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Fateen E, Abdallah ZY. Twenty- five years of biochemical diagnosis of Gaucher disease: the Egyptian experience. Heliyon 2019; 5:e02574. [PMID: 31720445 PMCID: PMC6838951 DOI: 10.1016/j.heliyon.2019.e02574] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/17/2019] [Accepted: 09/30/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Gaucher disease is a rare multi-systemic metabolic disorder resulting from the deficiency of acid β-glucosidase activity, with consequent accumulation of glucocerebroside. Less than 15% of mean normal acid β-glucosidase activity in leukocytes is the gold standard for the diagnosis of Gaucher disease, and is generally supplemented by a massive elevation in chitotriosidase activity. We report here our experience in the biochemical diagnosis of Gaucher disease by showing the heterogeneity of the activity of enzymes over 25 years from 1993-2017, through the analysis of 5128 clinically suspected Gaucher disease cases referred to the Biochemical Genetics Department, National Research Centre, as the main reference lab in Egypt for the diagnosis of Inherited Metabolic Disorders. METHODS Acid β-glucosidase and chitotriosidase activities were measured in all referred cases. Sphinogmylinase activity was estimated for all cases with normal β-glucosidase activity and moderate elevation of chitotriosidase. RESULTS Out of the 5128 suspected cases, 882 (17%) showed a deficiency in acid β-glucosidase activity, accompanied by a raised chitotriosidase activity, ranges (213-66700 umol/l/h) and mean (7255 umol/l/h). Deficient chitotriosidase activity was found in 9 patients (1%) with low β-glucosidase. 451 cases were diagnosed with acid sphingomyelinase deficiency patients (8.8%). CONCLUSION Other biochemical markers are needed in addition to chitotriosidase for the diagnosis and follow up. Molecular testing was done to a relatively small number but needs to be done to all diagnosed patients as many mutations are known to predict the course of the disease.
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Affiliation(s)
| | - Zeinab Y. Abdallah
- Biochemical Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Postal Code 12622, Egypt
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Breigeiron MK, Moraes VDC, Coelho JC. Signs and symptoms in Gaucher Disease: priority nursing diagnoses. Rev Bras Enferm 2018; 71:104-110. [PMID: 29324951 DOI: 10.1590/0034-7167-2016-0434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 04/07/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Identify the signs and symptoms of patients with Gaucher Disease, inferring possible priority nursing diagnoses. METHOD Cross-sectional study, developed in a specialized laboratory, between 2013 and 2015. The sample (n = 91) comprised the records of patients with genetic diagnosis for Gaucher Disease. The study respected research norms. RESULTS Prevalence of female sex (57.1%), age at diagnosis between 0 and 10 years, and origin from the Southeast Region of Brazil were prevalent. Hematologic changes, bone pain, hepatomegaly, splenomegaly, and fatigue were the most recurrent signs and symptoms. The inferred diagnoses for the studied population were: Risk for bleeding; Fatigue; Chronic pain and Acute pain; Impaired physical mobility; Imbalanced nutrition: less than body requirements; and Risk for Developmental Delay. CONCLUSION The establishment of Priority Nursing Diagnoses based on signs and symptoms makes it possible to achieve expected outcomes for each individual in the care context.
