Clinical and genetic studies in a family with a novel mutation in the sepiapterin reductase gene.

OBJECTIVES: Sepiapterin reductase deficiency is a rare, but treatable inherited disorder of tetrahydrobiopterin and neurotransmitter metabolism. This disorder is most probably underdiagnosed. To date, only 44 cases have been described in the literature. We present the clinical and genetic investigations in a family with a complex movement disorder. MATERIALS AND METHODS: We examined two affected sisters and three healthy family members. The cerebrospinal fluid was analyzed for neurotransmitter and pterins, and the sepiapterin reductase gene (SPR) was sequenced. RESULTS: The sisters had a complex movement disorders with dystonia and diurnal fluctuations. Both had oculogyric crises, and the older sister also hypersomnia. Both sisters had raised prolactin levels twice above the reference level. One sister had a dramatic response to levodopa, the other responded, but developed dyskinesia despite low doses. Both patients improved dramatically over time with levodopa (2.3 and 1.5 mg/kg/day). Very low levels of homovanillic acid and 5-hydroxyindoleacetic acid and increased levels of sepiapterin and dihydrobiopterin were measured in the cerebrospinal fluid before treatment. DNA analyses revealed a novel homozygous mutation in exon 2 in the SPR gene, c.364A>G/p.(Tyr123Cys), located in a highly conserved region in the gene. Both parents and the healthy sister were carriers for the same mutation. CONCLUSIONS: A new homozygous mutation in the SPR gene was found in two sisters with dopa-responsive dystonia. This important and treatable neurotransmitter disorder must be considered in patients with a complex movement disorder with diurnal fluctuations with or without intellectual impairment. Patients with these symptoms should undergo levodopa trial, cerebrospinal fluid investigations, and genetic analyses.

A study of inherited short tail and taillessness in Pembroke Welsh corgi.

OBJECTIVES: To study whether natural short tail in adult Pembroke Welsh corgi is associated with congenital spinal defects. To report anatomical defects in two newborn tailless puppies from short-tailed parents, and to check whether they were homozygous for the dominant mutation in the T-gene (C295G). METHODS: The vertebral column of 19 adult dogs with natural short tail, from short-tail x long-tail crossings, was radiographically examined. Two tailless puppies were radiographed and submitted for necropsy. Samples from the puppies, their parents and five siblings were analysed for the mutation of the T-gene. RESULTS: No congenital spinal defects were diagnosed in any of the short-tailed dogs. The tailless puppies had anorectal atresia, had multiple spinal defects and were homozygous for the mutation in the T-gene. CLINICAL SIGNIFICANCE: As tail docking is forbidden in many countries, breeding Pembroke Welsh corgis with natural short tail is becoming increasingly common. Previous studies indicated that the mutation in homozygotes is lethal in early fetal life. It is of clinical significance that natural short tail is probably not associated with congenital spinal defects, as is known from studies of other species, and that homozygotes for this mutation with serious anatomical defects may be born.