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Suppression of severe achondroplasia with developmental delay and acanthosis nigricans by the p.Thr651Pro mutation.
[achondroplasia]
Severe
achondroplasia
with
developmental
delay
and
acanthosis
nigricans
(
SADDAN
)
is
an
extremely
rare
severe
skeletal
dysplasia
characterized
by
significant
developmental
delay
,
brain
structural
abnormalities
,
hearing
loss
,
and
acanthosis
nigricans
.
The
disorder
is
the
result
of
a
single
missense
mutation
at
codon
650
(
p
.
Lys
650
Met
)
in
the
fibroblast
growth
factor
receptor
3
gene
(
FGFR
3
)
.
We
describe
a
child
who
initially
presented
with
a
mild
achondroplasia
or
hypochondroplasia
like
phenotype
.
Molecular
analysis
of
the
FGFR
3
gene
showed
the
common
SADDAN
mutation
and
a
second
novel
mutation
at
codon
651
(
p
.
Thr
651
Pro
)
.
Both
mutations
were
shown
to
occur
on
the
same
allele
(
cis
)
and
de
novo
.
Transient
transfection
studies
with
FGFR
3
double
mutant
constructs
show
that
the
p
.
Thr
651
P
ro
mutation
causes
a
dramatic
decrease
in
constitutive
receptor
kinase
activity
than
that
observed
by
the
p
.
Lys
650
Met
mutation
.
Our
data
suggest
that
the
molecular
effect
by
the
p
.
Thr
651
P
ro
is
to
elicit
a
conformational
change
that
decreases
the
FGFR
3
tyrosine
kinase
activity
,
which
is
constitutively
activated
by
the
SADDAN
mutation
.
Due
to
the
inheritance
of
both
a
gain-of-function
and
a
loss
-of-function
mutation
,
we
conclude
that
a
reduction
of
constitutive
activation
caused
the
milder
skeletal
phenotype
.
Although
the
occurrence
of
double
mutations
are
expected
to
be
rare
,
the
presence
of
other
FGFR
3
modifiers
may
be
responsible
for
some
of
the
clinically
discrepant
skeletal
dysplasia
cases
.
Diseases
Validation
Diseases presenting
"mild achondroplasia"
symptom
achondroplasia
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