Xanthinuria Type II via the MOCOS Gene

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  • Clinical Features and Genetics
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  • Methods
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Test Code Test Copy GenesIndividual Gene PriceCPT Code Copy CPT Codes
1855 MOCOS$1130.00 81479 Add to Order
Targeted Testing

For ordering targeted known variants, please proceed to our Targeted Variants landing page.

Turnaround Time

The great majority of tests are completed within 18 days.

Clinical Sensitivity

Clinical sensitivity cannot be estimated because only a small number of patients have been reported. Analytical sensitivity should be high because the great majority of pathogenic variants reported are detectable by sequencing.

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Clinical Features

Xanthinuria type II is an inherited metabolic disorder characterized by the deficiency of both of the molybdenum-cofactor requiring enzymes xanthine dehydrogenase and aldehyde oxidase (Mendel, 2009. PubMed ID: 19623604; Raivio et al., 2014). Biochemically, patients have greatly elevated serum and urinary xanthine, elevated serum and urinary hypoxanthine, and hypouricemia. The majority of patients may be asymptomatic, although roughly one-third of patients may present with urinary tract xanthine calculi that may lead to hematuria, crystalluria, renal colic or acute renal failure. Myositis is also sometimes observed (Raivio et al., 2014; Ceballos-Picot and Jinnah, 2016). Xanthinuria Type II is characterized by deficiency in xanthine dehydrogenase and aldehyde oxidase due to pathogenic variants in the molybdenum cofactor sulfurase, MOCOS, gene. Although the two types have similar clinical presentation, a distinction between the two types is based on the ability to oxidize allopurinol to oxypurinol (Raivio et al., 2014).


Xanthinuria Type II is a rare autosomal recessive disorder caused by pathogenic variants in the MOCOS gene located on chromosome 18 at 18q12.2. Although clinical reports indicate that types I and II are roughly equal in incidence, only a handful of type II patients have been molecularly diagnosed (Raivio et al., 2014). Reported pathogenic variants in MOCOS include missense, nonsense, and small frameshifts (Ichida et al., 2001. PubMed ID: 11302742; Yamamoto et al., 2003. PubMed ID: 14624414; Peretz et al., 2007. PubMed ID: 17368066; Zhou et al., 2015. PubMed ID: 25967871). Incidence estimates for xanthinuria types I and II range from 1 in 6,000 to 1 in 69,000 (Harkness et al., 1983. PubMed ID: 6422142; Harkness et al., 1986. PubMed ID: 3104682; Raivio et al., 2014). This large range may reflect the rarity of the disease and population differences. Xanthinuria may be more prevalent in Mediterranean countries (Raivio et al., 2014).

The MOCOS gene encodes molybdenum cofactor sulfurase, which is required for resulfuration of the molybdenum synthase enzyme during biosynthesis of the molybdenum cofactor molybdopterin (Johnson and Duran, 2014).

Testing Strategy

This test involves bidirectional Sanger sequencing using genomic DNA of all coding exons of the MOCOS gene plus ~20 bp of flanking non-coding DNA on each side. We will also sequence any single exon (Test #100) or pair of exons (Test #200) in family members of patients with known pathogenic variants or to confirm research results.

Indications for Test

Patients with biochemical and/or clinical features consistent with xanthinuria type II, such as xanthinuria, hypoxanthinuria, hypouricemia, and possibly kidney stones, are good candidates for this test. Family members of patients who have known MOCOS pathogenic variants are also good candidates. We will also sequence the MOCOS gene to determine carrier status.


Official Gene Symbol OMIM ID
MOCOS 613274
Inheritance Abbreviation
Autosomal Dominant AD
Autosomal Recessive AR
X-Linked XL
Mitochondrial MT


Name Inheritance OMIM ID
Xanthinuria, Type II AR 603592


Genetic Counselors
  • Ceballos-Picot and Jinnah, 2016. Disorders of Purine Metabolism Affecting Adults. In: Hollak C.E.M. and Lachmann R.H., editors. Inherited Metabolic Disease in Adults: A Clinical Guide. New York: Oxford University Press, p 251-.263.
  • Harkness et al., 1983. PubMed ID: 6422142
  • Harkness et al., 1986. PubMed ID: 3104682
  • Ichida et al., 2001. PubMed ID: 11302742
  • Johnson and Duran, 2014. Molybdenum Cofactor Deficiency and Isolated Sulfite Oxidase Deficiency. Online Metabolic & Molecular Bases of Inherited Disease, New York, NY: McGraw-Hill.
  • Mendel, 2009. PubMed ID: 19623604
  • Peretz et al., 2007. PubMed ID: 17368066
  • Raivio et al., 2014. Xanthine Oxidoreductase—Role in Human Pathophysiology and in Hereditary Xanthinuria. The Online Metabolic and Molecular Bases of Inherited Disease, New York, NY: The McGraw-Hill Companies, Inc.
  • Yamamoto et al., 2003. PubMed ID: 14624414
  • Zhou et al., 2015. PubMed ID: 25967871
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Bi-Directional Sanger Sequencing

Test Procedure

Nomenclature for sequence variants was from the Human Genome Variation Society (  As required, DNA is extracted from the patient specimen.  PCR is used to amplify the indicated exons plus additional flanking non-coding sequence.  After cleaning of the PCR products, cycle sequencing is carried out using the ABI Big Dye Terminator v.3.0 kit.  Products are resolved by electrophoresis on an ABI 3730xl capillary sequencer.  In most cases, sequencing is performed in both forward and reverse directions; in some cases, sequencing is performed twice in either the forward or reverse directions.  In nearly all cases, the full coding region of each exon as well as 20 bases of non-coding DNA flanking the exon are sequenced.

