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Supplementary Methods DNA preparation Biological specimens for the preparation of genomic DNA samples were obtained from one or several of the following sources: fresh whole blood; mononuclear cells found at the plasma/histopaque gradient interface after centrifugation of whole blood through a Histopaque1077 (Sigma) gradient or through a Leuco Prep cell separation tube (Becton-Dickinson), and cryopreserved in 10% dimethyl sulfoxide in liquid nitrogen; granulocytes, obtained from the layer that lies on the packed red cells after centrifugation of whole blood through a Histopaque1077 gradient or through a Leuco Prep tube and subsequently frozen in liquid nitrogen without preservative; cultured FCLs; and, cultured LCLs. DNA samples from a small number of registered persons were generously provided by cooperating geneticists. DNA samples were prepared using the DNAzol extraction method (Molecular Research Center, Inc.) or the PUREGENE kit (Gentra Systems, Inc.) according to the manufacturer’s instructions. The phenolchloroform extraction method was used to prepare some of the DNA samples, as described in German et al., 1994. Methods of mutation analysis Analysis by reverse transcription PCR (RT-PCR). The coding region of the BLM mRNA was divided into five overlapping DNA fragments (Supplementary Table S2A). First-strand 1 DNA synthesis was performed using 20 g of RNA isolated from BS cell lines. The RNA was incubated with RNAse inhibitor in 2x RT buffer (Life Technologies), 10 mM dithiothrietol, 0.5 mM dNTPs, 10 g/ml oligoT or hexanucleotides (Boehringer Mannheim) as primers, and 400 units of reverse transcriptase (Life Technologies, Inc) at 42 oC for 1 hr followed by heat inactivation at 70 oC for 10 min. A minus RT reaction was added as a control for the subsequent PCR steps. PCR was then carried out with each of the five pairs of oligonucleotide primers (Supplementary Table S2A). One l of copy DNA products was amplified in 1X PCR reaction buffer (Boehringer Mannheim) containing 0.25 M of each oligonucleotide primer, 0.2 mM dNTPs, and 2.5 units of Taq polymerase (Boehringer Mannheim) in a 50 l reaction volume. PCR consisted of 20 cycles of 94 oC for 1 min, 55 oC for 1 min, and 72 oC for 1 min, with a final incubation at 72 oC for 7 min. The amplification products were analyzed by agarose gel electrophoresis. DNA fragments that exhibited abnormal migration relative to fragments obtained by RT-PCR of mRNA from normal cells were excised from the agarose gel, reamplified, and subjected to direct DNA sequencing in order to identify changes that could explain the abnormal migration, such as exon mis-splicing. Subsequently, Southern blot analysis, direct sequence analysis of genomic DNA, or both analyses were performed to determine the genetic basis of the mRNA abnormality as described below. DNA fragments generated by RTPCR that exhibited normal migration based on agarose gel electrophoresis were subjected further to mutational analysis by either a nonisotopic RNAseA mismatch cleavage assay, the protein truncation test, or both. Nonisotopic RNAseA mismatch cleavage assay. First-strand copy DNA synthesis and the first round of PCR was performed using RT as described above, and this reaction was followed by PCR using nested oligonucleotide primers. The internal pair of primers included T7 and SP6 2 RNA polymerase transcription initiation sequences attached to the 5’ end of the forward and reverse oligonucleotide primers, respectively. The PCR was performed as described above, and products were divided into two separate RNA transcription reactions using the T7 and SP6 RNA polymerases. Two l of PCR product were incubated at 37 oC for 1 hr in a 10 l volume containing 1X Transcription Buffer (Promega), 0.5 mM NTPs, and 2 units of either T7 or SP6 RNA polymerase. For each fragment of BLM, a T7-generated RNA from a BS cell line was mixed with an SP6-generated RNA from a normal cell line and an SP6-generated RNA from a BS cell line was mixed with a T7-generated RNA from a normal cell line. The two RNAs were hybridized by combining empirically optimized volumes of “mutant” and “normal” transcription reactions, and “normal” and “normal” transcription reactions as a control, heating the mix to 95 o C for 3 min, and cooling at room temperature for 30 min. The heteroduplexes were treated with a mixture of RNAses under three different digestion conditions using the Mismatch Detect Point Mutation Screening Kit (Ambion, Inc.) according to the manufacturers’ instructions. The products generated by RNAse cleavage were separated by electrophoresis through 1% agarose gels containing 0.05 mg/ml ethidium bromide and visualized by ultraviolet light. RNAse digestions of heteroduplexes were compared to the control homoduplexes prepared by mixing RNAs generated from the normal cell line. RNA fragments with abnormal mobilities were identified as possible mutations. The estimated size of the abnormal RNA fragment was used to predict the site of RNAse cleavage, and therefore the site of the mutation. Direct DNA sequencing of the RT-PCR fragment and of the appropriately selected exon in genomic DNA was performed to identify the putative mutation. Protein truncation test (PTT). The coding region of the BLM mRNA was divided into three overlapping DNA fragments (Supplementary Table S2B). 