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Garrod's fourth inborn error of metabolism solved by the identification of mutations causing pentosuria.
[cystinuria]
Pentosuria
is
one
of
four
conditions
hypothesized
by
Archibald
Garrod
in
1908
to
be
inborn
errors
of
metabolism
.
Mutations
responsible
for
the
other
three
conditions
(
albinism
,
alkaptonuria
,
and
cystinuria
)
have
been
identified
,
but
the
mutations
responsible
for
pentosuria
remained
unknown
.
Pentosuria
,
which
affects
almost
exclusively
individuals
of
Ashkenazi
Jewish
ancestry
,
is
characterized
by
high
levels
of
the
pentose
sugar
L-
xylulose
in
blood
and
urine
and
deficiency
of
the
enzyme
L-
xylulose
reductase
.
The
condition
is
autosomal-recessive
and
completely
clinically
benign
,
but
in
the
early
and
mid-
20
th
century
attracted
attention
because
it
was
often
confused
with
diabetes
mellitus
and
inappropriately
treated
with
insulin
.
Persons
with
pentosuria
were
identified
from
records
of
Margaret
Lasker
,
who
studied
the
condition
in
the
1930
s
to
1960
s
.
In
the
DCXR
gene
encoding
L-
xylulose
reductase
,
we
identified
two
mutations
,
DCXR
c
.
583
ΔC
and
DCXR
c
.
52
(
+
1
)
G
>
A
,
each
predicted
to
lead
to
loss
of
enzyme
activity
.
Of
nine
unrelated
living
pentosuric
subjects
,
six
were
homozygous
for
DCXR
c
.
583
ΔC
,
one
was
homozygous
for
DCXR
c
.
52
(
+
1
)
G
>
A
,
and
two
were
compound
heterozygous
for
the
two
mutant
alleles
.
L-
xylulose
reductase
was
not
detectable
in
protein
lysates
from
subjects
'
cells
and
high
levels
of
xylulose
were
detected
in
their
sera
,
confirming
the
relationship
between
the
DCXR
genotypes
and
the
pentosuric
phenotype
.
The
combined
frequency
of
the
two
mutant
DCXR
alleles
in
1
,
067
Ashkenazi
Jewish
controls
was
0
.
0173
,
suggesting
a
pentosuria
frequency
of
approximately
one
in
3
,
300
in
this
population
.
Haplotype
analysis
indicated
that
the
DCXR
c
.
52
(
+
1
)
G
>
A
mutation
arose
more
recently
than
the
DCXR
c
.
583
ΔC
mutation
.
Diseases
Validation
Diseases presenting
"that the dcxr c"
symptom
cystinuria
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