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Thiamine transporter mutation: an example of monogenic diabetes mellitus

¹ Departments of Medicine and ² Genetics, King Faisal Specialist Hospital and Research Center, MBC 46, PO Box 3354, Riyadh 11211, Saudi Arabia

(Correspondence should be addressed to A S Alzahrani; Email: aliz{at}kfshrc.edu.sa)

Abstract

Objective: Thiamine-responsive megaloblastic anemia (TRMA) is a rare syndrome characterized by diabetes mellitus (DM), anemia, and sensorineural deafness. We describe the clinical course and the molecular defect of a young woman who was diagnosed to have this syndrome.

Case: The patient is an 18-year-old girl whowas born to non-consanguous parents. She was noted to be deaf-mute in the first year of life. She was diagnosed with DM at the age of 9 months and with severe anemia at the age of 2 years. An extensive work up could not identify the cause. She was treated with blood transfusions every 3–4 weeks for the past 16 years. A diagnosis of TRMAwas suspected and the patient was treated with thiamine hydrochloride. Hemoglobin and platelets increased to normal values after a few weeks of thiamine therapy. Diabetic control significantly improved but she had no noticeable changes in the deafness.

Methods: Peripheral blood DNAwas extracted from the patient, her mother, aunt, and a healthy sister. Exons and exon–intron boundaries of the thiamine transporter gene SLC19A2 were PCR amplified and directly sequenced.

Results: A G515C homozygous mutation was identified in the SLC19A2 gene of the patient. This mutation changes Gly to Arg at codon 172 (G172R). The mother, an aunt, and a sister had a heterozygous G172R mutation.

Conclusions: Mutations in thiamine transporter gene, SLC19A2, causes a rare form of monogenic diabetes, anemia, and sensorineural deafness. Thiamine induces a remarkable hematological response and improvement in the diabetic control but has no effect on deafness.