Genomics Inform Search


Genomics Inform > Volume 14(3); 2016 > Article
Kim, Cho, Han, and Lee: Structural Variation of Alu Element and Human Disease


Transposable elements are one of major sources to cause genomic instability through various mechanisms including de novo insertion, insertion-mediated genomic deletion, and recombination-associated genomic deletion. Among them is Alu element which is the most abundant element, composing ~10% of the human genome. The element emerged in the primate genome 65 million years ago and has since propagated successfully in the human and non-human primate genomes. Alu element is a non-autonomous retrotransposon and therefore retrotransposed using L1-enzyme machinery. The 'master gene' model has been generally accepted to explain Alu element amplification in primate genomes. According to the model, different subfamilies of Alu elements are created by mutations on the master gene and most Alu elements are amplified from the hyperactive master genes. Alu element is frequently involved in genomic rearrangements in the human genome due to its abundance and sequence identity between them. The genomic rearrangements caused by Alu elements could lead to genetic disorders such as hereditary disease, blood disorder, and neurological disorder. In fact, Alu elements are associated with approximately 0.1% of human genetic disorders. The first part of this review discusses mechanisms of Alu amplification and diversity among different Alu subfamilies. The second part discusses the particular role of Alu elements in generating genomic rearrangements as well as human genetic disorders.


Transposable elements accounts for ~45% of the human genome. They are divided into DNA transposon and retrotransposons, according to their amplification mechanisms. DNA transposons mobilize through a "cut and paste" mechanism while retrotransposons propagate through "copy and paste" mechanism. Retrotransposon transcribes its RNA intermediate, and the RNA intermediate integrates into a new genomic region using a mechanism called target primed reverse transcription (TPRT). Endogenous retroviruses, long interspersed elements (LINEs), and short interspersed elements (SINEs) belong to retrotransposon. Alu element, one of the SINEs, is the most successful retrotransposon in primate genomes. The estimated copy number of the elements is 1.1 million and it is currently retrotranspositionally active in the human genome [1]. The full-length Alu element is 300 bp long and has a dimeric structure. Both of the left and right monomers were derived from 7SL RNA gene and thus they share a high level of sequence identity. Alu elements have an internal RNA polymerase III promoter (A and B boxes) in the 5' region and a poly (A) tail in the 3' end. The transcription of Alu element is initiated by internal RNA polymerase III promoter and terminated at a nearby genomic location having TTTT terminator because the element lacks a transcription terminator (Fig. 1). Alu elements use L1 enzyme machinery for their mobilization. L1 provides Alu elements with endonuclease and reverse transcriptase. L1 endonuclease recognizes consensus oligomer (5'-TTTT/AA-3') and cleaves the genomic region. A-rich region of Alu elements binds to the released consensus site and the elements are reverse-transcribed by L1 reverse transcriptase. The second strand of the Alu element is synthesized by host DNA polymerase using the first strand of the Alu element as a DNA template. The newly inserted Alu element has 7 to 20 bp direct repeats on both sides of the element, termed target site duplications (TSDs) [2,3].
Alu elements are divided into several subfamilies which are determined based on diagnostic nucleotides. During the past 60 million years of the primate genome evolution, old Alu subfamilies became retrotranspositionally dormant while new Alu subfamilies emerged and expanded, leading to the increased number of different Alu subfamilies. The generally accepted canonical mechanism for Alu amplification is master gene model [4] but it could not explain the recent expansion of AluYb subfamily in the human genome: AluYb subfamily was retrotranspositionally dormant for the past 20 million years but it retrieved the ability to retrotranspose and rapidly expanded in the human genome within the past a few million years, which led to a new model of Alu amplification, stealth model, to explain the aberrant amplification of AluYb subfamily [5].
Some of Alu elements amplified and spread in genic regions contributing to human genetic diversity [2,4,6]. Alu element is able to disrupt gene function either by inserting into exonic regions or causing alternative splicing of the genes. In addition, they could cause genomic deletions through insertion-mediated deletion or recombination-associated deletion. The homologous recombination (HR) between Alu elements has associated with genomic duplications, genomic conversion as well as genomic deletions in the human genome. The genomic changes could affect gene expression and lead to abnormal proteins resulting in genetic diseases [7,8,9,10,11].