3 First-strand copy DNA synthesis was performed and again followed by PCR using a nested PCR strategy. The internal pair of primers included a T7 RNA polymerase transcription initiation sequence and an in-frame initiator methionine codon attached to the 5’ end of the forward oligonucleotide primer. RNA transcription and protein translation in the presence of 35 S-methionine (New England Nuclear) were carried out using a Novagen Single Tube System 2 kit according to the manufacturer’s instructions. In vitro synthesized protein products were analyzed by SDS-PAGE and autoradioagraphy. Proteins produced using BS cell line mRNAs were compared to proteins produced using normal cell line mRNA. Protein products of faster-than-normal mobility were identified. The estimated size of the abnormal protein product was used to predict the site of premature termination, and therefore the site of the mutation. Direct DNA sequencing of the RT-PCR fragment and of the appropriately selected exon in genomic DNA were performed to identify the putative mutation. Denaturing-high performance liquid chromatography (D-HPLC) analysis. Each of the 22 exons of BLM was amplified by PCR using oligonucleotide primers that flanked each exon (Supplementary Table S3). Exons 3 and 7 were too large to analyze by D-HPLC as a single exon; consequently, these exons were analyzed as two overlapping PCR fragments. Approximately 50 bp of up- and downstream DNA sequences were included in each PCR fragment to ensure that putative mutations in the splice-site regions were not missed by their presence in the easily melted sequences at the end of the fragment. PCR amplification was carried out in buffer II (Applied Biosystems, Inc.) containing 2 mM MgCl2, 0.2 mM each oligonucleotide primer, 0.2 mM dNTPs, 25 ng genomic DNA, and 1.25 units AmpliTaq Gold (Applied Biosystems, Inc.) in a 50 l reaction volume. PCR amplification consisted of 1 cycle of 94 oC for 10 minutes; followed by 1 cycle at the annealing temperature (see Supplementary 4 Table S3) for 45 seconds and 72 oC for 1 minute; followed by 35 cycles of 94 oC for 30 seconds, annealing for 54 seconds, and 72 oC for 1 minute; and finishing with 1 cycle of 72 oC for 7 minutes. Heteroduplex DNA molecules were formed by heating the DNA at 95 oC for 5 min and cooling at 1 oC per min for 30 min. D-HPLC analysis relies on the presence of normal and mutated DNA sequences so that heteroduplex DNAs can be formed in the population of molecules to be analyzed. Consequently, because it was not known beforehand in most cases whether or not a person was a genetic compound, we added an equal amount of amplified normal DNA to the amplified BS DNA to ensure that heteroduplex DNA products would be produced in the heteroduplexing step. This procedure was validated with DNA samples containing known BLM mutations in both the homozygous and heterozygous state to show that mutations could be detected under either condition. DNA fragments were subjected to chromatography using conditions determined by Wavemaker software (Transgenomic, Inc.) and a range of melting temperatures (Supplementary Table S3). Fragments that displayed an abnormal chromatograph in comparison to a normal, non-variant fragment were subjected to DNA sequencing. DNA sequencing. PCR amplification was performed for each of the BLM exons or for selected BLM exons. Amplified DNA fragments were prepared for sequencing by column purification (Qiagen) or by centrifugation through a Chromaspin 100 column (Clontech) followed by ethanol precipitation. The DNA fragment was quantified by agarose gel electrophoresis and sequenced either by cycle sequencing with Taq polymerase and BigDye Terminator reaction mixes (Applied Biosystems, Inc.) followed by electrophoretic analysis on an ABI377 sequencer as described [Ellis et al., 2001] or by “manual” sequencing as originally described [Ellis et al., 1995a]. 