title: As little as needed: the extraordinary case of a mild recessive osteopetrosis owing to a novel splicing hypomorphic mutation in the TCIRG1 gene.
abstract: Mutations in the TCIRG1 gene, coding for a subunit of the osteoclast proton pump, are responsible for more than 50% of cases of human malignant autosomal recessive osteopetrosis (ARO), a rare inherited bone disease with increased bone density owing to a failure in bone resorption. A wide variety of mutations has been described, including missense, nonsense, small deletions/insertions, splice-site mutations, and large genomic deletions, all leading to a similar severe presentation. So far, to the best of our knowledge, no report of a mild phenotype owing to recessive TCIRG1 mutations is present neither in our series of more than 100 TCIRG1-dependent ARO patients nor in the literature. Here we describe an 8-year-old patient referred to us with a clinical diagnosis of ARO, based on radiological findings; of note, no neurological or hematological defects were present in this girl. Surprisingly, we identified a novel nucleotide change in intron 15 of the TCIRG1 gene at the homozygous state, leading to the production of multiple aberrant transcripts, but also, more importantly, of a limited amount of the normal transcript. Our results show that a low level of normal TCIRG1 protein can dampen the clinical presentation of TCIRG1-dependent ARO. On this basis, a small amount of protein might be sufficient to rescue, at least partially, the severe ARO phenotype, and this is particularly important when gene therapy approaches are considered. In addition, we would also recommend that the TCIRG1 gene be included in the molecular diagnosis of mild forms of human ARO.
authors.affiliation: Unitá Operativa di Supporto (UOS)/Institute of Genetic and Biomedical Research (IRGB), Milan Unit, National Research Council (CNR), Milan, Italy; Humanitas Clinical and Research Center, Rozzano, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Sobacchi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Pangrazio
authors.forename: Antonio González-Meneses
authors.initials: AG
authors.lastname: Lopez
authors.forename: Diego Pascual-Vaca
authors.initials: DP
authors.lastname: Gomez
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Caldana
authors.forename: Lucia
authors.initials: L
authors.lastname: Susani
authors.forename: Paolo
authors.initials: P
authors.lastname: Vezzoni
authors.forename: Anna
authors.initials: A
authors.lastname: Villa
mesh_terms: D017398:Alternative Splicing / Q000235:genetics*; D001483:Base Sequence; D002648:Child; D004252:DNA Mutational Analysis; D005260:Female; D005808:Genes, Recessive; D006720:Homozygote; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008969:Molecular Sequence Data; D009154:Mutation / Q000235:genetics*; D010022:Osteopetrosis / Q000000981:diagnostic imaging / Q000235:genetics*; D011859:Radiography; D025262:Vacuolar Proton-Translocating ATPases / Q000235:genetics*
chemical_list: C472421:TCIRG1 protein, human; D025262:Vacuolar Proton-Translocating ATPases
keywords: AUTOSOMAL RECESSIVE OSTEOPETROSIS; HYPOMORPHIC MUTATION; SPLICING DEFECT; TCIRG1