Molecular and tissue-specific heterogeneity in HPRT deficiency

Mechanisms for phenotypic variation in Lesch-Nyhan disease and its variants

Lesch-Nyhan disease is a neurogenetic disorder caused by mutation of the HPRT1 gene on the X chromosome. There is significant variation in the clinical phenotype, with more than 300 different known mutations. There are few studies that have addressed whether similar mutations result in similar phenotypes across different patients because hypoxanthine-guanine phosphoribosyltransferase (HGprt) deficiency is rare, and most mutations are unique or limited to individual families. However, recent studies have revealed multiple unrelated patients with similar mutations, providing an opportunity to examine genotype-phenotype correlations. We found significant variation among the clinical features of 10 patients from 8 unrelated families all carrying a mutation replacing guanine with adenine at base position 143 (c.143G>A) in the HPRT1 gene. This mutation results in replacement of arginine by histidine at amino acid position 48 (p.arg48his) in the HGprt enzyme. Biochemically, the enzyme exhibits reduced thermal integrity, a mechanism that may explain clinical variation. The literature reveals similar clinical variation among other patients with similar mutations, although the variation is relatively minor across the whole population of patients. Identifiable sources of clinical variation include known limitations of clinical ascertainment and mechanisms that affect residual enzyme activity and stability. These results are helpful for understanding genotype-phenotype correlations and discordance and likely are applicable to other neurogenetic disorders where similar variation occurs.

Inherited purine enzyme deficiencies: prenatal diagnosis and heterozygote detection

A number of genetically determined enzyme defects leading to disturbances of purine metabolism can prenatally be monitored, and heterozygote detection is possible in several cases. In severe hypoxanthine-guanine phosphoribosyl transferase (HGPRT) deficiency, associated with a neurological disease known as the Lesch-Nyhan Syndrome, rapid prenatal diagnosis can be performed by means of a simple quantitative radiochemical enzyme assay at the single cell level. In this X-linked recessive disease, the female heterozygotes can be detected by using cultured skin fibroblasts, but alternatively single hair root enzymes can directly be assayed. Two other genetic purine enzyme defects lead to deranged immune function: in adenosine deaminase (ADA) deficiency both T- and B-lymphocyte function are severely impaired. In purine nucleoside phosphorylase (PNP) deficiency, only certain T-cell abnormalities have been observed, with apparently normal B-cell function. Both diseases are transmitted as autosomal recessive traits. Prenatal diagnosis is possible, e.g. by means of the above mentioned microtechniques. Heterozygote detection can be done using blood cells or cultured fibroblasts. Microchemical methods offer the possibility to perform enzyme characterisation even when a very limited amount of material is available. In the case of HGPRT, ADA, and PNP, for a substrate affinity curve and pH optimum curve a few hundred cells are sufficient. These and other possibilities illustrate the general usefulness of simple microtechniques in clinical enzymology.

Enzymes of purine nucleotide metabolism in human lymphocytes

A methodology is presented for systemic analysis of purine enzymes in small lymphocyte subfractions. For the determination of 7 different enzymes of purine metabolism *hypoxanthine-guanine phosphoribosyltransferase (HG-PRT), adenine phosphoribosyltransferase (A-PRT), adenosine deaminase (ADA), purine nucleoside phosphorylase (PNP), adenosine kinase (AK), 5'-nucleotidase (5'N), and AMP-deaminase) less than 200,000 peripheral blood lymphocytes are needed. 1000-6000 lyophilised lymphocytes are incubated in micro-incubation vessels (3 microliter) with radioactive substrates for 15-180 min. Separation of substrates and products is achieved by thin-layer chromatography on PEI-cellulose. Addition of BSA to the incubation mixtures results in higher specific enzyme activities and narrower ranges of mean values of a control group.