5 Southern blot analysis. Two to 10 g of genomic DNA were digested with EcoRI or BamHI and the DNA fragments were separated by electrophoresis through 0.8% agarose gels in 89 mM Tris, 89 mM boric acid, and 2 mM EDTA. The DNA was transferred to Hybond N+ nylon membrane (Amersham). Hybridization was performed as previously described [German et al., 1994] with the full-length BLM cDNA H1-5’ [Ellis et al., 1995a]. Three of the four large deletions identified were further characterized by long-range PCR followed by DNA sequencing to identify the breakpoints of the deletion. For one deletion, which included the deletion of sequences outside the BLM gene, this analysis was unsuccessful. Supplementary Figure Legend Figure S1. Northern blot analysis of mRNAs derived from selected Bloom’s syndrome cell lines. The BLM cDNA H1-5’ was radioactively labeled with 32P and hybridized to 20 micrograms of polyA-purified mRNA from the indicated cell lines. The BLM mRNA appears as a 4.5 kb major form and a 4.3 kb minor form. The cell lines HG1321, HG1805, HG2709, HG1440, HG1542, HG1544, and HG1547 are low-SCE Bloom’s syndrome lymphoblastoid cells. The cell lines HG1304, HG1309, HG14335, HG1431, HG2118, HG2508, HG1374, HG1348, and HG1783 are Bloom’s syndrome fibroblasts, all presumed to be high-SCE. See Supplementary Table S1 for further details on these cell lines. HG2608 is a normal lymphoblastoid cell, and HG2635 is a normal fibroblast line. The levels of BLM mRNA in fibroblasts are lower than in lymphoblastoid cells. To control for Northern blot loading and mRNA quality, the blot was probed with a labeled cDNA derived from the glucose-3-phosphate dehydrogenase gene. One preparation of RNA 6 from the normal fibroblast HG2635 (indicated by the dash) was poor quality and no signal from the BLM mRNA was detected. Supplementary Reference Passarge E. 1991. Bloom's syndrome: the German experience. Ann Genet 34:179-97. 7 Supplementary Table S1. Cell lines used in the mutational analysis of persons with Bloom’s syndrome. Cell line BSR IDa HG46 HG149 HG369 HG1013 HG1052g HG1179 HG1232 HG1289 HG1304 HG1309 HG1321h HG1348 HG1374 HG1431 HG1440h HG1435 HG1514 HG1525 HG1542g HG1544g HG1547h HG1584 HG1619 HG1624 HG1626 HG1647 HG1742 HG1751j HG1782 HG1783 HG1785 HG1805l HG1824 HG1926 HG1929 HG1947 HG1972m HG1974 BSR3 BSR5 BSR26 BSR71 BSR50 BSR6 BSR44 BSR20 BSR59 BSR86 BSR59 BSR31 BSR128 BSR87 BSR87 BSR54 BSR15 BSR81 BSR11 BSR11 BSR11 BSR92 BSR27 BSR113 BSR93 BSR32 BSR107 BSR126 BSR110 BSR129 BSR100 BSR86 BSR169 BSR97 BSR17 BSR53 BSR140 BSR121 Cell Typeb SCE ratec Northernd FCL FCL FCL FCL LCL FCL FCL FCL FCL FCL LCL FCL FCL FCL LCL FCL LCL LCL LCL LCL LCL LCL LCL LCL LCL FCL LCL LCL FCL FCL LCL LCL FCL LCL FCL LCL LCL LCL – – – + – Low High High High High Low High High Low Low Low High – – – + +/– – +/– + +/– – – + + + –i High High + –i High Low High + – – + – – – Low Low High Mutation 1e Mutation 2 e blmAsh c.2098C>T blmAsh c.1544_1545dupA blmAsh c.2923delC blmAsh del exon 15f c.2098C>T c.1544_1545dupA c.2098C>T c.960-2A>G c.557_559delCAA blmAsh blmAsh blmAsh blmAsh c.1784C>A blmAsh c.2098C>T c.3261delT c.2254C>T del exons 20-22f c.2923delC blmAsh c.2923delC del exons 11-12f blmAsh c.3164G>C c.1544_1545dupA blmAsh blmAsh blmAsh c.557_559delCAA c.1544_1545dupA c.1544_1545dupA c.1544_1545dupA c.1933C>T c.557_559delCAA c.1968_1969dupG blmAsh c.1544_1545dupA c.2015A>G c.557_559delCAA c.3163T>G c.2672G>A blmAsh c.1784C>A c.1933C>T c.1933C>T c.1933C>T del exons 11-12f blmAsh c.3164G>C c.1544_1545dupA blmAsh blmAsh c.98+1G>Tk c.557_559delCAA c.1544_1545dupA c.557_559delCAA c.1933C>T c.557_559delCAA c.1968_1969dupG blmAsh + blmAsh 8 blmAsh HG1987j BSR30 LCL Low + c.2695C>T c.3028delG HG1992 BSR133 FCL – c.1933C>T c.1933C>T g HG2045 BSR111 LCL Low + c.2695C>T del exons 11-12f g HG2118 BSR65 LCL Low + c.2488_2489dupA c.3681delA c.1933C>T HG2122 BSR61 LCL c.1933C>T g Ash HG2166 BSR26 LCL Low + blm c.3261delT l HG2169 BSR40 LCL Low + c.2702G>A HG2193 BSR170 LCL High – c.1933C>T c.3261delT HG2225 BSR22 LCL – c.3261delT c.3261delT i HG2231 BSR139 LCL + c.2015A>G c.3163T>C HG2252 BSR80 FCL +/– c.3164G>C c.311C>A HG2508 BSR105 FCL – c.1933C>T c.2725C>T HG2510 BSR112 LCL High – c.814A>T c.1220+3A>Gn HG2522o BSR42 FCL High – blmAsh blmAsh HG2703 BSR171 LCL High –i blmAsh blmAsh h Ash HG2709 BSR54 LCL Low + blm HG2721 BSR177 LCL Low + c.1933C>T c.2695C>T HG2726 BSR70 FCL HG2820 BSR142 LCL High –i blmAsh blmAsh HG2829 BSR98 LCL High + c.1090A>T c.1701G>A HG2830 BSR51 LCL High – c.2098C>T c.2098C>T HG2896 BSR191 FCL – c.2695C>T c.2695C>T HG2912 BSR193 LCL – c.2250_2251insAAAT c.3261delT HG2915 BSR197 LCL c.3197G>A blmAsh HG2917 BSR175 LCL – HG2940 BSR232 FCL c.582delT c.582delT a Bloom’s Syndrome Registry designation of the person from whom the cell line(s) was established. b FCL, fibroblast cell line; LCL, lymphoblastoid cell line. c The rate of sister-chromatid exchanges (SCEs) is indicated for those cell lines for which cytogenetic information was available. Low indicates that the average numbers of SCE per metaphase was <15; High indicates that the average numbers of SCE per metaphase was >35. The majority of