A novel nonsense mutation c.424G>T (p. G142X) in the first exon of XLas leading to osteopetrosis

Abstract

GNAS is one of the most complex gene loci in the human genome and encodes multiple gene products. XLas, the extra-large isoform of alpha-subunit of the stimulatory guanine nucleotide-binding protein (Gas), is paternally inherited. Although XLas can mimic the action of Gas, its significance remains largely unknown in humans. Here we report a patient presented with increased bone mass, hypophosphatemia, and elevated parathyroid hormone levels. His serum calcium was in the lower limit of normal range. DEXA scan revealed progressive increase in the bone density of this patient. Whole exome sequencing of this subject found a novel nonsense mutation c.424G>T (p. G142X) in the first exon of XLas, which was inherited from his father and transmitted to his daughter. This mutation was predicted to exclusively influence the expression of XLas, while may have no significant effects on other gene products of this locus. SaOS2 cells transfected with mutant XLas failed to generate cAMP under parathyroid hormone stimulation, indicating skeletal resistance to this hormone. This subject showed higher circulating SOST, DKK1 and OPG levels, while lower RANKL levels and RANKL/OPG ratio, leading to reduced bone resorption. It is speculated that this patient may belong to a very rare type of pseudohypoparathyroidism with selective skeletal resistance but normal renal tubular response to parathyroid hormone. Our findings indicate that XLas plays a critical role in bone metabolism and GNAS locus should be considered as a candidate gene for high bone mass.\n\nAuthor summaryGNAS has been regarded as one of the most complex gene loci and encodes multiple transcripts, including Gs, XLs, NESP55 and A/B transcripts. These isoforms share the same 2-13 exons with alternative first exons. Previously reported mutations often disrupt multiple protein-coding transcripts in addition to that encoding Gs, making it difficult to distinguish the contributions of each transcript to disease phenotypes. Here we first report a novel nonsense mutation c.424G>T (p. G142X) in the first exon of XLas in a subject presenting with high bone mass, unclosed cranial suture, and persistent hypophosphatemia, and elevated parathyroid hormone (PTH) levels. This is the first report of a mutation located in the first exon of XLas in humans, which was predicted to exclusively influence the expression of XLas, while may have no significant effects on other gene products of this locus. SaOS2 cells transfected with mutant XLas failed to generate cAMP under PTH stimulation, indicating skeletal resistance to this hormone. Our study suggests that XLas has an important physiological role in humans, and is involved in skeletal PTH/cAMP pathway. Our findings also indicate GNAS locus should be considered as a candidate gene for high bone mass.\n\nFundingThe National Natural Science Foundation of China.\n\nDeclaration of InterestsThe authors declare no competing interests.