome, was there an increased risk of having a child with hemophilia in a consanguineous (same family) marriage? Will a father with the disease produce children who have it? This pedigree was created by Janet Stein Carter, Clermont College, University of Cincinnati, who retains copyright. Gene Therapy Patients with Hemophilia A now receive regular injections of purified factor VIII protein, which enables them to live nearly normal lives. However, this therapy is expensive, and carries substantial lifelong risks of infection since the protein is generally purified from donated human blood, and must be injected by the patient. A much more radical approach, that could lead to a permanent cure for the disease, is gene therapy. Adding a new copy of the HEMA gene into the liver cells of the patient The current work on gene therapy uses a virus as a “vector” to carry theraputic genes into cells in the patient’s body. Adenovirus is often chosen because it is non-lethal and can be easily manipulated using biotechnology techniques. Adenovirus is efficient at infecting human cells and can be grown in the laboratory. Adenoviruses are non-enveloped viruses containing a linear double stranded DNA genome. There are over 40 strains of adenovirus, most of which cause benign respiratory tract infections in humans. The virus does not normally integrate into the host genome, rather they replicate as episomal elements in the nucleus of the host cell. As a result, adenovirus is eliminated from the body of an infected person by the immune system after a period of time, which may range from a few days to a few months. After repeated exposure to adenovirus, a person may develop enhanced immunity, which could prevent repeated infection, or possibly lead to severe allergic reaction. The wild type adenovirus genome is approximately 35 kb, of which up to 30 kb can be replaced with foreign DNA. The most recent vectors contain only the inverted terminal repeats (ITRs) and a packaging sequence around the transgene, all of the necessary viral genes being provided by a second “helper” virus. A New Adenoviral Vector: Replacement of All Viral Coding Sequences with 28 kb of DNA Independently Expressing both Full-Length Dystrophin and B-Galactosidase S Kochanek, PR Clemens, K Mitani, H Chen, S Chan, and CT Caskey Proc Natl Acad Sci U S A. 1996 June 11; 93(12): 5731–5736. http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=39129 Your Assignment: Design a gene therapy vector that could be used to cure hemophilia A. 1) Locate the coding sequence of the human HEMA (F8) gene in an online database of the human genome (UCSC Genome Browser) 2) Locate the sequence of an adenovirus that can be used for human gene therapy 3) Design a cloning strategy using restriction enzymes and ligase that would enable you to insert the HEMA gene into the adenovirus vector. 1) Find the DNA (Nucleotide) sequence of the normal human HEMA gene. The easiest place to find a single standard sequence for the human genome is the UCSC Genome Brower: http://genome.ucsc.edu/ (see Genomes Tutorial). Go to the Genome Browser home page and click on the link to Genome Browser. Choose “human” from the genome pulldown menu, and then type “HEMA” in the text box for position, then hit the Submit button. QuickTime™ and a TIFF (LZW) decompressor are needed to see this picture. The HEMA gene shows up under the “Known Genes” heading. Click on it to go to the chromosome map. QuickTime™ and a TIFF (LZW) decompressor are needed to see this picture. QuickTime™ and a TIFF (LZW) decompressor are needed to see this picture. Questions: What chromosome is the HEMA (F8) gene on? How long is this gene? How many exons and introns does it have? The factor VIII protein is 2351 amino acids long. What makes the sequence on the chromosome so much longer? The adenovirus vector can only hold 30 kb (30,000 base pairs) of inserted DNA, so we can’t use the full genomic segment in our engineered gene therapy virus. We need to use the protein coding parts of the gene (the exons) plus some of the upstream sequence (the promoter) and some downstream sequence. Fortunately, the Genome Browser makes it quite easy to get exactly the sequence that is needed. On the RefSeq Gene page, scroll down to the “Links to