Analytical Validity

As of March 2016, we compared 17.37 Mb of Sanger DNA sequence generated at PreventionGenetics to NextGen sequence generated in other labs. We detected only 4 errors in our Sanger sequences, and these were all due to allele dropout during PCR. For Proficiency Testing, both external and internal, in the 12 years of our lab operation we have Sanger sequenced roughly 8,800 PCR amplicons. Only one error has been identified, and this was due to sequence analysis error.

Our Sanger sequencing is capable of detecting virtually all nucleotide substitutions within the PCR amplicons. Similarly, we detect essentially all heterozygous or homozygous deletions within the amplicons. Homozygous deletions which overlap one or more PCR primer annealing sites are detectable as PCR failure. Heterozygous deletions which overlap one or more PCR primer annealing sites are usually not detected (see Analytical Limitations). All heterozygous insertions within the amplicons up to about 100 nucleotides in length appear to be detectable. Larger heterozygous insertions may not be detected. All homozygous insertions within the amplicons up to about 300 nucleotides in length appear to be detectable. Larger homozygous insertions may masquerade as homozygous deletions (PCR failure).

Analytical Limitations

In exons where our sequencing did not reveal any variation between the two alleles, we cannot be certain that we were able to PCR amplify both of the patient’s alleles. Occasionally, a patient may carry an allele which does not amplify, due for example to a deletion or a large insertion. In these cases, the report contains no information about the second allele.

Similarly, our sequencing tests have almost no power to detect duplications, triplications, etc. of the gene sequences.

In most cases, only the indicated exons and roughly 20 bp of flanking non-coding sequence on each side are analyzed. Test reports contain little or no information about other portions of the gene, including many regulatory regions.

In nearly all cases, we are unable to determine the phase of sequence variants. In particular, when we find two likely causative mutations for recessive disorders, we cannot be certain that the mutations are on different alleles.

Our ability to detect minor sequence variants, due for example to somatic mosaicism is limited. Sequence variants that are present in less than 50% of the patient’s nucleated cells may not be detected.

Runs of mononucleotide repeats (eg (A)n or (T)n) with n >8 in the reference sequence are generally not analyzed because of strand slippage during PCR and cycle sequencing.

Unless otherwise indicated, the sequence data that we report are based on DNA isolated from a specific tissue (usually leukocytes). Test reports contain no information about gene sequences in other tissues.

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Ordering Options

myPrevent - Online Ordering
  • The test can be added to your online orders in the Summary and Pricing section.
  • Once the test has been added log in to myPrevent to fill out an online requisition form.
  • A completed requisition form must accompany all specimens.
  • Billing information along with specimen and shipping instructions are within the requisition form.
  • All testing must be ordered by a qualified healthcare provider.


(Delivery accepted Monday - Saturday)

  • Collect 3 ml -5 ml (5 ml preferred) of whole blood in EDTA (purple top tube) or ACD (yellow top tube). For Test #500-DNA Banking only, collect 10 ml -20 ml of whole blood.
  • For small babies, we require a minimum of 1 ml of blood.
  • Only one blood tube is required for multiple tests.
  • Ship blood tubes at room temperature in an insulated container. Do not freeze blood.
  • During hot weather, include a frozen ice pack in the shipping container. Place a paper towel or other thin material between the ice pack and the blood tube.
  • In cold weather, include an unfrozen ice pack in the shipping container as insulation.
  • At room temperature, blood specimen is stable for up to 48 hours.
  • If refrigerated, blood specimen is stable for up to one week.
  • Label the tube with the patient name, date of birth and/or ID number.


(Delivery accepted Monday - Saturday)

  • Send in screw cap tube at least 5 µg -10 µg of purified DNA at a concentration of at least 20 µg/ml for NGS and Sanger tests and at least 5 µg of purified DNA at a concentration of at least 100 µg/ml for gene-centric aCGH, MLPA, and CMA tests, minimum 2 µg for limited specimens.
  • For requests requiring more than one test, send an additional 5 µg DNA per test ordered when possible.
  • DNA may be shipped at room temperature.
  • Label the tube with the composition of the solute, DNA concentration as well as the patient’s name, date of birth, and/or ID number.
  • We only accept genomic DNA for testing. We do NOT accept products of whole genome amplification reactions or other amplification reactions.


(Delivery preferred Monday - Thursday)

  • PreventionGenetics should be notified in advance of arrival of a cell culture.
  • Culture and send at least two T25 flasks of confluent cells.
  • Some panels may require additional flasks (dependent on size of genes, amount of Sanger sequencing required, etc.). Multiple test requests may also require additional flasks. Please contact us for details.
  • Send specimens in insulated, shatterproof container overnight.
  • Cell cultures may be shipped at room temperature or refrigerated.
  • Label the flasks with the patient name, date of birth, and/or ID number.
  • We strongly recommend maintaining a local back-up culture. We do not culture cells.
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