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Espectro mutacional de la distrofia muscular de Duchenne en España: estudio de 284 casos
Mutational spectrum of Duchenne muscular dystrophy in Spain: Study of 284 cases
I. Vieiteza,b, P. Gallanoc,j, L. González-Queredac,j, S. Borregod,j, I. Marcosd,j, J.M. Milláne,j, T. Jairoe,j, C. Priorf, J. Molanof, M.J. Trujillo-Tiebasg,j, J. Gallego-Merlog,j, M. García-Barcinah, M. Fenollari, C. Navarrob,
Autor para correspondencia
cnavfer@sergas.es

Autor para correspondencia.
a Grupo de Patología Neonatal y Pediátrica, Enfermedades raras, Instituto de Investigación Biomédica de Ourense-Pontevedra-Vigo (IBI), Vigo, España
b Complexo Hospitalario Universitario de Vigo (CHUVI), SERGAS, Vigo, España
c Departamento de Genética, Hospital de la Santa Creu i Sant Pau, Barcelona, España
d Departamento de Genética, Reproducción y Medicina fetal, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, España
e Unidad de Genética y Diagnóstico Prenatal, Hospital Universitario La Fe, Valencia, España
f Instituto de Genética Médica y Molecular (INGEMM), Hospital Universitario La Paz, Madrid, España
g Departamento de Genética, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
h Unidad de Genética, Hospital Universitario de Basurto, Vizcaya, España
i Sección de Genética Clínica, Servicio de Análisis Clínicos, Hospital Clínico San Carlos, Madrid, España
j CIBERER (Centro de Investigación Biomédica en Red de Enfermedades Raras), Instituto de Salud Carlos III, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Las distrofinopat&#237;as constituyen un grupo de enfermedades neuromusculares causadas por alteraciones en el gen de la distrofina <span class="elsevierStyleItalic">&#40;DMD&#41;&#46;</span> Este gen&#44; uno de los m&#225;s grandes encontrados en humanos &#40;79 exones y aproximadamente 2&#44;2<span class="elsevierStyleHsp" style=""></span>Mb de ADN gen&#243;mico<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">1</span></a>&#41;&#44; se localiza en la regi&#243;n cromos&#243;mica Xp21&#44; por lo que son enfermedades que siguen un patr&#243;n de herencia ligada al cromosoma <span class="elsevierStyleSmallCaps">X</span>&#46; La distrofina es una prote&#237;na muscular de 427<span class="elsevierStyleHsp" style=""></span>kDa que desempe&#241;a un papel fundamental en la estabilizaci&#243;n del sarcolema con el anclaje&#44; a trav&#233;s del complejo de glucoprote&#237;nas asociadas a la distrofina&#44; de los filamentos de actina en el citoesqueleto y la matriz extracelular&#46; La ausencia de distrofina da lugar a la rotura de esta conexi&#243;n provocando alteraciones en la membrana plasm&#225;tica y&#44; finalmente&#44; la degeneraci&#243;n y la necrosis de las miofibras<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">2</span></a>&#46; De forma esquem&#225;tica&#44; las mutaciones en la distrofina dan lugar a 2 formas cl&#237;nicas fundamentales de distrofia muscular&#58; una forma grave&#44; la distrofia muscular de Duchenne &#40;DMD&#59; MIM &#35;310200&#41;&#44; y otra m&#225;s leve&#44; la distrofia muscular de Becker &#40;DMB&#59; MIM&#35;300376&#41;&#46; Otras distrofinopat&#237;as incluyen los denominados &#171;<span class="elsevierStyleItalic">outliers</span>&#187; o formas intermedias&#44; el s&#237;ndrome de mialgia y calambres y la miocardiopat&#237;a dilatada ligada a <span class="elsevierStyleSmallCaps">X</span>&#46; Con menor frecuencia&#44; las mujeres portadoras pueden ser sintom&#225;ticas&#44; con cuadros de gravedad variable<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">3-5</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La DMD es la enfermedad muscular hereditaria m&#225;s frecuente&#44; con una incidencia estimada de 1 por cada 3&#46;500 varones nacidos<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">6</span></a>&#46; En esta enfermedad se observa una ausencia total de distrofina&#44; generalmente debida a mutaciones que alteran la pauta de lectura dando lugar a una prote&#237;na truncada y no funcional&#46; Estas mutaciones suelen generar un cod&#243;n de parada prematuro por lo que se activa el mecanismo de degradaci&#243;n de transcritos alterados <span class="elsevierStyleItalic">nonsense-mediated mRNA decay</span> &#40;NMD&#41;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">7</span></a>&#46; Por otra parte&#44; la DMB y otras distrofinopat&#237;as son causadas mayoritariamente por mutaciones que no alteran la pauta de lectura de la distrofina&#44; por lo que se genera una prote&#237;na semifuncional&#46; Esta correlaci&#243;n fenotipo-genotipo explica el 92&#37; de los casos y se conoce como la hip&#243;tesis de la alteraci&#243;n de la pauta de lectura<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">8</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En la DMD se han descrito diversos tipos de mutaciones&#59; alrededor del 65-70&#37; de los casos son debidos a grandes deleciones &#40;de uno o m&#225;s exones&#41; y en torno al 7-10&#37; a grandes duplicaciones &#40;de uno o m&#225;s exones&#41;&#46; El resto de los casos con DMD&#47;BMD se debe a mutaciones puntuales &#40;principalmente <span class="elsevierStyleItalic">nonsense</span>&#41; y peque&#241;as deleciones e inserciones<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">9-12</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A lo largo de los a&#241;os&#44; se han publicado diversos estudios epidemiol&#243;gicos que muestran datos de incidencia y prevalencia de DMD en distintos grupos poblacionales&#58; Suecia<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">13</span></a>&#59; Dinamarca<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">14</span></a>&#59; norte de Inglaterra<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">15</span></a>&#59; Irlanda del Norte<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">16</span></a>&#59; noroeste de Toscana<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">17</span></a>&#59; Estonia<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">18</span></a>&#59; Norteam&#233;rica<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">19</span></a>&#59; Sud&#225;frica<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">20</span></a>&#59; Egipto<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">21</span></a>&#59; China<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">22</span></a>&#44; y Jap&#243;n<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">23</span></a>&#46; Adem&#225;s&#44; en 2014 se publica una revisi&#243;n sistem&#225;tica y metaan&#225;lisis sobre la epidemiolog&#237;a de Duchenne&#44; donde se estima una prevalencia global de 4&#44;78 por cada 100&#46;000 varones<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Los pacientes con enfermedad de Duchenne son diagnosticados habitualmente entre los 3-5 a&#241;os de edad y cursan con debilidad muscular progresiva y p&#233;rdida de la deambulaci&#243;n sobre los 13 a&#241;os de edad&#46; En aproximadamente un 30&#37; de los casos se asocia a coeficiente intelectual