Elucidation of the pathogenic mechanism and potential treatment strategy for a female patient with spastic paraplegia derived from a single-nucleotide deletion in PLP1

J Hum Genet. 2019 Jul;64(7):665-671. doi: 10.1038/s10038-019-0600-x. Epub 2019 Apr 19.

Abstract

Pelizaeus-Merzbacher disease (PMD) is an X-linked recessive disorder caused by abnormalities in the gene PLP1. Most females harboring heterozygous PLP1 abnormalities are basically asymptomatic. However, as a result of abnormal patterns of X-chromosome inactivation, it is possible for some female carriers to be symptomatic. Whole-exome sequencing of a female patient with unknown spastic paraplegia was performed to obtain a molecular diagnosis. As a result, a de novo heterozygous single-nucleotide deletion in PLP1 [NM_000533.5(PLP1_v001):c.783del; p.Thr262Leufs*20] was identified. RNA sequencing was performed in a patient-derived lymphoblastoid cell line, confirming mono-allelic expression of the mutated allele and abnormal inactivation of the wild-type allele. The patient-derived lymphoblastoid cell line was then treated with VX680 or 5azadC, which resulted in restored expression of the wild-type allele. These two agents thus have the potential to reverse inappropriately-skewed inactivation of the X-chromosome.

Publication types

  • Case Reports

MeSH terms

  • Alleles
  • Cell Line
  • Child
  • Chromosomes, Human, X / genetics
  • Chromosomes, Human, X / metabolism
  • Decitabine / pharmacology
  • Exome Sequencing
  • Female
  • Frameshift Mutation*
  • Humans
  • Myelin Proteolipid Protein / genetics*
  • Paraplegia / genetics*
  • Pelizaeus-Merzbacher Disease / genetics*
  • Pelizaeus-Merzbacher Disease / pathology
  • Pelizaeus-Merzbacher Disease / therapy
  • Piperazines / pharmacology

Substances

  • Myelin Proteolipid Protein
  • PLP1 protein, human
  • Piperazines
  • tozasertib
  • Decitabine