MYO5BMutations in Patients With Microvillus Inclusion Disease Presenting With Transient Renal Fanconi Syndrome

Microvillus inclusion disease (MVID) is a rare congenital enteropathy associated with brush border atrophy and reduced expression of enzymes at the enterocytes' apical surface. MVID is associated with mutations in the MYO5Bgene, which is expressed in all epithelial tissues. Whether organs other than the intestine are affected in MVID is unclear. We report 2 patients with MVID that developed renal Fanconi syndrome while receiving total parenteral nutrition. Renal Fanconi syndrome has been correlated to apical plasma membrane defects in kidney proximal tubular epithelial cells. The aim of the present study was to determine whether MYO5Bmutations in these patients correlate with similar apical plasma membrane defects in renal tubular epithelial cells as observed in the intestine. Biopsies from kidney, duodenum, ileum, jejunum, and colon of 2 patients with MVID carrying MYO5Bmutations and of age-matched controls were fixed in paraffin and analyzed with immunohistochemistry and transmission electron microscopy. Structural defects of the brush border and apical recycling endosome organization are observed in enterocytes of all of the segments of the small intestine and colon. MYO5Bmutations in patients with MVID with renal Fanconi syndrome do not correlate with aberrant apical plasma membrane morphology or altered apical recycling endosome organization in renal tubular epithelial cells. MYO5Bmutations have divergent effects on the apical membrane system in kidney and intestinal epithelial cells. Epithelial defects presented in MVID are therefore likely triggered by intestine-specific factors, the identification of which may provide new targets and open avenues for the development of alternative therapeutic strategies to combat this devastating disease.