MRC-Holland MLPA. Description version 08; 18 November 2016

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SALSA MLPA probemix P122-D1 NF1 AREA Lot D1-1016. As compared to lot C2-0312, four probes in the NF1 area and one reference probe have been removed, four reference probes have been replaced and several probe lengths have been adjusted. Neurofibromatosis is an autosomal dominant disorder characterised by café-au-lait spots and fibromatous tumours of the skin. Neurofibromatosis type I is caused by defects in the NF1 gene on chromosome 17q11.2. This gene encodes neurofibromin 1, a cytoplasmic protein predominantly expressed in neurons, Schwann cells and leukocytes. Neurofibromatosis type II is caused by defects in the NF2 gene on chromosome 22q12.2. Deletions of part of the NF1 gene as well as deletions and duplications of the complete NF1 gene have been described. Relatively common (5-10% of NF1 cases) is a deletion of a 1500 kb chromosomal region that includes the NF1 gene. This interstitial 17q11.2 microdeletion arises from unequal crossover between 2 highly homologous 60-kb duplicons. Phenotype of the 17q11.2 microdeletion is usually much more severe than most other NF1 cases and may include severe developmental delay. The NF1 gene (58 exons) spans ~283 kb of genomic DNA and is located on chromosome 17q11.2. This P122-D1 NF1 area MLPA probemix contains 20 probes for 16 genes located at close distance to NF1 as well as probes for 5 distinct NF1 exons. In addition, 8 references probes are included in this probemix, detecting several different autosomal chromosomal locations. Note that the P081 and P082 probemixes contain probes for each individual NF1 exon. This SALSA probemix is designed to detect deletions/duplications of one or more sequences in the aforementioned region in a DNA sample. Heterozygous deletions of recognition sequences should give a 35-50% reduced relative peak height of the amplification product of that probe. Note that a mutation or polymorphism in the sequence detected by a probe can also cause a reduction in relative peak height, even when not located exactly on the ligation site! In addition, some probe signals are more sensitive to sample purity and small changes in experimental conditions. Therefore, deletions and duplications detected by MLPA should always be confirmed by other methods. Not all deletions and duplications detected by MLPA will be pathogenic; users should always verify the latest scientific literature when interpreting their findings. We have no information on what percentage of defects in these genes is caused by deletions/duplications of complete exons. Finally, note that most defects in this gene are expected to be small (point) mutations which will not be detected by this SALSA test. SALSA probemixes and reagents are sold by for research purposes and to demonstrate the possibilities of the MLPA technique. They are not CE/FDA certified for use in diagnostic procedures. Purchase of the SALSA test probemixes and reagents includes a limited license to use these products for research purposes. The use of a SALSA probemix and reagents requires a thermocycler with heated lid and sequence type electrophoresis equipment. Different fluorescent PCR primers are available. The MLPA technique has been first described in Nucleic Acid Research 30, e57 (2002). More information Website : www.mlpa.com E-mail : info@mlpa.com (information & technical questions); order@mlpa.com (for orders) Mail : bv; Willem Schoutenstraat 1, 1057 DL Amsterdam, the Netherlands Related SALSA probemix P081/P082 NF1: Neurofibromatosis type 1; these two probemixes contain probes for each NF1 exon. P044 NF2: Neurofibromatosis type 2; contains probes for each NF2 exon. SALSA P122 NF1 area probemix Page 1 of 6

