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Non-HFE mutations in haemochromatosis in China: combination of heterozygous mutations involving HJV signal peptide variants
  1. Tingxia Lv1,2,3,4,
  2. Wei Zhang1,3,4,
  3. Anjian Xu2,3,4,
  4. Yanmeng Li2,3,4,
  5. Donghu Zhou2,3,4,
  6. Bei Zhang2,3,4,
  7. Xiaojin Li2,3,4,
  8. Xinyan Zhao1,3,4,
  9. Yu Wang1,3,4,
  10. Xiaoming Wang1,3,4,
  11. Weijia Duan1,3,4,
  12. Qianyi Wang1,3,4,
  13. Hexiang Xu5,
  14. JiShun Zheng5,
  15. Rongrong Zhao6,
  16. Longdong Zhu6,
  17. Yuwei Dong7,
  18. Lungen Lu7,
  19. Yongpeng Chen8,
  20. Jiang Long9,
  21. Sujun Zheng10,
  22. Wei Wang11,
  23. Hong You1,3,4,
  24. Jidong Jia1,3,4,
  25. Xiaojuan Ou1,3,4,
  26. Jian Huang1,2,3,4
  1. 1 Beijing Key Laboratory of Translational Medicine on Liver Cirrhosis, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
  2. 2 Experimental Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
  3. 3 Clinical Research Center for Rare Liver Disease, Capital Medical University, Beijing, China
  4. 4 Liver Research Center, National Clinical Research Center for Digestive Diseases, Beijing, China
  5. 5 Department of Infectious Diseases, The Third Affiliated Hospital of Anhui Medical University, The First People’s Hospital of Hefei, Hefei, China
  6. 6 Department of Infectious Diseases, The First Hospital of Lanzhou University, Lanzhou, China
  7. 7 Department of Gastroenterology, School of Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
  8. 8 Department of Infectious Diseases, Institute of Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
  9. 9 Department of Oncology Minimally Invasive Interventional Radiology, Beijing You-An Hospital, Capital Medical University, Shanghai, China
  10. 10 Artificial Liver Center, Beijing You-An Hospital, Capital Medical University, Beijing, China
  11. 11 Department of Clinical Laboratory, Beijing Friendship Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Prof. Jidong Jia and Prof. Xiaojuan Ou, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; jia_jd{at}, ouxj16{at} and Dr Jian Huang, Liver Research Center, Experimental Center, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China; huangj1966{at}


Introduction Hereditary haemochromatosis (HH) caused by a homozygous p.C282Y mutation in haemochromatosis (HFE) gene has been well documented. However, less is known about the causative non-HFE mutation. We aimed to assess mutation patterns of haemochromatosis-related genes in Chinese patients with primary iron overload.

Methods Patients were preanalysed for mutations in the classic HH-related genes: HFE, HJV, HAMP, TFR2 and SLC40A1. Whole exome sequencing was conducted for cases with variants in HJV signal peptide region. Representative variants were analysed for biological function.

Results None of the cases analysed harboured the HFE p.C282Y; however, 21 of 22 primary iron-overload cases harboured at least one non-synonymous variant in the non-HFE genes. Specifically, p.E3D or p.Q6H variants in the HJV signal peptide region were identified in nine cases (40.9%). In two of three probands with the HJV p.E3D, exome sequencing identified accompanying variants in BMP/SMAD pathway genes, including TMPRSS6 p.T331M and BMP4 p.R269Q, and interestingly, SUGP2 p.R639Q was identified in all the three cases. Pedigree analysis showed a similar pattern of combination of heterozygous mutations in cases with HJV p.E3D or p.Q6H, with SUGP2 p.R639Q or HJV p.C321X being common mutation. In vitro siRNA interference of SUGP2 showed a novel role of downregulating the BMP/SMAD pathway. Site-directed mutagenesis of HJV p.Q6H/p.C321X in cell lines resulted in loss of membrane localisation of mutant HJV, and downregulation of p-SMAD1/5 and HAMP.

Conclusion Compound heterozygous mutations of HJV or combined heterozygous mutations of BMP/SMAD pathway genes, marked by HJV variants in the signal peptide region, may represent a novel aetiological factor for HH.

  • hereditary haemochromatosis
  • heterozygous mutation
  • non-HFE gene
  • HJV
  • signal peptide region

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  • TL, WZ and AX contributed equally.

  • Contributors JH, XO and JJ designed the study, analysed and interpreted the data, and wrote the manuscript. TL, WZ and AX provided patients' samples and clinical data, analysed and interpreted the data, and wrote the paper. TL, WZ, AX, YL, DZ, BZ and XL did the experiments, and analysed and interpreted the data. XZ, YW, XW, WD and QW provided, analysed and interpreted patients' samples and clinical data. HX, JZ, RZ, LZ, YD, LL, YC, JL, SZ and WW provided patients' samples, clinical data or both. XO, JJ and HY advised on the conception, designed the study and supervised the project. JH conceptualised and designed the study, supervised the project and revised the paper. All authors vouch for the respective data and analysis, approved the final version and agreed to publish the manuscript.

  • Funding This study was supported by grants from the National Key Technologies R&D Program (No 2015BAI13B09), the Beijing Natural Science Foundation (No 7132058, 7182039) and the National Natural Science Foundation of China (No 81650014).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval Clinical Research Ethics Committee of Beijing Friendship Hospital, Capital Medical University (No 2016-P2-061-01).

  • Provenance and peer review Not commissioned; externally peer reviewed.