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2014 ; 9
(10
): 1729-36
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Transcriptional complexity in autosomal recessive polycystic kidney disease
#MMPMID25104275
Frank V
; Zerres K
; Bergmann C
Clin J Am Soc Nephrol
2014[Oct]; 9
(10
): 1729-36
PMID25104275
show ga
BACKGROUND AND OBJECTIVES: Autosomal recessive polycystic kidney disease (ARPKD)
is caused by mutations in the PKHD1 gene. The longest open reading frame
comprises 66 exons encoding polyductin or fibrocystin, a type I transmembrane
protein with 4074 amino acids. Functional investigations are considerably
hampered by its large size and lack of expression in tissues that are usually
available for analysis such as lymphocytes or fibroblasts. DESIGN, SETTING,
PARTICIPANTS, & MEASUREMENTS: Allegedly strong and clear-cut genotype-phenotype
correlations for the type of PKHD1 mutation could be established. Thus far,
practically all patients with two truncating mutations showed perinatal or
neonatal demise and at least one hypomorphic missense mutation is thought to be
indispensable for survival. Mutation analysis of >500 ARPKD families was
performed by conventional and next-generation sequencing techniques. RESULTS:
This study presents four unrelated patients with ARPKD with a nonlethal, moderate
clinical course despite the burden of two PKHD1 mutations expected to lead to
premature termination of translation. In line with parental consanguinity, all
mutations occurred in the homozygous state and segregated with the disorder in
these families. To try to unravel the mechanisms that underlie this obvious
contradiction, these patients were further analyzed in detail by utilizing
different methods. In all cases, complex transcriptional alterations were
detected. Alternative splicing patterns might disrupt a critical stoichiometric
and temporal balance between different protein products and may play a crucial
role in defining the phenotype of these patients. CONCLUSIONS: Although these
findings represent rare events, they are of importance for genetic counseling and
illustrate that some caution is warranted in the interpretation of mutations and
their clinical significance. The authors hypothesize that expression of a minimal
amount of functional protein is needed for survival of the neonatal period in
ARPKD.