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Affiliation(s)
- Márcia Koja Breigeiron
- Universidade Federal do Rio Grande do Sul, Nursing school, Maternal and Child Department. Porto Alegre, Rio Grande do Sul, Brazil
| | - Vitória da Costa Moraes
- Universidade Federal do Rio Grande do Sul, Nursing school, Ungergraduate Program in Nursing. Porto Alegre, Rio Grande do Sul, Brazil
| | - Janice Carneiro Coelho
- Universidade Federal do Rio Grande do Sul, Institute of Bioscience, Department of Biochemistry. Porto Alegre, Rio Grande do Sul, Brazil
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Bravo H, Neto EC, Schulte J, Pereira J, Filho CS, Bittencourt F, Sebastião F, Bender F, de Magalhães APS, Guidobono R, Trapp FB, Michelin-Tirelli K, Souza CF, Rojas Málaga D, Pasqualim G, Brusius-Facchin AC, Giugliani R. Investigation of newborns with abnormal results in a newborn screening program for four lysosomal storage diseases in Brazil. Mol Genet Metab Rep 2017; 12:92-97. [PMID: 28721335 PMCID: PMC5498414 DOI: 10.1016/j.ymgmr.2017.06.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 12/27/2022] Open
Abstract
Lysosomal storage diseases (LSDs) are genetic disorders, clinically heterogeneous, mainly caused by defects in genes encoding lysosomal enzymes that degrade macromolecules. Several LSDs already have specific therapies that may improve clinical outcomes, especially if introduced early in life. With this aim, screening methods have been established and newborn screening (NBS) for some LSDs has been developed. Such programs should include additional procedures for the confirmation (or not) of the cases that had an abnormal result in the initial screening. We present here the methods and results of the additional investigation performed in four babies with positive initial screening results in a program of NBS for LSDs performed by a private laboratory in over 10,000 newborns in Brazil. The suspicion in these cases was of Mucopolysaccharidosis I - MPS I (in two babies), Pompe disease and Gaucher disease (one baby each). One case of pseudodeficiency for MPS I, 1 carrier for MPS I, 1 case of pseudodeficiency for Pompe disease and 1 carrier for Gaucher disease were identified. This report illustrates the challenges that may be encountered by NBS programs for LSDs, and the need of a comprehensive protocol for the rapid and precise investigation of the babies who have an abnormal screening result.
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Affiliation(s)
- Heydy Bravo
- Post-Graduate Program of Genetics and Molecular Biology, UFRGS, Av. Bento Gonçalves 9500, 91501-970 Porto Alegre, RS, Brazil
| | | | - Jaqueline Schulte
- CTN Diagnósticos, Av. Ipiranga 5000, Porto Alegre, RS 90610-000, Brazil
| | - Jamile Pereira
- CTN Diagnósticos, Av. Ipiranga 5000, Porto Alegre, RS 90610-000, Brazil
| | | | - Fernanda Bittencourt
- Medical Genetics Service, HCPA, Rua Ramiro Barcelos 2350, Porto Alegre, RS 90035-903, Brazil
| | - Fernanda Sebastião
- Medical Genetics Service, HCPA, Rua Ramiro Barcelos 2350, Porto Alegre, RS 90035-903, Brazil
| | - Fernanda Bender
- Medical Genetics Service, HCPA, Rua Ramiro Barcelos 2350, Porto Alegre, RS 90035-903, Brazil
| | | | - Régis Guidobono
- Medical Genetics Service, HCPA, Rua Ramiro Barcelos 2350, Porto Alegre, RS 90035-903, Brazil
| | - Franciele Barbosa Trapp
- Medical Genetics Service, HCPA, Rua Ramiro Barcelos 2350, Porto Alegre, RS 90035-903, Brazil
| | | | - Carolina F.M. Souza
- Medical Genetics Service, HCPA, Rua Ramiro Barcelos 2350, Porto Alegre, RS 90035-903, Brazil
| | - Diana Rojas Málaga
- Post-Graduate Program of Genetics and Molecular Biology, UFRGS, Av. Bento Gonçalves 9500, 91501-970 Porto Alegre, RS, Brazil
| | - Gabriela Pasqualim
- Post-Graduate Program of Genetics and Molecular Biology, UFRGS, Av. Bento Gonçalves 9500, 91501-970 Porto Alegre, RS, Brazil
- Gene Therapy Center, Experimental Research Center, HCPA, Rua Ramiro Barcelos 2350, Porto Alegre, RS 90035-903, Brazil
| | | | - Roberto Giugliani
- Post-Graduate Program of Genetics and Molecular Biology, UFRGS, Av. Bento Gonçalves 9500, 91501-970 Porto Alegre, RS, Brazil
- Medical Genetics Service, HCPA, Rua Ramiro Barcelos 2350, Porto Alegre, RS 90035-903, Brazil
- Post-Graduate Program in Medical Sciences, UFRGS, Rua Ramiro Barcelos 2400, 90035-003 Porto Alegre, RS, Brazil
- Gene Therapy Center, Experimental Research Center, HCPA, Rua Ramiro Barcelos 2350, Porto Alegre, RS 90035-903, Brazil
