The molecular basis of the genetic deficiencies of five of the components of the glucose-6-phosphatase system: improved diagnosis.

The understanding of type 1 glycogen storage diseases (GSDs) has been greatly hindered by a lack of knowledge of the molecular basis of glucose-6-phosphatase (Glc-6-P'ase). The problem has been the complete failure of many laboratories, including our own, to purify to homogeneity a single polypeptide with high levels of Glc-6-P'ase activity. The best preparations to date all contain five or six different polypeptide bands and have specific activities in the range 17-50 mumoles/min per milligram. The two major reasons for failure have been that Glc-6-P'ase is extremely difficult to solubilise from the microsomal membrane (large amounts of detergents are needed) and that it is not a single polypeptide as originally thought, but a multicomponent system. Recent studies of patients with type 1 GSD have proved that Glc-6-P'ase comprises at least five different polypeptides. Four of the proteins have now been purified and three have been cloned. We have assayed the Glc-6-P'ase system in over 600 human biopsy samples and developed microassays to diagnose deficiencies of each of the proteins. Ways of avoiding possible problems which have the potential to lead to the wrong diagnosis will be discussed.