Abstract

BackgroundAtypical iron overload without variation in the five clinically associated hereditary hemochromatosis genes is now recognized; however, their etiology remains unknown. Since the identification of iron overload in the bone morphogenetic protein 6 (Bmp6) knockout mouse, the search has been on for clinically pathogenic variants in the BMP6 gene. A recent report proposes that variants in the pro-peptide region of BMP6 are the underlying cause of several cases of iron overload. We performed targeted next-generation sequencing on three cases of atypical iron overload with Asian ethnicity and identified a p.Q118dup (aka p.E112indelEQ, p.Q115dup, p.Q118_L119insQ) variant in BMP6. The purpose of this study was to characterize the molecular function of the identified BMP6 variant. Molecular characterization by immunofluorescence microscopy and Western blotting of transfected cells, bioinformatics, and population analyses was performed.ResultsIn contrast to reports for other BMP6 pro-peptide variants in this region, our data indicates that this variant does not affect the function of the mature BMP6 protein.ConclusionsOur data suggest that assignment of disease causation in clinical cases of iron overload to pro-peptide variants in BMP6 should thus be treated with caution and requires biological characterization.

Highlights

  • Atypical iron overload without variation in the five clinically associated hereditary hemochromatosis genes is recognized; their etiology remains unknown

  • McDonald et al Human Genomics (2018) 12:23 between 1261 and 1675 μg/L, with transferrin saturation (TS) 40 to 53%. His alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT) levels all remained normal during this time

  • Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), and GGT were all normal ultrasound revealed a diffusely echogenic liver suggesting fatty liver

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Summary

Introduction

Atypical iron overload without variation in the five clinically associated hereditary hemochromatosis genes is recognized; their etiology remains unknown. A recent report proposes that variants in the pro-peptide region of BMP6 are the underlying cause of several cases of iron overload. We performed targeted next-generation sequencing on three cases of atypical iron overload with Asian ethnicity and identified a p.Q118dup (aka p.E112indelEQ, p.Q115dup, p.Q118_L119insQ) variant in BMP6. A recent report associated heterozygosity for three variants p.P95S, p.L96P, and p.Q113E in the BMP6 pro-peptide region with nine clinical cases of unexplained atypical iron overload [9]. We report on three clinical cases of unexplained atypical iron overload carrying an amino acid insertion within the same region of the BMP6 pro-peptide

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