A Novel Mutation in the AGXT Gene Causing Primary Hyperoxaluria Type I: Genotype–Phenotype Correlation
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c Indian Academy of Sciences RESEARCH ARTICLE A novel mutation in the AGXT gene causing primary hyperoxaluria type I: genotype–phenotype correlation SAOUSSEN M’DIMEGH1∗, CÉCILE AQUAVIVA-BOURDAIN2, ASMA OMEZZINE1, IBTIHEL M’BAREK1, GENEVIÉVE SOUCHE2, DORSAF ZELLAMA4, KAMEL ABIDI3, ABDELATTIF ACHOUR4, TAHAR GARGAH3, SAOUSSEN ABROUG3 and ALI BOUSLAMA1 1Biochemistry Department, LR12SP11, Sahloul University Hospital, 4054 Sousse, Tunisia 2Laboratory of Inborn Metabolic Diseases, Centre de Biologie Est, Hospices Civils de Lyon, Lyon, 69677 Bron Cedex, France 3Pediatric Department, Charles Nicolle University Hospital, 1002-2 Tunis, Tunisia 4Nephrology Department, Sahloul University Hospital, 4054 Sousse, Tunisia Abstract Primary hyperoxaluria type I (PH1) is an autosomal recessive metabolic disorder caused by inherited mutations in the AGXT gene encoding liver peroxisomal alanine : glyoxylate aminotransferase (AGT) which is deficient or mistargeted to mitochon- dria. PH1 shows considerable phenotypic and genotypic heterogeneity. The incidence and severity of PH1 varies in different geographic regions. DNA samples of the affected members from two unrelated Tunisian families were tested by amplifying and sequencing each of the AGXT exons and intron–exon junctions. We identified a novel frameshift mutation in the AGXT gene, the c.406_410dupACTGC resulting in a truncated protein (p.Gln137Hisfs*19). It is found in homozygous state in two nonconsanguineous unrelated families from Tunisia. These molecular findings provide genotype/phenotype correlations in the intrafamilial phenotypic and permit accurate carrier detection, and prenatal diagnosis. The novel p.Gln137Hisfs*19 mutation detected in our study extend the spectrum of known AGXT gene mutations in Tunisia. [M’Dimegh S., Aquaviva-Bourdain C., Omezzine A., M’Barek I., Souche G., Zellama D., Abidi K., Achour A., Gargah T., Abroug S. and Bouslama A. 2016 A novel mutation in the AGXT gene causing primary hyperoxaluria type I: genotype–phenotype correlation. J. Genet. 95, 659–666] Introduction Most of the PH1-causing mutations identified on the AGXT gene are single base pair substitutions leading to the Primary hyperoxaluria type1 (PH1) is an autosomal reces- synthesis of an aberrant gene product (Williams et al. 2009). sive metabolic disorder caused by inherited mutations in the Wild-type AGXT gene comes in two polymorphic variants, AGXT gene encoding liver peroxisomal alanine : glyoxylate the most frequent major haplotype (Maj) and the less fre- aminotransferase (AGT) (Danpure and Jennings 1986). AGT quent minor haplotype (Min), carrying two single amino acid is a pyridoxal5 -phosphate (PLP)-dependent enzyme that cat- substitutions (p.Pro11Leu and p.Ile340Met) among other alyzes the transamination between L-alanine and glyoxylate genomic changes in strong linkage disequilibrium. This fact to pyruvate and glycine, respectively. The absence of func- can help in the clinic, when searching for mutations in new tional AGT leads to glyoxylate accumulation peroxisomes. PH1 cases (Williams and Rumsby 2007). The Min haplo- Glyoxylate is then transported into the hepatocyte cytosol to type (p.Pro11Leu) allows a small portion of AGT (about be oxidized to oxalate by cytosolic L-lactate dehydrogenase. 5%) to be rerouted from peroxisomes to mitochondria (Lumb Oxalate overproduction leads to the formation and deposition and Danpure 2000). The p.Pro11Leu does not cause PH1 by of insoluble calcium oxalate crystals, expand in nephrocal- itself, but it is known to act synergistically with the delete- cinosis and urolithiasis. This ultimately causes renal failure rious effects of several common mutations that leads to sen- and the consequent systemic oxalosis with calcium oxalate sitization of the protein (Santana et al. 2003; Danpure and precipitation in the whole body (Hoppe et al. 2009). Rumsby 2004). Most of the mutations described are typi- cally found in either Maj or Min haplotypes, but rarely in ∗ For correspondence. E-mail: [email protected]. both (Williams and Rumsby 2007). AGXT mutations result in Keywords. primary hyperoxaluria type 1; AGXT gene; genotype–phenotype correlations. Journal of Genetics, DOI 10.1007/s12041-016-0676-4, Vol. 95, No. 3, September 2016 659 Saoussen M’Dimegh et al. different phenotypic expressions of the disease due to various Methods molecular mechanisms. Four basic mechanisms have been reported to explain the consequences of mutations: mito- Mutational analysis chondrial mistargeting, protein aggregation, abolition of cat- Genomic DNA was extracted from peripheral blood leuco- alytic activity (catalytic defects) and synthesis defect (Salido cytes. Initially, the seven most frequent mutations (c.33dupC et al. 2012). (p.Lys12GlnfsX156), c.508G>A (p.G170R), c.731T>C In the present study, we describe a novel mutation in AGXT (p.I244T), c.454T>A (p.F152I), c.322T>C (p.W108R), identified in two unrelated Tunisian PH1 families. We have c.976delG (p.Val326fs) and c.588G>A (p.G156R)) were also analysed the clinical