Amplification and Diversity of Alu Elements

Alu elements emerged in the primate genome, approximately 65 million years ago (mya). Since then, they have successfully amplified and diversified in primate genomes. However, their amplification rate has been fluctuated over the time. The majority of Alu elements were inserted in the primate genome ~40 mya and one new Alu insertion occurred in every birth at the time of the most successful amplification [1], which is much higher than an averaged amplification rate, one insertion every 21 new births during the past 60 million years [10,12]. Alu elements are divided into different subfamilies according to key diagnostic nucleotides on them. Therefore, Alu elements sharing the diagnostic nucleotides are grouped into the same subfamily. Major Alu lineages are AluJ, AluS, and AluY which are distinguished from each other, based on 18 diagnostic nucleotides on their sequences [6]. Among the three major lineages, AluY lineage is the youngest and AluJ lineage is the oldest. During the long time, AluJ subfamilies have accumulated more random mutations on them and thus their mutation rates are much higher than the younger subfamilies [2].
There are four different models suggested for Alu expansion. The first model is master gene model which well explains how new Alu subfamily is created. It suggests that new Alu subfamily is generated by point mutation(s) of retrotranspositionally hyperactive Alu element. During the primate evolution, the master genes accumulated diagnostic nucleotide changes, leading to different subfamilies at different times. Thus, all Alu subfamilies were derived from a series of sequential master genes which accumulated diagnostic base changes, and all members of an Alu subfamily were propagated from a few master genes representing the subfamily. Because Alu element contains a high content of CpG dinucleotide, point mutation frequently occurs on them. In general, the master genes produce a high number of its progenies (Fig. 2A) [4,6]. However, some Alu elements have low retrotranspositional activity and their amplification is not well explained by the master gene model. Unlike the master gene model, transposon model suggests that all elements have a similar capability of generating new copies (Fig. 2C). The third model is intermediate model which is literally the intermediate of master gene and transposon models. The third model suggests that there are much more than a few hyperactive Alu elements (Fig. 2B) [4,13]. Recently, Han et al. [5] introduced the forth model called stealth model. It follows the concept of the master gene model but explains aberrant amplification of Alu elements. Hyperactive Alu elements get mutated and lose its retrotranspositional capability relatively quickly by selection. In contrast, Alu elements with a low retrotransposition activity are able to retain its retrotransposition activity and produce the short-lived hyperactive Alu elements over an extended period of time. It was introduced to explain the recent remarkable expansion of old Alu elements, AluYb lineage, in the human genome (Fig. 2D) [5].

