Digenic inheritance of mutations in the coproporphyrinogen oxidase and protoporphyrinogen oxidase genes in a unique type of porphyria

J Invest Dermatol. 2011 Nov;131(11):2249-54. doi: 10.1038/jid.2011.186. Epub 2011 Jul 7.

Abstract

The simultaneous dysfunction of two enzymes within the heme biosynthetic pathway in a single patient is rare. Not more than 15 cases have been reported. A woman with a transient episode of severe photosensitivity showed a biochemical porphyrin profile suggestive of hereditary coproporphyria (HCP), whereas some of her relatives had a profile that was suggestive of variegate porphyria (VP). HCP and VP result from a partial enzymatic deficiency of coproporphyrinogen oxidase (CPOX) and protoporphyrinogen oxidase (PPOX), respectively. DNA analysis in the index patient revealed mutations in both the CPOX and PPOX genes, designated as c.557-15C>G and c.1289dupT, respectively. The CPOX mutation leads to a cryptic splice site resulting in retention of 14 nucleotides from intron 1 in the mRNA transcript. Both mutations encode null alleles and were associated with nonsense-mediated mRNA decay. Given the digenic inheritance of these null mutations, coupled with the fact that both HCP and VP can manifest with life-threatening acute neurovisceral attacks, the unusual aspect of this case is a relatively mild clinical phenotype restricted to dermal photosensitivity.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Coproporphyria, Hereditary / genetics
  • Coproporphyrinogen Oxidase / genetics*
  • DNA Mutational Analysis
  • Female
  • Humans
  • Male
  • Middle Aged
  • Pedigree
  • Photosensitivity Disorders / genetics
  • Porphyria, Variegate / genetics
  • Porphyrias / classification*
  • Porphyrias / diagnosis
  • Porphyrias / genetics*
  • Protoporphyrinogen Oxidase / genetics*
  • Sequence Deletion / genetics*

Substances

  • Coproporphyrinogen Oxidase
  • Protoporphyrinogen Oxidase