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PREPL, a prolyl endopeptidase-like enzyme by name only?--Lessons from patients.
[cystinuria]
Deletion
of
the
Prolyl
Endopeptidase-like
(
PREPL
)
gene
has
been
described
in
three
contiguous
gene
deletion
syndromes
at
the
2
p
21
locus
and
current
developments
in
high
resolution
microarrays
and
whole
genome
sequencing
will
no
doubt
soon
result
in
the
identification
of
isolated
PREPL
deficiency
.
But
by
comparing
the
differences
in
phenotypes
with
the
number
of
genes
deleted
,
the
contribution
of
PREPL
deficiency
can
already
be
deduced
.
Homozygous
or
compound
heterozygous
loss
of
PREPL
is
predicted
to
cause
neonatal
hypotonia
and
severe
feeding
problems
.
Failure
to
thrive
usually
persists
for
several
years
,
followed
by
a
period
of
hyperphagia
and
excessive
weight
gain
.
Growth
retardation
is
usually
observed
,
which
responds
well
to
growth
hormone
therapy
.
In
addition
,
minor
facial
dysmorphism
,
nasal
speech
,
viscous
saliva
,
hypergonadotropic
hypogonadism
and
learning
problems
are
frequently
observed
.
How
PREPL
deficiency
causes
these
clinical
manifestations
remains
unknown
.
PREPL
is
highly
expressed
in
brain
and
based
on
gene
coexpression
network
architecture
it
has
been
placed
in
a
group
enriched
with
markers
of
neurons
and
synaptic
proteins
.
PREPL
is
predicted
to
be
a
serine
oligopeptidase
based
on
its
homology
with
prolyl
endopeptidase
(
PREP
)
and
the
presence
of
an
active
catalytic
triad
.
However
,
until
now
no
substrates
have
been
found
.
Recent
observations
that
PREP
has
non-catalytic
functions
in
the
cytoplasm
through
interactions
with
its
amino-
terminal
propeller
domain
,
suggests
that
of
PREPL
may
also
have
biological
functions
independent
of
its
predicted
peptidase
activity
.
This
raises
the
possibility
that
PREP
and
PREPL
are
homologous
,
not
just
by
name
but
also
by
nature
.
Diseases
Validation
Diseases presenting
"hypergonadotropic hypogonadism and learning problems"
symptom
cystinuria
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