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11.2 Genotyping a Known Disease-Causing Mutation   373


                       DNA polymerase to generate new strands of DNA comple-  (CNVs) affect many nucleotide pairs that extend over
                       mentary to both strands of genomic DNA between the     regions much larger than can be amplified into a PCR prod-
                       primers; remember that DNA polymerase adds nucleotides   uct, so they must be analyzed by other methods that will be
                       sequentially onto the 3′ end of a primer.           described later in the book.
                          After sufficient time has elapsed to allow copying of
                       the target region, the reaction is heated in order to melt   Sequencing PCR products
                       apart the original template strands of DNA from the newly   As you may remember, the mutation  Hbβ  that causes
                                                                                                                 S
                       synthesized strands. The reaction tube is allowed to cool,   sickle-cell anemia changes the identity of a single amino
                       so that the starting DNA and the copies synthesized in the   acid in the β chain of adult hemoglobin from glutamic acid
                       previous step become templates for further replication, us-  to valine. The mutant allele is a single nucleotide substitu-
                       ing the oligonucleotides remaining in the tube as primers.   tion that changes an A to a T in the mRNA-like strand of
                       Performing this same sequence of steps—denaturation into   the β-globin gene; the mutation is thus a single nucleotide
                       single strands, hybridization of primers, and polymeriza-  polymorphism (SNP) (Fig. 11.11a). By genotyping the al-
                       tion by DNA polymerase—as an iterative loop results in an   leles of this SNP, we can identify people who will suffer
                       exponential increase in the number of copies of the target   from sickle-cell anemia or are carriers for this trait.
                       region with each step (Fig. 11.10). Repeating the cycle just   The process begins by PCR amplifying the locus from
                       22 times would generate more than a million double-  the person’s genomic DNA using a pair of primers comple-
                       stranded copies of the target region; after 32 repetitions, the   mentary to sequences on either side of the actual disease-
                       reaction tube would have over a billion copies of this part   causing mutation (Fig. 11.11a). Once the PCR product is
                       of the genome.                                      made, its DNA sequence can be determined by the auto-
                          The iterative steps of the protocol can be automated in
                       a PCR machine that heats up and cools down the sample   mated Sanger method shown previously in Fig. 9.7. Either
                                                                           one of the two PCR primers can serve as the primer for the
                       according to a preprogrammed  schedule. The  reaction   sequencing reactions.
                       tubes placed into the machine contain enough nucleotide   As Fig. 11.11b shows, the nucleotide substitution re-
                       triphosphates and oligonucleotide primers to support these   sponsible for the disease shows up clearly in comparing the
                       multiple rounds of DNA replication. Moreover, the tubes   sequence obtained from the PCR products in Hbβ Hbβ
                                                                                                                            S
                                                                                                                        S
                       contain a special DNA polymerase from a bacterium that   sickle-cell patients and  Hbβ Hbβ  normal homozygotes.
                                                                                                    A
                                                                                                        A
                       grows in hot springs. This DNA polymerase remains active   But importantly, both alleles are visible simultaneously in
                       after being subjected to the high temperatures used to melt   the sequence trace made from the PCR product generated
                       apart the DNA strands at each round of the PCR protocol.  using Hbβ Hbβ  heterozygous genomic DNA as the tem-
                                                                                    A
                                                                                         S
                          It is crucial for you to remember from Fig. 11.9 that the
                       two priming oligonucleotides dictate the nature of the final   plate. Genomic DNA prepared from somatic cells of the
                                                                           heterozygote contains both allelic variants. Because the
                       PCR product. The ultimate PCR product is a double-  primers hybridize equally well with the two homologous
                       stranded fragment of DNA that extends from the position   chromosomes (given that the sickle-cell mutation does not
                       of one primer’s 5′ end to the position of the other primer’s   alter the genomic sequences complementary to the prim-
                       5′ end. The primers must be complementary to opposite   ers), about half the DNA molecules in the final PCR prod-
                       strands and have 5′-to-3′ polarities that point toward each   uct will contain the mutant sequence and the other half the
                       other through the region of interest. In practice, PCR is in-  wild-type sequence. Heterozygosity for the disease- causing
                       efficient if the primers are far apart, so the protocol gener-  SNP is thus seen as a double peak showing both A and T in
                       ally cannot amplify DNA regions greater than 25 kb long.
                                                                           the DNA sequence trace.
                                                                               The technique of sequencing PCR products amplified
                                                                           from genomic DNA is a straightforward way to determine
                       PCR Products Are Genotyped                          one’s genotype for any SNP. The same method can also be
                       by Sequencing or Sizing                             used to genotype other kinds of polymorphisms involving
                                                                           small numbers of nucleotides, such as small deletions/
                       For Mendelian genetic diseases caused by changes involv-  insertions (DIPs) or expansions/contractions of the num-
                       ing only one or a few nucleotides in a single gene, all of the   bers of repeats in simple sequence repeats (SSRs).
                       information that distinguishes a normal allele from a mu-
                       tant allele resides within a discrete region of the genome
                       that can be encompassed by a PCR product. The differ-  Size variation in PCR products
                       ences between alleles can be recognized either by direct   In some cases it is possible to genotype a polymorphism in
                       sequencing of PCR products, or in cases in which muta-  a PCR product without actually sequencing it. Gel electro-
                       tions add or subtract nucleotide pairs from the genome, by   phoresis can easily distinguish small variations in the  actual
                       simply looking at the sizes of the PCR products. More   size of a locus caused by DIPs or SSRs, as illustrated in
                       complex polymorphisms such as copy number variants   Fig. 11.12. Again, you begin by using a pair of primers
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