bajo<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">25</span></a>&#46; Tambi&#233;n es com&#250;n la afectaci&#243;n card&#237;aca y respiratoria&#44; que normalmente conlleva a la muerte entre la segunda y la tercera d&#233;cadas de vida<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En este art&#237;culo se recoge la informaci&#243;n relativa a las alteraciones gen&#233;ticas que subyacen en un amplio grupo de pacientes diagnosticados de enfermedad de Duchenne de la poblaci&#243;n espa&#241;ola entre los a&#241;os 2007 y 2014&#44; permitiendo realizar una visi&#243;n global del estado de esta enfermedad en Espa&#241;a y revisar su algoritmo de diagn&#243;stico gen&#233;tico&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Pacientes y m&#233;todos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Se han revisado un total de 284 casos de varones diagnosticados gen&#233;ticamente de DMD entre enero del 2007 y diciembre del 2014&#46; Provienen de 8 hospitales espa&#241;oles de referencia que cubren la mayor parte del territorio espa&#241;ol&#58; 151 casos del Hospital de la Santa Creu i Sant Pau &#40;Barcelona&#41;&#44; 39 casos del Hospital Universitario Virgen del Roc&#237;o &#40;Sevilla&#41;&#44; 38 casos del Hospital Universitari i Polit&#232;cnic La Fe &#40;Valencia&#41;&#44; 26 casos del Hospital Universitario de la Paz &#40;Madrid&#41;&#44; 18 casos del Hospital Universitario Fundaci&#243;n Jim&#233;nez D&#237;az &#40;Madrid&#41; y 12 casos recogidos entre el Complexo Hospitalario Universitario de Vigo &#40;Pontevedra&#41;&#44; Hospital Universitario de Basurto &#40;Vizcaya&#41; y Hospital Cl&#237;nico San Carlos &#40;Madrid&#41;&#46; El diagn&#243;stico de DMD fue establecido por diversos especialistas bas&#225;ndose en estrictos criterios que incluyen&#58; presentaci&#243;n cl&#237;nica indicativa de DMD&#44; antecedentes familiares de distrofia muscular de herencia ligada al cromosoma <span class="elsevierStyleSmallCaps">X</span>&#44; an&#225;lisis gen&#233;tico del gen <span class="elsevierStyleItalic">DMD</span> y&#47;o estudio de la biopsia muscular con an&#225;lisis de distrofina mediante inmunohistoqu&#237;mica o Western blot&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Extracci&#243;n de ADN</span><p id="par0040" class="elsevierStylePara elsevierViewall">Se realiz&#243; la extracci&#243;n del ADN gen&#243;mico de los pacientes a partir de leucocitos de sangre perif&#233;rica mediante protocolos estandarizados&#46; Todos los pacientes o tutores&#44; en el caso de menores de edad&#44; firmaron el consentimiento informado para la realizaci&#243;n de estudios gen&#233;ticos&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Reacci&#243;n en cadena de la polimerasa multiplex</span><p id="par0045" class="elsevierStylePara elsevierViewall">La reacci&#243;n en cadena de la polimerasa &#40;PCR&#41; multiplex permite la identificaci&#243;n de grandes deleciones en <span class="elsevierStyleItalic">DMD</span> mediante la amplificaci&#243;n simult&#225;nea&#44; sobre la base de 2 series de oligonucle&#243;tidos<a class="elsevierStyleCrossRefs" href="#bib0355"><span class="elsevierStyleSup">27&#44;28</span></a>&#44; del promotor muscular y 17 exones que cubren las regiones donde se acumula el mayor n&#250;mero de deleciones de la distrofina &#40;Pm&#44; 3&#44; 4&#44; 6&#44; 8&#44; 12&#44; 13&#44; 17&#44; 19&#44; 43&#44; 44&#44; 45&#44; 47&#44; 48&#44; 50&#44; 51&#44; 52 y 60&#41;&#46; Algunos laboratorios de referencia complementaron la PCR multiplex con una tercera serie de oligonucle&#243;tidos que incluye el promotor cerebral y 6 exones m&#225;s de la distrofina &#40;2&#44; 20&#44; 33&#44; 53&#44; 54 y 66&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Multiplex ligation-dependent probe amplification</span><p id="par0050" class="elsevierStylePara elsevierViewall">EL an&#225;lisis por <span class="elsevierStyleItalic">multiple ligation-dependent probe amplification</span> &#40;MLPA&#41; permite identificar tanto grandes deleciones como duplicaciones en <span class="elsevierStyleItalic">DMD</span> mediante hibridaci&#243;n de sondas espec&#237;ficas marcadas y amplificadas por PCR&#46; En aquellos pacientes en los que no se identific&#243; una deleci&#243;n en el gen de la distrofina por PCR multiplex&#44; o incluso como primera aproximaci&#243;n gen&#233;tica&#44; se realiz&#243; un an&#225;lisis de deleciones&#47;duplicaciones mediante esta t&#233;cnica utilizando los kits SALSA P034 y P035&#44; siguiendo las instrucciones establecidas por el fabricante &#40;MRC-Holland&#44; Amsterdam&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Secuenciaci&#243;n</span><p id="par0055" class="elsevierStylePara elsevierViewall">La detecci&#243;n de mutaciones puntuales se realiz&#243; mediante secuenciaci&#243;n directa basada en la t&#233;cnica de Sanger de los 79 exones y las regiones intr&#243;nicas flanqueantes del gen <span class="elsevierStyleItalic">DMD</span> a partir de ADN gen&#243;mico&#46; En aquellos casos en los que se dispon&#237;a de tejido muscular&#44; el an&#225;lisis molecular se realiz&#243; en primer lugar en ADNc retrotranscrito a partir del ARN mensajero extra&#237;do de biopsia muscular y las mutaciones identificadas fueron confirmadas posteriormente en el ADN gen&#243;mico&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En algunos centros se realiz&#243; el an&#225;lisis de mutaciones puntuales mediante la secuenciaci&#243;n de nueva generaci&#243;n en la plataforma MiSeq de Illumina o en la plataforma PGM de Life Technologies&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Confirmaci&#243;n de mutaciones</span><p id="par0065" class="elsevierStylePara elsevierViewall">Se actualizaron todas las mutaciones recogidas en el estudio siguiendo las normas establecidas por la Human Genome Variation Society &#40;HGVS&#44; <a href="http://www.hgvs.org/">www&#46;hgvs&#46;org</a>&#41;&#44; la Leiden Open Variant Database &#40;LOVD&#44; <a href="http://www.dmd.nl/">www&#46;dmd&#46;nl</a>&#41; y el Exome Variant Server &#40;<a href="http://evs.gs.washington.edu/EVS/">http&#58;&#47;&#47;evs&#46;gs&#46;washington&#46;edu&#47;EVS&#47;</a>&#41; a fin de confirmar su nomenclatura y determinar si hab&#237;an sido descritas previamente&#46; Las posiciones nucleot&#237;dicas se determinaron en relaci&#243;n con la secuencia de referencia de DMD &#40;RefSeq NM&#95;004006&#46;2&#41;&#46; La evaluaci&#243;n de la patogenicidad de las nuevas variaciones identificadas fue realizada en base a an&#225;lisis <span class="elsevierStyleItalic">&#171;in silico&#187;</span> mediante algoritmos computacionales de predicci&#243;n&#46; La alteraci&#243;n de los sitios de <span class="elsevierStyleItalic">splicing</span> fue analizada mediante diferentes matrices de peso posicional integradas en los programas Splicing Finder y Alamut&#46; En cuanto a las alteraciones por sustituciones aminoac&#237;dicas&#44; fueron valoradas mediante los programas Polyphen-2 y SIFT&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">An&#225;lisis de datos poblacionales</span><p id="par0070" class="elsevierStylePara elsevierViewall">Para los