Unmeasurable low vitamin D levels caused by a novel, homozygote loss-of-function variant in the group-specific component gene

Author:

Nygaard Rie Harboe1,Lauritzen Esben Stistrup23ORCID,Sikjær Tanja23,Højskov Carsten Schriver1,Rejnmark Lars2ORCID,Møller Holger Jon14

Affiliation:

1. Department of Clinical Biochemistry, Aarhus University Hospital , 8200 Aarhus , Denmark

2. Department of Endocrinology and Internal Medicine, Aarhus University Hospital , 8200 Aarhus , Denmark

3. Department of Internal Medicine, Horsens Regional Hospital , 8700 Horsens , Denmark

4. Department of Clinical Medicine, Aarhus University , 8200 Aarhus , Denmark

Abstract

Abstract A 29-year-old female, born to consanguineous parents, was found with unmeasurable levels of vitamin D (<10 nmol/L) after routine biochemical screening during her first pregnancy. She did not respond to either oral or intramuscular vitamin D supplementation and was an otherwise healthy young woman, with no signs of rickets, osteomalacia, osteoporosis, or secondary hyperparathyroidism. Western blot analysis revealed total lack of vitamin D binding protein, and next generation sequencing confirmed a novel, pathogenic homozygote loss-of-function mutation in exon 13 of the group-specific component gene, that encodes the poly A tail for vitamin D binding protein. She was therefore diagnosed with hereditary DBP deficiency, and vitamin D supplementation was diminished to life-long regular vitamin D supplementation (25 μg per day). This case is extremely interesting, as it expands our knowledge of vitamin D physiology and supports the free hormone hypothesis, given that the patient was asymptomatic despite no measurable levels of vitamin D.

Publisher

Oxford University Press (OUP)

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