FCLs were not tested (blanks in the column), because each of the FCLs studied to date has exhibited a high level of SCEs; consequently, it is assumed that all FCLs employed here have a high-SCE phenotype. Certain of the LCLs, however, have a low-SCE phenotype. The two genetic mechanisms responsible for the low-SCE LCLs are somatic intragenic recombination, which was described in Ellis et al. 1995b, and back mutation, which was described in Ellis et al. 2001. The arrangement of mutations in low-SCE cell lines was inferred from molecular haplotype and mutational analyses, as indicated in footnotes g and h. d Summary of the results of Northern blot analyses performed on RNA samples prepared from the different cell lines. A plus sign (+) indicates that the signal from the mRNA detected in the BS cell line was 50% or more of the signal detected in the RNA from a normal cell line. A minus sign (–) indicates that the signal from the mRNA detected in the BS cell line was less than 20% of the signal detected in the RNA from a normal cell line. A plus/minus (+/–) indicates that the signal from the mRNA detected in the BS cell line was between 20 and 50% of the signal 9 detected in the RNA from a normal cell line. Steady-state levels of BLM mRNAs are ten fold higher in LCLs than in FCLs; consequently, the sensitivity of Northern analysis is less for FCLs than for LCLs. A blank in the column indicates that the RNA sample was not analyzed by Northern analysis. e Mutations and their putative effects on protein structure are delineated using conventional mutation nomenclature (cf. http://www.hqcv.org/mutnomen/), wherein +1 corresponds to the A of the ATG translation initiation codon in the reference cDNA sequence (accession number U39817) and the initiation codon is amino acid residue 1 in the protein sequence. The two mutations present in each cell line are indicated, and the putative effects on the gene products are shown in Tables 1 and 2. If the cell line has a low-SCE phenotype, then a normal allele is inferred to be present in the cell line (see footnotes g and h). Consistent with this claim, all the low-SCE cell lines have normal levels of steady-state BLM mRNAs. For a few cell lines, the BScausing mutation putatively present at BLM on one or both chromosomes is not known (blanks). f The formal names for the gross deletions are as follows: del exons 11-12 (BSR92), c.2308953_2555+4719del6126; del exons 11-12 (BSR111), c.2308-117_2555+7420del7811; del exon15, c.2824-1077_2999+310del1583; del exons 20-22, c.3752-?_4442+?del. See Tables 1 and 2. g The cell line exhibits low levels of SCEs. Consequently, a normal allele at BLM is presumed to be present on one chromosome No. 15. Molecular haplotype and mutational analyses indicate that a normal BLM gene is present on one chromosome No. 15 and a mutated BLM gene that contains both constitutional mutations is present on the other chromosome No. 15. These lowSCE cells lines were described in Ellis et al. 1995b along with their high-SCE counterparts. h The cell line exhibits low levels of SCEs. Consequently, a normal allele at BLM is presumed to be present on one chromosome No. 15. Molecular haplotype and mutational analyses indicate that a normal BLM gene is present on one chromosome No. 15 and a mutated BLM that contains a single constitutional mutation—the more distal mutation within the BLM gene—is present on the other chromosome No. 15. These low-SCE cells lines were described in Ellis et al. 1995b along with their high-SCE counterparts. i Northern analysis of these cell lines was shown in Ellis et al. 1995a. j Two different mutations of BLM that cause premature protein-translation termination were uncovered in the cell line, however the LCL is low-SCE or presumed to be low-SCE based on the presence of normal levels of steady-state BLM mRNAs by Northern blot analysis. Consequently, it is probable that a normal BLM gene is present on one chromosome No. 15 and a mutated BLM gene that contains both constitutional mutations is present on the other chromosome No. 15. Molecular haploptype analyses have not been performed on DNA from these cell lines. k RT-PCR products of smaller-than-normal sizes were detected by agarose gel electrophoresis. The consequence of this mutation of the 5’ splice site of exon 2 was a deletion in the mRNA product of exon 2, nucleotides –4 to 98, as determined by DNA sequencing of the abnormallysized cDNA fragment. Splicing out exon 2 removes the initiator methionine for BLM. Use by the ribosome of the next downstream AUG would result in a small out-of-frame peptide. l A normal allele at BLM is present on one chromosome No. 15 due to a back mutation at BLM. See Ellis et al. 2001. m The Northern analysis suggests that at least one normal BLM allele probably is present. Sequencing