features to investigate a possible tested by amplification of genomic DNA and restriction relationship between genotype and phenotype. enzyme digestion using primers and conditions that were pre- viously documented (Purdue et al. 1990; Rinat et al. 1999; Coulter-Mackie et al. 2005). The PCR test designed to detect Materials and methods c.33dupC mutation was used simultaneously to distinguish Subjects and data collection the Maj and Min alleles by the research of the IVS1+74 bp in intron 1, which is a characteristic duplication for the Min PH1 was diagnosed in two patients from two unrelated haplotype (Coulter-Mackie et al. 2005). Tunisian families. Informed consent was obtained from all Next, the 11 exons and exon–intron boundaries of the patients for the collection of blood samples. Familial screen- AGXT gene were amplified from genomic DNA using stan- ing in family 2 revealed another affected patient. dard PCR procedures. Direct sequencing of purified PCR products was performed using the BigDye Terminator v3.1 Family 1: Patient II-5, a 8-year-old boy who was diagnosed sequencing kit (Applied Biosystems, Foster City, USA) and with nephrolithiasis at the age of 5, and had been maintained an ABI 3730 genetic analyser. The sequencing of all 11 on dialysis therapy for 7 years prior to the study. exons and flanking intronic sequences of the AGXT gene was performed at the reference laboratory in Lyon, France. Family 2: Other samples were obtained from members of Sequences were analysed using Seqscape Analysis Soft- another family, including a 20-year-old girl (patient V-3) and ware (Applied Biosystems) in comparison with GenBank a 9-year-old boy (patient V-6), who were the case index and reference genomic sequence (NM 000030.2). were diagnosed with nephrolithiasis and her sister (patient Assessment of pathogenicity V-4), 16 years old, who was found by family screening. The families pedigree are shown in figure 1. To investigate the pathogenicity of variants, we performed An information sheet was prepared including the follow- in silico analysis using the AlamutR software (Interactive ing data: clinical presentation, biochemical and radiological Biosoftware, member of the Human Genome Variation data, treatment and outcomes. Society and EBI SME Support Forum). Figure 1. Pedigree of the families under study. 660 Journal of Genetics, Vol. 95, No. 3, September 2016 Novel mutation in the AGXT gene and outcome Biochemical analysis recurrent kidney stones. She had a family history of renal failure (patient III-1), but not tested for PH1, which would The urinary oxalate excretion was assayed by a colorimet- be most likely affected by PH1. Physical examination was ric enzymatic method in 24-h urine collections. The plasma normal. Laboratory studies showed: urea = 6.8 mmol/L, cre- oxalate levels were measured by HPLC method in a spe- atinine = 133 μmol/L, Na = 135 mmol/L, K = 5 mmol/L, cialized French laboratory of clinical pathology. In children, Ca = 2.17 mmol/L, Hb = 11.7g/dL, CBEU was positive of the renal function was estimated by the Schwartz formula Enteroccus faecalis germ. Renal ultrasound showed a nor- (Schwartz et al. 1987). mal sized kidneys and multiple bilateral lithiasis. She was Equations of Schwartz: eGFR (glomerular filtration rate) treated with high fluid intake, strict dietary restrictions on 2 = k × height (cm) oxalate-containing foods and a trial of pyridoxine for many (mL/min/1.73 m ) serum creatinine (mg/dL) (the considered k values were 0.55 for girls and for boys <12). months. Then, she had a rise in the creatinine concentration i.e. 172 μmol/L. Patient V-6, a 9-year-old boy was admitted to hospital to manage familial nephropathy. He is sibling of patient V-3. Results He presented with diagnosis of urolithiasis and nephrocalci- nosis. In his past history, he had repeated episodes of kidney Clinical report stone and urinary tract infection of Proteus and Entero- Family 1: Patient II-5 is an 8 years boy, native to central bacter germs at the age of 4 years. He had been receiving western Tunisia. He was apparently healthy until 5 years of an ureterostomy with stone extraction, several ureteroscopy age when he was admitted with symptoms of a urinary tract with fragmentation of calculi and a lithotripsy. Stone anal- infection. In his past history, he had a recurrent urinary tract ysis showed whewellite. Physical examination was normal. infection. At the time of admission, the child appeared critically Laboratory studies showed: clearance = 72 mL/min per ill with generalized oedema and pallor. Blood pressure 1.73 m2,urea= 7.1 mmol/L, creatinine = 84 μmol/L, Na = was elevated. Renal ultrasonography revealed multiple bilat- 136 mmol/L, K = 3.7 mmol/L, Ca = 2.41 mmol/L, Hb = eral nephrocalcinosis and urolithiasis with the suspicion 9.3 g/dL, CBEU was positive. Renal ultrasound showed an of PH1. The level of 24-h urinary oxalate excretion was asymmetric size of kidneys and bilateral medullary nephro- very high (1828 mmol/L), oxalate : creatinine ratio was calcinosis. Urinary oxalate excretion was 0.02 mmol/24 h 0.712 mmol/mmol (normal value 0.085 at 10 years of age) which is normal and (normal 0.14–0.42 mmol/24 h).