Isolated glycerol kinase deficiency (GKD) is an Xlinked inborn error of metabolism that is either symptomatic or asymptomatic. GKD is due to deletions of, or mutations within, the GK gene, and there is no genotype-phenotype correlation. We identified three patients with asymptomatic GKD, determined that they had GK splice-site mutations, and studied the stability of their GK mRNA to understand the molecular mechanism of the GKD. All three patient mutations caused a frameshift and introduction of a premature stop codon. A fourth patient had an Alu insertion in intron 4 that led to alternative splicing. To study the effect of splice-site mutations on RNA species, we performed reverse transcriptase PCR and found only normal-sized products for all patients. Incubation with anisomycin to block nonsense-mediated decay (NMD), revealed two RNA species for each individual. Sequence analysis revealed that the larger bands represented the wild-type GK RNA and smaller bands represented mutant misspliced RNA, suggesting that the abnormal RNA species were targeted by NMD. Normal RNA species observed in each patient are likely responsible for their mild phenotypes. We speculate that influences on RNA processing and protein stability represent modifiers of the GKD phenotype. (Pediatr Res 59: 590-592, 2006) I solated GKD is an X-linked inborn error of metabolism (1). We have previously shown that GKD is due to deletions of, or mutations within, the glycerol kinase gene (GK) located on Xp21 that encodes a 524 aa protein (1). Isolated GKD is either asymptomatic or symptomatic with episodes of vomiting, acidosis (metabolic crises), and lethargy that can progress to coma or CNS crises. GKD is caused by large deletions, insertions, missense mutations, nonsense mutations, and splice-site mutations (1-3). Our previous work has shown that there is no genotype-phenotype correlation in GKD (2). We hypothesize that this lack of genotype-phenotype correlation in patients with GKD is due to the role of modifier genes in the GK phenotype (2,4).NMD is a quality-control mechanism naturally occurring in cells to maintain homeostasis and destroy mRNA that contain premature stop codons (5,6). This process is evolutionarily conserved and is found in species from yeast (Saccharomyces cerevisiae) to worms (Caenorhabditis elegans) to humans (5). NMD occurs in the nucleus and cytoplasm (5,6), and evidence suggests that NMD and alternative splicing are coupled (7). Better understanding of this natural process to minimize the effect of DNA mutations in the genome will be important in understanding human disease.The purpose of this investigation was to identify patients with GKD due to splice-site mutations and to determine the effect of the splice-site mutation on the GK mRNA stability. Our results indicate that GKD is one of the many disorders with splice-site mutations and that the aberrant transcripts are targeted for NMD.
METHODSIndividuals with isolated GKD. Patient 020518-1 presented with pseudohypertriglyceridemia and asymptomatic GKD. H...