Sequence” section and click on the link for “Genomic Sequence from assembly.” QuickTime™ and a TIFF (LZW) decompressor are needed to see this picture. Now there are a number of options to set up exactly what sequence you want to retrieve from the database. Check the box for “Promoter/Upstream by 1000 bases” and uncheck the box for “Introns” (this will remove all introns from the sequence that is retrieved). We also want to add 500 bases past the end of the gene, so check the box for “Downstream by 100 bases.” Also, make sure that under “Sequence Formatting Options,” the button is set to “Exons in upper case, everything else in lower case.” Then hit the “submit” button. You will get a screen full of DNA sequence. Save this sequence to a word processing file. Note that the first 1000 bases are in lower case, then several thousand uppercase bases, and finally 1000 bases in lowercase at the end. It is within these two lowercase sections that you wish to find restriction enzyme recognition sites. QuickTime™ and a TIFF (LZW) decompressor are needed to see this picture. >hg16_refGene_NM_000132 range=chrX:152532711-152674280 5'pad=0 3'pad=0 revComp=TRUE strand=caccatggctacattctgatgtaaagagatatatcctatacctgggccaa atgtaaacagcctggcaaaagtgttaggttaaaaacaaaacaaaataaat aaatgaataaatgccaggtggttatgagtgctattgagaaaaatgaagcc aagagggatatcagtgatgcaggtgggggtaaagagcttacaacataaat gtggtgttccatatttaaacctcattcaacagggaagattggagctgaaa tgtgaaggagttgtgggagtggaactacgtggaaatctgggggaaaggtg ttttgggtaaaagaaatagcaagtgttgaggtccaggggcatgagtgtgc ttgatattttagggaagagtaaggagaccagtataaccagagtgagatga gactacagaggtcaggagaaagggcatgcagaccatgtgggatgctctag gacctaggccatggtaaagatgtagggttttaccctgatggaggtcagaa gccattgaaggattctgagaagaggagtgacaggactcgctttatagttt taaattataactataaattatagtttttaaaacaatagttgcctaacctc atgttatatgtaaaactacagttttaaaaactataaattcctcatactgg cagcagtgtgaggggcaagggcaaaagcagagagactaacaggttgctgg ttactcttgctagtgcaagtgaattctagaatcttcgacaacatccagaa cttctcttgctgctgccactcaggaagagggttggagtaggctaggaata ggagcacaaattaaagctcctgttcactttgacttctccatccctctcct cctttccttaaaggttctgattaaagcagacttatgcccctactgctctc agaagtgaatgggttaagtttagcagcctcccttttgctacttcagttct tcctgtggctgcttcccactgataaaaaggaagcaatcctatcggttact GCTTAGTGCTGAGCACATCCAGTGGGTAAAGTTCCTTAAAATGCTCTGCA AAGAAATTGGGACTTTTCATTAAATCAGAAATTTTACTTTTTTCCCCTCC TGGGAGCTAAAGATATTTTAGAGAAGAATTAACCTTTTGCTTCTCCAGTT GAACATTTGTAGCAATAAGTCATGCAAATAGAGCTCTCCACCTGCTTCTT TCTGTGCCTTTTGCGATTCTGCTTTAGTGCCACCAGAAGATACTACCTGG GTGCAGTGGAACTGTCATGGGACTATATGCAAAGTGATCTCGGTGAGCTG CCTGTGGACGCAAGATTTCCTCCTAGAGTGCCAAAATCTTTTCCATTCAA CACCTCAGTCGTGTACAAAAAGACTCTGTTTGTAGAATTCACGGATCACC TTTTCAACATCGCTAAGCCAAGGCCACCCTGGATGGGTCTGCTAGGTCCT ACCATCCAGGCTGAGGTTTATGATACAGTGGTCATTACACTTAAGAACAT GGCTTCCCATCCTGTCAGTCTTCATGCTGTTGGTGTATCCTACTGGAAAG CTTCTGAGGGAGCTGAATATGATGATCAGACCAGTCAAAGGGAGAAAGAA GATGATAAAGTCTTCCCTGGTGGAAGCCATACATATGTCTGGCAGGTCCT GAAAGAGAATGGTCCAATGGCCTCTGACCCACTGTGCCTTACCTACTCAT ATCTTTCTCATGTGGACCTGGTAAAAGACTTGAATTCAGGCCTCATTGGA GCCCTACTAGTATGTAGAGAAGGGAGTCTGGCCAAGGAAAAGACACAGAC CTTGCACAAATTTATACTACTTTTTGCTGTATTTGATGAAGGGAAAAGTT GGCACTCAGAAACAAAGAACTCCTTGATGCAGGATAGGGATGCTGCATCT . . . (~9,000 bases) . . taaaacaaataggggcactgaatagcaagatggacactctagaaaaccaa attagtgagttagaaaaccagattaaattgaactcagagtaaaaatgata taattcatgagagtctgaataaaataaatcagaaatggag 2) Download from GenBank (the NCBI website) the sequence of an adenovirus vector used in recent gene therapy work. Stratagene, a private company that provides supplies to biological researchers, sells an adenovirus vector that has been specially designed for easy cloning, called AdEasy. You can look it up in GenBank and directly download the sequence (AF334399). Just go to the GenBank website: http://www.ncbi.nlm.nih.gov/, Set the Search pulldown menu to “Nucleotide” and type in “AdEasy” in the Search text box at the top of the page. QuickTime™ and a TIFF (LZW) decompressor are needed to see this picture. Change the “Display” pulldown menu to FASTA and hit the Display button. Copy the AF334399 sequence to a text file on your computer. 