Selected references for SALSA probemix P122 NF1 AREA Van Minkelen et al., 2014. A clinical and genetic overview of 18 years neurofibromatosis type 1 molecular diagnostics in the Netherlands. Clin Genet. 85:318-327. Zickler et al., 2012. Characterization of the nonallelic homologous recombination hotspot PRS3 associated with type 3 NF1 deletions. Hum Mutat. 33: 372-383. Valero et al., 2011. A highly sensitive genetic protocol to detect NF1 mutations. J Mol Diagn. 13:113-122. Garcia-Linares et al., 2011. Dissecting Loss of Heterozygosity (LOH) in Neurofibromatosis Type 1- Associated Neurofibromas: Importance of Copy Neutral LOH. Hum Mutat. 32:78-80. Mautner et al., 2010. Clinical characterization of 29 neurofibromatosis type-1 patients with molecularly ascertained 1.4 Mb type-1 NF1 deletions. J Med Genet. 47:623-630. Upadhyaya et al., 2009. The spectrum of somatic and germline NF1 mutations in NF1 patients with spinal neurofibromas. Neurogenetics 3:251-253. Grisart et al., 2008. NF1 microduplication first clinical report: association with mild mental retardation, early onset of baldness and dental enamel hypoplasia? Eur J Hum Genet. 16:305-311. De Luca et al., 2007. Deletions of NF1 gene and exons detected by multiplex ligation-dependent probe amplification. J Med Genet. 44:800-808. Data analysis The P122-D1 NF1 area probemix contains 33 MLPA probes with amplification products between 128 and 416 nt. In addition, it contains 9 control fragments generating an amplification product smaller than 120 nt: four DNA Quantity fragments (Q-fragments) at 64-70-76-82 nt, three DNA Denaturation control fragments (Dfragments) at 88-92-96 nt, one X-fragment at 100 nt and one Y-fragment at 105 nt. More information on how to interpret observations on these control fragments can be found in the MLPA protocol. Data generated by this probemix can first be normalised intra-sample by dividing the peak height of each probe s amplification product by the total peak height of only the reference probes in this probemix (block normalization). Secondly, inter-sample normalisation can be achieved by dividing this intra-normalized probe ratio in a sample by the average intra-normalised probe ratio of all reference samples. Please note that this type of normalisation assumes that no changes occurred in the genomic regions targeted by the reference probes. Data normalisation should be performed within one experiment. Only samples purified by the same method should be compared. Confirmation of most exons deletions and amplifications can be done by e.g. Southern blotting, long range PCR, qpcr, FISH. Note that Coffalyser, the MLPA analysis tool developed at, can be downloaded free of charge from our website www.mlpa.com. Many copy number alterations in healthy individuals are described in the database of genomic variants: http://dgv.tcag.ca/dgv/app/home. For example, a duplication of a complete gene might not be pathogenic, while a partial duplication or a deletion may result in disease. For some genes, certain in-frame deletions may result in a very mild, or no disease. Copy number changes of reference probes are unlikely to be the cause of the condition tested for. Users should always verify the latest scientific literature when interpreting their findings. This probemix was developed at. Info/remarks/suggestions for improvement: info@mlpa.com. SALSA P122 NF1 area probemix Page 2 of 6

