Biochemical and clinical characterization of prealbumin CHICAGO: An apparently benign variant of serum prealbumin (transthyretin) discovered with high‐resolution two‐dimensional electrophoresis

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Abstract
We report identification, biochemical, clinical, and genetic studies of an apparently benign, electrophoretic variant of serum prealbumin (PALB, transthyretin, TTR) in a North American kindred of Swedish ancestry. The variant polypeptide stems from a C to T point mutation in exon 4 which results in methionine instead of threonine at position 119 of the mature molecule. It was discovered incidentally in a girl with classic alpha‐1‐antitrypsin (A1AT) deficiency and her father during diagnostic A1AT phenotyping by ISO‐DALT high‐resolution two‐dimensional electrophoresis (2DE). Twelve relatives in the four‐generation paternal kindred, including five individuals who were heterozygous for the variant prealbumin, were studied. In each of these five heterozygotes, the variant allele product was equimolar and isoelectric with the normal protein, yet migrated with an apparently lower mass in the SDS‐PAGE dimension. The inheritance pattern was consistent with autosomal dominant transmission. Histories and physical examinations showed no evidence of amyloidosis, as has been observed with other variants of prealbumin. Mean values of serum prealbumin and retinol binding protein levels were higher in the carriers as compared to the normal relatives in the family, but the difference was not statistically significant. Thyroid hormone levels and distribution of thyroxine and triiodothyronine among binding proteins in serum were within reference limits. Four members of the lineage had dominant, scalp‐restricted keratinaceous cysts, yet only three of these four individuals had the variant. We counseled the family that this is likely a benign variant with regard to amyloidosis‐related morbidity or shortened life span, although senile effects cannot be entirely ruled out. The provisional designation assigned to this allele is PALBCHICAGO. The substitution of methionine at position 119, as predicted by the DNA sequence, was confirmed by amino acid sequencing of CNBr and tryptic peptides. This substitution occurs at a CpG dinucleotide that may be a point mutational “hot spot,” as has been postulated for the methionine‐30 and isoleucine‐122 PALB variants. The apparently lower mass of the variant probably results from a more compact conformation in SDS. With the exception of histidine‐58, a charge substitution, all other amyloidosis‐related prealbumin variant polypeptides had normal mobility in the ISODALT 2DE system.