A Novel Missense Mutation in the Second Extracellular Domain of GJB2, p.Ser183Phe, Causes a Syndrome of Focal Palmoplantar Keratoderma with Deafness 

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A Novel Missense Mutation in the Second Extracellular Domain of GJB2, p.Ser183Phe, Causes a Syndrome of Focal Palmoplantar Keratoderma with Deafness  Eugene A. de Zwart-Storm, Michel van Geel, Pierre A.F.A. van Neer, Peter M. Steijlen, Patricia E. Martin, Maurice A.M. van Steensel  The American Journal of Pathology  Volume 173, Issue 4, Pages 1113-1119 (October 2008) DOI: 10.2353/ajpath.2008.080049 Copyright © 2008 American Society for Investigative Pathology Terms and Conditions

Figure 1 Presence of the mutation within the index family. A: Pedigree of the family, with the filled symbols representing the affected members and the proband indicated by an arrow. B: Restriction analysis with NciI; mutation present in the mother and daughter (lanes 1 and 3, respectively; 535, 440, 318, and 122 bp), not in the father or a son (lanes 2 and 4, respectively; 535, 318, and 122 bp). The American Journal of Pathology 2008 173, 1113-1119DOI: (10.2353/ajpath.2008.080049) Copyright © 2008 American Society for Investigative Pathology Terms and Conditions

Figure 2 Clinical phenotype of the index patient. A: Diffuse, flat, hyperkeratotic translucent plaques were present on the palms, in particular on the border of the thenar and wrist. B: Close-up view of the mild palmar hyperkeratosis. C: Hyperkeratotic plaques were seen in areas exposed to mechanical stress, such as heels, balls of feet, knuckles, and wrists, sometimes in the form of knuckle pads. D: Hyperkeratotic plaques (knuckle pads) on the toes. E: Mild diffuse plantar hyperkeratosis. F: Close-up of the plantar surface, where areas with hyperkeratosis are clearly visible. Note that the plaques seem to actually be formed by confluence of smaller hyperkeratotic papules. The American Journal of Pathology 2008 173, 1113-1119DOI: (10.2353/ajpath.2008.080049) Copyright © 2008 American Society for Investigative Pathology Terms and Conditions

Figure 3 Pronounced sensory hearing loss, in particular for higher frequencies (vertical: decibels; horizontal: the frequency in KHz). Air conduction: cross/round marks; bone conduction: triangles, arrows pointing downwards indicate the loudest tone was not heard). The curves of a normal-hearing person are almost horizontal at ∼10 to 15 decibels. The American Journal of Pathology 2008 173, 1113-1119DOI: (10.2353/ajpath.2008.080049) Copyright © 2008 American Society for Investigative Pathology Terms and Conditions

Figure 4 GJB2 sequence chromatograms of an unaffected family member (Wt) and a patient (Mt) at the mutated location (arrow). The American Journal of Pathology 2008 173, 1113-1119DOI: (10.2353/ajpath.2008.080049) Copyright © 2008 American Society for Investigative Pathology Terms and Conditions

Figure 5 Results of GJB2/EGFP fusion protein (green: Cx26wt/mt, red: stably expressed Cx26wt) detection in HeLa Ohio cells. A: Gap junction plaque formation by wild-type GJB2/EGFP fusion protein (arrows). B: Some gap junction plaque formation is visible with p.Ser183Phe-GJB2/EGFP mutant fusion protein (arrows), but most of the protein accumulates in the cytoplasm and endoplasmic reticulum. C: Co-localization of stably expressed Cx26wt (red) and transfected Cx26wt (green) at the membrane and in intercellular gap junction plaques (merge = yellow, arrow gap junction plague). D: There is no rescue of the mutant protein with Cx26wt; its primarily cytoplasmatic distribution is suggestive for ER localization. Note that most of the wild-type protein co-localizes with the mutant, suggesting a dominant-negative effect on transport of the latter (arrows, gap junction plaques). The American Journal of Pathology 2008 173, 1113-1119DOI: (10.2353/ajpath.2008.080049) Copyright © 2008 American Society for Investigative Pathology Terms and Conditions

Figure 6 HeLa Ohio cells (marked with an asterisk) transfected with GJB2/EGFP, p.Ser183Phe-GJB2/EGFP, or untransfected, loaded with CM-DiI (red) and calcein (MW622 Da, charge −4) parachuted onto a monolayer of HeLa Ohio cells stably expressing Cx26wt. A: HeLa Ohio cells transfected with GJB2/EGFP show transfer of calcein to a monolayer of HeLa Ohio cells stably expressing Cx26wt. B: HeLa Ohio cells transfected with p.Ser183Phe-GJB2/EGFP show transfer of calcein to a monolayer of HeLa Ohio cells stably expressing Cx26wt. C: HeLa Ohio cells, untransfected, show no transfer of calcein to a monolayer of HeLa Ohio cells stably expressing Cx26wt. The American Journal of Pathology 2008 173, 1113-1119DOI: (10.2353/ajpath.2008.080049) Copyright © 2008 American Society for Investigative Pathology Terms and Conditions

Figure 7 Conservation throughout species and within connexins of E2 domain sequence. No Cx preface is Homo sapiens. Abbreviations: Mmul, Macaca mulatta; Bt, Bos taurus; Cf, Canis familiaris; Ec, Equus caballus; Mm, Mus musculus; Md, Monodelphis domestica; Oa, Ornithorhynchus anatinus; Gg, Gallus gallus; Xl, Xenopus laevis. The American Journal of Pathology 2008 173, 1113-1119DOI: (10.2353/ajpath.2008.080049) Copyright © 2008 American Society for Investigative Pathology Terms and Conditions