of the cDNA from this cell line and sequencing and Southern analysis of the 10 genomic DNA from the person with BS from whom this cell line was developed failed to uncover mutation of BLM. n RT-PCR products with a smaller-than-normal size were detected by agarose gel electrophoresis. The consequence of this mutation in the 5’ splice site of exon 6 was a deletion in the mRNA product of exon 6, nucleotides 1088 to 1220, as determined by DNA sequencing of the abnormally-sized cDNA fragment. The effect on BLM translation is a frameshift beginning at codon 363, which normally codes for alanine. o This widely used cell line is also known as GM08505; it was transformed with simian virus 40 and propagated through crisis to produce an indefinitely proliferating cell line. 11 Supplementary Table S2. Oligonucleotide primers used in the mutational analysis of mRNA from Bloom’s syndrome cells. A. RNAseA Mismatch Cleavage Analysis Primers Segment Primer 1 name (cDNA Nos.) Sequence primer 1 SR1 Outside Y180 (–71 TO –56) CGGCGGCCGTGGTTGC SR1 Nested 1F (–47 TO –32) AAGTTTGGATCCTGGT SR2 Outside BC16 (586-610) GCACAGCTTTATACAACAAACACAG SR2 Nested 2F (752-767) ATGCTCAGGAAAGTGA SR3 Outside BC21 (1634-1657) GAGAAACCCAACCTTCCTATGATA SR3 Nested 3F (1697-1712) ACTGGGAAGACATAAT SR4 Outside BC27 (2307-2328) GATCTGTGCAAGTAACAGACTC SR4 Nested 4F (2566-2581) AGCTTTAACAGACATA SR5 Outside BC2 (3477-3499) ATATATCAATGCCAATGACCAGG SR5 Nested 5F (3449-3464) CAATTTAAAGGTAGAC B. Protein Truncation Test Primers Segment Primer 1 name (cDNA Nos.) SP1 Outside Y189 (–46 to –27) SP1 Nested PTT1 (–26 to –7) SP2 Outside SP2 Nested Y204 (969-990) PTT2 (1128-1148) SP3 Outside SP3 Nested BC27 (2307-2328) PTT3 (2482-2501) Primer 2 name (cDNA Nos.) BC17 (963-942) 1R (902-887) BC7 (1935-1914) 2R (1800-1785) BC3 (2842-2821) 3R (2688-2673) HG5 (3690-3767) 4R (3624-3609) 5R (4324-4309) 5R (same) Sequence primer 1 AGTTTGGATCCTGGTTCCGT TAATACGACTCACTATAGGAACAGACCAC C-ATG-CCGCTAGGAGTCTGCGTGCG GGACCTTGACACATCTGACAGA TAATACGACTCACTATAGGAACAGACCAC CATGGAGCACATCTGTAAATTAAT GATCTGTGCAAGTAACAGACTC TAATACGACTCACTATAGGAACAGACCAC C-ATG-GCTCTTACGGCCACAGCTAA 12 Sequence primer 2 CGTACTAAGGCATTTTGAAGAG ACAAAATCCGTATCAT TTGGAAACGCTCATGTTTCAGA AAGTCTTTCTGATACT CAATTGTAGCACAGATAACCTG GAGGCAGTAAATTATC CCCCAGAGATTTGCAGACTTCTGT CACTTTTGCTACTAAC GCTTTATAGTCACAGA Same Primer 2 name (cDNA Nos.) BC32 (2037-2020) BC7 (1935-1914) Sequence primer 2 TGCAGCATTGATCGCCTC TTGGAAACGCTCATGTTTCAGA BC34 (3200-3183) BC25 (2999-2978) CAGCAATTATCACAAGAA CTGGTCACATCATGATAGGTAT HG8 (4319-4294) HG2 (4252-4233) ATAGTCACAGATGGTCAGATGCTGAC ATGAGAATGCATATGAAGGC Supplementary Table S3. Oligonucleotide primers used in the mutational analysis of genomic DNA from persons with Bloom’s syndrome. Exon Primer 1 Sequence Primer 1 Primer 2 Sequence Primer 2 2 3 3 2A5’ 3A5’ BC41 AGTCCTTCCTCCCCTCAAA GGATTCTTTGCTCAGTTGGGATAC CGGGATACTGCTCTCAAGAAAT 2A3’ BC15 3A3’ 4 5 6 7 7 8 9 10 11-12 13 14 15 16 17 18 19 20 21 22 4D5’ 5A5’ 6A5’ 7A5’ BC20 8A5’ 9A5’ Y209 11A5’ 13A5’ 14D5’ 15A5’ 16A5’ 17A5’ 18A5’ 19A5’ 20A5’ 21A5’ 22A5’ GACTTAATCCACTTGACTCA TATTGTCTGATCAGTGGTAGAA CTGGGATTACAGTCATGAGCC TGTGGCCTACCAGAGTAAACTAC GAAAGGCCTTTATTCAATACCCA CTTTCACTGTATTCATGTACTG TGCCTTGGTGTCCTATTAATGAT CTTTGATAGGTTTGATATGTG CGACCTCGGATGATCCAC CTCATTCATAACTCCACCCCTC TGGTCTTCCAGCAGTATAAG GGACCAAGTTAAGATATTAGGT GTCTTACTATAGTCTTCATCTC GGTTATGATGAATCTACTATAG AGAAATGAGTGTCTGTGCCGGG CCTGTATGGTACAAGTGCACAT TGGGTTTTCTATGGGTGATAA GTGTCTCTTCATATACACTAAA GAAGTGGTATTGTAGCTCTGTGC 4D3’ 5A3’ 6A3’ BC19 7A3’ 8A3’ 9A3’ 10A3’ 12B3’ 13B3’ 14A3’ 15A3’ 16A3’ 17A3’ 18A3’ 19B3’ 20A3’ 21A3’ 22A3’ TCTCTCAGCTTCATTTCCTCATCTG GTCATCCATATCATCCCAATC TGACTATTCCCAATGGCTAGCTTT G AACAATTTAAAGTATCCCAG CACAATCTTTGTGTTACGTTGT TCCTTATGCCATTTCCAGGCCAG TTGTGAGAACATTTCCTGGGAA CAGGCAATGATGATTTGCTATG GAGCTTTCATTTAACATCTGCC AAAGGTTATGCAGAGGACTGAA ATATGTATTCTAGTGGTCTTTAAT CTCTGGCAGTCACTGC AGACAGCTAATCACATGGCTG GTTTGCATTCTACATGTGCATG CATGAGGCTGAAGATGACAG GTTAATCTGTCGGAGACCACCT CAATTGAAGTAACTCAAAC TTTGGTTCACTCATTGTGAGAT CTTTCGGCCTATTAATCTGTGC AGTGTGACGAGGTGTAGGAAGC TTCAAAGCAAGGCAGAGCTGTTG TAAAAAGAAGAACTATCACCCC 13 PCR (oC) 55 55 50 Size (bp) 297 506 478 HPLC (oC) 57, 58 57, 58 57, 58 HPLC Gradient (%A) 52/47/38 48/43/34 49/44/35 43 55 60 50 55 55 55 50 60 55 50 55 50 50 55 55 55 50 50 413 304 336 418 515 302 289 281 687 303 373 384 324 288 387 301 285 358 429 54, 57 56, 58 52, 57, 58 57, 58, 60 55, 57, 58 55, 57 56, 59 53, 54, 55 58, 59, 60 57, 58 55, 57, 60 57, 58, 60 55, 57 56, 57 54, 58, 59 56, 58, 59 55, 58, 59 59, 60 56, 58, 59 52/47/38 52/47/38 51/46/37 50/45/36 48/43/34 52/47/38 53/48/39 53/48/39 47/42/33 52/47/38 50/45/36 50/45/36 52/47/38 53/48/39 50/45/36 52/47/38 53/48/39 51/46/37 49/44/35 Supplementary Table S4. Foundredsa identified in the Bloom's Syndrome Registry as result of the analysis of the