estudios de prevalencia&#44; a partir de los datos obtenidos&#44; se utiliz&#243; la informaci&#243;n recogida por el Instituto Nacional de Estad&#237;stica teniendo en cuenta el 1 de enero del 2015 como punto de referencia para los c&#225;lculos&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Grandes deleciones y duplicaciones</span><p id="par0075" class="elsevierStylePara elsevierViewall">Con el an&#225;lisis mutacional de <span class="elsevierStyleItalic">DMD</span> en los 284 pacientes&#44; combinando las t&#233;cnicas de PCR multiplex y MLPA&#44; se encontraron 187 pacientes que presentaban deleciones o duplicaciones de uno o m&#225;s exones&#44; correspondiendo a un 46&#44;1&#37; &#40;131&#47;284&#41; y un 19&#44;7&#37; &#40;56&#47;284&#41;&#44; respectivamente &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Se identificaron 71 tipos distintos de grandes deleciones&#44; siendo la deleci&#243;n del ex&#243;n 51 la m&#225;s frecuente &#40;10&#47;131&#58; 7&#44;6&#37;&#41;&#44; seguida de la deleci&#243;n del ex&#243;n 45 &#40;7&#47;131&#58; 5&#44;3&#37;&#41;&#44; las deleciones de los exones 3-7 y 45-50 en igual frecuencia &#40;6&#47;131&#58; 4&#44;6&#37;&#41;&#44; y la deleci&#243;n del ex&#243;n 44 &#40;5&#47;131&#58; 3&#44;8&#37;&#41;&#46; Tras el an&#225;lisis de la longitud de las grandes deleciones identificadas&#44; se observ&#243; que las m&#225;s frecuentes eran aquellas que implican a un &#250;nico ex&#243;n&#44; presentes en un 29&#37; &#40;38&#47;131&#41; de los casos con grandes deleciones&#46; A partir de estos datos&#44; junto a la distribuci&#243;n del resto de grandes deleciones identificadas en el estudio&#44; se confirma la clusterizaci&#243;n preferente en 2 regiones del gen de la distrofina&#58; la regi&#243;n pr&#243;xima al 5&#8242; del dominio N-terminal &#40;exones 2 al 20&#41; y la regi&#243;n media-distal del dominio central &#40;exones 44 al 55&#41; con un 32&#44;7&#37; y 57&#44;4&#37;&#44; respectivamente&#44; correspondientes a las denominadas zonas calientes del gen o <span class="elsevierStyleItalic">&#171;hot spots&#187;</span> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Respecto al efecto a nivel de transcrito de las grandes deleciones&#44; el 88&#44;5&#37; &#40;116&#47;131&#41; de las identificadas en nuestro estudio rompieron la pauta de lectura&#44; mientras que un 11&#44;5&#37; &#40;15&#47;131&#41; de casos presentaron deleciones que manten&#237;an la pauta de lectura&#44; por lo que no cumpl&#237;an la hip&#243;tesis de Monaco<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">8</span></a>&#46; En estos casos&#44; el diagn&#243;stico de DMD se bas&#243; en criterios cl&#237;nicos y&#47;o referentes a la biopsia muscular &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Se identificaron 27 tipos distintos de grandes duplicaciones&#44; siendo la m&#225;s frecuente la duplicaci&#243;n del ex&#243;n 2 &#40;10&#47;56&#58; 17&#44;9&#37;&#41;&#46; Al igual que en el caso de las grandes deleciones&#44; se observ&#243; que las duplicaciones m&#225;s frecuentes eran aquellas que implican a un &#250;nico ex&#243;n &#40;15&#47;56&#58; 26&#44;8&#37;&#41;&#46; Analizando la localizaci&#243;n de las grandes duplicaciones dentro de la prote&#237;na&#44; tambi&#233;n se observ&#243; un agrupamiento en la regi&#243;n pr&#243;xima al 5&#8242; del dominio N-terminal &#40;67&#44;9&#37;&#41;&#44; y en la regi&#243;n media-distal del dominio central &#40;28&#44;6&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Se analiz&#243; la frecuencia con la que las zonas intr&#243;nicas de DMD est&#225;n implicadas en los puntos de corte de las grandes deleciones y duplicaciones&#44; tanto en los inicios 5&#8242; como en las terminaciones 3&#8242;&#46; En el caso de las grandes deleciones&#44; se observ&#243; que las regiones m&#225;s implicadas son las correspondientes al intr&#243;n 7 &#40;30&#47;131&#41;&#44; intr&#243;n 44 &#40;26&#47;131&#41; e intr&#243;n 50 &#40;29&#47;131&#41;&#44; que corresponden al 64&#44;9&#37; de los pacientes con deleciones&#46; En el caso de las grandes duplicaciones&#44; las regiones intr&#243;nicas m&#225;s frecuentemente afectadas son las correspondientes al intr&#243;n 1 &#40;12&#47;56&#41;&#44; intr&#243;n 2 &#40;18&#47;56&#41; e intr&#243;n 9 &#40;12&#47;56&#41;&#44; que corresponden al 75&#37; de los pacientes con duplicaciones&#46; A diferencia de las grandes deleciones&#44; en las que los puntos de corte parecen estar concentrados en las 2 regiones con m&#225;s mutaciones&#44; en el caso de las grandes duplicaciones los puntos de corte se encuentran dispersos por todo el gen de la distrofina &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Mutaciones puntuales&#58; nonsense y otras mutaciones</span><p id="par0100" class="elsevierStylePara elsevierViewall">En aquellos pacientes en los que&#44; tras la PCR multiplex o MLPA&#44; no se identific&#243; la mutaci&#243;n en <span class="elsevierStyleItalic">DMD</span>&#44; se realizaron estudios de secuenciaci&#243;n directa por el m&#233;todo Sanger a nivel de ADN&#44; o ARN en caso de disponer de biopsia de m&#250;sculo&#46; En los casos estudiados m&#225;s recientemente&#44; el an&#225;lisis se realiz&#243; mediante secuenciaci&#243;n de nueva generaci&#243;n&#46; Se identificaron 97 mutaciones puntuales que corresponden al 34&#44;2&#37; de los 284 pacientes iniciales&#46; Cabe destacar que de estas mutaciones puntuales identificadas&#44; m&#225;s de la mitad son sustituciones nucleot&#237;dicas que generan codones de parada o mutaciones <span class="elsevierStyleItalic">nonsense</span> &#40;49&#47;97&#44; 50&#44;5&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; En este tipo de mutaciones&#44; el cambio de una citosina por timina ocurre en un 67&#44;3&#37; &#40;33&#47;49&#41; de los casos&#44; y en un 51&#44;5&#37; &#40;17&#47;33&#41; de estos casos las citosinas forman parte de dinucle&#243;tidos CpG &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; En 16 casos se analiz&#243; la mutaci&#243;n a nivel de transcrito mediante an&#225;lisis de ARN extra&#237;do de la biopsia muscular&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">El resto de las mutaciones identificadas representa el 16&#44;9&#37; del total de pacientes e incluye 15 peque&#241;as deleciones&#44; 12 peque&#241;as duplicaciones&#44; 10 alteraciones de <span class="elsevierStyleItalic">splicing</span>&#44; 7 <span class="elsevierStyleItalic">indels</span>&#44; 2 peque&#241;as inserciones y 2 sustituciones <span class="elsevierStyleItalic">missense&#46;</span> El rango de tama&#241;o de estas variaciones oscila entre la sustituci&#243;n de un &#250;nico nucle&#243;tido hasta la deleci&#243;n de 23 nucle&#243;tidos&#46; En 10 casos se confirm&#243; la mutaci&#243;n a nivel de transcrito &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Nuevas mutaciones en el gen DMD</span><p id="par0110" class="elsevierStylePara elsevierViewall">En el estudio realizado se identificaron 23 alteraciones gen&#233;ticas en el gen <span class="elsevierStyleItalic">DMD</span> no descritas con anterioridad&#58; 7 corresponden a