- Corresponding author at: Medical Genetics Service, HCPA, Rua Ramiro Barcelos 2350, Porto Alegre, RS, Brazil.Medical Genetics ServiceHCPARua Ramiro Barcelos 2350Porto AlegreRSBrazil
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Giugliani R, Vairo FP, Riegel M, de Souza CFM, Schwartz IVD, Pena SDJ. Rare disease landscape in Brazil: report of a successful experience in inborn errors of metabolism. Orphanet J Rare Dis 2016; 11:76. [PMID: 27282290 PMCID: PMC4901491 DOI: 10.1186/s13023-016-0458-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 05/27/2016] [Indexed: 11/10/2022] Open
Abstract
Brazil is a country of continental dimensions, with many social inequalities. The latter are reflected on its health system, which comprises a large public component called SUS, a small paid health insurance component and a third very small private component, in which patients pay personally for medical services. Seventy five percent of the population depends on SUS, which thus far does not provide adequate coverage for genetic medical procedures. In 2014, SUS introduced the “Policy for the Integral Attention to Subjects with Rare Diseases”, establishing guidelines for offering diagnosis and treatment. The policy defines the two main axes, genetic and non-genetic rare diseases. In this fashion, public genetic services in SUS will be installed and funded not by themselves, but as part of the more general policy of rare diseases. Unfortunately, up to now this policy is still depending on financial allowances to be effectively launched. In this article, our intention was to describe activities developed in the area of inborn errors of metabolism by a Brazilian reference center. In spite of the lack of support of SUS, thousands of Brazilian families affected by rare genetic metabolic disorders, and many health professionals from all regions of Brazil, already have benefited from the services, training programs and research projects provided by this comprehensive center.
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Affiliation(s)
- Roberto Giugliani
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil. .,Department of Genetics, UFRGS, Porto Alegre, RS, Brazil. .,Postgraduate Program in Genetics and Molecular Biology, UFRGS, Porto Alegre, RS, Brazil.
| | - Filippo P Vairo
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil
| | - Mariluce Riegel
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil.,Postgraduate Program in Genetics and Molecular Biology, UFRGS, Porto Alegre, RS, Brazil
| | - Carolina F M de Souza
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil
| | - Ida V D Schwartz
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, RS, Brazil.,Department of Genetics, UFRGS, Porto Alegre, RS, Brazil.,Postgraduate Program in Genetics and Molecular Biology, UFRGS, Porto Alegre, RS, Brazil
| | - Sérgio D J Pena
- Laboratório de Genômica Clínica da Faculdade de Medicina and Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Novel mutations in the glucocerebrosidase gene of brazilian patients with Gaucher disease. JIMD Rep 2012; 9:7-16. [PMID: 23430543 DOI: 10.1007/8904_2012_174] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2011] [Revised: 07/30/2012] [Accepted: 08/17/2012] [Indexed: 12/14/2022] Open
Abstract
Gaucher disease (GD) is an autosomal recessive disorder resulting from glucocerebrosidase (GC) deficiency due to mutations in the gene (GBA) coding for this enzyme. We have developed a strategy for analyzing the entire GBA coding region and applied this strategy to 48 unrelated Brazilian patients with GD. We used long-range PCR, genotyping based on the Taqman® assay, nested PCR, and direct DNA sequencing to define changes in the gene. We report here seven novel mutations that are likely to be harmful: S125N (c.491G>A), F213L (c.756T>G), P245T (c.850C>A), W378C (c.1251G>C), D399H (c.1312G>C), 982-983insTGC (c.980_982dupTGC), and IVS10+1G>T (c.1505+1G>T). The last alteration was found as a complex allele together with a L461P mutation. We also identified 24 different mutations previously reported by others. G377S was the third most frequent mutation among the patients included in this study, after N370S and L444P. Therefore, this mutation needs be included in preliminary screens of Brazilian GD patients. The identification of mutant GBA alleles is crucial for increasing knowledge of the GBA mutation spectrum and for better understanding of the molecular basis of GD.
