A young girl presented with severe type 111 osteogenesis imperfecta; her otherwise healthy mother also had a mild connective tissue disorder with blue sclerae and recurrent joint dislocations. Skin fibroblast cultures from the child produced both normal and post-translationally overmodified type I collagen.
The mutant collagen was poorly secreted but had normal thermal stability. Cyanogen bromide peptide maps of the abnormal protein indicated a C-terminal mutation. The mother's cells produced only normal-appearing collagens.Mismatch analysis and extensive sequencing of cDNAs covering the suspect region did not reveal any potentially causal changes in the triple helical domains of either the al(1) or a2( I) chains. However, examination of the C-propeptide sequences revealed two heterozygous single base changes in the child. One, an A -C changing threonine to proline at residue 29 of the &!(I)
C-propeptide was also present in the mother and maternal grandfather but not in 50 unrelated control individuals. The second, a T -C altered the last amino acid residue of the al(1) C-propeptide from leucine to proline and had occurred de novo in the affected child. This mutation highlights the importance of the C-propeptides in molecular assembly but it is not clear how such an extreme mutation causes the delay in triple helix formation indicated by the extensive overmodification and reduced secretion of the mutant type I collagen. It may inhibit intrachain disulfide bonding or possibly affect the association of the procollagen chain with an intracellular "chaperone" protein that normally assists the assembly of trimeric procollagen molecules.