Background This study reports on a hitherto undescribed autosomal recessive syndrome characterised by dysmorphic features and multiple congenital anomalies together with severe neurological impairment, chorea and seizures leading to early death, and the identification of a gene involved in the pathogenesis of the disease.
Methods Homozygosity mapping was performed using Affymetrix Human Mapping 250k NspI arrays. Sequencing of all coding exons of the candidate genes was performed with primer sets designed using the Primer3 program. Fluorescence activated cell sorting was performed using conjugated antibody to CD59. Staining, acquisition and analysis were performed on a FACSCalibur flow cytometer.
Results Using homozygosity mapping, the study mapped the disease locus to 18q21.32–18q22.1 and identified the disease-causing mutation, c.2126G→A (p.Arg709Gln), in PIGN, which encodes glycosylphosphatidylinositol (GPI) ethanolamine phosphate transferase 1, a protein involved in GPI-anchor biosynthesis. Arginine at the position 709 is a highly evolutionarily conserved residue located in the PigN domain. The expression of GPI linked protein CD59 on fibroblasts from patients as compared to that in a control individual showed a 10-fold reduction in expression, confirming the pathogenic consequences of the mutation on GPI dependent protein expression.
Conclusions The abundant expression of PIGN in various tissues is compatible with the diverse phenotypic features observed in the patients and with the involvement of multiple body systems. The presence of developmental delay, hypotonia, and epilepsy combined with multiple congenital anomalies, especially anorectal anomalies, should lead a clinician to suspect a GPI deficiency related disorder.
- Neurological impairment
- dysmorphic features
- PIGN, glycosylphosphatidylinositol (GPI) ethanolamine phosphate transferase 1
- clinical genetics
- epilepsy and seizures
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Funding This study was supported by the Israeli Ministry of Health Chief Scientist Foundation (grant No 3-4963) and the Israeli Science Foundation (grant No558/09).
Competing interests None.
Patient consent Obtained.
Ethics approval This study was conducted with the approval of the National Committee for Genetic Studies, Israeli Ministry of Health, and the Rabin Medical Center.
Provenance and peer review Not commissioned; externally peer reviewed.