{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T16:33:00Z","timestamp":1759336380757,"version":"3.40.5"},"reference-count":26,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T00:00:00Z","timestamp":1675900800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J of Med Genetics Pt A"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Prolidase deficiency is an autosomal recessive disease that causes impaired collagen degradation. Altered collagen homeostasis results in the intracellular accumulation of imidodipeptides, which contain proline and hydroxyproline. The many clinical manifestations of prolidase deficiency include dysmorphic facial features, skeletal deformities, hepatosplenomegaly, necrotizing skin ulcers, and recurrent infections. Current clinical knowledge of this genetic disease relies upon few case reports due to its extreme rarity. Diagnosis is dependent on the detection of a pathologic gene variant. Additional diagnostic confirmation may be provided by urine amino acid quantification or reduced in vitro prolidase activity. We present a case of prolidase deficiency caused by a novel variant manifested by skeletal malformations and lifelong multisystemic infections. Genetic testing revealed a homozygous missense variant in the <jats:italic>PEPD<\/jats:italic> gene at nucleotide position 200, whereby adenine was replaced by guanine (c.200A\u2009&gt;\u2009G). The corresponding amino acid change replaced glutamine with arginine at codon 67 (p.Gln67Arg). After boiling the urine sample for hydrolysis, quantitative urine amino acids demonstrated a markedly elevated proline level, confirming the diagnosis. We also provide a discussion of the pathophysiology, clinical manifestations, diagnostic testing, and clinical management of this disease.<\/jats:p>","DOI":"10.1002\/ajmg.a.63137","type":"journal-article","created":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T15:07:01Z","timestamp":1675955221000},"page":"1388-1394","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Prolidase deficiency: A novel <scp><i>PEPD<\/i><\/scp> missense variant in exon 2"],"prefix":"10.1002","volume":"191","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5049-5433","authenticated-orcid":false,"given":"Firas","family":"Ido","sequence":"first","affiliation":[{"name":"Department of Pulmonary and Critical Care St. Luke's University Health Network  Bethlehem Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2416-8054","authenticated-orcid":false,"given":"Steven","family":"Tessier","sequence":"additional","affiliation":[{"name":"Lewis Katz School of Medicine Temple University  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"Yoder","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care St. Luke's University Health Network  Bethlehem Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph","family":"Ramzy","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care St. Luke's University Health Network  Bethlehem Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Santo","family":"Longo","sequence":"additional","affiliation":[{"name":"Department of Pathology St. Luke's University Health Network  Bethlehem Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,2,9]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/1708538117741764"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0058792"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-4838(97)00134-9"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-0960.2008.00485.x"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0021-9258(18)83768-1"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmolb.2021.723003"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/8904_2016_552"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(68)90016-8"},{"key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1007\/BF01810368","article-title":"Biochemical and immunological studies on a family with prolidase deficiency","volume":"6","author":"Gray R. 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