Alu Insertion

Alu element is a primate-specific retrotransposon and has played an important role in primate genomic diversity. During the past six million years, 5,530 Alu elements newly inserted into the human genome [14,15]. Most of them were propagated through classical insertion, in that, Alu elements are inserted into the human genome using TPRT mechanism. The hallmark of the classical Alu insertions is TSDs flanking both ends of an Alu element. However, Alu elements integrated through non-classical insertions are deficient of TSDs but have instead 1 to 7 bp microhomologous sequences on their pre-insertion site. When chromosomal double strand break (DSB) happens, Alu element is able to integrate into the genomic region through the HR between the elements and the chromosomal break site [14,16]. Through the de novo insertion event, Alu elements have modified the human genome in a species-specific manner. In addition, they could disrupt genes by inserting into their exonic regions (Fig. 3A). Alu elements locating in the intronic region could also regulate gene function by promoting alternative splicing of the genes; the elements have multiple splice donor/accept sites (Fig. 3D). The alternative splicing generates Alu exonization or/and intron retention in respective transcripts, which could disrupt or modify the function of the genes (Fig. 3C and 3E) [8,17]. As mentioned above, Alu elements have a relatively high point mutation rate and can obtain splicing sites by the point mutations after the insertion. The Alu elements provide cryptic splicing sites and recognize these sites by splicing factors (Fig. 3C and 3D). Ornithine aminotransferase (OAT) gene encodes mitochondrial enzyme ornithine δ-aminotransferase, which converts ornithine to glutamate. The deficiency of this enzyme results in autosomal recessive eye disease. The third intron of OAT gene contains the right monomer of Alu element which is residues, 279 to 138, of antisense Alu element. The antisense Alu monomer provides cryptic splicing sites by the point mutation, cytosine to guanine. The cryptic splicing site causes an alternative splicing of the gene, disrupting the function of OAT gene. Consequently, patients suffer from gyrate atrophy of the choroid and retina by producing abnormal proteins [18]. Alu elements can influence gene function through RNA editing which is a post-transcriptional alteration. Adenosine deamination by an enzyme, adenosine deaminase acting on RNA (ADAR) results in inosine, which in turn interpreted as guanosine by translation or spliceosome machinery. Adenosine to inosine (A-to-I) is the most frequent RNA editing in humans. A-to-I RNA editing occurs within a long duplex of RNA sequence because ADAR works only on double strand RNA structures. Due to the dimeric structure, Alu element in RNA sequences forms the stem loop structure, leading to A-to-I RNA editing [19]. In addition, two Alu elements located in close to each other can make a stem loop structure, which result in A-to-I editing and the edited Alu element could subsequently bring out novel alternative splicing site [19,20,21,22,23]. On the other hand, the intronic Alu elements could lead to deletion of nascent exons, which is called exon skipping. It therefore disrupts open reading frames of the human genes (Fig. 3A). Ganguly et al. [24] have reported that intronic insertion of AluYb9 causes exon skipping and leads to hemophilia A disease. Hemophilia A is an X-linked disorder caused by exon skipping of exon 19 in Factor VIII gene. AluYb9 locates in the intron 18 of the gene and causes the skipping of the exon19 from the gene transcript.
Alu elements could regulate gene function by providing canonical polyadenylation signal, AATAAA (Fig. 3B) [25,26]. Alu elements contain three potential polyadenylation sites and two of them are active in the human genome. One of the previous studies on Alu elements has reported that ~10,000 Alu elements are identified within the 3' untranslated region (UTR) of protein coding human genes. Among them, 107 Alu elements retain active polyadenylation site. Interestingly, 99% of polyadenylation-active Alu elements locate in the forward direction although the elements exist in the 3' UTR of human genes randomly, regarding the insertion direction. In addition, old Alu subfamily has more active polyadenylation sites than younger subfamilies [27,28]. An example of Alu polyadenylation site affecting gene function is calcium-sensing receptor (CaSR) which is a member of G protein-coupled receptor. The gene involves in regulating extracellular level of calcium ion. Alu element locates in the exon 7 of the gene and pre-terminates transcripts of CaSR by providing a stop codon signal. Patients having the missense mutations show symptoms of familial hypocalciuric hypercalcemia and neonatal severe hyperparathyroidism [29,30,31].

Recombination between Alu Elements

A total of 515 Alu-mediated deletion events have been identified in the human genome. The deletion events occurred either through Alu insertion-mediated deletions (AIMD) or Alu recombination-mediated deletions (ARMD): 24 AIMDs and 492 ARMDs. AIMDs and ARMDs have deleted 11,206 and 396,420 base pairs of the human genome, respectively, after the divergence of the human and chimpanzee lineages (~6 mya) [14,32,33,34]. Alu element has been frequently involved in the genomic recombination because of its two characteristics: a high level of sequence identity among them and its abundance in the human genome. Among the 492 ARMD events, 197 ARMD events were occurred by the recombination between Alu elements belonging to different subfamilies. Although AluJ subfamily is more abundant than AluY subfamily in the human genome, AluY subfamily is more associated with ARMD events because AluY subfamily retains a higher sequence identity among its members than AluJ subfamily does. Alu element accumulates random mutations over time so that older Alu elements have more mutations than younger elements [33].
DNA DSB is one of the most dangerous events of DNA damage. In the human genome, it could be repaired by retrotransposons using two different mechanisms: nonhomologous end-joining mediated deletion (NHEJ) and HR [34]. NHEJ does not need a homologous template for repair of DSBs while HR requires sequence homologies on either side of the break for the repair (Fig. 4A). DSB repair by NHEJ mechanism is initiated by an enzyme complex including Ku70/80 heterodimer. After the enzyme complex binds to either side of DSB, it functions as a docking site for other NHEJ enzymes such as DNA ligase [35,36]. Nonallelic homologous recombination (NAHR) is one of HRs. It occurs between two DNA sequences which are not alleles but share a high sequence similarity from one another. Major NAHR hotspots for several human diseases locate at repeat elements including Alu element. During meiosis, Alu elements can misalign and the subsequent crossover could lead to genetic rearrangements of duplication, deletion, and translocation [37,38]. NAHR is proceeded either by interchromosomal recombination, in which occurs between different chromosomes or intrachromosomal recombination, in which recombination occurs via crossing over within the same chromosome. Interchromosomal recombination results in a deletion or duplication depending the orientation of the DNA sequences. Intrachromosomal recombination results in a deletion or inversion (Fig. 4B).

