title: Argininosuccinate lyase deficiency: mutational spectrum in Italian patients and identification of a novel ASL pseudogene.
abstract: Argininosuccinic aciduria (ASAuria) is an inborn error of metabolism caused by mutations in the argininosuccinate lyase (ASL) gene, which leads to the accumulation of argininosuccinic acid (ASA) in body fluids and severe hyperammonemia. A severe neonatal form and a milder late-onset variant are described. We report a novel ASL pseudogene located in the centromeric region of chromosome 7, 14 novel mutations in the ASL gene, and a novel intronic polymorphism found in a cohort of Italian patients. Our approach relied exclusively on genomic DNA analysis. We found seven missense mutations, two nonsense, three small insertions/deletions, and two splicing mutations. Only two patients harbored previously described mutations, and among the novel variants only two were present in more than one kindred. The pathogenicity of the splicing mutations was demonstrated by a functional splicing assay that employed a hybrid minigene. We also performed molecular modeling using the reported three-dimensional structure of ASL to predict the functional consequences of the missense mutations. There was no genotype-phenotype correlation. Patients with neonatal onset display developmental delay and seizures despite adequate metabolic control. Moreover, hepatomegaly, fibrosis, and abnormal liver function tests are common complications in these patients, but not in patients with the late infancy form. We stress the importance of mutation analysis in patients with ASAuria, to confirm the clinical diagnosis, and to perform DNA-based prenatal diagnosis in future pregnancies of these families.
authors.affiliation: Department of Pediatrics, University of Padova, Padova, Italy.
authors.forename: Eva
authors.initials: E
authors.lastname: Trevisson
authors.forename: Leonardo
authors.initials: L
authors.lastname: Salviati
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Baldoin
authors.forename: Irene
authors.initials: I
authors.lastname: Toldo
authors.forename: Alberto
authors.initials: A
authors.lastname: Casarin
authors.forename: Sabrina
authors.initials: S
authors.lastname: Sacconi
authors.forename: Luca
authors.initials: L
authors.lastname: Cesaro
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Basso
authors.forename: Alberto B
authors.initials: AB
authors.lastname: Burlina
mesh_terms: D000595:Amino Acid Sequence; D000818:Animals; D001123:Argininosuccinate Lyase / Q000097:blood / Q000737:chemistry / Q000235:genetics*; D001483:Base Sequence; D002897:Chromosomes, Human, Pair 7; D017931:DNA Primers; D004912:Erythrocytes / Q000201:enzymology; D005091:Exons; D005838:Genotype; D006801:Humans; D007438:Introns; D008958:Models, Molecular; D008969:Molecular Sequence Data; D009154:Mutation; D010641:Phenotype; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D011544:Pseudogenes; D017386:Sequence Homology, Amino Acid
chemical_list: D017931:DNA Primers; D001123:Argininosuccinate Lyase