Novel form of rhizomelic skeletal dysplasia associated with a homozygous variant in <i>GNPNAT1</i>.

Abstract

Studies exploring molecular mechanisms underlying congenital skeletal disorders have revealed novel regulators of skeletal homeostasis and shown protein glycosylation to play an important role. To identify the genetic cause of rhizomelic skeletal dysplasia in a consanguineous Pakistani family. Clinical investigations were carried out for four affected individuals in the recruited family. Whole genome sequencing (WGS) was completed using DNA from two affected and two unaffected individuals from the family. Sequencing data were processed, filtered and analysed. In silico analyses were performed to predict the effects of the candidate variant on the protein structure and function. Small interfering RNAs (siRNAs) were used to study the effect of <i>Gnpnat1</i> gene knockdown in primary rat chondrocytes. The patients presented with short stature due to extreme shortening of the proximal segments of the limbs. Radiographs of one individual showed hip dysplasia and severe platyspondyly. WGS data analyses identified a homozygous missense variant c.226G>A; p.(Glu76Lys) in <i>GNPNAT1</i>, segregating with the disease. Glucosamine 6-phosphate N-acetyltransferase, encoded by the highly conserved gene <i>GNPNAT1</i>, is one of the enzymes required for synthesis of uridine diphosphate N-acetylglucosamine, which participates in protein glycosylation. Knockdown of <i>Gnpnat1</i> by siRNAs decreased cellular proliferation and expression of chondrocyte differentiation markers collagen type 2 and alkaline phosphatase, indicating that <i>Gnpnat1</i> is important for growth plate chondrocyte proliferation and differentiation. This study describes a novel severe skeletal dysplasia associated with a biallelic, variant in <i>GNPNAT1</i>. Our data suggest that GNPNAT1 is important for growth plate chondrogenesis.