Genetic Disorder Caused by Alu Elements

During the past 6 million years, Alu elements have modified the human genome in a species-specific manner and also caused human disease through de novo insertion or the recombination between them. Genomic rearrangements induced by Alu insertion account for approximately 0.1% of human diseases and genomic deletions by ARMD are responsible for approximately 0.3% of human genetic disorders [10,32,33]. There are many Alu elements which are closely related to human diseases (Table 1) [39,40,41,42,43,44,45,46,47,48,49,50,51,52,53]. Alström syndrome is a rare genetic disease which is caused by Alu insertion in ALMS1 gene. ALMS1 is composed of 23 exons and encodes centrosome and basal body-associated protein which plays an important role in microtubule organization, especially form and maintain cilia. The protein is associated with insulin resistance, hypogonadism, and heart disease. Therefore, Alström syndrome has several symptoms such as blindness and obesity. Most mutations causing Alström syndrome occur in exons 8, 10, and 16 of ALMS1 [54]. The mutation of ALMS1 caused by Alu element was first discovered in 2013. AluYa5 element exists in the exon 16 of ALMS1, which disrupts open reading frame, leading to frameshift mutation [40]. Pulmonary arterial hypertension (PAH) is also caused by Alu element, which locates in BMPR2 gene. BMPR2 locates on chromosome 2 and has 13 exons. Exons 1–3 encoding an extracellular domain were deleted by the recombination between two different AluY elements in PAH patients. In another PAH patient, the exon 10 of the gene was deleted by AluSx involved-nonhomologous recombination. The recombination took place between the Alu element in the intron 9 and a unique sequence in the intron 10 of the gene [41]. Fork stalling and template switching/microhomology-mediated break-induced replication model (FoSTeS/MMBIR) has been often proposed in cases where the complexity of the genomic rearrangement is not able to be explained by using classic recombination mechanisms. Recently, Alu element was reported to be associated with a human genomic deletion responsible for Waardenburg syndrome type 4 (WS4). WS4 is a rare neural crest disorder. Three Alu elements are involved in the large deletion within SOX10 regulatory sequences in patients with WS4. The deletion could be explained by a two-step FoSTeS/MMBIR mechanism mediated via the 4-bp and 13-bp microhomology found at the Alu1/Alu3 and Alu3/Alu2 breakpoints, respectively. The deletion of SOX10 regulatory sequences was also identified in patients with Hirschsprung disease and peripheral demyelinating neuropathy–central dysmeylinating leukodystrophy [50].


In this review, we discuss the amplification of Alu elements and its impact on human genomic rearrangements and human disease. Four different models: master gene, intermediate, transposon, and stealth models have been suggested to explain the Alu amplification during primate evolution. Among them, master gene model is generally accepted to explain the diversity of Alu subfamilies. Since the divergence of human and chimpanzee, Alu elements have caused various genetic/genomic rearrangements in the human genome through human-specific insertion, deletion, and recombination. Alu elements could repair DSBs in the human genome using microhomology between the element and the break point, leading to de novo Alu insertion. In spite of the positive effect, Alu element is considered to be one of major factors to cause human genomic instability because many Alu elements are associated with various human diseases. The recombination between Alu elements has deleted human genic regions and subsequently disrupted gene function, leading to human diseases. The abundance of Alu elements in the human genome and a high level of sequence identity among them predispose them to be a tremendous and unpredictable factor to cause genomic instability and the related human diseases. Characterization of Alu amplification in the human genome and elucidating the mechanisms which Alu elements could utilize to cause human diseases may help us understand Alu-associated pathogenesis and predict Alu-associated human diseases.


