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迄今为止报道的最良性纤维发育不良性骨化进展变异病例中,在甘氨酸/丝氨酸丰富区发现了一种新型的 ACVR1 突变。

A novel ACVR1 mutation in the glycine/serine-rich domain found in the most benign case of a fibrodysplasia ossificans progressiva variant reported to date.

机构信息

Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Bristol, UK.

出版信息

Bone. 2011 Mar 1;48(3):654-8. doi: 10.1016/j.bone.2010.10.164. Epub 2010 Oct 29.

Abstract

Fibrodysplasia Ossificans Progressiva (FOP) is a rare, autosomal dominant condition, classically characterised by heterotopic ossification beginning in childhood and congenital great toe malformations; occurring in response to a c.617 G > A ACVR1 mutation in the functionally important glycine/serine-rich domain of exon 6. Here we describe a novel c.587 T > C mutation in the glycine/serine-rich domain of ACVR1, associated with delayed onset of heterotopic ossification and an exceptionally mild clinical course. Absence of great toe malformations, the presence of early ossification of the cervical spine facets joints, plus mild bilateral camptodactyly of the 5th fingers, together with a novel ACVR1 mutation, are consistent with the 'FOP-variant' syndrome. The c.587 T > C mutation replaces a conserved leucine with proline at residue 196. Modelling of the mutant protein reveals a steric clash with the kinase domain that will weaken interactions with FKBP12 and induce exposure of the glycine/serine-rich repeat. The mutant receptor is predicted to be hypersensitive to ligand stimulation rather than being constitutively active, consistent with the mild clinical phenotype. This case extends our understanding of the 'FOP-variant' syndrome.

摘要

进行性骨化性纤维发育不良(FOP)是一种罕见的常染色体显性疾病,其特征通常为儿童期开始的异位骨化和先天性大脚趾畸形;这是由于 ACVR1 基因 6 号外显子功能重要的甘氨酸/丝氨酸丰富区发生 c.617G > A ACVR1 突变所致。在此,我们描述了一种新型的 ACVR1 甘氨酸/丝氨酸丰富区 c.587T > C 突变,其与异位骨化的迟发发作和异常轻微的临床病程有关。没有大脚趾畸形,颈椎小关节的早期骨化,以及双侧第 5 指轻度的屈指畸形,加上新型的 ACVR1 突变,与“FOP 变异型”综合征一致。c.587T > C 突变将残基 196 处的保守亮氨酸突变为脯氨酸。突变蛋白的建模显示与激酶结构域存在空间冲突,这将削弱与 FKBP12 的相互作用,并诱导甘氨酸/丝氨酸丰富重复序列的暴露。该突变受体被预测对配体刺激更为敏感,而不是持续激活,这与轻微的临床表型一致。该病例扩展了我们对“FOP 变异型”综合征的认识。

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