We performed a comprehensive analysis for mutations in the TSC1
gene using Southern blot
analysis, and SSCP and heteroduplex analysis of amplified exons in 13 families
with genetic linkage
to the TSC1 region, 22 small families without linkage information, and
126 sporadic patients. 17
unique mutations were identified in 21 patients. Mutations were found in
7/13 (54%) TSC1-linked
families, 1/22 (5%) small families without linkage, and 13 of 126 (10%)
sporadic cases. The
mutations were all chain-terminating, with 14 small deletions, 1 small
insertion, and 6 nonsense
mutations. In families with mutations, all individuals carrying a mutation
met formal diagnostic
criteria for TSC, apart from a 3-year-old girl who had inherited a deletion
mutation, and who had
no seizures, normal intelligence, normal abdominal ultrasound, and hypomelanotic
macules only on
physical exam. We assessed the incidence and severity of mental retardation
in the 13 sporadic
patients with TSC1 mutations versus the entire sporadic cohort, and found
no significant difference.
The observations indicate that TSC1 mutations are all inactivating, suggest
that TSC1 disease occurs
in only 15–20% of the sporadic TSC population, and demonstrate that
presymptomatic TSC does
occur.