1. Cordaux R, Batzer MA. The impact of retrotransposons on human genome evolution. Nat Rev Genet 2009;10:691–703. PMID: 19763152.
crossref pmid pmc
2. Batzer MA, Deininger PL. Alu repeats and human genomic diversity. Nat Rev Genet 2002;3:370–379. PMID: 11988762.
crossref pmid
3. Deininger P. Alu elements: know the SINEs. Genome Biol 2011;12:236. PMID: 22204421.
crossref pmid pmc
4. Deininger PL, Batzer MA, Hutchison CA 3rd, Edgell MH. Master genes in mammalian repetitive DNA amplification. Trends Genet 1992;8:307–311. PMID: 1365396.
crossref pmid
5. Han K, Xing J, Wang H, Hedges DJ, Garber RK, Cordaux R, et al. Under the genomic radar: the stealth model of Alu amplification. Genome Res 2005;15:655–664. PMID: 15867427.
crossref pmid pmc
6. Shen MR, Batzer MA, Deininger PL. Evolution of the master Alu gene(s). J Mol Evol 1991;33:311–320. PMID: 1774786.
crossref pmid
7. Ayarpadikannan S, Kim HS. The impact of transposable elements in genome evolution and genetic instability and their implications in various diseases. Genomics Inform 2014;12:98–104. PMID: 25317108.
crossref pmid pmc
8. Ayarpadikannan S, Lee HE, Han K, Kim HS. Transposable element-driven transcript diversification and its relevance to genetic disorders. Gene 2015;558:187–194. PMID: 25617522.
crossref pmid
9. Belancio VP, Hedges DJ, Deininger P. Mammalian non-LTR retrotransposons: for better or worse, in sickness and in health. Genome Res 2008;18:343–358. PMID: 18256243.
crossref pmid
10. Deininger PL, Batzer MA. Alu repeats and human disease. Mol Genet Metab 1999;67:183–193. PMID: 10381326.
crossref pmid
11. Hancks DC, Kazazian HH Jr. Active human retrotransposons: variation and disease. Curr Opin Genet Dev 2012;22:191–203. PMID: 22406018.
crossref pmid pmc
12. Xing J, Zhang Y, Han K, Salem AH, Sen SK, Huff CD, et al. Mobile elements create structural variation: analysis of a complete human genome. Genome Res 2009;19:1516–1526. PMID: 19439515.
crossref pmid pmc
13. Cordaux R, Hedges DJ, Batzer MA. Retrotransposition of Alu elements: how many sources? Trends Genet 2004;20:464–467. PMID: 15363897.
crossref pmid
14. Kim YJ, Lee J, Han K. Transposable elements: no more 'Junk DNA'. Genomics Inform 2012;10:226–233. PMID: 23346034.
crossref pmid pmc
15. Mills RE, Bennett EA, Iskow RC, Luttig CT, Tsui C, Pittard WS, et al. Recently mobilized transposons in the human and chimpanzee genomes. Am J Hum Genet 2006;78:671–679. PMID: 16532396.
crossref pmid pmc
16. Baskaev KK, Buzdin AA. Evolutionary recent insertions of mobile elements and their contribution to the structure of human genome. Zh Obshch Biol 2012;73:3–20. PMID: 22567964.
17. Sorek R, Ast G, Graur D. Alu-containing exons are alternatively spliced. Genome Res 2002;12:1060–1067. PMID: 12097342.
crossref pmid pmc
18. Mitchell GA, Labuda D, Fontaine G, Saudubray JM, Bonnefont JP, Lyonnet S, et al. Splice-mediated insertion of an Alu sequence inactivates ornithine delta-aminotransferase: a role for Alu elements in human mutation. Proc Natl Acad Sci U S A 1991;88:815–819. PMID: 1992472.
crossref pmid pmc
19. Lev-Maor G, Sorek R, Levanon EY, Paz N, Eisenberg E, Ast G. RNA-editing-mediated exon evolution. Genome Biol 2007;8:R29. PMID: 17326827.
crossref pmid pmc
20. Athanasiadis A, Rich A, Maas S. Widespread A-to-I RNA editing of Alu-containing mRNAs in the human transcriptome. PLoS Biol 2004;2:e391. PMID: 15534692.
crossref pmid pmc
21. Bass BL. RNA editing by adenosine deaminases that act on RNA. Annu Rev Biochem 2002;71:817–846. PMID: 12045112.
crossref pmid pmc