grandes deleciones &#40;deleci&#243;n de los exones 2 al 15&#59; 3 al 45&#59; 56 al 61&#59; 56 al 64&#59; 63 al 64&#59; 64 al 70 y deleci&#243;n del ex&#243;n 67&#41; y 16 a mutaciones puntuales &#40;4 sustituciones <span class="elsevierStyleItalic">nonsense</span>&#44; 4 peque&#241;as deleciones&#44; 2 peque&#241;as duplicaciones&#44; 2 <span class="elsevierStyleItalic">indels</span>&#44; 2 peque&#241;as inserciones y 2 variaciones de <span class="elsevierStyleItalic">splicing&#41;</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Distribuci&#243;n geogr&#225;fica de los casos estudiados</span><p id="par0115" class="elsevierStylePara elsevierViewall">La serie de casos recogida se sit&#250;a en torno al 26&#37; &#40;284&#47;1091&#41; de los casos de DMD que se esperar&#237;a tener en Espa&#241;a en el periodo estudiado&#44; teniendo en cuenta la prevalencia global estimada para DMD de 4&#44;78 &#40;IC del 95&#37;&#44; 1&#44;94-11&#44;81&#41; casos por cada 100&#46;000 varones<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">24</span></a> y los datos poblacionales facilitados por el Instituto Nacional de Estad&#237;stica &#40;22&#46;820&#46;775 varones en enero de 2015&#41;&#46; La distribuci&#243;n geogr&#225;fica de los casos observados en este estudio es heterog&#233;nea&#44; siendo las comunidades aut&#243;nomas con m&#225;s casos de DMD diagnosticados gen&#233;ticamente las correspondientes a los centros de referencia que participan en el estudio&#58; Catalu&#241;a&#44; Comunidad de Madrid&#44; Andaluc&#237;a&#44; Comunidad Valenciana&#44; Pa&#237;s Vasco&#44; Galicia y Cantabria&#46;</p></span></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Discusi&#243;n</span><p id="par0120" class="elsevierStylePara elsevierViewall">La DMD es una de las enfermedades neuromusculares m&#225;s frecuentes&#44; con patr&#243;n de herencia ligada al cromosoma <span class="elsevierStyleSmallCaps">X</span>&#46; Es la variante fenot&#237;pica m&#225;s grave asociada al gen de la distrofina y se suele diagnosticar entre los 2 y 5 a&#241;os de edad&#46; La ausencia de la distrofina da lugar a la degeneraci&#243;n progresiva de la fibra muscular con fibrosis y sustituci&#243;n adiposa terminal&#44; lo que determina una debilidad muscular progresiva y p&#233;rdida de la deambulaci&#243;n alrededor de los 13 a&#241;os de edad&#46; A diferencia de otras distrofinopat&#237;as&#44; el cuadro cl&#237;nico de los pacientes afectados de DMD es relativamente uniforme&#44; y las diferencias en la evoluci&#243;n individual se deben especialmente a la afectaci&#243;n card&#237;aca asociada y a las terapias o cuidados particulares otorgados a los pacientes a distintos niveles&#58; rehabilitaci&#243;n&#44; seguimiento card&#237;aco&#44; respiratorio&#44; ortop&#233;dico&#44; psicosocial y nutricional<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">14&#44;29&#44;30</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">En este art&#237;culo se han recogido los casos diagnosticados de DMD en los principales laboratorios espa&#241;oles de gen&#233;tica molecular&#44; tratando de profundizar en las caracter&#237;sticas gen&#233;ticas que presentan&#46; El an&#225;lisis mutacional de los 284 pacientes estudiados confirma la gran heterogeneidad gen&#233;tica de la DMD&#44; identific&#225;ndose 179 mutaciones distintas en <span class="elsevierStyleItalic">DMD</span> que se pueden clasificar en 3 categor&#237;as&#58; grandes deleciones &#40;con 71 tipos distintos en 131 pacientes&#41;&#59; grandes duplicaciones &#40;con 27 tipos distintos en 56 pacientes&#41;&#44; y mutaciones puntuales &#40;con 81 tipos distintos en 97 pacientes&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">De la serie de afectados de DMD estudiados&#44; un 46&#44;1&#37; de los casos present&#243; grandes deleciones&#46; Este porcentaje es menor de lo publicado en estudios previos<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">31</span></a>&#46; Esto podr&#237;a deberse a un sesgo en la selecci&#243;n de los pacientes&#44; ya que algunos de ellos corresponden a portadores de mutaciones puntuales que no fueron detectadas antes de 2007&#44; y cuyo an&#225;lisis se retom&#243; posteriormente empleando nuevas tecnolog&#237;as<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">11</span></a>&#46; Las deleciones m&#225;s frecuentes en la serie analizada fueron las de los exones 51 &#40;7&#44;6&#37;&#41; y 45 &#40;5&#44;3&#37;&#41;&#44; y se observ&#243; una agrupaci&#243;n de las deleciones en los 2 puntos calientes del gen&#58; el 38&#44;2&#37; en la regi&#243;n proximal y el 55&#44;9&#37; en la distal&#46; Estos datos est&#225;n en consonancia con estudios previos publicados sobre grandes series de pacientes con DMD<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">11&#44;12&#44;32&#44;33</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En cuanto a las duplicaciones ex&#243;nicas&#44; representan un 19&#44;7&#37; de los pacientes estudiados&#44; y un 17&#44;9&#37; de ellos portan la duplicaci&#243;n del ex&#243;n 2&#46; Estos datos son similares a los reportados en estudios anteriores<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">12&#44;34</span></a>&#46; Analizando la distribuci&#243;n de las grandes duplicaciones identificadas&#44; tambi&#233;n tienden a la agrupaci&#243;n en las regiones calientes del gen de la distrofina&#44; aunque&#44; en este caso&#44; parecen tener una mayor concentraci&#243;n en la regi&#243;n proximal que en la distal &#40;el 67&#44;9 y el 28&#44;6&#37;&#44; respectivamente&#41;&#46; Estos datos son concordantes con estudios previos<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">11&#44;12&#44;32&#44;33</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">El patr&#243;n de distribuci&#243;n de los puntos de corte de las mutaciones var&#237;a entre grandes deleciones y duplicaciones&#46; En las deleciones los puntos de corte se concentran en las regiones calientes del gen de la distrofina&#44; especialmente en la regi&#243;n distal&#44; y&#44; en cambio&#44; los puntos de corte implicados en las duplicaciones se localizan principalmente en la regi&#243;n proximal&#44; estando el resto m&#225;s dispersos a lo largo del gen&#46; Por otra parte&#44; aunque los puntos de corte en las deleciones coinciden fundamentalmente con los intrones de gran tama&#241;o&#44; la longitud de la regi&#243;n intr&#243;nica no debe considerarse como el &#250;nico determinante en el perfil de punto de corte de deleciones en el gen <span class="elsevierStyleItalic">DMD</span><a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">35</span></a>&#46; En nuestra serie&#44; aunque el intr&#243;n 7&#44; de unos 110<span class="elsevierStyleHsp" style=""></span>kb&#44; es el que presenta un mayor n&#250;mero de puntos de corte&#44; el segundo con una elevada concentraci&#243;n de puntos de corte es el intr&#243;n 50&#44; de mucho menor tama&#241;o &#40;46<span class="elsevierStyleHsp" style=""></span>kb&#41;&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">A diferencia de las grandes deleciones y duplicaciones&#44; las