Table 1. SALSA MLPA P122-D1 NF1 AREA probemix Length Chromosomal position SALSA MLPA probe (nt) reference NF1 NF1 area genes 64-70-76-82 Q-fragments: DNA quantity; only visible with less than 100 ng sample DNA 88-92-96 D-fragments: Low signal of 88 or 96 nt fragment indicates incomplete denaturation 100 X-fragment: Specific for the X chromosome 105 Y-fragment: Specific for the Y chromosome 128 * Reference probe 19616-L26684 4p13 133 ± TRAF4 probe 09176-L19109 2348 kb upstream of NF1 142 NF1 probe 02491-L01922 Exon 1 147 NF1 probe 02512-L01943 Exon 30 154 NF1 probe 05220-L03309 Exon 57 160 Reference probe 17436-L21192 16p13 166 PSMD11 probe 09632-L09917 1086 kb downstream of NF1 175 CRLF3 probe 03780-L03289 298 kb upstream of NF1 184 SUZ12 probe 03786-L03295 628 kb downstream of NF1 190 SUZ12P probe 11798-L12590 363 kb upstream of NF1 197 CPD probe 09629-L09914 632 kb upstream of NF1 208 SUZ12P probe 11801-L12592 336 kb upstream of NF1 220 ± RNF135 probe 03783-L03292 110 kb upstream of NF1 226 CPD probe 09628-L21977 651 kb upstream of NF1 238 * Reference probe 20555-L14777 1p31 247 ATAD5 probe 03781-L03290 260 kb upstream of NF1 256 UTP6 probe 03785-L03294 515 kb downstream of NF1 265 ASPA probe 01325-L07456 23001 kb upstream of NF1 274 Reference probe 02470-L01914 15q21 283 PMP22 probe 01463-L00928 11243 kb upstream of NF1 292 ADAP2 probe 03782-L03291 168 kb upstream of NF1 301 LRRC37B probe 03787-L03296 648 kb downstream of NF1 310 Reference probe 01789-L01353 13q14 319 NF1 probe 02525-L01956 Exon 49 328 MYO1D probe 09630-L09915 1420 kb downstream of NF1 337 NF1 probe 02507-L01938 Exon 17 346 Reference probe 01232-L00780 10p14 362 ZNF207 probe 09637-L09949 1006 kb downstream of NF1 373 BLMH probe 09627-L09912 822 kb upstream of NF1 382 ± TRAF4 probe 08620-L08632 2347 kb upstream of NF1 391 MYO1D probe 09631-L09916 1407 kb downstream of NF1 409 * Reference probe 18498-L23723 19q13 416 * Reference probe 20960-L29094 6p12 * New in version D1 (From lot D1-1016 onwards). Changed in version D1 (from lot D1-1016 onwards). Small change in length, no change in sequence detected. ± This probe is located within, or close to, a very strong CpG island. A low signal of this probe can be due to incomplete sample DNA denaturation, e.g. due to the presence of salt in the sample DNA. The identity of the genes detected by the reference probes is available on request: info@mlpa.com. SALSA P122 NF1 area probemix Page 3 of 6

Table 2. P122 probes arranged according to chromosomal location Length SALSA MLPA Partial sequence (24 nt Distance to Gene/ Exon Genbank # Ligation site (nt) probe adjacent to ligation site) next probe 265 01325-L07456 ASPA exon 6 NM_001128085 765-766 GGTCTATAAAAT-TATAGAGAAAGT 11758.7 kb 283 01463-L00928 PMP22 exon 4 NM_000304.2 328-329 GATCTCTGGCAG-AACTGTAGCACC 8995.2 kb 133 ± 09176-L19109 TRAF4 exon 2 NM_004295.3 20 nt after exon 2 ACACTGCCAGGA-AGAAGCCCAAGC 0.8 kb 382 ± 08620-L08632 TRAF4 exon 4 NM_004295.3 437-438 CAGCTTCAATGT-CATTCCCTGCCC 888.5 kb 373 09627-L09912 BLMH exon 9 NM_000386.3 1330-1331 TGGCTGTGATGT-TGGAAAACACTT 18.9 kb 226 09628-L21977 CPD exon 12 NM_001304.4 2532-2533 CCAGTGACTACT-TACAAAACTGGA 18.5 kb 196 09629-L09914 CPD exon 21 NM_001304.4 3917-3918 GGTGATAGTCTT-TGACACAGATAA 269 kb 190 11798-L12590 SUZ12P exon 1 NR_024187.2 321 nt before exon 1 GATCTAGACTCT-CTAAACCGCTCG 0.5 kb 208 11801-L12592 SUZ12P exon 3 NR_024187.2 33 nt before exon 3 CCATGGAAATGA-CTTTCTTACTTG 39.2 kb 175 03780-L03289 CRLF3 exon 3 NM_015986.3 471-472 