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From the Genetics Service IDIBAPS (M. Ezquerra, and Drs. Ballesta and Oliva), Institut de Investigació Biomédica Agustí Pi i Sunyer, Hospital Clínic and Faculty of Medicine, University of Barcelona; Neurology Service of the Hospital Universitario Virgen de las Nieves (Dr. Carnero), Granada; Neurology Service (Dr. Blesa), Hospital Clínic, Barcelona; and Biochemistry Department (Dr. Gelpí), Faculty of Chemistry, University of Barcelona, Spain.
Address correspondence and reprint requests to Dr. Rafael Oliva, Genetics Service, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain.
OBJECTIVE: To characterize the mutation responsible for early-onset AD in a large Spanish kindred.
BACKGROUND: Mutations in the presenilin 1 (PS1) gene have been identified and are known to be responsible for 18 to 50% of familial early-onset AD cases.
METHODS: Patients were characterized clinically. The proband was further studied with EEG, CSF analysis, CT, brain biopsy, and histology. Other members were studied using EEG, CT, MRI, and SPECT. Genetic analysis of PS1 was performed using PCR amplification of PS1 exons and direct sequencing followed by PS1 modeling of the normal and mutant PS1 proteins.
RESULTS: A novel mutation (Ser169Pro) in exon 6 of the PS1 gene was identified in different affected members. The Ser169Pro mutation is located at a site of the PS1 protein that is not a cluster of mutations. The mutation was not present in 100 general population controls and in 50 unrelated sporadic AD cases. The Ser169Pro mutation is associated with generalized myoclonic seizures several years after the initial symptoms of AD, a very early AD onset (
35 years), and a rapidly progressive cognitive decline.
CONCLUSIONS: The absence of the PS1 Ser169Pro mutation in the general population and in sporadic AD cases together with its detection in the affected members of this kindred suggests that it is a pathogenic mutation. The serine to proline change predicts a kink in the 
-helix of the transmembrane domain of the PS1 protein that could radically disrupt its normal structure. Further characterization of the effect of this mutation could help identify the function of the PS1 protein and the pathogenic mechanisms of AD.
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