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Himmelreich N, Bertoldi M, Alfadhel M, Alghamdi MA, Anikster Y, Bao X, Bashiri FA, Zeev BB, Bisello G, Ceylan AC, Chien YH, Choy YS, Elsea SH, Flint L, García-Cazorla À, Gijavanekar C, Gümüş EY, Hamad MH, Hişmi B, Honzik T, Kuseyri Hübschmann O, Hwu WL, Ibáñez-Micó S, Jeltsch K, Juliá-Palacios N, Kasapkara ÇS, Kurian MA, Kusmierska K, Liu N, Ngu LH, Odom JD, Ong WP, Opladen T, Oppeboen M, Pearl PL, Pérez B, Pons R, Rygiel AM, Shien TE, Spaull R, Sykut-Cegielska J, Tabarki B, Tangeraas T, Thöny B, Wassenberg T, Wen Y, Yakob Y, Yin JGC, Zeman J, Blau N. Corrigendum to: Prevalence of DDC genotypes in patients with aromatic L-amino acid decarboxylase (AADC) deficiency and in silico prediction of structural protein changes. Mol Genet Metab 2023; 139:107647. [PMID: 37453860 DOI: 10.1016/j.ymgme.2023.107647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Nastassja Himmelreich
- Dietmar-Hopp Metabolic Center and Centre for Pediatrics and Adolescent Medicine, University Children's Hospital, Heidelberg, Germany
| | - Mariarita Bertoldi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Majid Alfadhel
- Medical Genomic Research Department, King Abdullah International Medical Research Center (KAIMRC), King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; Genetics and Precision Medicine Department, King Abdullah Specialized Children's Hospital, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Malak Ali Alghamdi
- Medical Genetic Division, Pediatric Department, College of Medicine, King Saud University, Riyadh, SA, Saudi Arabia
| | - Yair Anikster
- Metabolic Disease Unit, The Edmond and Lily Safra Childrens Hospital, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Israel
| | - Xinhua Bao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Fahad A Bashiri
- Division of Neurology, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Bruria Ben Zeev
- Pediatric Neurology, Safra Pediatric Hospital, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Giovanni Bisello
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Ahmet Cevdet Ceylan
- Ankara Yıldırım Beyazıt University, Department of Medical Genetics, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Yin-Hsiu Chien
- Department of Medical Genetics & Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Sarah H Elsea
- Dept. of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | | | - Àngels García-Cazorla
- Neurometabolic Unit, Department of Neurology, Hospital Sant Joan de Déu, CIBERER, Barcelona, Spain
| | - Charul Gijavanekar
- Dept. of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Emel Yılmaz Gümüş
- Department of Pediatrics and Inherited Metabolic Diseases, Marmara University School of Medicine, Istanbul, Turkey
| | - Muddathir H Hamad
- Neurology Division, Pediatric Department, King Saud University Medical City, Riyadh, SA, Saudi Arabia
| | - Burcu Hişmi
- Department of Pediatrics and Inherited Metabolic Diseases, Marmara University School of Medicine, Istanbul, Turkey
| | - Tomas Honzik
- Dept. of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Oya Kuseyri Hübschmann
- Dietmar-Hopp Metabolic Center and Centre for Pediatrics and Adolescent Medicine, University Children's Hospital, Heidelberg, Germany; Division of Neuropediatrics and Metabolic Medicine, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Wuh-Liang Hwu
- Department of Medical Genetics & Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Kathrin Jeltsch
- Division of Neuropediatrics and Metabolic Medicine, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Natalia Juliá-Palacios
- Neurometabolic Unit, Department of Neurology, Hospital Sant Joan de Déu, CIBERER, Barcelona, Spain
| | - Çiğdem Seher Kasapkara
- Department of Pediatric Metabolism, Ankara Yıldırım Beyazıt University, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Manju A Kurian
- Developmental Neurosciences, Zayed Centre for Research, UCL GOS-Institute of Child Health & Department of Neurology, Great Ormond Street Hospital, London, United Kingdom
| | - Katarzyna Kusmierska
- Department of Screening and Metabolic Diagnostics, Institute of Mother and Child, Warsaw, Poland
| | - Ning Liu
- Dept. of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Lock Hock Ngu
- Department of Genetics, Hospital Kuala Lumpur, Ministry of Health, Malaysia
