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Searching for somatic mutations in McCune–Albright syndrome: a comparative study of the peptidic nucleic acid versus the nested PCR method based on 148 DNA samples

¹ Unité d’Endocrinologie-Gynécologie Pédiatrique, Service de Pédiatrie 1, Hôpital Arnaud-de-Villeneuve, CHU Montpellier, 34295 Montpellier, France, ² Service d’Hormonologie du Développement et de la Reproduction, Hôpital Lapeyronie, CHU Montpellier, 34295 Montpellier, France, ³ INSERM U540, Hormones et Cancers, Montpellier, France, ⁴ Department of Pediatrics, Section of Pediatric Endocrinology, James Withcomb Riley Hospital, Wells Center for Pediatric Research, Indianapolis, Indiana, USA

(Correspondence should be addressed to C Sultan; Email: c-sultan{at}chu-montpellier.fr)

Background: Activating mutations of the Gs gene (GNAS), which encodes for the -subunit of the stimulatory G protein, have been identified in patients with McCune–Albright syndrome (MAS). Accuracy and sensitivity in the molecular diagnosis of MAS is mandatory for optimal therapeutic strategy and adapted follow-up, especially for incomplete clinical forms of MAS. To date, the highly sensitive nested PCR method with intermediary digestion by a restriction enzyme at the mutation site is one of the most widely used techniques. This study evaluated a new diagnostic method using a peptidic nucleic acid (PNA) and compared it with the nested PCR method.

Material and methods: One hundred and forty-eight DNA samples from eighty-eight patients presenting clinical symptoms compatible with MAS were included. The DNA samples were mainly obtained from peripheral blood, ovarian tissue or cyst liquid, and bone lesions. The nested PCR method required 4 days. PNA clamping required 1.5 days and utilized the higher thermal stability and specificity of PNA–DNA coupling to inhibit PCR product formation. Direct sequencing was subsequently performed in all cases.

Results: The sensitivity of mutation detection was 54% (n = 80) for nested PCR and 46.6% (n = 69) for PNA (P > 0.05). The 11 cases where PNA failed to detect the mutation were mainly incomplete and atypical clinical forms of MAS (n = 10/11). The cost per sample was 50 euros for PNA clamping versus 136 euros for nested PCR.

Conclusion: PNA clamping is a rapid, reliable, and economical method to diagnose MAS. It should be the first-line diagnostic method, although negative results, especially for incomplete clinical forms of MAS, should be confirmed by nested PCR.

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