High frequency of BMPR2 exonic deletions/duplications in familial pulmonary arterial hypertension

Am J Respir Crit Care Med. 2006 Sep 1;174(5):590-8. doi: 10.1164/rccm.200602-165OC. Epub 2006 May 25.


Rationale: Previous studies have shown that approximately 55% of patients with familial pulmonary arterial hypertension (FPAH) have BMPR2 coding sequence mutations. However, direct sequencing does not detect other types of heterozygous mutations, such as exonic deletions/duplications.

Objective: To estimate the frequency of BMPR2 exonic deletions/duplications in FPAH.

Methods: BMPR2 mRNA from lymphoblastoid cell lines of 30 families with PAH and 14 patients with idiopathic PAH (IPAH) was subjected to reverse transcriptase-polymerase chain reaction (RT-PCR) and sequencing. Sequencing of genomic DNA was used to identify point mutations in splice donor/acceptor sites. Multiplex ligation-dependent probe amplification (MLPA) was used to detect exonic deletions/duplications with verification by real-time PCR.

Measurements and main results: Eleven (37%) patients with FPAH had abnormally sized RT-PCR products. Four of the 11 patients were found to have splice-site mutations resulting in aberrant splicing, and exonic deletions/duplications were detected in the remaining seven patients. MLPA identified three deletions/duplications that were not detectable by RT-PCR. Coding sequence point mutations were identified in 11 of 30 (37%) patients. Mutations were identified in 21 of 30 (70%) patients with FPAH, with 10 of 21 mutations (48%) being exonic deletions/duplications. Two of 14 (14%) patients with IPAH exhibited BMPR2 point mutations, whereas none showed exonic deletions/duplications.

Conclusions: Our study indicates that BMPR2 exonic deletions/duplications in patients with FPAH account for a significant proportion of mutations (48%) that until now have not been screened for. Because the complementary approach used in this study is rapid and cost effective, screening for BMPR2 deletions/duplications by MLPA and real-time PCR should accompany direct sequencing in all PAH testing.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Bone Morphogenetic Protein Receptors, Type II / genetics*
  • Case-Control Studies
  • Exons / genetics*
  • Humans
  • Hypertension, Pulmonary / genetics*
  • Mutation / genetics*
  • Nucleic Acid Amplification Techniques
  • RNA Splice Sites / genetics
  • Sequence Analysis


  • RNA Splice Sites
  • BMPR2 protein, human
  • Bone Morphogenetic Protein Receptors, Type II