title: A 93 year old man with the PRSS1 R122H mutation, low SPINK1 expression, and no pancreatitis: insights into phenotypic non-penetrance.
abstract: BACKGROUND
  The cationic trypsinogen (PRSS1) R122H mutation causes autosomal dominant hereditary pancreatitis (HP) with multiple attacks of acute pancreatitis, but the penetrance, frequency, and severity of attacks are highly variable. HP twins study suggests that modifier genes influence severity but not penetrance.
  
  
  OBJECTIVE
  To investigate potential trypsin associated factors in subjects with the PRSS1 R122H mutation and phenotypic non-penetrance.
  
  
  METHODS
  Two subjects from HP families (including a 93 year old subject with PRSS1 R122H without pancreatitis), one with chronic pancreatitis and one with a normal pancreas, were studied. Relative expression of: (a) the PRSS1 R122 and H122 alleles; and (b) the PRSS1 and SPINK1 genes in pancreatitis were determined using complementary methods.
  
  
  RESULTS
  PRSS1 wild-type (R122) and mutant (H122) allele expression was equivalent in multiple (> 3) samples from the phenotypically affected and non-penetrant subjects with R122H genotypes using allele specific quantitative reverse transcription-polymerase chain reaction (RT-PCR) and intron spanning nested RT-PCR followed by cDNA sequencing. Compared with PRSS1 mRNA levels, SPINK1 mRNA levels were low in normal appearing tissue but markedly increased in samples with chronic inflammation, independent of PRSS1 genotype.
  
  
  CONCLUSIONS
  Attacks of acute pancreatitis in HP subjects appear to be independent of the relative expression of the mutant PRSS1 H122 allele or SPINK1 gene expression. The marked increase in SPINK1 gene expression with inflammation is consistent with its regulation as an acute phase protein.
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, M2, C-wing, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA. khalida@upmc.edu
authors.forename: A
authors.initials: A
authors.lastname: Khalid
authors.forename: S
authors.initials: S
authors.lastname: Finkelstein
authors.forename: B
authors.initials: B
authors.lastname: Thompson
authors.forename: L
authors.initials: L
authors.lastname: Kelly
authors.forename: C
authors.initials: C
authors.lastname: Hanck
authors.forename: T E
authors.initials: TE
authors.lastname: Godfrey
authors.forename: D C
authors.initials: DC
authors.lastname: Whitcomb
mesh_terms: D000369:Aged, 80 and over; D000483:Alleles; D001483:Base Sequence; D002352:Carrier Proteins / Q000235:genetics* / Q000378:metabolism; D016022:Case-Control Studies; D018076:DNA, Complementary / Q000032:analysis; D005091:Exons; D015870:Gene Expression; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006801:Humans; D008297:Male; D008969:Molecular Sequence Data; D009154:Mutation; D010179:Pancreas / Q000378:metabolism; D010195:Pancreatitis / Q000235:genetics / Q000378:metabolism; D019683:Penetrance; D016133:Polymerase Chain Reaction / Q000379:methods; D020133:Reverse Transcriptase Polymerase Chain Reaction; D014357:Trypsin / Q000378:metabolism; D014359:Trypsin Inhibitor, Kazal Pancreatic; D014362:Trypsinogen / Q000235:genetics* / Q000378:metabolism
chemical_list: D002352:Carrier Proteins; D018076:DNA, Complementary; C486642:SPINK1 protein, human; D014359:Trypsin Inhibitor, Kazal Pancreatic; D014362:Trypsinogen; D014357:Trypsin