12) Selleck Epacadostat and consists of 12 exons encoding TNAP . Currently, at least 264 distinct mutations and 16 polymorphisms
in the ALPL gene have been identified and associated with various forms of HPP. Missense mutations account for 75% of these mutations, while the remaining percentage are represented by small deletions (11%), splicing mutations (5.7%), nonsense mutations (3.8%), small insertions (2.3%), large deletions (1.1%), insertions or deletions (0.7%), and mutations in regulatory ALPL sequences (0.4%) (http://www.sesep.uvsq.fr/03_hypo_mutations.php#stat). In milder forms, in which one mutant allele is believed to be sufficient to cause disease, mutation detection rate is more difficult to estimate . Deficient TNAP activity is thought to Hydroxychloroquine be the major cause for skeletal mineralization defects observed in HPP  and . TNAP regulates mineralization by hydrolyzing the mineralization inhibitor, inorganic pyrophosphate (PPi), and by increasing inorganic phosphate (Pi) locally which participates in propagation of hydroxyapatite crystals in the extracellular matrix, and in deposition of hydroxyapatite between collagen fibrils  and . Decrease or loss of TNAP activity leads to accumulation of extracellular PPi, provided in part by nucleotide pyrophosphatase phosphodiesterase 1 (NPP1) and progressive ankylosis protein homolog (ANKH), resulting in inhibition
of hydroxyapatite formation ,  and . TNAP is reported to be a dimeric structure on the cell surface, linked to the membrane via glycosylphosphatidylinositol (GPI) anchors, and oriented so that the active sites face the extracellular environment. The enzyme is also active as a homodimer but not as a monomer  and . Due to the structural properties of the TNAP, some mutations affecting protein structure may exhibit a dominant negative effect. These dominant negative mutations (also called antimorphic mutations) usually result in an altered molecular function due to inhibition of enzymatic activity of the normal monomer by the mutated partner in heterodimers, thus contributing to highly variable clinical phenotypes of HPP . Consequently,
genotype–phenotype correlations are difficult to establish, because most patients are compound heterozygous for missense mutations and/or are carriers of mutations exhibiting a dominant Demeclocycline negative effect. Genotype–phenotype correlations have been examined by the use of site-directed mutagenesis and three dimensional (3D) modeling of the enzyme , , , , ,  and . Most of these studies show an excellent correlation between the severity of the phenotype and residual enzymatic activities produced in vitro, and/or localization of mutant residues in the 3D structure, whereas transfection assays may not distinguish structural mutations from functional ones . To date, all clinical forms of HPP have been shown to involve TNAP mutations that compromise the protein structure.