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World J Gastroenterol. Oct 14, 2008; 14(38): 5876-5879
Published online Oct 14, 2008. doi: 10.3748/wjg.14.5876
High frequency of the c.3207C>A (p.H1069Q) mutation in ATP7B gene of Lithuanian patients with hepatic presentation of Wilson’s disease
Laimutis Kucinskas, Jolanta Jeroch, Astra Vitkauskiene, Raimundas Sakalauskas, Vitalija Petrenkiene, Vaidutis Kucinskas, Rima Naginiene, Hartmut Schmidt, Limas Kupcinskas
Laimutis Kucinskas, Institute of Biology of Kaunas University of Medicine, Mickevičiaus 9, Kaunas LT-44307, Lithuania
Jolanta Jeroch, Rima Naginiene, Institute of Biomedical Research of Kaunas University of Medicine, Eiveniu 4, Kaunas LT-50009, Lithuania
Astra Vitkauskiene, Laboratory of Immunology and Genetics, Kaunas University of Medicine, Eiveniu 2, Kaunas LT-50009, Lithuania
Raimundas Sakalauskas, Department of Pulmonology and Immunology, Kaunas University of Medicine, Eiveniu 2, Kaunas LT-50009, Lithuania
Vitalija Petrenkiene, Limas Kupcinskas, Department of Gastroenterology, Kaunas University of Medicine, Eiveniu 2, Kaunas LT-50009, Lithuania
Vaidutis Kucinskas, Department of Human and Medical Genetics, Faculty of Medicine, Vilnius University, Santariskiu 2, Vilnius LT-08661, Lithuania
Hartmut Schmidt, Department of Hepatotransplanthology, University of Munster, Schlossplatz 2, Munster D-48149, Germany
Author contributions: Kucinskas L and Kupcinskas L contributed equally to this work; Kucinskas L designed research/performed research/wrote paper; Jeroch J wrote paper; Vitkauskiene A wrote paper/contributed new reagents/analytic tools; Sakalauskas R designed research; Petrenkiene V analysed data; Kucinskas V designed research; Naginiene R performed research; Kupcinskas L designed research/wrote paper; Schmidt H performed research/wrote paper.
Supported by The National Science and Education Foundation of Lithuania, No. M-06005
Correspondence to: Dr. Limas Kupcinskas, PhD, Professor, Department of Gastroenterology, Kaunas University of Medicine, Eiveniu 2, Kaunas LT-50009, Lithuania. likup@takas.lt
Telephone: +370-68-640575 Fax: +370-37-3361458
Received: May 30, 2008
Revised: July 19, 2008
Accepted: July 26, 2008
Published online: October 14, 2008
Abstract

AIM: To investigate the prevalence of the ATP7B gene mutation in patients with hepatic presentation of Wilson’s disease (WD) in Lithuania.

METHODS: Eleven unrelated Lithuanian families, including 13 WD patients were tested. Clinically WD diagnosis was established in accordance to the Leipzig scoring system. Genomic DNA was extracted from whole venous blood using a salt precipitation method. Firstly, the semi-nested polymerase chain reaction (PCR) technique was used to detect the c.3207C>A (p.H1069Q) mutation. Patients not homozygous for the c.3207C>A (p.H1069Q) mutation were further analyzed. The 21 exons of the WD gene were amplified in a thermal cycler (Biometra T3 Thermocycler, Göttingen, Germany). Direct sequencing of the amplified PCR products was performed by cycle sequencing using fluorescent dye terminators in an automatic sequencer (Applied Biosystems, Darmstadt, Germany).

RESULTS: Total of 13 WD patients (mean age 26.4 years; range 17-40; male/female 3/10) presented with hepatic disorders and 16 their first degree relatives (including 12 siblings) were studied. Some of WD patients, in addition to hepatic symptoms, have had extrahepatic disorders (hemolytic anemia 3; Fanconi syndrome 1; neuropsychiatric and behavioural disorder 2). Liver biopsy specimens were available in all of 13 WD patients (8 had cirrhosis; 1-chronic hepatitis; 3-acute liver failure, 1-liver steatosis). Twelve of 13 (92.3%) WD patients had the c.3207C>A (p.H1069Q) mutation, 6 of them in both chromosomes, 6 were presented as compound heterozygotes with additional c.3472-82delGGTTTAACCAT, c.3402delC, c.3121C>T (p.R1041W) or unknown mutations. For one patient with liver cirrhosis and psychiatric disorder (Leipzig score 6), no mutations were found. Out of 16 first degree WD relatives, 11 (68.7%) were heterozygous for the c.3207C>A (p.H1069Q) mutation. Two patients with fulminant WD died from acute liver failure and 11 are in full remission under penicillamine or zinc acetate treatment. Three women with WD successfully delivered healthy babies.

CONCLUSION: The c.3207C>A (p.H1069Q) missense mutation is the most characteristic mutation for Lithuanian patients with WD. Even 92.3% of WD patients with hepatic presentation of the disease are homozygous or compound heterozygotes for the p.H1069Q mutation.

Keywords: Wilson disease, ATP7B gene, c.3207C>A (p.H1069Q) mutation, Cirrhosis, Urine copper, Copper in liver biopsies