mutaciones puntuales&#44; que representan en su conjunto el 34&#44;2&#37; de los casos estudiados&#44; se distribuyen uniformemente a lo largo del gen <span class="elsevierStyleItalic">DMD</span> y son muy poco recurrentes&#44; siendo la mayor&#237;a de ellas identificadas en un &#250;nico paciente&#46; Dentro de las mutaciones puntuales&#44; las sustituciones sin sentido o <span class="elsevierStyleItalic">nonsense</span> son las m&#225;s frecuentes&#44; con un 50&#44;5&#37; de los casos estudiados&#46; Un dato a resaltar es el elevado porcentaje de sustituciones de citosina por timina&#44; que corresponden a citosinas implicadas en los dinucle&#243;tidos CpG &#40;51&#44;5&#37;&#41;&#46; Adem&#225;s&#44; en la distrofina existen 29 codones CGA &#40;arginina&#41;&#44; y en este estudio se ha identificado la transici&#243;n de la citosina a timina en 11 de ellos&#46; Varios estudios publicados con anterioridad ya observaron esta tendencia a la transici&#243;n a timina de las citosinas metiladas de los dinucle&#243;tidos CpG por desaminaci&#243;n espont&#225;nea&#44; por lo que estos dinucle&#243;tidos CpG son puntos calientes de mutaciones en el gen de la distrofina<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">11&#44;32&#44;33&#44;36&#44;37</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">La hip&#243;tesis de la pauta de lectura establecida por Monaco et al&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">8</span></a> postula que mutaciones que alteran la pauta de lectura dan lugar a la ausencia de distrofina generando el fenotipo de DMD&#46; En esta serie&#44; 254 pacientes son portadores de mutaciones que rompen la pauta de lectura &#40;89&#44;4&#37;&#41; y 30 pacientes presentan mutaciones que mantienen la pauta de lectura &#40;10&#44;6&#37;&#41;&#44; siendo estas &#250;ltimas excepciones a la regla&#46; En el caso de las grandes deleciones&#44; se ajustan a la hip&#243;tesis el 88&#44;5&#37; de los casos y no se ajustan el 11&#44;5&#37; de ellos&#46; Una posible explicaci&#243;n a esta excepci&#243;n ser&#237;a que el punto de corte de la deleci&#243;n se produjese dentro de regiones ex&#243;nicas&#44; lo que s&#237; podr&#237;a dar lugar a una alteraci&#243;n de la pauta de lectura<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">38</span></a>&#46; Por otra parte&#44; algunas deleciones que mantienen la pauta de lectura afectan a dominios de uni&#243;n de la distrofina &#40;dominio de uni&#243;n a la actina y dominio rico en ciste&#237;na&#41;&#44; lo que afectar&#237;a seriamente al correcto funcionamiento de la prote&#237;na<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">33</span></a>&#46; Hay que considerar que la aplicaci&#243;n de esta hip&#243;tesis sobre las duplicaciones no es totalmente fiable&#44; ya que se presupone una duplicaci&#243;n en t&#225;ndem&#44; lo que no siempre ocurre&#44; siendo necesario un estudio del mARN para comprobar esta afirmaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">34</span></a>&#46; Otras mutaciones que escapan a la regla de Monaco son las de tipo <span class="elsevierStyleItalic">missense</span>&#44; que&#44; en principio&#44; se asociar&#237;an con un fenotipo menos grave de distrofinopat&#237;a&#46; En cambio&#44; las 2 mutaciones de este tipo identificadas en nuestra serie de pacientes se localizan en los dominios de uni&#243;n de la distrofina&#58; la mutaci&#243;n p&#46; Trp24Arg se localiza en el dominio ABD y la mutaci&#243;n p&#46; Pro3320Ser en el dominio CRD&#46; En cuanto a las alteraciones de <span class="elsevierStyleItalic">splicing</span>&#44; estudios previos en mARN han demostrado que este tipo de variaciones suele provocar alteraciones de la pauta de lectura<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">Sobre la base de los resultados obtenidos&#44; creemos que el algoritmo de diagn&#243;stico aplicado en los centros que participaron en este estudio es el m&#225;s adecuado para el diagn&#243;stico molecular de la DMD&#44; permitiendo genotipificar&#44; mediante MLPA y&#47;o PCR multiplex&#44; el 65&#44;8&#37; de los casos&#44; aplicando&#44; en segundo t&#233;rmino&#44; tecnolog&#237;as de secuenciaci&#243;n para completar el an&#225;lisis de mutaciones puntuales en <span class="elsevierStyleItalic">DMD</span>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">En los &#250;ltimos a&#241;os se ha desarrollado un elevado n&#250;mero de ensayos cl&#237;nicos dirigidos al tratamiento de los pacientes de DMD&#44; que incluyen estrategias de sustituci&#243;n g&#233;nica&#44; correcci&#243;n del gen <span class="elsevierStyleItalic">DMD</span> o modificaci&#243;n del producto g&#233;nico&#44; y que pueden ser aplicados &#250;nicamente en pacientes con determinados tipos de mutaciones<a class="elsevierStyleCrossRefs" href="#bib0415"><span class="elsevierStyleSup">39&#44;40</span></a>&#46; Una de las terapias en estudio m&#225;s prometedora en la actualidad se basa en la relectura de mutaciones sin sentido <span class="elsevierStyleItalic">&#40;nonsense read-through&#41;</span> que trata de suprimir el efecto de una sustituci&#243;n que genera un cod&#243;n de parada mediante el tratamiento con PTC124<a class="elsevierStyleCrossRefs" href="#bib0425"><span class="elsevierStyleSup">41&#44;42</span></a>&#46; Un 17&#44;2&#37; &#40;110&#47;284&#41; de los casos de DMD de la serie son portadores de mutaciones sin sentido&#44; por lo que ser&#237;an potencialmente beneficiarios de este tipo de tratamiento&#46; Otra terapia destacada en el tratamiento de pacientes de DMD consiste en el salto de ex&#243;n <span class="elsevierStyleItalic">&#40;exon skipping&#41;</span>&#44; de forma que se restaurar&#237;a la pauta de lectura mediante la supresi&#243;n de uno o 2 exones&#46; El mecanismo de salto de ex&#243;n 51 es el m&#225;s desarrollado&#44; seguido de los exones 44&#44; 45&#44; 52&#44; 53 y 55<a class="elsevierStyleCrossRefs" href="#bib0435"><span class="elsevierStyleSup">43&#44;44</span></a>&#46; Tras el an&#225;lisis gen&#233;tico&#44; se encontr&#243; que un 21&#44;5&#37; &#40;61&#47;284&#41; de los pacientes presentan deleciones que&#44; mediante omisi&#243;n de alguno de estos exones&#44; podr&#237;an restablecer la pauta de lectura de la distrofina&#46; Esto hace que el 38&#44;7&#37; &#40;110&#47;284&#41; de los pacientes de nuestra serie sean <span class="elsevierStyleItalic">a priori</span> susceptibles de participar en alguno de los recientes ensayos cl&#237;nicos a expensas de los criterios de inclusi&#243;n&#47;exclusi&#243;n&#46; Con esto queremos resaltar la gran importancia de identificar el tipo de mutaci&#243;n que presentan los pacientes con <span class="elsevierStyleItalic">DMD</span> con el fin de seleccionar los que podr&#237;an eventualmente ser incluidos en un ensayo cl&#237;nico y en qu&#233; tipo de ensayo&#46; Por otra parte&#44; el diagn&#243;stico gen&#233;tico es igualmente importante para la prevenci&#243;n de nuevos casos en una familia afectada&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Otro de los objetivos de este art&#237;culo fue analizar la distribuci&#243;n geogr&#225;fica