22. Bazak L, Haviv A, Barak M, Jacob-Hirsch J, Deng P, Zhang R, et al. A-to-I RNA editing occurs at over a hundred million genomic sites, located in a majority of human genes. Genome Res 2014;24:365–376. PMID: 24347612.
crossref pmid pmc
23. Kim DD, Kim TT, Walsh T, Kobayashi Y, Matise TC, Buyske S, et al. Widespread RNA editing of embedded Alu elements in the human transcriptome. Genome Res 2004;14:1719–1725. PMID: 15342557.
crossref pmid pmc
24. Ganguly A, Dunbar T, Chen P, Godmilow L, Ganguly T. Exon skipping caused by an intronic insertion of a young Alu Yb9 element leads to severe hemophilia A. Hum Genet 2003;113:348–352. PMID: 12884004.
crossref pmid
25. Beaudoing E, Freier S, Wyatt JR, Claverie JM, Gautheret D. Patterns of variant polyadenylation signal usage in human genes. Genome Res 2000;10:1001–1010. PMID: 10899149.
crossref pmid pmc
26. Lopez F, Granjeaud S, Ara T, Ghattas B, Gautheret D. The disparate nature of "intergenic" polyadenylation sites. RNA 2006;12:1794–1801. PMID: 16931874.
crossref pmid pmc
27. Chen C, Ara T, Gautheret D. Using Alu elements as polyadenylation sites: a case of retroposon exaptation. Mol Biol Evol 2009;26:327–334. PMID: 18984903.
crossref pmid
28. Roy-Engel AM, El-Sawy M, Farooq L, Odom GL, Perepelitsa-Belancio V, Bruch H, et al. Human retroelements may introduce intragenic polyadenylation signals. Cytogenet Genome Res 2005;110:365–371. PMID: 16093688.
crossref pmid
29. Bai M, Janicic N, Trivedi S, Quinn SJ, Cole DE, Brown EM, et al. Markedly reduced activity of mutant calcium-sensing receptor with an inserted Alu element from a kindred with familial hypocalciuric hypercalcemia and neonatal severe hyperparathyroidism. J Clin Invest 1997;99:1917–1925. PMID: 9109436.
crossref pmid pmc
30. Cole DE, Yun FH, Wong BY, Shuen AY, Booth RA, Scillitani A, et al. Calcium-sensing receptor mutations and denaturing high performance liquid chromatography. J Mol Endocrinol 2009;42:331–339. PMID: 19179454.
crossref pmid
31. Janicic N, Pausova Z, Cole DE, Hendy GN. Insertion of an Alu sequence in the Ca(2+)-sensing receptor gene in familial hypocalciuric hypercalcemia and neonatal severe hyperparathyroidism. Am J Hum Genet 1995;56:880–886. PMID: 7717399.
pmid pmc
32. Callinan PA, Wang J, Herke SW, Garber RK, Liang P, Batzer MA. Alu retrotransposition-mediated deletion. J Mol Biol 2005;348:791–800. PMID: 15843013.
crossref pmid
33. Sen SK, Han K, Wang J, Lee J, Wang H, Callinan PA, et al. Human genomic deletions mediated by recombination between Alu elements. Am J Hum Genet 2006;79:41–53. PMID: 16773564.
crossref pmid pmc
34. Srikanta D, Sen SK, Huang CT, Conlin EM, Rhodes RM, Batzer MA. An alternative pathway for Alu retrotransposition suggests a role in DNA double-strand break repair. Genomics 2009;93:205–212. PMID: 18951971.
crossref pmid pmc
35. Davis AJ, Chen DJ. DNA double strand break repair via non-homologous end-joining. Transl Cancer Res 2013;2:130–143. PMID: 24000320.
pmid pmc
36. Weterings E, Chen DJ. The endless tale of non-homologous end-joining. Cell Res 2008;18:114–124. PMID: 18166980.
crossref pmid
37. Gu W, Zhang F, Lupski JR. Mechanisms for human genomic rearrangements. Pathogenetics 2008;1:4. PMID: 19014668.
crossref pmid pmc
38. Purandare SM, Patel PI. Recombination hot spots and human disease. Genome Res 1997;7:773–786. PMID: 9267802.
crossref pmid
39. Wu SJ, Hsieh TJ, Kuo MC, Tsai ML, Tsai KL, Chen CH, et al. Functional regulation of Alu element of human angiotensin-converting enzyme gene in neuron cells. Neurobiol Aging 2013;34:1921.e1–1921.e7.
crossref pmid