3) Find restriction sites that can be used to clone the HEMA gene into the AdEasy virus Strategene has made Adenovirus cloning experiments quite easy by creating a Multiple Cloning Site (MCS) in their AdEasy vector. This is a short stretch of DNA sequence that contains several restriction enzyme sites, which do not occur anywhere else in the vector (unique sites). So if you cut the vector with any one of these enzymes (or any combination of two of them), the vector will open up and you can attach another DNA fragment to the sticky ends. [This may seem like cheating, but this is the way that almost all molecular biologists actually work.] So your job becomes relatively simple – find a restriction site at each end of the HEMA gene that is compatible with a site in the MCS of the AdEasy vector. However, you need to find an enzyme that cuts the HEMA gene only once, in the desired location, and nowhere else, since you can’t clone the gene if it is cut into bits. The enzyme sites in the MCS are: Kpn I, Not I, Xho I, Xba I, Eco RV, Hind III, Sal I, and Bgl II. QuickTime™ and a TIFF (LZW) decompressor are needed to see this picture. Also, each of these enzymes produces a sticky end that is compatible with sticky ends produced by several other enzymes. New England Biolabs (a commercial producer of restriction enzymes) has created a nice table of compatible sticky ends on their website: http://www.neb.com/nebecomm/tech_reference/restriction_enzymes/ compatible_cohesive_overhangs.asp For example, XbaI ends are compatible with ends cut by Avr II, Nhe I, Spe I, and Sty I. Also, note that EcoRV produces a “blunt end” with no sticky overhang. Any blunt end can be joined to any other blunt end. So any two enzymes that produce blunt ends are compatible. These are not included in the NEB table of compatible cohesive ends, but they are listed here: http://rebase.neb.com/cgi-bin/bluntlist Use the NEBCutter restriction enzyme tool to find restriction sites that are near the ends of the DNA fragment containing the coding sequence for the HEMA gene. Paste the entire sequence into the text box on the NEBcutter web page, then hit the submit button. http://tools.neb.com/NEBcutter2/ QuickTime™ and a TIFF (LZW) decompressor are needed to see this picture. Look for enzyme sites near the ends of the sequence. We want to include most of the 1000 bases of upstream sequence, since this has the promoter, and at least 500 bp of downstream sequence as a “terminator” in the sequence that is inserted into the virus vector. We want to find restriction enzymes that are compatible with the cloning sites in the adenovirus vector. Also, we want enzymes that cut at the ends, but not anywhere else in the HEMA sequence – its no good if we cut our gene into bits when we are trying to clone it into the vector. The results display in the NEB cutter has an option to show a list of “1 cutters.” These are enzymes that cut the sequence only one time. QuickTime™ and a TIFF (LZW) decompressor are needed to see this picture. You can work backward from the enzymes listed as 1 cutters. Find enzymes that cut near the ends, check if they are on the list of enzymes in the MCS, or if they form sticky ends compatible with an enzyme in the MCS. If you click on each enzyme in the NEBcutter display, it will take you to a page that shows what type of sticky end it produces and a list of other enzymes that create compatible ends. Remember to also check for enzymes that make blunt ends that can be joined with the Eco RV site in the AdEasy vector. If you can’t find a suitable enzyme site at one end of the HEMA gene, go back to the Genome Browser and extend the sequence by adding more bases to the Upstream or Downstream ends. Questions 1) What enzymes did you use to cut the HEMA gene? Where do these enzymes cut? Show a map of your sequence with the enzyme sites that you will use for cloning. 2) How long is the fragment you will be inserting into the vector? 3) Some researchers have found that the Adenovirus vector works best if it has exactly 30 kb inserted. How might you increase the size of the inserted fragment to 30 kb? What are the risks of this plan? 4) Once you have cut and ligated the HEMA gene into the AdEasy vector, how will you test this construct before you inject it into humans? 5) This engineered adenovirus is supposed to produce coagulation factor VIII. What cells in the human body normally produce this protein? Design a hypothetical experiment to test the ability of your gene therapy vector to produce factor 8 in these cells.