syndrome-causing mutations. The individuals with Bloom's syndrome comprising the foundredsb The mutations at BLM The mutations carried by the founders - the founder mutationsc The mutations at BLM on the homologous chromosomesd Identical (i.e., homozygous) Identificatione Parental consanguinityf Noteworthy parental ancestryg Places of birth and/or principal residence Different (i.e., heterozygous) Jews Foundred 1 (n = 35) blmAsh blmAsh BSR2 AA New York blmAsh blmAsh BSR3 AA New York blmAsh blmAsh BSR9 AA Israel blmAsh blmAsh BSR14 AA New York blmAsh blmAsh BSR15 AA California blmAsh blmAsh BSR16 AA New York blmAsh BSR26 A- Indiana blmAsh blmAsh c.3261delT (Foun. 10) BSR27 AA Ohio blmAsh blmAsh BSR32 AA New Jersey blmAsh blmAsh BSR34 AA Illinois blmAsh blmAsh BSR42 AA Israel blmAsh blmAsh BSR44 AA Israel blmAsh blmAsh BSR45 AA Israel blmAsh blmAsh BSR47 AA New York BSR50 A- Ontario BSR53 AA New Jersey BSR54 A- New York blmAsh blmAsh blmAsh c.3752-?_4442+?del (Foun. 5) blmAsh c.2672G>A 14 blmAsh blmAsh BSR56 AA Ohio blmAsh blmAsh BSR57 AA Israel blmAsh blmAsh BSR79 AA Connecticut BSR87 A- Michigan blmAsh c.3163T>G + blmAsh blmAsh BSR106 AA Florida blmAsh blmAsh BSR107 JA New York blmAsh blmAsh BSR119 AA New York blmAsh blmAsh BSR121 AA Israel c.98+1G>T BSR126 AJ Brazil c.2407_2408dupT (Foun. 2) blmAsh blmAsh BSR141 AA Israel blmAsh blmAsh BSR142 AA Israel blmAsh blmAsh BSR171 AA District of Columbia blmAsh blmAsh BSR172 AA Michigan blmAsh blmAsh BSR178 AA New York blmAsh blmAsh BSR182 AA Belgium blmAsh c.3510T>A BSR225 A- Minnesota blmAsh c.2407_2408dupT (Foun. 2) BSR237 AA New York BSR238 AA Israel blmAsh blmAsh Foundred 2 (n = 2) c.2407_2408dupT blmAsh (Foun. 1) [BSR141] [AA] [Israel] c.2407_2408dupT blmAsh [BSR237] [AA] [New York] Spanish via Mexico Colorado Mexican, Texan, New Mexican Utah (Foun. 1) Mexicans and Americans of Spanish Ancestry Foundred 3 (n = 5) blmAsh blmAsh blmAsh BSR127 c.2506_2507delAG (Foun. 4) BSR130 15 + blmAsh blmAsh blmAsh blmAsh BSR179 c.3197G>A blmAsh Mexico BSR197 El Salvadoran and Ecuadoran Texas BSR200 El Salvadoran Maryland [BSR130] [Mexican, Texan, New Mexican] [Utah] Foundred 4 (n = 2) blmAsh c.2506_2507delAG c.2506_2507delAG c.2506_2507delAG BSR173 Mexico Portuguese and Brazilians Foundred 5 (n = 4) blmAsh (Foun. 1) c.3752-?_4442+?del [BSR50] [A-] [Vancouver] Portuguese Switzerland c.3752-?_4442+?del c.3752-?_4442+?del BSR181 c.3752-?_4442+?del c.3752-?_4442+?del BSR195 Brazil c.3587delG (Foun. 6) BSR216 Brazil c.3752-?_4442+?del (Foun. 5) [BSR216] [Brazil] c.3752-?_4442+?del Foundred 6 (n = 2) c.3587delG c.3587delG c.3587delG BSR217 + Brazil Non-Italian Europeans and North Americans Foundred 7 (n = 18) c.1933C>T c.1933C>T c.1933C>T c.1933C>T c.1933C>T c.2250_2251insAAAT (Foun. 15) c.1933C>T BSR11 Ontario BSR61 California BSR64 + Ohio BSR67 The Netherlands c.1933C>T c.1284G>A (Foun. 16) BSR91 The Netherlands c.1933C>T c.2725C>T BSR105 Texas c.1933C>T c.3223_3224dupA BSR114 Germany c.1933C>T c.2098C>T (Foun. 17) BSR115 Florida 16 c.1933C>T c.1933C>T c.1284G>A (Foun. 16) c.1933C>T c.1933C>T c.1933C>T c.1933C>T c.2923delC (Foun. 9) c.1933C>T BSR118 Germany BSR133 Germany BSR147 Belgium BSR164 New Brunswick BSR169 Ontario c.1933C>T c.3261delT (Foun. 10) BSR170 New York c.1933C>T c.2695C>T (Foun. 8) BSR177 Michigan c.1933C>T c.2695C>T (Foun. 8) BSR183 Utah c.1933C>T c.1933C>T BSR188 + Belgium c.1933C>T c.1933C>T BSR189 c.2695C>T BSR21 + California + Germany California Foundred 8 (n = 9) c.2695C>T c.2695C>T c.3028delG (Foun. 11) BSR30f c.2695C>T c.3415C>T BSR109 New York c.2695C>T c.2308-117_2555+7420del7811 BSR111 Massachusetts BSR136 Maryland c.2695C>T c.2695C>T c.1933C>T (Foun. 7) [BSR177] [Michigan] c.2695C>T c.1933C>T (Foun. 7) [BSR183] [Utah] c.2695C>T c.2695C>T BSR185 El Salvadoran Ontario c.2695C>T c.2695C>T BSR191 South Carolina c.2923delC BSR6 Maine BSR20 Maryland c.2923delC BSR69 Washington c.2923delC BSR137 Australia Foundred 9 (n = 7) c.2923delC c.2923delC c.2824-1077_2999+310del1583bp 17 c.2923delC c.2098C>T (Foun. 17) BSR146 Minnesota c.2923delC c.1933C>T (Foun. 7) [BSR164] [New Brunswick] c.2923delC c.2923delC BSR176 + BSR22 + French Canadian Quebec Foundred 10 (n = 4) c.3261delT c.3261delT Illinois c.3261delT blmAsh c.3261delT c.1933C>T (Foun. 7) [BSR170] [New York] c.3261delT c.2250_2251insAAAT (Foun. 15) BSR194 California c.2695C>T (Foun. 8) [BSR30]g (Foun. 1) [BSR26] [A-] [Indiana] Foundred 11 (n = 3) c.3028delG c.3028delG [Germany] BSR52 Germany c.991_995delAAAGA (Foun. 14) BSR207 Kentucky c.1642C>T c.991_995delAAAGA (Foun. 14) BSR167 Adopted (American) Virginia c.1642C>T c.1882+5G>A BSR202 Adopted (German) Germany c.2015A>G c.1088-2A>G BSR31 Belgium c.2015A>G c.3163T>C BSR139 Illinois c.991_995delAAAGA c.1642C>T (Foun. 12) [BSR167] c.991_995delAAAGA c.3028delG (Foun. 11) [BSR207] [Kentucky] c.2250_2251insAAAT