Deep phenotyping of MARS1 (interstitial lung and liver disease) and LARS1 (infantile liver failure syndrome 1) recessive multisystemic disease using Human Phenotype Ontology annotation: Overlap and differences. Case report and review of literature

Eur J Med Genet. 2021 Nov;64(11):104334. doi: 10.1016/j.ejmg.2021.104334. Epub 2021 Sep 5.


Introduction: Aminoacyl transfer RNA (tRNA) synthetases are associated with diseases when mutations occur in their encoding genes. Pulmonary alveolar proteinosis can be caused by mutation in the methionyl-tRNA synthetase (MARS) gene while mutations in the leucine-tRNA synthetase (LARS) gene lead to infantile liver failure syndrome type 1. We report the case of a patient with LARS1 pathogenics variants and two patients with MARS1 pathogenics variants. The aim of this study was to analyze the phenotypes of our three patients in detail and classify cases in the literature using Human Phenotype Ontology (HPO) terms.

Results: The first patient has two previously undescribed heterozygous variants in LARS1 (c.1818dup and c.463A>G). The other two patients' MARS1 variants (c.1177G>A and c.1700C>T) have already been described in the literature. All three patients had anemia, hepatomegaly, feeding difficulties, failure to thrive and hypoalbuminemia. Including ours, 65 patients are described in total, for whom 117 phenotypic abnormalities have been described at least once, 41.9% of which both in patients with LARS1 and MARS1 mutations.

Conclusion: Patients with LARS1 and MARS1 mutations seem to share a common phenotype but further deep phenotyping studies are required to clarify the details of these complex pathologies.

Keywords: Infantile liver failure syndrome type 1; LARS1; MARS1; Pulmonary alveolar proteinosis; tRNA synthetase deficiency.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Failure to Thrive / genetics*
  • Failure to Thrive / pathology
  • Female
  • Humans
  • Infant
  • Leucine-tRNA Ligase / genetics*
  • Liver Diseases / genetics*
  • Liver Diseases / pathology
  • Lung Diseases, Interstitial / genetics*
  • Lung Diseases, Interstitial / pathology
  • Male
  • Methionine-tRNA Ligase / genetics*
  • Phenotype*
  • Syndrome


  • MARS1 protein, human
  • Methionine-tRNA Ligase
  • LARS1 protein, human
  • Leucine-tRNA Ligase