HPD

Researchers have identified at least six HPD gene mutations that cause tyrosinemia type III. This condition is characterized by neurological problems such as intellectual disability, seizures, and periodic loss of balance and coordination (intermittent ataxia). Some of the mutations that cause this condition change single amino acids in the 4-hydroxyphenylpyruvate dioxygenase enzyme. Other mutations lead to the production of an unusually small enzyme. As a result of these mutations, the activity of the 4-hydroxyphenylpyruvate dioxygenase enzyme is unusually low or absent. As a result, the enzyme cannot perform its role in the breakdown of tyrosine, so 4-hydroxyphenylpyruvate is converted to toxic compounds instead of homogentisic acid. As these toxic compounds builds up in cells, they can impair function and eventually cause cell death. Cells in the nervous system are particularly sensitive to this toxic accumulation. Nerve cell damage and death likely lead to the characteristic features of tyrosinemia type III.

At least two HPD gene mutations have been found to cause a rare condition called hawkinsinuria. In infants, this condition is characterized by a failure to gain weight and grow at the expected rate (failure to thrive) and abnormally high acid levels in the blood (acidosis). The HPD gene mutations that cause hawkinsinuria result in decreased enzyme activity so that 4-hydroxyphenylpyruvate is not efficiently converted to homogentisic acid. Instead, some 4-hydroxyphenylpyruvate forms an unusual sulfur-containing amino acid called hawkinsin. It remains unclear how the production of hawkinsin leads to the features of hawkinsinuria.