| | - John D Odom
- Dept. of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Winnie Peitee Ong
- Department of Genetics, Hospital Kuala Lumpur, Ministry of Health, Malaysia
| | - Thomas Opladen
- Division of Neuropediatrics and Metabolic Medicine, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Mari Oppeboen
- Children's Department, Division of Child Neurology and Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Phillip L Pearl
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Belén Pérez
- Centro de Diagnostico de Enfermedades Moleculares, CIBERER, IdiPAZ, Universidad Autonoma de Madrid, Madrid, Spain
| | - Roser Pons
- First Department of Pediatrics, Aghia Sophia Children's Hospital, University of Athens, Athens, Greece
| | - Agnieszka Magdalena Rygiel
- Department of Medical Genetics, Laboratory of Hereditary Diseases, Institute of Mother and Child, Warsaw, Poland
| | - Tan Ee Shien
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Robert Spaull
- Developmental Neurosciences, Zayed Centre for Research, UCL GOS-Institute of Child Health & Department of Neurology, Great Ormond Street Hospital, London, United Kingdom
| | - Jolanta Sykut-Cegielska
- Department of Inborn Errors of Metabolism and Paediatrics, The Institute of Mother and Child, Warsaw, Poland
| | - Brahim Tabarki
- Division of Neurology, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Trine Tangeraas
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Beat Thöny
- Divisions of Metabolism, University Children's Hospital, Zürich, Switzerland
| | | | - Yongxin Wen
- Medical Genetic Division, Pediatric Department, College of Medicine, King Saud University, Riyadh, SA, Saudi Arabia
| | - Yusnita Yakob
- Molecular Diagnostics Unit, Specialised Diagnostics Centre, Institute for Medical Research, National Institute of Health, Ministry of Health, Malaysia
| | - Jasmine Goh Chew Yin
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Jiri Zeman
- Dept. of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Nenad Blau
- Divisions of Metabolism, University Children's Hospital, Zürich, Switzerland.
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Clinical Features in Aromatic L-Amino Acid Decarboxylase (AADC) Deficiency: A Systematic Review. Behav Neurol 2022; 2022:2210555. [PMID: 36268467 PMCID: PMC9578880 DOI: 10.1155/2022/2210555] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/01/2022] [Accepted: 09/22/2022] [Indexed: 11/18/2022] Open
Abstract
Aromatic L-amino acid decarboxylase (AADC) deficiency is a rare congenital autosomal recessive metabolic disorder caused by pathogenic homozygous or compound heterozygous variants in the dopa decarboxylase (DDC) gene. Adeno-associated viral vector-mediated gene transfer of the human AADC gene into the putamina has become available. This systematic review on PubMed, Scopus databases, and other sources is aimed at describing the AADC whole phenotypic spectrum in order to facilitate its early diagnosis. Literature reviews, original articles, retrospective and comparative studies, large case series, case reports, and short communications were considered. A database was set up using Microsoft Excel to collect clinical, molecular, biochemical, and therapeutic data. By analysing 261 patients from 41 papers with molecular and/or biochemical diagnosis of AADC deficiency for which individuality could be determined with certainty, we found symptom onset to occur in the first 6 months of life in 93% of cases. Hypotonia and developmental delay are cardinal signs, reported as present in 73.9% and 72% of cases, respectively. Oculogyric crises were seen in 67% of patients while hypokinesia in 42% and ptosis in 26%. Dysautonomic features have been revealed in 53% and gastrointestinal symptoms in 19% of cases. With 37% and 30% of patients reported being affected by sleep and behavioural disorders, it seems to be commoner than previously acknowledged. Although reporting bias cannot be excluded, there is still a need for comprehensive clinical descriptions of symptoms at onset and during follow-up. In fact, our review suggests that most of the neurological and extraneurological symptoms and signs reported, although quite frequent in this condition, are not pathognomonic, and therefore, ADCC deficiency can remain an underdiscovered disorder.