GCTTGGTGGTGT-GGGAGAAGAGAA 37.7 kb 247 03781-L03290 ATAD5 exon 2 NM_024857.4 1334-1335 GCAGGTACGCTT-TAAGACAGTTAC 91.8 kb 292 03782-L03291 ADAP2 exon 3 NM_018404.2 544-545 TGAAGGCCAAGT-TCGAAGCCAGAG 57.8 kb 220 ± 03783-L03292 RNF135 exon 2 NM_032322.3 573-574 GGAACATCTTGT-AGACATTGTCAG 109.9 kb 142 02491-L01922 NF1 exon 1 NM_000267.3 335 nt before exon 1 GCAGAGATCCGC-GCGCTGGGAGAA 130.6 kb 337 02507-L01938 NF1 exon 17 NM_000267.3 2329-2330 GGATCATGAAGA-ATTACTACGTAC 23.8 kb 147 02512-L01943 NF1 exon 30 NM_000267.3 4390-4391 TGAGGAAAACCA-GCGGAACCTCCT 100.1 kb 319 02525-L01956 NF1 exon 49 NM_000267.3 7535-7536 TCACCTGCTATT-GTTGCAAGAACA 11.4 kb 154 05220-L03309 NF1 exon 57 NM_000267.3 8563-8564 TGGAATTGATGA-AGAAACCAGTGA 514.8 kb 256 03785-L03294 UTP6 exon 14 NM_018428.2 1282-1281, reverse TCCCAGAGTCTC-TAAACAATTCAG 113.1 kb 184 03786-L03295 SUZ12 exon 10 NM_015355.3 1343-1344 CAATGATAAATC-TACGGCTCCTAT 33.2 kb 301 03787-L03296 LRRC37B exon 1 NM_052888.2 426-427 TTCCGCTTCTCA-ACCGGGATCAGA 345.2 kb 362 09637-L09949 ZNF207 exon 9 NM_003457.3 1009-1010 GCTCTGTTTCCT-AGCACAGCACAA 80.2 kb 166 09632-L09917 PSMD11 exon 2 NM_002815.3 180-181 GGAAAACGATGA-AGAGGCAGTGCA 22.1 kb 391 09631-L09916 MYO1D exon 7 NM_015194.2 1064-1065 CTGATGCCATGA-AAGTCATTGGCT 12.9 kb 328 09630-L09915 MYO1D exon 2 NM_015194.2 535-536 CCGCCTCACCTT-TTTGCTATTGCG Changed in version D1 (from lot D1-1016 onwards). Small change in length, no change in sequence detected. ± This probe is located within, or close to, a very strong CpG island. A low signal of this probe can be due to incomplete sample DNA denaturation, e.g. due to the presence of salt in the sample DNA. The sequence NM_000267.3 represents transcript variant 2 of NF1 and is a reference standard in the NCBI RefSeqGene project. Complete probe sequences are available on request: info@mlpa.com. Please notify us of any mistakes: info@mlpa.com. SALSA P122 NF1 area probemix Page 4 of 6

SALSA MLPA probemix P122-D1 NF1 sample picture Figure 1. Capillary electrophoresis pattern of a sample of approximately 50 ng human male control DNA analysed with SALSA MLPA P122-D1 (lot D1-1016). SALSA P122 NF1 area probemix Page 5 of 6

Implemented Changes compared to the previous product description version. Version 08 18 November 2016 (55) - Product description adapted to a new product version (version number changed, lot number added, changes in Table 1 and Table 2, new picture included). Version 07 22 July 2015 (54) - Figure based on the use of old MLPA buffer (replaced in December 2012) removed. - Various minor textual changes throughout the document. Version 06 (48) - Warning added in Table 1, 256 nt probe 03785-L03294. Version 05 (48) - Electropherogram pictures using the new MLPA buffer (introduced in December 2012) added. Version 04 (48) - Various minor textual changes. Version 03 (46) - Exon numbering of the CPD and SUZ12P genes has been changed in Table 2. - Various minor textual changes. - Small correction of chromosomal locations in Table 1 and 2. - Remark on RefSeqGene standard and transcript variant added below Table 2. Version 02 (46) - New reference added on page 1. - Partial sequence for probe 02491-L01922 corrected. - Exon numbering has been changed on page 3 and 4. - Gene names updated. - Ligation sites updated according to new version of the NM_reference sequence. - Small changes of probe lengths in Table 2 in order to better reflect the true lengths of the amplification products. - Various minor textual changes on page 1 and 2. - Various minor layout changes. SALSA P122 NF1 area probemix Page 6 of 6