Mutations in the gene encoding lysosomal protective protein/cathepsin A (PPCA) are the cause of the lysosomal disorder galactosialidosis (GS). Depending on age of onset and severity of the symptoms, patients present with either an early infantile (EI), a late infantile (LI), or a juvenile/adult (J/A) form of the disease. To study genotype-phenotype correlation in this disorder, we have analyzed the mutations in the PPCA gene of eight clinically different patients. In two EI and one J/A patient, we have identified four novel point mutations (Val104Met, Leu208Pro, Gly411Ser and Ser23Tyr), that prevent phosphorylation and, hence, lysosomal localization and maturation of the mutant precursors. Two amino acid substitutions (Phe412Val and Tyr221Asn) are shared by five LI patients. These mutations appear to be pathognomonic for this phenotype, and determine the clinical outcome depending on whether they are present together or in combination with other mutations. The latter include a single base deletion and a novel amino acid change (Met378Thr), which generates an additional glycosylation site. Within the LI group, patients carrying the Phe412Val mutation are clinically more severe than those with the Tyr221Asn substitution. This is in agreement with the biochemical behavior of the Asn221-mutant protein, that is, like the Phe412Val protein, phosphorylated, routed to lysosomes and proteolytically processed, but its intralysosomal stability is intermediate between that of wild-type PPCA and Val412-PPCA. Overall, these results may explain the clinical heterogeneity observed in GS patients and may help to correlate mutant allelic combinations with specific clinical phenotypes.
Title: Combined deficiency of beta-galactosidase and neuraminidase: natural history of the disease in the first 18 years of an American patient with late infantile onset form Strisciuglio P, Sly WS, Dodson WE, McAlister WH, Martin TC Ref: American Journal of Medicine Genet, 37:573, 1990 : PubMed
We describe the clinical findings over the first 18 years of a patient with a novel phenotype for galactosialidosis, the storage disease produced by the combined deficiency of beta-galactosidase and neuraminidase. Clinical findings in the first few months included somewhat unusual appearance and hepatosplenomegaly. Dysostosis multiplex was evident by age 2 1/2 years. Mitral and aortic valvular disease appeared over the next few years and cardiac disease has become the most important clinical problem. Foam cells were present in the bone marrow, and vacuolated lymphocytes were present in the peripheral blood smear. The patient had no neurological symptoms, cherry red spots, or intellectual deterioration during the first 18 years. Evidence presented elsewhere indicates that the basic defect in this late infantile form of galactosialidosis (as is thought to be true for the other forms of galactosialidosis) is a reduced amount of the 32 kDa phosphoglycoprotein which associates with beta-galactosidase and alpha-neuraminidase in lysosomes.
The biochemical defect underlying the late infantile form of galactosialidosis has been investigated in fibroblasts from two patients presenting with this phenotype. Immunoprecipitation experiments demonstrated that a reduced amount of 32-kd "protective" protein and a normal amount of its precursor are present in late infantile galactosialidosis fibroblasts, while neither of the two polypeptides are detectable in early infantile and juvenile/adult fibroblasts. Leupeptin treatment led to a slight increase in the amount of 54-kd and 32-kd polypeptides in both late-infantile galactosialidosis cell lines. Uptake studies in one of the two cell lines confirmed the hypothesis that a block in the maturation of the protective protein is responsible for the late infantile type of galactosialidosis. This mutation seems to be a distinct finding in all patients affected by this form of the disease.
Title: Complementation, cross correction, and drug correction studies of combined beta-galactosidase neuraminidase deficiency in human fibroblasts Strisciuglio P, Creek KE, Sly WS Ref: Pediatr Res, 18:167, 1984 : PubMed
Neuraminidase activity in fibroblasts obtained from a patient with combined beta-galactosidase-neuraminidase deficiency (beta-gal-/neur-) was partially restored by fusion with two ML I cell lines and an ML II cell line. As observed with neuraminidase activity, beta-galactosidase also showed complementation with an increase in activity when beta-gal-/neur- fibroblasts were fused with an ML II or a GMI gangliosidosis cell line. Both GMI gangliosidosis and sialidosis fibroblasts secreted a "corrective factor" which, when added to medium above beta-gal-/neur- fibroblasts, was pinocytosed and partially corrected its deficiencies for these two enzymes. This partial correction of beta-galactosidase and neuraminidase activities persisted for at least 72 h after removal of the "corrective factor" from the medium. A "corrective factor" with similar properties was obtained from glycoproteins isolated by chromatography of human spleen homogenates on concanavalin A-Sepharose. Treatment of beta-gal-/neur- fibroblasts with leupeptin or EP475, two inhibitors of lysosomal thiol-proteases, partially restored beta-galactosidase activity but caused no significant improvement in neuraminidase levels. The partial corrective effect of leupeptin on beta-galactosidase activity persisted for at least 2 d after removal of the drug, even in the presence of cycloheximide.