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Screening of high-risk Gaucher disease patients in Brazil using miniaturized dried blood spots and leukocyte techniques. Gene 2012; 508:197-8. [DOI: 10.1016/j.gene.2012.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 07/01/2012] [Accepted: 07/09/2012] [Indexed: 11/16/2022]
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Kurt I, Abasli D, Cihan M, Serdar MA, Olgun A, Saruhan E, Erbil MK. Chitotriosidase levels in healthy elderly subjects. Ann N Y Acad Sci 2007; 1100:185-8. [PMID: 17460177 DOI: 10.1196/annals.1395.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Chitotriosidase (CHIT) belongs to the family of glycosylhydrolases and is highly homologous to chitinases from lower organisms. The enzyme CHIT is of interest for clinical reasons, because it is selectively expressed in chronically activated tissue macrophages. In most ethnic groups, approximately 6% of all individuals are homozygous for CHIT deficiency. Pathological tissue macrophages in several disease conditions massively express CHIT. A shared feature of such cells in the different conditions is the accumulation of lipid material in the lysosomal apparatus. Serum CHIT activity is significantly increased in individuals suffering from atherosclerosis disease and is related to the severity of the atherosclerotic lesion, suggesting a possible role as atherosclerotic extent marker. Our objective is to determine the levels of serum CHIT activity in healthy elderly subjects. Healthy 90 (between 65-94 years old) elderly people and 69 (between 20-44 years old) young people were chosen. Serum CHIT enzymatic activity was determined with the flurometric enzyme activity assay using artificial 4-MU substrate. We found CHIT activity 270 +/- 21 (nmol/mL/h) (values are mean +/- SD) in elderly people and 136 +/- 17 in young people. There are statistical differences between elderly and young subjects.
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Affiliation(s)
- Ismail Kurt
- Department of Biochemistry and Clinical Biochemistry, Gulhane School of Medicine, Etlik 06018, Ankara, Turkey.
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Rozenberg R, Araújo FT, Fox DC, Aranda P, Nonino A, Micheletti C, Martins AM, Cravo R, Sobreira E, Pereira LV. High frequency of mutation G377S in Brazilian type 3 Gaucher disease patients. Braz J Med Biol Res 2007; 39:1171-9. [PMID: 16981045 DOI: 10.1590/s0100-879x2006000900004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2005] [Accepted: 07/20/2006] [Indexed: 11/22/2022] Open
Abstract
Gaucher disease (GD), the most prevalent lysosome storage disorder, presents an autosomal recessive mode of inheritance. It is a paradigm for therapeutic intervention in medical genetics due to the existence of effective enzyme replacement therapy. We report here the analysis of GD in 262 unrelated Brazilian patients, carried out in order to establish the frequency of the most common mutations and to provide prognostic information based on genotype-phenotype correlations. Among 247 type 1 GD patients, mutation N370S was detected in 47% of all the alleles, but N370S/N370S homozygosity was found in only 10% of the patients, a much lower frequency than expected, suggesting that most individuals presenting this genotype may not receive medical attention. Recombinant alleles were detected at a high frequency: 44% of the chromosomes bearing mutation L444P had other mutations derived from the pseudogene sequence, present in 25% of patients. Three neuronopathic type 2 patients were homozygous for L444P, all presenting additional mutations (E326K or recombinant alleles) that probably lead to the more severe phenotypes. Six children, classified as type 1 GD patients, had a L444P/L444P genotype, showing that neuronopathic symptoms may only manifest later in life. This would indicate the need for a higher treatment dose during enzyme replacement therapy. Finally, mutation G377S was present in 4 homozygous type 1 patients and also in compound heterozygosity in 5 (42%) type 3 patients. These findings indicate that G377S cannot be unambiguously classified as mild and suggest an allele-dose effect for this mutation.
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Affiliation(s)
- R Rozenberg
- Departamento de Genética e Biologia Evolutiva, Instituto de Biociências, Universidade de São Paulo, São Paulo, SP, Brasil.
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