Ribose-5-phosphate isomerase deficiency is a human disorder caused by mutations in

ribose-5-phosphate isomerase Ribose-5-phosphate isomerase (Rpi) encoded by the RPIA gene is an enzyme () that catalyzes the conversion between ribose-5-phosphate (R5P) and ribulose-5-phosphate (Ru5P). It is a member of a larger class of isomerases which catalyze the interco ...

, an

enzyme Enzymes () are proteins that act as biological catalysts by accelerating chemical reactions. The molecules upon which enzymes may act are called substrate (chemistry), substrates, and the enzyme converts the substrates into different molecule ...

of the

pentose phosphate pathway The pentose phosphate pathway (also called the phosphogluconate pathway and the hexose monophosphate shunt and the HMP Shunt) is a metabolic pathway parallel to glycolysis. It generates NADPH and pentoses (5-carbon sugars) as well as ribose 5-p ...

. With only four diagnosed patients over a 27-year period, RPI deficiency is the second rarest disease known as of now, being beaten only by

Fields Condition Fields may refer to: Music *Fields (band), an indie rock band formed in 2006 *Fields (progressive rock band), a progressive rock band formed in 1971 * ''Fields'' (album), an LP by Swedish-based indie rock band Junip (2010) * "Fields", a song by ...

affecting three individuals, Catherine and Kirstie Fields, and one unknown person.

Mechanism

In the search for an explanation for this rarity, it has been found that the patient has a seldom-seen

allelic An allele (, ; ; modern formation from Greek ἄλλος ''állos'', "other") is a variation of the same sequence of nucleotides at the same place on a long DNA molecule, as described in leading textbooks on genetics and evolution. ::"The chrom ...

combination. One allele is a non-functional

null allele A null allele is a nonfunctional allele (a variant of a gene) caused by a genetic mutation. Such mutations can cause a complete lack of production of the associated gene product or a product that does not function properly; in either case, the alle ...

, while the other encodes for a partially active enzyme. Furthermore, the partially functional allele has

expression Expression may refer to: Linguistics * Expression (linguistics), a word, phrase, or sentence * Fixed expression, a form of words with a specific meaning * Idiom, a type of fixed expression * Metaphorical expression, a particular word, phrase, ...

deficits that depend on the

cell type A cell type is a classification used to identify cells that share morphological or phenotypical features. A multicellular organism may contain cells of a number of widely differing and specialized cell types, such as muscle cells and skin cells ...

in which it is expressed. Therefore, some of the patient's cells have a considerable amount of RPI activity, whereas others do not. The molecular cause of the pathology is not fully understood. One hypothesis is that

ribose-5-phosphate Ribose 5-phosphate (R5P) is both a product and an intermediate of the pentose phosphate pathway. The last step of the oxidative reactions in the pentose phosphate pathway is the production of ribulose 5-phosphate. Depending on the body's state, ...

may be insufficient for

RNA synthesis Transcription is the process of copying a segment of DNA into RNA. The segments of DNA transcribed into RNA molecules that can encode proteins are said to produce messenger RNA (mRNA). Other segments of DNA are copied into RNA molecules calle ...

. Another possibility is that the accumulation of D-

ribitol Ribitol, or adonitol, is a crystalline pentose alcohol (C5H12O5) formed by the reduction of ribose. It occurs naturally in the plant ''Adonis vernalis'' as well as in the cell walls of some Gram-positive bacteria, in the form of ribitol phosphate ...

and D-

arabitol Arabitol, or arabinitol, is a sugar alcohol. It can be formed by the reduction of either arabinose or lyxose. Some organic acid tests check for the presence of D-arabitol, which may indicate overgrowth of intestinal microbes such as ''Candida al ...

may be toxic.

Diagnosis

Symptoms include

optic atrophy Optic neuropathy is damage to the optic nerve from any cause. The optic nerve is a bundle of millions of fibers in the retina that sends visual signals to the brain. Damage and death of these nerve cells, or neurons, leads to characteristic featu ...

nystagmus Nystagmus is a condition of involuntary (or voluntary, in some cases) eye movement. Infants can be born with it but more commonly acquire it in infancy or later in life. In many cases it may result in reduced or limited vision. Due to the invol ...

cerebellar ataxia Cerebellar ataxia is a form of ataxia originating in the cerebellum. Non-progressive congenital ataxia (NPCA) is a classical presentation of cerebral ataxias. Cerebellar ataxia can occur as a result of many diseases and may present with symptoms ...

seizures An epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with los ...

spasticity Spasticity () is a feature of altered skeletal muscle performance with a combination of paralysis, increased tendon reflex activity, and hypertonia. It is also colloquially referred to as an unusual "tightness", stiffness, or "pull" of muscles ...

psychomotor retardation Psychomotor may refer to: * Psychomotor learning, the relationship between cognitive functions and physical movement * Psychomotor retardation Psychomotor may refer to: * Psychomotor learning, the relationship between cognitive functions and phys ...

leukoencephalopathy Leukoencephalopathy (leukodystrophy-like diseases) is a term that describes all of the brain white matter diseases, whether their molecular cause is known or unknown. It can refer specifically to any of these diseases: *Progressive multifocal leuko ...

and global

developmental delay Global developmental delay is an umbrella term used when children are significantly delayed in their cognitive and physical development. It can be diagnosed when a child is delayed in one or more milestones, categorised into motor skills, speech, ...

Treatment

There is no current treatment or prognosis for ribose-5-phosphate isomerase deficiency.

History

The first patient was a male born in 1984 to healthy, unrelated parents. Early in life, the patient had psychomotor retardation and developed epilepsy at age four. From age seven, a slow neurological regression occurred with prominent cerebellar ataxis, some spasticity, optic atrophy, and a mild sensorimotor neuropathy with no observed organomegaly dysfunction of internal organs. MRI scans at age 11 and 14 revealed extensive abnormalities of the cerebral white matter elevated levels of the ribitol and D-arabitol. In 1999 van der Knaap and colleagues reviewed this case of the then 14-year-old boy and characterised the associated symptoms of RPI deficiency as the following: developmental delay, insidious psychomotor regression, epilepsy, leukoencephalopathy and abnormal polyol metabolism. Later, Naik and colleagues reported a second case, an 18-year-old man with seizures, psychomotor regression and diffuse white matter abnormality. A third case was reported in 2018 by Sklower Brooks and colleagues, a child with neonatal onset leukoencephalopathy and psychomotor delays. A fourth case was reported in 2019 by Kaur and colleagues with progressive leukoencephalopathy and elevated urine polyols arabitol and ribitol.

References

External links

{{Medical resources , OMIM = 608611 , Orphanet = 440706 , MeshID = C563212 Rare diseases