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Blood, 15 February 2001, Vol. 97, No. 4, pp. 1106-1114
RED CELLS
Seven new mutations in the nicotinamide adenine
dinucleotide reduced-cytochrome b5 reductase
gene leading to methemoglobinemia type I
Jan Dekker,
Michel H. M. Eppink,
Rob van Zwieten,
Thea de Rijk,
Angel F. Remacha,
Lap Kay Law,
Albert M. Li,
Kam Lau Cheung,
Willem J. H. van Berkel, and
Dirk Roos
From the Central Laboratory of the Netherlands Blood
Transfusion Service (CLB), and Laboratory for Experimental and Clinical
Immunology, Academic Medical Center, University of Amsterdam,
Amsterdam, and Department of Biomolecular Sciences, Laboratory of
Biochemistry, Wageningen University, Wageningen, The Netherlands;
Hospital de la Santa Creu I Sant Pau, Barcelona, Spain; Departments of
Chemical Pathology and Paediatrics, Prince of Wales Hospital, Shatin,
NT, Hong Kong.
Cytochrome b5 reductase (b5R) deficiency
manifests itself in 2 distinct ways. In methemoglobinemia type I, the
patients only suffer from cyanosis, whereas in type II, the patients
suffer in addition from severe mental retardation and neurologic
impairment. Biochemical data indicate that this may be due to a
difference in mutations, causing enzyme instability in type I and
complete enzyme deficiency or enzyme inactivation in type II. We have
investigated 7 families with methemoglobulinemia type I and found 7 novel mutations in the b5R gene. Six of these mutations
predicted amino acid substitutions at sites not involved in reduced
nicotinamide adenine dinucleotide (NADH) or flavin adenine dinucleotide
(FAD) binding, as deduced from a 3-dimensional model of human b5R. This
model was constructed from comparison with the known 3-dimensional
structure of pig b5R. The seventh mutation was a splice site mutation
leading to skipping of exon 5 in messenger RNA, present in heterozygous
form in a patient together with a missense mutation on the other
allele. Eight other amino acid substitutions, previously described to cause methemoglobinemia type I, were also situated in
nonessential regions of the enzyme. In contrast, 2 other substitutions,
known to cause the type II form of the disease, were found to directly affect the consensus FAD-binding site or indirectly influence NADH
binding. Thus, these data support the idea that enzyme inactivation is
a cause of the type II disease, whereas enzyme instability may lead to
the type I form.

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