PDXK-Related Neuropathy: A Case With a Novel Splice-Altering Missense Variant and Literature Review

PDXK-related neuropathy is a rare form of hereditary motor and sensory neuropathy with optic atrophy, caused by biallelic variants in the PDXK gene. To date, only four missense variants have been reported in 13 patients from six families. Unlike most inherited neuropathies, which currently have only symptomatic treatments, this type of neuropathy can be managed with pyridoxal 5'-phosphate supplementation.

The clinical presentation of the patient was evaluated twice, at ages 14 and 15 years. The whole-exome sequencing was performed for the proband followed by functional studies using RNA extracted from the proband's and proband's mother's peripheral blood mononuclear cells.

In this study, we provided a brief literature review on PDXK-related neuropathy and reported a female patient with a novel missense variant (c.826G>C, p.(Ala276Pro)) found in compound heterozygous state with a previously reported variant (c.659G>A, p.[Arg220Gln]) in the PDXK gene. Additionally, she carried a novel likely pathogenic missense variant (c.1180C>T, p.[Arg394Cys]) in the GCK gene, associated with MODY2, which was segregated with hyperglycemia in her family. The novel variant c.826G>C in the PDXK gene was predicted to disrupt splicing that was confirmed by our functional studies. The patient exhibited typical peripheral neuropathy but no optic atrophy, likely due to her young age.

Here we report a novel splice-altering missense variant in PDXK that induces aberrant transcript degradation, revealing a new disease mechanism for PDXK-related neuropathy.