Mutations in GPAA1, Encoding a GPI Transamidase Complex Protein, Cause Developmental Delay, Epilepsy, Cerebellar Atrophy, and Osteopenia

Am J Hum Genet. 2017 Nov 2;101(5):856-865. doi: 10.1016/j.ajhg.2017.09.020.

Abstract

Approximately one in every 200 mammalian proteins is anchored to the cell membrane through a glycosylphosphatidylinositol (GPI) anchor. These proteins play important roles notably in neurological development and function. To date, more than 20 genes have been implicated in the biogenesis of GPI-anchored proteins. GPAA1 (glycosylphosphatidylinositol anchor attachment 1) is an essential component of the transamidase complex along with PIGK, PIGS, PIGT, and PIGU (phosphatidylinositol-glycan biosynthesis classes K, S, T, and U, respectively). This complex orchestrates the attachment of the GPI anchor to the C terminus of precursor proteins in the endoplasmic reticulum. Here, we report bi-allelic mutations in GPAA1 in ten individuals from five families. Using whole-exome sequencing, we identified two frameshift mutations (c.981_993del [p.Gln327Hisfs102] and c.920delG [p.Gly307Alafs11]), one intronic splicing mutation (c.1164+5C>T), and six missense mutations (c.152C>T [p.Ser51Leu], c.160_161delinsAA [p.Ala54Asn], c.527G>C [p.Trp176Ser], c.869T>C [p.Leu290Pro], c.872T>C [p.Leu291Pro], and c.1165G>C [p.Ala389Pro]). Most individuals presented with global developmental delay, hypotonia, early-onset seizures, cerebellar atrophy, and osteopenia. The splicing mutation was found to decrease GPAA1 mRNA. Moreover, flow-cytometry analysis of five available individual samples showed that several GPI-anchored proteins had decreased cell-surface abundance in leukocytes (FLAER, CD16, and CD59) or fibroblasts (CD73 and CD109). Transduction of fibroblasts with a lentivirus encoding the wild-type protein partially rescued the deficiency of GPI-anchored proteins. These findings highlight the role of the transamidase complex in the development and function of the cerebellum and the skeletal system.

Keywords: GPAA1; GPI; alkaline phosphatase; epilepsy; glycosylphosphatidylinositol; osteopenia; seizures.

MeSH terms

  • Acyltransferases / genetics*
  • Adolescent
  • Adult
  • Alleles
  • Atrophy / genetics*
  • Bone Diseases, Metabolic / genetics*
  • Cerebellum / pathology
  • Child
  • Child, Preschool
  • Developmental Disabilities / genetics*
  • Epilepsy / genetics*
  • Exome / genetics
  • Female
  • Fibroblasts / pathology
  • Glycosylphosphatidylinositols / genetics
  • Humans
  • Male
  • Membrane Glycoproteins / genetics*
  • Muscle Hypotonia / genetics
  • Mutation / genetics*
  • Pedigree
  • RNA, Messenger / genetics
  • Seizures / genetics

Substances

  • GPAA1 protein, human
  • Glycosylphosphatidylinositols
  • Membrane Glycoproteins
  • RNA, Messenger
  • Acyltransferases
  • COOH-terminal signal transamidase