c.1933C>T (Foun. 7) [BSR64] [Ohio] c.2250_2251insAAAT c.3261delT (Foun. 10) [BSR194] [California] c.3028delG c.3028delG [+] Foundred 12 (n = 2) Foundred 13 (n = 2) Foundred 14 (n = 2) [Adopted (American)] [Virginia] Foundred 15 (n = 2) Foundred 16 (n = 2) 18 c.1284G>A c.1933C>T (Foun. 7) [BSR91] [The Netherlands] c.1284G>A c.1933C>T (Foun. 7) [BSR118] [Germany] Italians and North Americans Foundred 17 (n = 8) c.2098C>T c.2098C>T BSR5 + Colorado c.2098C>T c.2098C>T BSR51 + Kentucky c.2098C>T BSR59 Connecticut Italy (Sicily) c.2098C>T c.3191A>T BSR102 c.2098C>T c.3475_3476delTT BSR103 c.2098C>T c.1933C>T (Foun. 7) [BSR115] [Florida] c.2098C>T c.3210+3A>T BSR134 Missouri c.2098C>T c.2923delC (Foun. 9) [BSR146] [Minnesota] c.311C>A BSR80 Italian (Sicilian) Switzerland Foundred 18 (n = 3) c.3164G>C + Italian Massachusetts Italian New York c.3164G>C c.3164G>C BSR113 c.3164G>C c.3164G>C BSR222 Italy BSR78 Japan BSR97 Japan Japanese Foundred 19 (n = 5) c.557_559delCAA c.557_559delCAA c.2074+1G>T c.557_559delCAA c.557_559delCAA c.1544_1545dupA (Foun. 20) BSR100 c.557_559delCAA c.557_559delCAA BSR110 c.557_559delCAA c.557_559delCAA BSR128 + Japan Japan + Japan Foundred 20 (n = 5) c.1544_1545dupA c.2254C>T BSR71 19 West African Pennsylvania c.1544_1545dupA c.1544_1545dupA BSR86 Japan c.1544_1545dupA c.1544_1545dupA BSR93 Japan [BSR100] [Japan] c.1544_1545dupA c.1544_1545dupA c.557_559delCAA (Foun. 19) c.1544_1545dupA BSR129 + Japan a The term foundred (abbreviated foun.) refers to a group of persons with BS each of whom has a particular BS-causing mutation, all of whom, therefore, are descended from a person who carried that mutation—the founder. n, the number of persons comprising the foundred. Note. Dividing the 20 foundreds broadly into 6 groups as attempted in this table -- Jews, Non-Italian Europeans and North Americans, Italians and North Americans, et cetera - is arbitrary and imperfect, exceptions readily noted being the following: In Foun. 1, four nonJewish parents, identifiable by "A-" in Col 6; in Foun. 5, a person with an Ashkenazi Jewish father and a non-Jewish North American mother ("A-" in Col. 6), whereas all others in Founs. 5 + 6 are Portuguese or Brazilian; in Foun. 8. an El Salvadoran homozygous for a mutation limited otherwise to North Americans and Europeans; in Foun. 9, an Australian; and, in Foun. 20, a North American of West African ancestry living in the United States, all others in Founs. 19 + 20 being Japanese living in Japan. Note. Only two of the 153 families represented in the survey knew of any "blood" relationship. The mothers of BSR9 and BSR44, two young men with BS in Foun. 1, shared two of their great grandparents, i.e., were 2nd cousins twice removed. Both families lived in Israel. b Their mutations assign 20 persons not to just 1 but to 2 foundreds. To facilitate counting, square bracketing is used in Cols. 4-7 to identify such persons (and those data that pertain to them) who had been listed earlier in the table. c Mutations and their putative effects on protein structure are delineated using conventional mutation nomenclature (cf. http://www.hqcv.org/mutnomen/), wherein +1 corresponds to the A of the ATG translation initiation codon in the reference cDNA sequence (accession number U39817) and the initiation codon is amino acid residue 1 in the protein sequence. The mutation referred to as blmAsh is a 6-bp deletion and 7-bp insertion at nucleotide 2207 described as c.2207_2212delATCTGAinsTAGATTC. For reasons given in the Ellis et al. [1998], blmAsh appears in this table as the founding mutation in both Foun. 1 and Foun. 3. d1 A blank in both Cols. 2 and 3 for a given individual indicates that although DNA was available and successfully analyzed, only a single BLM mutation could be identified. The six such individuals are in Founs. 7, 8, 9, and 17. d2 For a mutation that is in another foundred also, that other foundred is indicated in parenthesis in Col. 3. 20 d3 Re the possibility of identifying mutational hot spots: the only instances in either Table 1 or 2 of the same nucleotide's being mutated in more than one way are in individuals BSR87 in Foun. 1 in whom a T becomes a G and BSR139 in Foun. 13 (also listed in Table 2 in whom the same T becomes a C. e The identification of persons with BS accessioned to the Registry has since the early 1960s (see German [1969] and German and Passarge [1989]) been by number (signifying the order in which they came to the Registry’s attention) plus the two (or three) first letters in the given and the surname. E.g., if the 225th person to be registered has the name Boaz Strizinski, he would be identified 255(BoSt), or 255(BoStr) if a family with a surname beginning with “St” was already registered. In the present report, on the direction of the