title: Variegate porphyria in Western Europe: identification of PPOX gene mutations in 104 families, extent of allelic heterogeneity, and absence of correlation between phenotype and type of mutation.
abstract: Variegate porphyria (VP) is a low-penetrance, autosomal dominant disorder characterized clinically by skin lesions and acute neurovisceral attacks that occur separately or together. It results from partial deficiency of protoporphyrinogen oxidase encoded by the PPOX gene. VP is relatively common in South Africa, where most patients have inherited the same mutation in the PPOX gene from a common ancestor, but few families from elsewhere have been studied. Here we describe the molecular basis and clinical features of 108 unrelated patients from France and the United Kingdom. Mutations in the PPOX gene were identified by a combination of screening (denaturing gradient gel electrophoresis, heteroduplex analysis, or denaturing high-performance liquid chromatography) and direct automated sequencing of amplified genomic DNA. A total of 60 novel and 6 previously reported mutations (25 missense, 24 frameshift, 10 splice site, and 7 nonsense) were identified in 104 (96%) of these unrelated patients, together with 3 previously unrecognized single-nucleotide polymorphisms. VP is less heterogeneous than other acute porphyrias; 5 mutations were present in 28 (26%) of the families, whereas 47 mutations were restricted to 1 family; only 2 mutations were found in both countries. The pattern of clinical presentation was identical to that reported from South Africa and was not influenced by type of mutation. Our results define the molecular genetics of VP in western Europe, demonstrate its allelic heterogeneity outside South Africa, and show that genotype is not a significant determinant of mode of presentation.
authors.affiliation: Department of Medical Biochemistry, University of Wales College of Medicine, Heath Park, Cardiff, UK.
authors.forename: S D
authors.initials: SD
authors.lastname: Whatley
authors.forename: H
authors.initials: H
authors.lastname: Puy
authors.forename: R R
authors.initials: RR
authors.lastname: Morgan
authors.forename: A M
authors.initials: AM
authors.lastname: Robreau
authors.forename: A G
authors.initials: AG
authors.lastname: Roberts
authors.forename: Y
authors.initials: Y
authors.lastname: Nordmann
authors.forename: G H
authors.initials: GH
authors.lastname: Elder
authors.forename: J C
authors.initials: JC
authors.lastname: Deybach
mesh_terms: D000483:Alleles; D000595:Amino Acid Sequence; D004252:DNA Mutational Analysis; D005091:Exons / Q000235:genetics; D005260:Female; D005420:Flavoproteins; D005602:France; D005787:Gene Frequency / Q000235:genetics; D018740:Genetic Heterogeneity; D005820:Genetic Testing; D005838:Genotype; D006801:Humans; D007438:Introns / Q000235:genetics; D008297:Male; D024101:Mitochondrial Proteins; D008969:Molecular Sequence Data; D009154:Mutation / Q000235:genetics*; D010088:Oxidoreductases / Q000737:chemistry / Q000235:genetics*; D044925:Oxidoreductases Acting on CH-CH Group Donors; D010641:Phenotype; D020641:Polymorphism, Single Nucleotide / Q000235:genetics; D017094:Porphyrias, Hepatic / Q000201:enzymology* / Q000235:genetics* / Q000503:physiopathology; D050768:Protoporphyrinogen Oxidase; D013019:South Africa; D006113:United Kingdom
chemical_list: D005420:Flavoproteins; D024101:Mitochondrial Proteins; D010088:Oxidoreductases; D044925:Oxidoreductases Acting on CH-CH Group Donors; C493978:PPOX protein, human; D050768:Protoporphyrinogen Oxidase