A hallmark of Griscelli syndrome is hair hypopigmentation characterized by a silver-gray sheen and the presence of large clusters of pigment unevenly distributed in the hair shaft. Either a primary neurological impairment or immune abnormalities are associated with this GS phenotype. They result from two different gene defects underlying GS1 and GS2, respectively (
2,
3). Mutations in the gene that encodes the molecular motor protein MyoVa cause GS1 and the
dilute mutant phenotype in mice, whereas mutations in the gene that encodes Rab27a are responsible for GS2 and the
ashen mouse model. We show herein that, in addition to these two previously described GS forms, a third genetically defined GS form (GS3) results from mutation in
MLPH. Phenotypic expression of GS3 is restricted to the characteristic hypopigmentation of this syndrome and appears to be the human counterpart to the
leaden mutant in mice (
14).
GS3-associated albinism was found to be indistinguishable from that described in GS. Absence of linkage of this phenotype to the GS1-2 locus and its compatibility with the human chromosome region synthenic to the
leaden locus designated
MLPH as a potential candidate gene. The missense mutation, identified in PA’s
MLPH gene, clearly affects the function of the corresponding encoding protein. The Mlph mutant protein is indeed unable to associate with Rab27a, either transiently overexpressed or endogenously expressed in melanocytes. The absolute requirement of an arginine residue at position 35 of the Mlph protein was also demonstrated by the complete failure to restore Mlph-Rab27a association when several residues, with molecular characteristics similar to those of arginine, were introduced at the same position. Mutation identified in this first GS3 case thus points to a critical residue of Mlph involved in direct interaction with Rab27a. In the absence of the tripartite protein complex (Rab27a-Mlph-MyoVa) formation in melanocytes (Figure ), melanosomes cannot be connected to the actin network and thus transported toward the melanocyte tips. A previous in vitro study has shown that MyoVa interacts with Mlph through its F-exon (
15). The study performed with cells from PB shows that this molecular interaction also operates in vivo in humans and is essential for melanosome transport. In contrast, the short F-exon–negative isoform of
MYO5A appears sufficient to allow normal neurological development and function, since, unlike in previous patients identified with null mutation of
MYO5A, deletion of the F-exon in PB did not result in any neurological manifestations. A previous study in mutant mice in which
Myo5a mutations failed to incorporate the F-exon led to similar conclusions (
29).
Three genetic forms of GS have thus been identified. They result from mutations in
MYO5A,
RAB27A, and
MLPH, respectively. The different phenotypes observed in each GS form are in accordance with the functions and tissue expression of the respective proteins (Figure ): (a) The common pigmentary defect observed in GS1, GS2, and GS3 results from the absolute requirement and interaction of the three encoded proteins for melanosome transport, through the SHD of Mlph and the F-exon of MyoVa. (b) Normal neurological development and functions require the presence of MyoVa, at least in its short F-exon–spliced isoform. Absence of MyoVa accounts for the primary severe neurological impairment observed in GS1. (c) The defective cytotoxic activity that characterized the GS2 phenotype results from the crucial role of Rab27a in the exocytosis of cytotoxic granules in T and NK lymphocytes (
3), while MyoVa and Mlph are not expressed in cytotoxic cells (
17). The severe and early immune dysregulation known as HS, which invariably leads to death in GS2 patients, most likely results from this defective cytotoxic activity. We indeed previously demonstrated that perforin mutations, which also impair this cytotoxic pathway, lead to the occurrence of an identical HS in patients with familial hemophagocytic lymphohistiocytosis (
7). It is interesting to note that the same genetic defect in
ashen mice is not associated with such severe immune manifestations. Although
ashen mice exhibit a similar defective cytotoxic activity, their survival and fertility are identical to those of WT mice in nonprotected animal facilities, and they do not develop spontaneous HS. Similarly, perforin-deficient mice do not spontaneously develop HS (
31). It will be interesting to investigate whether or not
ashen mice develop HS when challenged with lymphocytic choriomeningitis virus, as perforin-deficient mice have been reported to do (
32,
33).
Since the first description, by Griscelli et al., of a syndrome associating partial albinism and immunodeficiency (
1), various expressions and three genetic causes have been associated with the typical hypopigmentation. GS diagnosis thus depends on the observation of this characteristic hypopigmentation in association with additional features. The molecular understanding of GS conditions now allows better prediction of the phenotypic consequences of any new anomalies identified in these three genes. Since prognosis, treatment, and genetic counseling differ considerably among the various forms, the performance of accurate genetic diagnosis, early in life, would be an important tool in medical decision-making.
The various genetic defects associated with GS have demonstrated that, although melanosome transport in humans involves a Rab27a-dependent, Mlph-dependent, F-exon–MyoVa–dependent pathway, neither Mlph nor the F-exon of MyoVa plays a significant role in other functions. The existence of immune and neuronal cell type–specific effectors for MyoVa and Rab27a has thus been predicted. Forthcoming molecular and functional studies should show new partners of these proteins that are dedicated to organelle transport in these tissues.