de afectos de DMD en Espa&#241;a en el periodo 2007-2014&#46; Observamos que solo hemos logrado reunir el 26&#37; de los casos que se esperar&#237;a obtener en la poblaci&#243;n espa&#241;ola&#44; lo que pone de manifiesto&#44; al margen de que existan posibles casos no identificados&#44; el infradiagn&#243;stico gen&#233;tico de DMD en Espa&#241;a&#46; Esto puede ser debido&#44; en parte&#44; a las dificultades de acceso a los centros de referencia y posiblemente tambi&#233;n a una insuficiente relaci&#243;n entre cl&#237;nicos y genetistas&#46; Una mayor coordinaci&#243;n entre ellos ayudar&#237;a a agilizar y mejorar el diagn&#243;stico gen&#233;tico en las distrofinopat&#237;as y otras enfermedades neuromusculares&#44; profundizando en la correlaci&#243;n cl&#237;nico-patol&#243;gica y gen&#233;tica y favoreciendo la aplicaci&#243;n de posibles tratamientos en estos pacientes con enfermedades tan graves y que&#44; hasta el momento&#44; cuentan con tan escasas ayudas terap&#233;uticas&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicto de intereses</span><p id="par0170" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "Extracci&#243;n de ADN"
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              "titulo" => "Nuevas mutaciones en el gen DMD"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La distrofia muscular de Duchenne &#40;DMD&#41; es una enfermedad neuromuscular grave que afecta a uno de cada 3&#46;500 varones nacidos y sigue un patr&#243;n de herencia ligada al cromosoma <span class="elsevierStyleSmallCaps">X</span>&#46; En esta enfermedad se observa una ausencia total de la distrofina&#44; generalmente debida a mutaciones en el gen DMD&#44; que altera la pauta de lectura y en torno al 80&#37; de los casos son debidos a deleciones y duplicaciones de uno o m&#225;s exones&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se han revisado 284 casos de varones diagnosticados gen&#233;ticamente de DMD entre los a&#241;os 2007 y 2014&#46; Estos pacientes provienen de 8 hospitales espa&#241;oles de referencia que cubren la mayor parte del territorio espa&#241;ol&#46; Para la identificaci&#243;n de las mutaciones se realizaron las t&#233;cnicas de reacci&#243;n en cadena de la polimerasa multiplex&#44; MLPA y secuenciaci&#243;n&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Los pacientes con DMD presentan en su mayor&#237;a grandes deleciones &#40;46&#44;1&#37;&#41; o grandes duplicaciones &#40;19&#44;7&#37;&#41; en el gen de la distrofina&#46; El restante 34&#44;2&#37; corresponde al conjunto de mutaciones puntuales&#44; destacando las sustituciones nucleot&#237;dicas tipo <span class="elsevierStyleItalic">nonsense</span> que aparecen en la mitad de los casos&#46; Este estudio permiti&#243; identificar 23 nuevas mutaciones en DMD&#58; 7 grandes deleciones y 16 mutaciones puntuales&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El algoritmo de diagn&#243;stico gen&#233;tico aplicado por los centros participantes es el m&#225;s adecuado para genotipificar a los pacientes con DMD&#46; La especificidad gen&#233;tica de las distintas terapias en desarrollo pone de manifiesto la importancia de conocer la mutaci&#243;n de cada paciente&#44; siendo un 38&#44;7&#37; de ellos susceptibles de participar en los ensayos cl&#237;nicos actuales&#46;</p></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Duchenne muscular dystrophy &#40;DMD&#41; is a severe <span class="elsevierStyleSmallCaps">X</span>-linked recessive neuromuscular disease that affects one in 3500 live-born males&#46; The total absence of dystrophin observed in DMD patients is generally caused by mutations that disrupt the reading frame of the DMD gene&#44; and about 80&#37; of cases harbour deletions or duplications of one or more exons&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We reviewed 284 cases of males with a genetic diagnosis of DMD between 2007 and 2014&#46; These patients were selected from 8 Spanish reference hospitals representing most areas of Spain&#46; Multiplex PCR&#44; MLPA&#44; and sequencing were performed to identify mutations&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Most of these DMD patients present large deletions &#40;46&#46;1&#37;&#41; or large duplications &#40;19&#46;7&#37;&#41; in the dystrophin gene&#46; The remaining 34&#46;2&#37; correspond to point mutations&#44; and half of these correspond to nonsense mutations&#46; In this study we identified 23 new mutations in DMD&#58; 7 large deletions and 16 point mutations&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The algorithm for genetic diagnosis applied by the participating centres is the most appropriate for genotyping patients with DMD&#46; The genetic specificity of different therapies currently being developed emphasises the importance of identifying the mutation appearing in each patient&#59; 38&#46;7&#37; of the cases in this series are eligible to participate in current clinical trials&#46;</p></span>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tipo mutaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#37;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Deleci&#243;n ex&#243;nica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">131&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Frameshift&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">116&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Inframe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Duplicaci&#243;n ex&#243;nica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Frameshift&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">76&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Inframe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Mutaciones puntuales</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34&#44;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#44;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Peque&#241;as deleciones&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Peque&#241;as duplicaciones&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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        "identificador" => "tbl0010"
