The pathogenic c.1171A>G (p.Arg391Gly) and c.2359G>A (p.Val787Ile) ABCC6 variants display incomplete penetrance causing pseudoxanthoma elasticum in a subset of individuals.

The pathogenic c.1171A>G (p.Arg391Gly) and c.2359G>A (p.Val787Ile) ABCC6 variants display incomplete penetrance causing pseudoxanthoma elasticum in a subset of individuals.
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致病性c.1171A>G(p.Arg391Gly)和c.2359G>A(p.Val787Ile)ABCC6变异体在一个个体亚组中显示不完全变性,导致弹性假黄瘤。

DOI:
10.1002/humu.24498
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发表时间:
2022-12
期刊:
影响因子:
3.9
通讯作者:
Aranyi, Tamas
Aranyi, Tamas
中科院分区:
医学2区
文献类型:
--
作者:
Szeri, Flora;Miko, Agnes;Navasiolava, Nastassia;Kaposi, Ambrus;Verschuere, Shana;Molnar, Beatrix;Li, Qiaoli;Terry, Sharon F.;Boraldi, Federica;Uitto, Jouni;van de Wetering, Koen;Martin, Ludovic;Quaglino, Daniela;Vanakker, Olivier M.;Tory, Kalman;Aranyi, Tamas

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ABCC6 促进 ATP 从肝细胞流出至血液。 ATP 代谢为焦磷酸盐,一种异位钙化的抑制剂。 ABCC6 的致病性变异会导致弹性假黄瘤,这是一种高度变异的隐性异位钙化病。不完全外显可能会引发疾病异质性,因此携带者中可能不会出现症状,或者表现出不同的症状。在这里,我们研究了不完全外显率是否是弹性假黄瘤异质性的来源。通过整合 589 名患者的临床和遗传数据,我们创建了最大的欧洲队列。根据等位基因频率变化,我们鉴定了两个不完全外显致病变异:c.2359G>A (p.Val787Ile) 和 c.1171A>G (p.Arg391Gly),外显率分别为 6.5% 和 2%。然而,当渗透时,c.1171A>G (p.Arg391Gly) 表现出临床上未改变的严重程度。在应用计算机模拟和体外表征后,我们认为,只有当 ABCC6 的未知相互作用伙伴同时突变时,不完整的渗透变体才是有害的。在遗传咨询中应考虑到这些变异的低外显率。
ABCC6 promotes ATP efflux from hepatocytes to bloodstream. ATP is metabolized to pyrophosphate, an inhibitor of ectopic calcification. Pathogenic variants of ABCC6 cause pseudoxanthoma elasticum, a highly variable recessive ectopic calcification disorder. Incomplete penetrance may initiate disease heterogeneity, hence symptoms may not, or differently manifest in carriers. Here, we investigated whether incomplete penetrance is a source of heterogeneity in pseudoxanthoma elasticum. By integrating clinical and genetic data of 589 patients, we created the largest European cohort. Based on allele frequency alterations, we identified two incomplete penetrant pathogenic variants, c.2359G>A (p.Val787Ile) and c.1171A>G (p.Arg391Gly), with 6.5% and 2% penetrance, respectively. However, when penetrant, the c.1171A>G (p.Arg391Gly) manifested a clinically unaltered severity. After applying in-silico and in-vitro characterization, we suggest that incomplete penetrant variants are only deleterious if a yet unknown interacting partner of ABCC6 is mutated simultaneously. The low penetrance of these variants should be contemplated in genetic counselling.
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