40. Taşkesen M, Collin GB, Evsikov AV, Güzel A, Özgül RK, Marshall JD, et al. Novel Alu retrotransposon insertion leading to Alström syndrome. Hum Genet 2012;131:407–413. PMID: 21877133.
crossref pmid pmc
41. Kataoka M, Aimi Y, Yanagisawa R, Ono M, Oka A, Fukuda K, et al. Alu-mediated nonallelic homologous and nonhomologous recombination in the BMPR2 gene in heritable pulmonary arterial hypertension. Genet Med 2013;15:941–947. PMID: 23579436.
crossref pmid
42. Wada T, Matsuda Y, Muraoka M, Toma T, Takehara K, Fujimoto M, et al. Alu-mediated large deletion of the CDSN gene as a cause of peeling skin disease. Clin Genet 2014;86:383–386. PMID: 24116970.
crossref pmid
43. Nozu K, Iijima K, Ohtsuka Y, Fu XJ, Kaito H, Nakanishi K, et al. Alport syndrome caused by a COL4A5 deletion and exonization of an adjacent AluY. Mol Genet Genomic Med 2014;2:451–453. PMID: 25333070.
crossref pmid pmc
44. Flynn EK, Kamat A, Lach FP, Donovan FX, Kimble DC, Narisu N, et al. Comprehensive analysis of pathogenic deletion variants in Fanconi anemia genes. Hum Mutat 2014;35:1342–1353. PMID: 25168418.
crossref pmid pmc
45. Cozar M, Bembi B, Dominissini S, Zampieri S, Vilageliu L, Grinberg D, et al. Molecular characterization of a new deletion of the GBA1 gene due to an inter Alu recombination event. Mol Genet Metab 2011;102:226–228. PMID: 21036086.
crossref pmid
46. Amiñoso C, Vallespin E, Fernández L, Arrabal LF, Desviat LR, Pérez B, et al. Identification of the first deletion-insertion involving the complete structure of GAA gene and part of CCDC40 gene mediated by an Alu element. Gene 2013;519:169–172. PMID: 23402890.
crossref pmid
47. Dobrovolny R, Nazarenko I, Kim J, Doheny D, Desnick RJ. Detection of large gene rearrangements in X-linked genes by dosage analysis: identification of novel α-galactosidase A (GLA) deletions causing Fabry disease. Hum Mutat 2011;32:688–695. PMID: 21305660.
crossref pmid
48. Zhu M, Chen X, Zhang H, Xiao N, Zhu C, He Q, et al. AluYb8 insertion in the MUTYH gene and risk of early-onset breast and gastric cancers in the Chinese population. Asian Pac J Cancer Prev 2011;12:1451–1455. PMID: 22126480.
49. Choi BO, Kim NK, Park SW, Hyun YS, Jeon HJ, Hwang JH, et al. Inheritance of Charcot-Marie-Tooth disease 1A with rare nonrecurrent genomic rearrangement. Neurogenetics 2011;12:51–58. PMID: 21193943.
crossref pmid
50. Bondurand N, Fouquet V, Baral V, Lecerf L, Loundon N, Goossens M, et al. Alu-mediated deletion of SOX10 regulatory elements in Waardenburg syndrome type 4. Eur J Hum Genet 2012;20:990–994. PMID: 22378281.
crossref pmid pmc
51. Boone PM, Liu P, Zhang F, Carvalho CM, Towne CF, Batish SD, et al. Alu-specific microhomology-mediated deletion of the final exon of SPAST in three unrelated subjects with hereditary spastic paraplegia. Genet Med 2011;13:582–592. PMID: 21659953.
crossref pmid pmc
52. Conceição Pereira M, Loureiro JL, Pinto-Basto J, Brandão E, Margarida Lopes A, Neves G, et al. Alu elements mediate large SPG11 gene rearrangements: further spatacsin mutations. Genet Med 2012;14:143–151. PMID: 22237444.
crossref pmid
53. Borun P, De Rosa M, Nedoszytko B, Walkowiak J, Plawski A. Specific Alu elements involved in a significant percentage of copy number variations of the STK11 gene in patients with Peutz-Jeghers syndrome. Fam Cancer 2015;14:455–461. PMID: 25841653.
crossref pmid pmc
54. Marshall JD, Hinman EG, Collin GB, Beck S, Cerqueira R, Maffei P, et al. Spectrum of ALMS1 variants and evaluation of genotype-phenotype correlations in Alström syndrome. Hum Mutat 2007;28:1114–1123. PMID: 17594715.
crossref pmid
Fig. 1

