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Molecular epidemiology of erythropoietic protoporphyria in the U.K.
[erythropoietic protoporphyria]
Erythropoietic
protoporphyria
(
EPP
)
is
a
cutaneous
porphyria
caused
by
mutations
in
the
ferrochelatase
(
FECH
)
or
,
less
frequently
,
the
delta-aminolaevulinate
synthase
2
(
ALAS
2
)
gene
.
Predictive
genetic
counselling
requires
accurate
molecular
diagnosis
and
knowledge
of
patterns
of
inheritance
.
To
investigate
the
molecular
epidemiology
of
EPP
in
the
U
.
K
.
DNA
samples
from
191
unrelated
patients
resident
in
the
U
.
K
.
were
analysed
for
mutations
in
the
FECH
and
ALAS
2
genes
and
for
the
FECH
IVS
3
-
48
dimorphism
.
Mutations
were
identified
in
179
(
94
%
)
patients
.
Most
(
169
;
94
%
)
had
a
FECH
mutation
on
one
allele
and
were
classified
as
having
pseudodominant
EPP
(
psdEPP
)
;
seven
(
4
%
)
patients
had
FECH
mutations
on
both
alleles
(
autosomal
recessive
EPP
)
and
three
(
2
%
)
patients
had
ALAS
2
mutations
(
X-
linked
dominant
protoporphyria
)
.
The
FECH
IVS
3
-
48
C
allele
was
strongly
associated
with
psdEPP
and
with
the
absence
of
mutations
at
the
FECH
or
ALAS
2
loci
.
Fifty
-
six
FECH
mutations
were
identified
,
19
being
previously
unreported
.
Missense
mutations
were
predominant
in
autosomal
recessive
EPP
(
82
%
)
but
not
in
psdEPP
(
32
%
)
.
One
mutation
(
c
.
314
+
2
T
>
G
)
was
present
in
41
(
24
%
)
of
EPP
families
,
most
of
whom
appeared
to
be
descended
from
a
common
ancestor
resident
in
the
north
of
England
.
These
data
define
the
prevalence
and
molecular
epidemiology
of
each
type
of
EPP
in
the
U
.
K
.
Diseases
Validation
Diseases presenting
"alas2 mutations"
symptom
erythropoietic protoporphyria
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