How to cite this article: Hoffman WH, Jain A, Chen H, Fedarko NS. 2008. Matrix extracellular phosphoglycoprotein (MEPE) correlates with serum phosphorus prior to and during octreotide treatment and following excisional surgery in hypophosphatemic linear sebaceous nevus syndrome. Am J Med Genet Part A 146A:2164-2168.
To the Editor:Hereditary and acquired forms of hypophosphatemia result in metabolic bone disease with significant degrees of disability in children, adolescents and adults. Linear sebaceous nevus syndrome (LSNS) is a rare sporadic congenital phakomatosis of unknown etiology with a variable phenotype that includes hypophosphatemia [Carey et al., 1986].We have previously reported on a patient with LSNS and hypophosphatemia where the plasma phosphatonin, fibroblast growth factor-23 (FGF-23), was inversely related to the serum phosphorous prior to and after treatment with octreotide and excision surgery [Hoffman et al., 2005]. We now extend that observation by reporting on the positive correlation between serum phosphorus and matrix extracellular phosphoglycoprotein (MEPE), a downstream member of phosphate homeostasis and mineralization.Briefly, the patient, a 7-year-old boy of Korean ancestry with LSNS (which followed Blaschko's lines and involved the left side of his face, trunk, upper and lower extremities and epidermal nevi of the limbus) began treatment for hypophosphatemic rickets with phosphate and calcitriol for vitamin Dresistant rickets. Octreotide (Sandostatin LAR) was added to the phosphate and calcitriol therapy when he was 16 years of age, due to increasing musculoskeletal symptoms and frequent stress fractures and persistent hypophosphatemia [Hoffman et al., 2005]. Further details of the treatment protocol are given in the legend for Figure 1. The competitive enzyme-linked immunosorbent (ELISA) assays for MEPE were performed as previously described [Jain et al., 2004]. The antibody employed in the competitive ELISA (LF-155, a kind gift of Dr. L.W. Fisher, N.I.D.C.R., N.I.H.) was raised against exon 4, the last coding exon of human MEPE, and was affinitypurified using recombinantly expressed protein. The assay entails an anion exchange column chromatography step to clean up the sample and detects intact, full length MEPE. The bioactive acidic serineaspartate-rich MEPE (ASARM) peptide was assayed by a competitive ELISA specific for ASARM-peptide epitopes [Bresler et al., 2004] in the laboratory of Dr. P Rowe. Associations between MEPE and phosphorus were analyzed by Pearson regression analysis.FGF-23 decreased within 1 month following the first injection of depot octreotide, was suppressed during the 4 months of injections, and remained in the normal range over the following 6 months. After a further decrease following surgery, FGF-23