Structural schema of Alu elements. A full-length Alu element is 300 bp in length and composed of left monomer, right monomer, and poly(A) tail. A and B boxes in the left monomer contain RNA polymerase III promoter binding sites. Alu inserts in the host genome using target site duplication (TSD) of flanking region.

Fig. 2

Mechanisms of Alu amplification. This figure depicts four different mechanisms for Alu amplification. (A) Master gene model is a typical mechanism. All members of the same Alu subfamily are derived from one or a few transpositionally active Alu elements. When the active Alu element mutates but remains the transposition activity, it will produce a new Alu subfamily. (B) Intermediate model is literally an intermediate form of master gene and transposon models. More than a few active Alu elements exist in host genome and each of them actively produces its progenies. (C) Transposon model suggests that all Alu elements including mutated elements have transposition activities. (D) Stealth driver model suggests that old Alu element which stayed transcriptionally dormant for the extended period can produce a new Alu subfamily by retrieving a high transposition activity. Green and blue boxes indicate active and inactive Alu elements, respectively. X indicates a mutation and the mutated Alu elements represent different subfamilies.

Fig. 3

Impact of Alu insertion on alternative transcription. Alu element inserting in the genic region could alter the expression level of the respective gene. (A) Alu insertion in the exonic region. Exons could be skipped and deleted, called exon skipping. (B) Alu insertion in the genic region, Alu element is able to provide a polyadenylation signal. Thus, Alu element could induce the premature termination of gene transcription. (C–E) Alu element is also able to provide cryptic splicing sites, leading to alternative gene transcripts. Blue and red boxes indicate exon and Alu element. Arrow shows promoter and the dash line indicates alternative splicing form.

Fig. 4

Mechanisms of Alu recombination-mediated deletions. (A) Nonhomologous end-joining mediated deletion mechanism. After DNA double strand breaks, non-homologous templates are ligated by Alu element. (B) Nonallelic homologous recombination mechanism, interchromosomal recombination occurs between two different Alu elements which locate on different chromosomes and mediates genomic duplication or deletion. Intrachromosomal recombination occurs between two different Alu elements which locate on the same chromosome and mediates genomic deletion. Green and yellow boxes represent Alu elements. The red dot line indicates homologous sequences.

Table 1.

A list of Alu-mediated genetic disorder in recent studies

Gene Position Subfamily Mechanism Disease Reference
ACE Chr 17 AluYa5 Insertion Alzheimer's disease [39]
ALMS1 Chr 2 AluYa5 Insertion Alström syndrome [40]
BMPR2 Chr 2 AluY ARMD_NAHR Pulmonary arterial hypertension [41]
CDSN Chr 6 AluS ARMD_NHEJ Peeling skin disease [42]
COL4A5 Chr X AluY Insertion Alport syndrome [43]
FA Chr X AluY ARMD_NAHR Fanconi anemia [44]
GBA1 Chr 1 AluSx ARMD_NAHR Gaucher disease [45]
GGA Chr 17 AluS ARMD_NAHR Pomp disease [46]
GLA Chr X Alu Insertion mediated deletion Fabry disease [47]
MUTYH Chr 1 AluYb8 Insertion Breast cancer/gastric cancer [48]
PMP22 Chr 17 AluY/AluSc ARMD_NAHR Charcot-Marie-Tooth disease [49]
SOX10 Chr 22 AluS FoSTes/MMBIR Waardenburg syndrome type 4 [50]
SPAST Chr 2 AluY/AluS FoSTes/MMBIR Hereditary spastic paraplegia [51]
Chr 2 AluY
SPG11 Chr 15 AluY/AluS ARMD_NAHR Spastic paraplegias [52]
Chr 15 AluS
STK11 Chr 19 AluY ARMD_NAHR Peutz-Jeghers syndrome [53]

ARMD, Alu recombination-mediated deletions; NAHR, nonallelic homologous recombination; NHEJ, nonhomologous end-joining mediated deletion; FoSTeS/MMBIR, fork stalling and template switching/microhomology-mediated break-induced replication.

Share :
Facebook Twitter Linked In Google+
METRICS Graph View
  • 63 Crossref
  • 0 Scopus
  • 12,802 View
  • 344 Download
Related articles in GNI


Browse all articles >

Editorial Office
Room No. 806, 193 Mallijae-ro, Jung-gu, Seoul 04501, Korea
Tel: +82-2-558-9394    Fax: +82-2-558-9434    E-mail:                

Copyright © 2023 by Korea Genome Organization.

Developed in M2PI

Close layer
prev next