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A nonsense mutation of PEPD in four Amish children with prolidase deficiency
Heng Wang1, Biji T Kurien, David Lundgren
1Das Deutsch Center (DDC) Clinic for Special Needs Children, Middlefield, Ohio 44062, USA. wang@ddclinic.org
Insights
This study identifies a novel mutation in the PEPD gene causing severe prolidase deficiency in Amish children. The findings highlight a unique presentation of the disorder in the United States.
Area of Science:
- Biochemistry
- Genetics
- Pediatrics
Background:
- Prolidase deficiency is a rare genetic disorder affecting cytosolic enzyme activity.
- The peptidase D (PEPD) gene encodes prolidase, crucial for peptide hydrolysis.
- Previous reports predominantly feature skin ulcers as the primary symptom.
Purpose of the Study:
- To report the first cases of prolidase deficiency in the Amish population in the United States.
- To characterize the clinical and genetic features of severe prolidase deficiency in affected children.
- To investigate the molecular basis of the observed severe phenotype.
Main Methods:
- Clinical evaluation of four Amish children with suspected prolidase deficiency.
- Biochemical assays to measure prolidase activity.
- Genomic DNA sequencing of the PEPD gene to identify mutations.
Main Results:
- Four Amish children presented with a severe phenotype including infections, hepatosplenomegaly, and thrombocytopenia, differing from typical presentations.
- All patients exhibited characteristic facial features, skin ulcers, multisystem involvement, and massive imidodipeptiduria.
- A homozygous single nucleotide mutation (c.793 T > C) in exon 11 of the PEPD gene, leading to a premature stop-codon (p.R265X), was identified in all patients.
Conclusions:
- This study reports the first cases of prolidase deficiency in the Amish population and the United States.
- The identified PEPD gene mutation (p.R265X) is associated with a severe, multisystemic phenotype.
- The specific type of PEPD mutation may influence the severity of prolidase deficiency.
Abstract:
Encoded by the peptidase D (PEPD) gene located at 19q12-q13.11, prolidase is a ubiquitous cytosolic enzyme that catalyzes hydrolysis of oligopeptides with a C-terminal proline or hydroxyproline. We describe here four Amish children with a severe phenotype of prolidase deficiency in the Geauga settlements of Ohio as the first report of prolidase deficiency in the Amish population as well as in the United States. The patients presented with infection, hepatosplenomegaly, or thrombocytopenia, in contrast to most cases previously reported in the literature, presenting with skin ulcers. All four patients had typical facial features, classic skin ulcers, and multisystem involvement. Recurrent infections, asthma-like chronic reactive airway disease, hyperimmunoglobulins, hepatosplenomegaly with mildly elevated aspartate transaminase (AST), anemia, and thrombocytopenia were common and massive imidodipeptiduria was universal. Prolidase activity in our patients is nearly undetectable. Direct sequencing of PCR-amplified genomic DNA for all of the exons from the four patients revealed the same homozygous single nucleotide mutation c.793 T > C in exon 11, resulting in a premature stop-codon at amino acid residue 265 (p.R265X). It is speculated that the severe phenotype in these patients might be associated with the type of the PEPD gene mutation.
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