        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">En negrita&#44; las mutaciones puntuales no descritas&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Posici&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Tipo mutaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cambio nucleot&#237;dico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cambio aminoac&#237;dico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">N&#46;&#176; casos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;11G&#62;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Trp4&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Missense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;70T&#62;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46; Trp24Arg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Exon 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;133C&#62;T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Gln45&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deleci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;114&#95;115del&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Asn39Profs&#42;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Duplicaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;116dupA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Asn39Lysfs&#42;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deleci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;174&#95;175del<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Gly59Alafs&#42;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;353G&#62;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Trp118&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intr&#243;n 5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Splice site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;358-1G&#62;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46; spl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;583C&#62;T<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Arg195&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">c&#46;693C&#62;A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">p&#46;Tyr231&#42;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Duplicaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">c&#46;773dupC</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">p&#46;Lys259&#42;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intr&#243;n 9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Splice site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;961 -1G&#62;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;spl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Indel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;1183&#95;1186delins18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Arg395Cysfs&#42;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intr&#243;n 11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Splice site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;1332 -9A&#62;G<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;&#91;&#61;&#59; Asn444LysfsX9&#59; Asn444LysfsX5&#59; p&#46;Asn444LysfsX7&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;1438G&#62;T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Gly480&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;1510C&#62;T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Gln504&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Duplicaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;1510dupC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Gln504Profs&#42;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;2032C&#62;T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Gln678&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intr&#243;n 17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Splice site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;2169 -2A&#62;G&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;spl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;2227C&#62;T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Gln743&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deleci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">c&#46;2224&#95;2242del</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">p&#46;Lys742Cysfs&#42;25</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deleci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">c&#46;2266delT</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup"><span class="elsevierStyleBold">b</span></span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">p&#46;Phe756Serfs&#42;4</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;2518C&#62;T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Gln840&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deleci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;2559&#95;2560delGA<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Lys854Asnfs&#42;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Inserci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">c&#46;2666insA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">p&#46;Arg889Glnfs&#42;30</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Duplicaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;2712dupC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Met905Hisfs&#42;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Inserci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">c&#46;2733insG</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">p&#46;Val925Glyfs&#42;13</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;2869C&#62;T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Gln957&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;3136C&#62;T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Gln1046&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;3427C&#62;T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Gln1143&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;3511G&#62;T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Glu1171&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;3578T&#62;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Leu1193&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;3580C&#62;T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Gln1194&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;3850G&#62;T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Glu1284&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">c&#46;3862A&#62;T</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">p&#46;Lys1288&#42;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;3982C&#62;T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Gln1328&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;4527T&#62;G&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Tyr1509&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;4729C&#62;T<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Arg1577&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;4838G&#62;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Trp1632&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Duplicaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">c&#46;5056&#95;5078dup</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">p&#46;Lys1693Asnfs&#42;36</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Indel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;5139&#95;5140delinsT<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Lys1713Asnfs&#42;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;5371C&#62;T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Gln1791&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deleci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;5444A&#62;G&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Asp1815Glufs&#42;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;5530C&#62;T<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Arg1844&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;5611A&#62;T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