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Academic Endocrine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford Center for Diabetes, Endocrinology, and Metabolism, Churchill Hospital (M.C.L., P.T.C., B.H., R.V.T.), Headington, Oxford OX3 7LJ, United Kingdom; Krankenhaus der Barmherzigen Brüder, Department of Internal Medicine, Teaching Hospital Medical University Graz (P.K., T.J.), A-8020 Graz, Austria; and Bone Metabolism Group, Division of Clinical Sciences, University of Sheffield, Northern General Hospital (C.S., R.E.), Sheffield S5 7AU, United Kingdom
Address all correspondence and requests for reprints to: Dr. Rajesh V. Thakker, Academic Endocrine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford Center for Diabetes, Endocrinology, and Metabolism, Churchill Hospital, Headington, Oxford OX3 7LJ, United Kingdom. E-mail: rajesh.thakker{at}ndm.ox.ac.uk.
Context: Hereditary multiple exostosis (HME) is an autosomal dominant disorder characterized by the development of benign cartilage-capped tumors at the juxta-epiphyseal regions of long bones. HME is usually caused by mutations of EXT1 or EXT2.
Objective: The objective of this study was to investigate a three-generation Austrian kindred with HME for EXT1 and EXT2 mutations and for abnormalities of bone mineral density (BMD).
Methods: DNA sequence and mRNA analyses were used to identify the mutation and its associated consequences. Serum biochemical and radiological investigations assessed bone metabolism and BMD.
Results: HME-affected members had a lower femoral neck BMD compared with nonaffected members (z-scores, 2.98 vs. 1.30; P = 0.011), and in those less than 30 yr of age, the lumbar spine BMD was also low (z-scores, 2.68 vs. 1.42; P = 0.005). However, they had normal mobility and normal serum concentrations of calcium, phosphate, alkaline phosphatase activity, creatinine, PTH, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, osteocalcin, and ß-crosslaps. DNA sequence analysis of EXT1 revealed a heterozygous g
c transversion that altered the invariant ag dinucleotide of the intron 8 acceptor splice site. RT-PCR analysis using lymphoblastoid RNA showed that the mutation resulted in skipping of exon 9 with a premature termination at codon 599. DNA sequence abnormalities of the osteoprotegerin gene, which is in close proximity to the EXT1 gene, were not detected.
Conclusions: A novel heterozygous acceptor splice site mutation of EXT1 results in HME that is associated with a low peak bone mass, indicating a possible additional role for EXT1 in bone biology and in regulating BMD.
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