administrative director of the Weill Medical College IRB (Institutional Review Board), the initials are deleted, each individual now being identified simply by a Bloom’s Syndrome Registry number, e.g., BSR1, BSR2, …BSR238. Note. The numbers that have been assigned to the 238 persons in the Bloom's Syndrome Registry signify nothing more than the order in which the persons were accessioned. In this table,within each foundred, persons are listed in numerical order (Col. 4). f A second cousin or closer relationship was reported by the family in all those indicated by a plus sign except in BSR30 whose parents are 4th cousins. Re BSR30: his parents did not themselves know that they were related, but they were found to be 4th cousins in an exhaustive search of church records in the valley in Germany's Sauerland where their families long had dwelt [Passarge, 1991]; BSR30 is the only persons with known parental consanguinity who is not homozygous at BLM. g1 "Noteworthy" in the sense that the ancestry differs from that expected from the individual's place of birth or principal dwelling place shown in Col. 7. g2 For those who were adopted, the ancestry of their biological parents is shown in parenthesis. g3 A, an Ashkenazi Jewish parent; J, a Jewish parent but not Ashkenazi [see (g4) below]; -, a non-Jewish parent in a union in which the other parent is Jewish; the father's designation appears before the mother's, so that A- indicates that the father was Ashkenazi Jewish and the mother non-Jewish. g4 The non-Ashkenazi but Jewish father of BSR107 in Foun. 1 was Bulgarian, and he emphasized that he was Sephardi; he, therefore, provides evidence that blmAsh is segregating in the Sephardi Jewish population of Eastern Europe. The Jewish but non-Ashkenazi mother of BSR126 in Foun. 1, who transmitted to BSR126 the unique mutation c.98+1G>T, was born to a Sephardi Jewish father and an Egyptian Jewish, but non-Sephardi, mother. 21 Supplementary Table S5. The 64 Bloom’s syndrome-causing mutations from the Bloom’s Syndrome Registry as of December 31, 1999. Person a Mutation Exon(s) Effect on protein or foundredb c.98+1G>T 2 p.0 BSR126 c.275delA 3 p.Asn92fs BSR186 c.311C>A 3 p.Ser104X BSR80 c.557_559delCAA 3 p.Ser186X Foundred 19 c.582delT 3 p.Phe194fs BSR232 c.772_773delCT 3 p.Leu257fs BSR211 c.814A>T 4 p.Lys272X BSR112 c.991_995delAAAGA 5 p.Lys331fs Foundred 14 c.1088-2A>G 6 p.Ala363fs BSR31 c.1090A>T 6 p.Arg364X BSR98 c.1220+3A>G 6 p.Ala363fs BSR112 c.1284G>A 7 p.Trp428X Foundred 16 c.1346delC 7 p.Ser449fs BSR74 c.1544_1545dupA 7 p.Asn515fs Foundred 20 c.1628T>A 7 p.Leu543X BSR192 c.1642C>T 7 p.Gln548X Foundred 12 c.1701G>A 7 p.Trp567X BSR98 c.1784C>A 7 p.Ser595X BSR81 c.1882+5G>A 7 p.Arg408fs BSR202 c.1933CT 8 p.Gln645X Foundred 7 c.1968_1969dupG 8 p.Lys657fs BSR17 c.2015A>G 8 p.Gln672Arg Foundred 13 c.2074+1G>T 8 p.628_691del BSR78 c.2098C>T 9 p.Gln700X Foundred 17 c.2193+2T>G 9 p.Gly692fs BSR205 c.2207_2212delATCTGAinsTAGATTCc 10 p.Tyr736fs Foundreds 1 & 3 c.2250_2251insAAAT 10 p.Leu751fs Foundred 15 c.2254C>T 10 p.Gln752X BSR71 c.2308-953_2555+4719del6126 11-12 p.Ile770fs BSR92 c.2308-117_2555+7420del7811 11-12 p.Ile770fs BSR111 c.2406+2T>G 11 p.770_802del BSR218 c.2407_2408dupT 12 p.Trp803fs Foundred 2 c.2488_2489dupA 12 p.Thr830fs BSR65 c.2506_2507delAG 12 p.Arg836fs Foundred 4 c.2643G>A 13 p.Trp881X BSR149 c.2672G>A 14 p.Gly891Glu BSR54 c.2695C>T 14 p.Arg899X Foundred 8 c.2702G>A 14 p.Cys901Tyr BSR40 c.2725C>T 14 p.Gln909X BSR105 c.2824-1077_2999+310del1583 15 p.Val942fs BSR20 c.2855G>T 15 p.Gly952Val BSR223 c.2887C>T 15 p.His963Tyr BSR123 22 c.2923delC 15 p.Gln975fs Foundred 9 c.3028delG 16 p. Asp1010fs Foundred 11 c.3118C>T 16 p.Gln1040X BSR10 c.3163T>G 16 p.Cys1055Gly BSR87 c.3163T>C 16 p.Cys1055Arg BSR139 c.3164G>C 16 p.Cys1055Ser Foundred 18 c.3191A>T 16 p.Asp1064Val BSR102 c.3197G>A 16 p.Cys1066Tyr BSR197 c.3210+3A>T 16 p.Met1007fs BSR134 c.3223_3224dupA 17 p.Arg1075fs BSR114 c.3255_3256insT 17 p.Arg1086X BSR166 c.3261delT 17 p. Phe1087fs Foundred 10 c.3278C>G 17 p.Ser1093X BSR215 c.3415C>T 18 p.Arg1139X BSR109 c.3475_3476delTT 18 p.Lys1159fs BSR103 c.3510T>A 18 p.Tyr1170X BSR225 c.3558+1G>A 18 p.Ser1121fs BSR198 c.3587delG 19 p.Ser1196fs Foundred 6 c.3681delA 19 p.Lys1227fs BSR65 c.3727_3728dupA 19 p.Thr1243fs BSR104 c.3752-?_4442+?del 20-22 p.Glu1251fs Foundred 5 c.3847C>T 20 p.Gln1283X BSR7 a Mutations and their putative effects on protein structure are delineated using conventional mutation nomenclature (cf. http://www.hqcv.org/mutnomen/), wherein +1 corresponds to the A of the ATG translation initiation codon in the reference cDNA sequence (accession number U39817) and the initiation codon is amino acid residue 1 in the protein sequence. b See Tables 1 and 2 for further information on foundreds and persons with BS. c The blmAsh mutation. 23