Genetic Defects and Clinical Characteristics of Patients with a Form of Oculocutaneous Albinism (HermanskyPudlak Syndrome)
William A. Gahl, M.D., Ph.D., Mark Brantly, M.D., Muriel I. Kaiser-Kupfer, M.D., Fumino Iwata, M.D., Senator Hazelwood, B.S., Vorasuk Shotelersuk, M.D., Lynn F. Duffy, M.D., Ernest M. Kuehl, James Troendle, Ph.D., and Isa Bernardini, M.Ed.
Background HermanskyPudlak syndrome is characterizedby oculocutaneous albinism, a storage-pool deficiency, and lysosomalaccumulation of ceroid lipofuscin, which causes pulmonary fibrosisand granulomatous colitis in some cases. All identified affectedpatients in northwest Puerto Rico are homozygous for a 16-bpduplication in exon 15 of a recently cloned gene, HPS. We comparedthe clinical and laboratory characteristics of these patientswith those of patients without the 16-bp duplication.
Methods Forty-nine patients 27 Puerto Ricans and 22patients from the mainland United States who were not of PuertoRican descent were given a diagnosis on the basis ofalbinism and the absence of platelet dense bodies. We used thepolymerase chain reaction to determine which patients carriedthe 16-bp duplication.
Results Twenty-five of the Puerto Rican patients were homozygousfor the 16-bp duplication, whereas none of the nonPuertoRican patients carried this mutation. Like the patients withoutthe duplication, the patients with the 16-bp duplication hada broad variation in pigmentation. Nine of 16 adults with theduplication, but none of the 10 without it, had a diffusingcapacity for carbon monoxide that was less than 80 percent ofthe predicted value. High-resolution computed tomography in12 patients with the 16-bp duplication revealed minimal fibrosisin 8, moderate fibrosis in 1, severe fibrosis in 1, and no fibrosisin 2. Computed tomography in eight patients without the duplicationrevealed minimal fibrosis in three and no fibrosis in the rest.Inflammatory bowel disease developed in eight patients (fourin each group) between 3 and 25 years of age.
Conclusions The 16-bp duplication in exon 15 of HPS, which wefound only in Puerto Rican patients, is associated with a broadrange of pigmentation and an increased risk of restrictive lungdisease in adults.
Source Information
From the Heritable Disorders Branch (W.A.G., S.H., V.S., I.B.) and the Biometry and Mathematical Statistics Branch (J.T.), National Institute of Child Health and Human Development; the PulmonaryCritical Care Medicine Branch, National Heart, Lung, and Blood Institute (M.B.); the Ophthalmic Genetics and Clinical Services Branch, National Eye Institute (M.I.K.-K., F.I., E.M.K.); and the Howard Hughes Medical Institute, National Institutes of Health Research Scholars Program (S.H.) all in Bethesda, Md.; and Gastroenterology Associates of Northern Virginia, Fairfax (L.F.D.).
Address reprint requests to Dr. Gahl at the Section on Human Biochemical Genetics, 10 Center Dr., MSC 1830, Bldg. 10, Rm. 9S-241, NICHD, NIH, Bethesda, MD 20892-1830.
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