AN OSTEOPENIC NONFRACTURE SYNDROME WITH FEATURES OF MILD OSTEOGENESIS IMPERFECTA ASSOCIATED WITH THE SUBSTITUTION OF A CYSTEINE FOR GLYCINE AT TRIPLE HELIX POSITION-43 IN THE PRO-ALPHA-1(I) CHAIN OF TYPE-I COLLAGEN

Mutations affecting the pro-alpha-1(I) or pro-alpha-2(I) collagen genes have been identified in each of the major clinical types of osteogenesis imperfecta. This study reports the presence of a heritable connective tissue disorder in a family with an osteopenic syndrome which has features of mild osteogenesis imperfecta but was considered idiopathic osteoporosis in the proband. At age 38, while still premenopausal, she was found to have osteopenia, short stature, hypermobile joints, mild hyperelastic skin, mild scoliosis, and blue sclerae. There was no history of vertebral or appendicular fracture. Hip and vertebral bone mineral density measurements were consistent with marked fracture risk. Delayed reduction SDS-PAGE of pepsin-digested collagens from dermal fibroblast cultures demonstrated an anomalous band migrating between alpha-1(I) and alpha-1(III). This band merged with the normal alpha-chains upon prereduction, indicating an unexpected cysteine residue. Cyanogen bromide peptide mapping suggested that the mutation was in the smaller NH2-terminal peptides. cDNA was reverse transcribed from mRNA and amplified by the polymerase chain reaction. A basepair mismatch between proband and control alpha-1(I) cDNA hybrids was detected by chemical cleavage with hydroxylamine:piperidine. The cysteine substitution was thus localized to alpha-1(I) exon 9 within the cyanogen bromide 4 peptide. Nucleotide sequence analysis localized a G --> T point mutation in the first position of helical codon 43, replacing the expected glycine (GGT) residue with a cysteine (TGT). The prevalence of similar NH2-terminal mutations in subjects with this phenotype which clinically overlaps idiopathic osteoporosis remains to be determined.