Clinical and animal research findings in pycnodysostosis and gene mutations of cathepsin K from 1996 to 2011

Abstract

Cathepsin K (CTSK) is a member of the papain-like cysteine protease family. Mutations in the CTSK gene cause a rare autosomal recessive bone disorder called pycnodysostosis (OMIM 265800). In order to follow the advances in the research about CTSK and pycnodysostosis, we performed a literature retrospective study of 159 pycnodysostosis patients reported since 1996 and focused on the genetic characteristics of CTSK mutations and/or the clinical phenotypes of pycnodysostosis. Thirty three different CTSK mutations have been found in 59 unrelated pycnodysostosis families. Of the 59 families, 37.29% are from Europe and 30.51% are from Asia. A total of 69.70% of the mutations were identified in the mature domain of CTSK, 24.24% in the proregion, and 6.06% in the preregion. The hot mutation spots are found in exons 6 and 7. CTSK mutations result in total loss or inactivity of the CTSK protein, which causes abnormal degradation of bone matrix proteins such as type I collagen. Skeletal abnormalities, including short stature, an increase in bone density with pathologic fractures, and open fontanels and sutures, are the typical phenotypes of pycnodysostosis. Research on Ctsk(-/-) mouse models was also reviewed here to elucidate the biological function of Ctsk and the mechanism of pycnodysostosis. New evidence suggests that Ctsk plays an important role in the immune system and may serve as a valid therapeutic target in the future treatment of pycnodysostosis.

Figure 1

Reported mutations of CTSK. (A) Distribution of the CTSK gene and polypeptide mutations. The genomic structure of the CTSK gene with 8 exons (purple boxes numbered 1-8) is shown in the top half. The bottom half illustrates the schematic representation of the polypeptide comprising a 15-amino acid preregion (yellow box), a 99-residue proregion (light blue boxes), and a 215-amino acid mature domain (orange boxes). A total of 23 missense mutations (black type) are represented at the top of the gene diagram, while frame-shift mutations (red type), nonsense mutations (light green type), splicing mutations (blue type), and termination codon mutations (yellow type) are at the bottom. (B) Frequency of different mutations. The height of each bar represents the number of afflicted families. #: Both mutations in the Glu70 residue. ##: Both mutations in the Ala277 residue. (C) The type of reported CTSK mutations. The mutations reported in pycnodysostosis patients consist of 23 missense mutations, 4 frame-shift mutations, 3 nonsense mutations, 2 splicing mutations, and 1 termination codon mutation. (D) Distribution of reported CTSK mutations. A total of 69.70% of the mutations occurred in the mature domain, 24.24% in the proregion, and 6.06% in the preregion.