Lys1871&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;5646C&#62;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Tyr1882&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deleci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;5613delG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Ala1872Leufs&#42;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Indel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">c&#46;5699&#95;5704delinsG</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">p&#46;Leu1900Trpfs&#42;4</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deleci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;5768&#95;5771delAAGA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Lys1923Argfs&#42;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">c&#46;6286C&#62;T</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">p&#46;Gln2096&#42;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deleci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;6128&#95;6131delATAG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Asp2043Valfs&#42;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;6292C&#62;T<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Arg2098&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;6352C&#62;T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Gln2118&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Splice site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;6581&#95;6614&#43;1del<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Glu2194Alafs&#42;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deleci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">c&#46;7195delG</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">p&#46;Val2399&#42;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Duplicaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;7360dupA<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Thr2454Asnfs&#42;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Indel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">c&#46;7447&#95;7451delinsTCT</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">p&#46;Thr2483Serfs&#42;6</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">c&#46;7585G&#62;T</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">p&#46;Glu2529&#42;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;7657C&#62;T<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Arg2553&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;8214G&#62;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Trp2738&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;8608C&#62;T<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Arg2870&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Indel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;8711&#95;8715indelAGG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Leu2904Glnfs&#42;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;8944C&#62;T<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Arg2982&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Duplicaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;8955dupT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Ala2986Cysfs&#42;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;9148C&#62;T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Gln3050&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intr&#243;n 61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Splice site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">c&#46;9164 -1G&#62;A</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">p&#46;spl</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;9337C&#62;T<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Arg3113&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Duplicaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;9348dupG&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Gln3117Glufs&#42;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;9380C&#62;G&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Ser3127&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deleci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">c&#46;9562delA</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">p&#46;spl</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intr&#243;n 65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Splice site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;9563&#43;1G&#62;A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;spl&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;9568C&#62;T<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Arg3190&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intr&#243;n 66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Splice site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">c&#46;9649 &#43;2insT</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleBold">p&#46;spl</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deleci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;9885delG<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Val3297Serfs&#42;33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Missense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;9958C&#62;T<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Pro3320Ser&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Intr&#243;n 69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Splice site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;10086&#43;5G&#62;C<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Ala3270&#95;Pro3362del&#44; Tyr3326Leufs&#42;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;10108C&#62;T<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Arg3370&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;10171C&#62;T<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Arg3391&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Deleci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;10406&#95;10407del&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;His3469Phefs&#42;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Duplicaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;10409dupT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Leu3470Phefs&#42;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Ex&#243;n 76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Nonsense&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">c&#46;10801C&#62;T&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">p&#46;Gln3601&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Mutaciones puntuales identificadas en <span class="elsevierStyleItalic">DMD</span></p>"
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                          "etal" => false
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                      "Revista" => array:6 [
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                        0 => array:2 [
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                        "tituloSerie" => "Neuromuscul Disord&#46;"
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