In order to search for mutations resulting in hemophilia A that are not detectable by restriction analysis, three regions of the factor VIII gene were chosen for direct sequence analysis. Short segments of genomic DNA of 127 unrelated patients with hemophilia A were amplified by polymerase chain reaction. A total of 136,017 nucleotides were sequenced, and four mutations leading to the disease were found: a frameshift at codon 360 due to deletion of two nucleotides (GA), a nonsense codon 1705 due to a C → T transition, and two missense codons at positions 1699 and 1708. The first missense mutation (A → T) results in a Tyr → Phe substitution at a putative von Willebrand factor binding site. The second results in an Arg → Cys substitution at a thrombin cleavage site. In addition, we identified three rare sequence variants: a silent C → T transition at codon 34 which does not result in an amino acid change, a G → C change at codon 345 (Val → Leu), and an A → G change at the third nucleotide of intron 14. Direct sequence analysis of amplified DNA is a powerful but labor-intensive method of identifying mutations in large genes such as the human factor VIII gene.
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