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Updated: Mar 22, 2026

Targeted Next-generation Sequencing and Bioinformatics Pipeline to Evaluate Genetic Determinants of Constitutional Disease
Published on: April 4, 2018
Homozygous mutation in the APOA1BP is associated with a lethal infantile leukoencephalopathy
Ronen Spiegel1,2, Avraham Shaag3, Stavit Shalev4,5
1Pediatric Department B, Emek Medical Center, Afula, Israel. spiegelr@zahav.net.il.
Insights
A genetic defect in the APOA1BP gene causes febrile-induced neurodegenerative disease in children, leading to severe leukoencephalopathy. This study identifies a novel mutation in the nicotinamide nucleotide repair system.
Area of Science:
- Genetics
- Neuroscience
- Metabolism
Background:
- Febrile-induced neurodegenerative diseases are often inborn errors of metabolism causing irreversible central nervous system damage.
- A consanguineous family presented with five siblings exhibiting normal development for 6-12 months, followed by severe leukoencephalopathy after a febrile illness.
Purpose of the Study:
- To identify the genetic cause of febrile-induced neurodegenerative disease in a consanguineous family.
- To elucidate the molecular mechanism underlying this newly identified neurological disorder.
Main Methods:
- Homozygosity mapping was employed to identify regions of shared homozygosity among affected siblings.
- Whole exome sequencing was performed to pinpoint the causative genetic mutation.
- Functional analysis of the identified gene and its encoded protein was conducted.
Main Results:
- A homozygous c.281C>A mutation in the APOA1BP gene was identified, leading to a p.Ala94Asp substitution.
- The mutation affects epimerase, an enzyme critical for NAD(P)XH dehydration and toxic metabolite clearance.
- This represents the first reported human defect in the nicotinamide nucleotide repair system.
Conclusions:
- A novel genetic defect in APOA1BP causes a severe, febrile-induced leukoencephalopathy.
- Disruption of the nicotinamide nucleotide repair pathway is implicated in neurodegeneration.
- This finding expands the spectrum of inborn errors of metabolism affecting the central nervous system.
Abstract:
Febrile-induced neurodegenerative diseases are a heterogeneous group of genetic disorders most commonly inborn errors of metabolism that result in irreversible damage involving the central nervous system. Here, we report on five siblings of consanguineous family who developed normally for the first 6-12 months of life then presented with a severe leukoencephalopathy following a trivial febrile illness. Using homozygosity mapping followed by whole exome sequencing, we identified a homozygous c. 281C>A mutation in the APOA1BP gene resulting in substitution of a highly conserved alanine residue with aspartic acid (p.Ala94Asp). APOA1BP encodes for epimerase that catalyzes the R to S epimerization of NAD(P)XH, a crucial step in the dehydration of these toxic metabolites accumulating during cellular metabolism. This is the first report of a defect in the nicotinamide nucleotide repair system in humans.
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