Second transplantation after kidney graft loss in primary hyperoxaluria type 2: a pedigree study and mutation analysis

Background Primary hyperoxaluria type 2 (PH2) is a rare disorder caused by GRHPR mutations. Research on the mutation spectrum and pedigree of PH2 helps in comprehending its pathogenesis and clinical outcomes, guiding clinical diagnosis and treatment.Methods We report a case of PH2 with a three-gener...

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Main Authors: Yushi Peng, Yingchun Zheng, Fu Xiong, Mingming Zhang, Yuchen Wang, Jia Luo, Wenli Zeng, Jialiang Hui, Wenfeng Deng, Jian Xu, Yun Miao, Renfei Xia, Yiling Fang
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Language:English
Published: Taylor & Francis Group 2024-12-01
Series:Renal Failure
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Online Access:https://www.tandfonline.com/doi/10.1080/0886022X.2024.2417743
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author Yushi Peng
Yingchun Zheng
Fu Xiong
Mingming Zhang
Yuchen Wang
Jia Luo
Wenli Zeng
Jialiang Hui
Wenfeng Deng
Jian Xu
Yun Miao
Renfei Xia
Yiling Fang
author_facet Yushi Peng
Yingchun Zheng
Fu Xiong
Mingming Zhang
Yuchen Wang
Jia Luo
Wenli Zeng
Jialiang Hui
Wenfeng Deng
Jian Xu
Yun Miao
Renfei Xia
Yiling Fang
author_sort Yushi Peng
collection DOAJ
description Background Primary hyperoxaluria type 2 (PH2) is a rare disorder caused by GRHPR mutations. Research on the mutation spectrum and pedigree of PH2 helps in comprehending its pathogenesis and clinical outcomes, guiding clinical diagnosis and treatment.Methods We report a case of PH2 with a three-generational pedigree. The GRHPR genotypes of the family members were confirmed by Sanger sequencing. Urine and blood samples were collected for biochemical analysis. Computational analysis was performed to assess the pathogenicity of the mutations. Cellular experiments based on site-directed mutagenesis were conducted to confirm the effect of mutations on GRHPR expression, activity, and subcellular localization.Results The proband underwent her first kidney transplantation in 2015, and experienced recurrent urinary tract infections and urolithiasis postoperatively. Graft failure occurred in 2018. Whole exome sequencing identified compound heterozygous GRHPR mutations p.G160E/p.P203Rfs*7. The patient underwent a second kidney transplantation in 2019 and maintained good graft function with urine dilution measures. Notably, her brother and sister carried the same mutations; however, only the proband progressed to renal failure. Computational analysis suggested that p.G160E reduced the affinity of GRHPR for coenzymes. Cellular experiments indicated that p.G160E reduced GRHPR activity (p < 0.001), whereas p.P203Rfs*7 not only suppressed expression (p < 0.001) and reduced activity (p < 0.001), but also facilitated protein aggregation. Based on our results, the variant p.G160E was classified as ‘pathogenic’ according to ACMG guidelines.Conclusions Our findings suggest that treatment strategies for the long-term prevention of oxalate nephropathy should be developed for patients with PH2 receiving isolated kidney transplantation. Moreover, the pathogenicity of the compound heterozygous GRHPR mutations p.G160E/p.P203Rfs*7 was also validated.
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spelling doaj-art-6ebf6e3dc6e3492f865ddc940e8b9c072025-08-20T02:29:56ZengTaylor & Francis GroupRenal Failure0886-022X1525-60492024-12-0146210.1080/0886022X.2024.2417743Second transplantation after kidney graft loss in primary hyperoxaluria type 2: a pedigree study and mutation analysisYushi Peng0Yingchun Zheng1Fu Xiong2Mingming Zhang3Yuchen Wang4Jia Luo5Wenli Zeng6Jialiang Hui7Wenfeng Deng8Jian Xu9Yun Miao10Renfei Xia11Yiling Fang12Department of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaDepartment of Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, ChinaDepartment of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, ChinaDepartment of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, ChinaDepartment of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaDepartment of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaDepartment of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaDepartment of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaDepartment of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaDepartment of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaDepartment of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaDepartment of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaDepartment of Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaBackground Primary hyperoxaluria type 2 (PH2) is a rare disorder caused by GRHPR mutations. Research on the mutation spectrum and pedigree of PH2 helps in comprehending its pathogenesis and clinical outcomes, guiding clinical diagnosis and treatment.Methods We report a case of PH2 with a three-generational pedigree. The GRHPR genotypes of the family members were confirmed by Sanger sequencing. Urine and blood samples were collected for biochemical analysis. Computational analysis was performed to assess the pathogenicity of the mutations. Cellular experiments based on site-directed mutagenesis were conducted to confirm the effect of mutations on GRHPR expression, activity, and subcellular localization.Results The proband underwent her first kidney transplantation in 2015, and experienced recurrent urinary tract infections and urolithiasis postoperatively. Graft failure occurred in 2018. Whole exome sequencing identified compound heterozygous GRHPR mutations p.G160E/p.P203Rfs*7. The patient underwent a second kidney transplantation in 2019 and maintained good graft function with urine dilution measures. Notably, her brother and sister carried the same mutations; however, only the proband progressed to renal failure. Computational analysis suggested that p.G160E reduced the affinity of GRHPR for coenzymes. Cellular experiments indicated that p.G160E reduced GRHPR activity (p < 0.001), whereas p.P203Rfs*7 not only suppressed expression (p < 0.001) and reduced activity (p < 0.001), but also facilitated protein aggregation. Based on our results, the variant p.G160E was classified as ‘pathogenic’ according to ACMG guidelines.Conclusions Our findings suggest that treatment strategies for the long-term prevention of oxalate nephropathy should be developed for patients with PH2 receiving isolated kidney transplantation. Moreover, the pathogenicity of the compound heterozygous GRHPR mutations p.G160E/p.P203Rfs*7 was also validated.https://www.tandfonline.com/doi/10.1080/0886022X.2024.2417743primary hyperoxaluria type 2GRHPRkidney transplantationpedigreemutationfunctional analysis
spellingShingle Yushi Peng
Yingchun Zheng
Fu Xiong
Mingming Zhang
Yuchen Wang
Jia Luo
Wenli Zeng
Jialiang Hui
Wenfeng Deng
Jian Xu
Yun Miao
Renfei Xia
Yiling Fang
Second transplantation after kidney graft loss in primary hyperoxaluria type 2: a pedigree study and mutation analysis
Renal Failure
primary hyperoxaluria type 2
GRHPR
kidney transplantation
pedigree
mutation
functional analysis
title Second transplantation after kidney graft loss in primary hyperoxaluria type 2: a pedigree study and mutation analysis
title_full Second transplantation after kidney graft loss in primary hyperoxaluria type 2: a pedigree study and mutation analysis
title_fullStr Second transplantation after kidney graft loss in primary hyperoxaluria type 2: a pedigree study and mutation analysis
title_full_unstemmed Second transplantation after kidney graft loss in primary hyperoxaluria type 2: a pedigree study and mutation analysis
title_short Second transplantation after kidney graft loss in primary hyperoxaluria type 2: a pedigree study and mutation analysis
title_sort second transplantation after kidney graft loss in primary hyperoxaluria type 2 a pedigree study and mutation analysis
topic primary hyperoxaluria type 2
GRHPR
kidney transplantation
pedigree
mutation
functional analysis
url https://www.tandfonline.com/doi/10.1080/0886022X.2024.2417743
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