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One-third of the UK haemophilia A population was screened to establish a national database of mutations and pedigrees and advance knowledge of the disease. The following mutations were found: 131 intron 22- and 13 intron1-breaking inversions; 11 gross deletions and an insertion; 65 frameshifts; three in-frame deletions and one insertion; 46 nonsense; 30 intronic mutations affecting splice sites and four generating new sites; 469 non-synonymous mutations due to 203 different base substitutions of which four affected, and nine were predicted to affect, splicing; three promoter mutations; two synonymous exon 14 mutations possibly affecting splicing; two VWF mutations. Of the above mutations, 176 are not listed in the Haemophilia A Mutation, Structure, Test and Resource Site (HAMSTeRS). Four gross deletions arose by non-homologous end-joining; we detected unexpected splicing in some mutations; substitution of amino acids conserved for less than 90 million years are rare; the risk of developing inhibitors for patients with nonsense mutations is greater when the stop codon is in the 3' half of the mRNA; changes likely to generate splice sites causing frameshifts are over-represented among non-synonymous mutations associated with inhibitors; our data and those in HAMSTeRS enabled the size of the spectrum of specific mutations causing the disease to be estimated and to determine how much of it is known.

Summary. We have constructed a confidential U.K. database of haemophilia A mutations and pedigrees by characterizing the gene defect of one index patient in each U.K. family. Mutations were identified by screening all coding regions of the factor VIII (FVIII) mRNA, using solid-phase fluorescent chemical cleavage of mismatch and examining additional non-coding regions of the gene. Here we report two haemophilia A patients (UK 114 FVIII:C 2% and UK 243 FVIII:C < 1%) with an abnormal FVIII mRNA due to an A to G point mutation, 1·4 kb downstream from exon 1 in the FVIII gene. This mutation creates a new donor splice site in intron 1 and leads to insertion of a 191 bp novel exon in the mRNA. Haplotype analysis suggests that the mutation may have originated in a common ancestor of the two patients, who further illustrate how mRNA analysis allows higher efficiency of haemophilia A mutation detection, because their mutation would not have been identified by direct analysis of the factor VIII gene.

Summary. The families of sporadic haemophilia A patients registered at the Royal London Hospital and with living grandparents were selected for study. Twelve of the 13 known families agreed to collaborate. Of these 11 had a patient with severe and one a patient with mild haemophilia. Five of the severely affected patients had inversions of type 1, that is involving int22h-1 and int22h-3, and two had inversions of type 2, that is involving int22h-1 and int22h-2. The remaining four patients with severe disease had single base substitutions causing two different non-sense (Gln592Stop; Trp2313Stop) and two different mis-sense mutations (His267Pro; Arg2209Gln). A single base substitution causing a mis-sense mutation (His1961Asp) was also found in the patient with mild haemophilia. The Arg2209Gln mutation has previously been found in other patients while the other single base substitutions have not hitherto been observed. Three mutations (all single base substitutions) appear to have arisen in the germline of the patient’s mother, while seven mutations originated in the gonad of one of the patient’s grandparents. In two of the latter families (both with inversion type 2) the origin of muta-tions could be clearly assigned to the grandpaternal gonad. Data on parental age at the onset of mutation were ob-tained in the families investigated. In addition, further evidence was obtained that the int-22h-related inversions arise by intrachromatid, intrachromosome homologous re-combination as the int22h repeat sequences of a patient were found to be identical to those of the maternal grand-father whose germline represents the origin of mutation.

— Long wavelength UV radiations (320–400 nm) cause persistent inhibition of RNA synthesis and marked cytopathic changes in fibroblasts from patients with actinic reticuloid (AR) but not in those from patients with Bloom syndrome or xeroderma pigmentosum. Furthermore, the AR cells show abnormal DNA fragmentation when they are irradiated at temperatures compatible with enzyme activity. Germicidal UVR (ca. 95% 254 nm) stimulates DNA repair synthesis and inhibits DNA replication to a normal extent in the AR cells. Thus, actinic reticuloid, a severe photodermatosis, characterised by skin sensitivity to UV-B, UV-A and part of the visible spectrum and by infiltrates reminiscent of mycosis fungoides, is a human disease with in vitro cellular sensitivity to UV-A and, to our knowledge, is also the first to be reported. We advance the hypothesis that inefficient cellular neutralisation of free radicals may explain the cellular phenotype of actinic reticuloid and contribute to the establishment of a vicious circle that would favour the chronic clinical course and persistent lympho-histiocytic skin infiltrates characteristic of the disease.