Rare Childhood Bone Disorder Linked To Gene Deletion In Two Navajo Patients

The research team found that both patients are completely missing the gene for a recently discovered protein called osteoprotegerin, known to protect bone. The study is the first to identify a genetic cause for JPD and is published in the July 18 issue of the New England Journal of Medicine.

"By identifying this genetic defect in two people, our results not only provide insight into the cause of JPD, but also shed light on the control of bone metabolism in general," says lead investigator Michael P. Whyte, M.D., professor of medicine, genetics, and pediatrics at the School of Medicine and director of the Center for Metabolic Bone Disease and Molecular Research at Shriners Hospitals for Children. "Understanding how the skeleton forms and breaks down is key to developing ways to diagnose and treat bone disorders in children and adults, including adult Paget's disease and osteoporosis."

JPD, also known as hereditary hyperphosphatasia or hyperostosis corticalis deformans juvenilis, has only been reported in about 40 people worldwide. It is a painful skeletal disease characterized by abnormally fast formation and breakdown of bone throughout the body, resulting in debilitating fractures and deformities beginning soon after birth. These features are similar to the much more common adult disease called Paget's disease of bone, the second most prevalent metabolic bone disorder after osteoporosis. However, JPD appears to affect all bones in the body, whereas Paget's disease of bone involves only a select few.

The Washington University and Shriners team examined DNA samples from two Native Americans. The first was referred to St. Louis from New Mexico in 1996 for confirmation of diagnosis and treatment at one year of age. The team later learned that a second JPD patient, described in the medical literature in 1979, also was living in New Mexico. The second patient contacted the investigators and voluntarily sent her blood samples for genetic study.

The team first evaluated the gene for RANK in these two patients. In a previous collaborative study, they had identified a RANK defect as the cause of three other rare but somewhat similar genetic bone disorders also characterized by accelerated bone metabolism. The two Navajo patients, however, had normal RANK genes.

The researchers next tested the gene that makes osteoprotegerin, a protein discovered only a few years ago. Osteoprotegerin is related functionally to RANK and recent studies have found that mice lacking the protein have a condition where bone formation and breakdown is rapid, seemingly similar to osteoporosis.

The results were surprising. Neither patient had any trace of the gene for osteoprotegerin.