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Hasegawa Y, Nishi E, Mishima Y, Sakaguchi T, Sekiguchi F, Miyake N, Kojima K, Osaka H, Matsumoto N, Okamoto N. Novel variants in aromatic L-amino acid decarboxylase deficiency: Case report of sisters with mild phenotype. Brain Dev 2021; 43:1023-1028. [PMID: 34481663 DOI: 10.1016/j.braindev.2021.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/01/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Aromatic L-amino acid decarboxylase (AADC) deficiency, caused by a pathogenic variant in the dopa decarboxylase (DDC) gene, is a rare neurometabolic disorder in which catecholamine and serotonin are not synthesized. From a large number of reports, it has been recognized that most affected patients show severe developmental delay in a bedridden state and are unable to speak. On the other hand, patients with a mild phenotype with AADC deficiency have been reported, but they number only a few cases. Therefore, the variation of phenotypes of the disease appears to be broad, and it may be challenging to diagnose an atypical phenotype as AADC deficiency. CASE REPORT We report novel compound heterozygous variants in DDC (c.202G > A and c.254C > T) in two sisters, whose main complaint was mild developmental delay, by whole-exome sequencing (WES). Additionally, we describe their clinical features and provide an image that shows the variants located at different sites responsible for the catalysis of AADC in a three-dimensional structure. The patients were prescribed a Monoamine oxidase (MAO) inhibitor after diagnosis. INTERPRETATION Our cases indicate that a comprehensive genomic approach helps to diagnose AADC deficiency with atypical features, and underscore the significance of understanding the variations of this disorder for diagnosis and appropriate treatment.
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Affiliation(s)
- Yuiko Hasegawa
- Department of Medical Genetics, Osaka Women's and Children's Hospital, Izumi, Japan.
| | - Eriko Nishi
- Department of Medical Genetics, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Yuko Mishima
- Department of Medical Genetics, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Tomohiro Sakaguchi
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Futoshi Sekiguchi
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Noriko Miyake
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Karin Kojima
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | - Hitoshi Osaka
- Department of Pediatrics, Jichi Medical University, Tochigi, Japan
| | - Naomichi Matsumoto
- Department of Human Genetics, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuhiko Okamoto
- Department of Medical Genetics, Osaka Women's and Children's Hospital, Izumi, Japan
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Wen Y, Wang J, Zhang Q, Chen Y, Bao X. The genetic and clinical characteristics of aromatic L-amino acid decarboxylase deficiency in mainland China. J Hum Genet 2020; 65:759-769. [PMID: 32409695 DOI: 10.1038/s10038-020-0770-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/12/2020] [Accepted: 04/26/2020] [Indexed: 11/10/2022]
Abstract
Aromatic L-amino acid decarboxylase deficiency (AADCD) is a rare neurotransmitter metabolic disorder caused by DDC gene mutations, which leads to the metabolic disturbance of dopamine and serotonin. Most of the reported cases came from Taiwan China, but patients from mainland China were seldomly reported. The current study was the largest AADCD patient cohort from mainland China. Twenty-three patients with clinical features of AADCD and DDC gene variants were recruited. A total of 16 DDC variants were identified in this study, of which four variants (c.2T>C, c.277A>G, c.1021+1G>A, c.565G>T) were never reported previously. The intronic variant c.714+4A>T was the most common one, with an allele frequency of 45.7%. And patients carried this intronic variant presented with severe clinical manifestations, all of whom were bedridden. In this study, the average onset age was 3.61 ± 1.28 months and the average age of diagnosis was 12.91 ± 5.62 months. Early onset hypotonia, oculogyric crises, and autonomic symptoms such as excessive sweating, nasal congestion and profuse nasal, and oropharyngeal secretions, were common in our patients. Eighteen patients (78.3%) got various degree of improvement after using pyridoxine monotherapy or different combination of pyridoxine, dopamine agonists, and monoamine oxidase (MAO) inhibitors.
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Affiliation(s)
- Yongxin Wen
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jiaping Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Qingping Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yan Chen
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xinhua Bao
- Department of Pediatrics, Peking University First Hospital, Beijing, China.
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5
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Hyland K, Reott M. Prevalence of Aromatic l-Amino Acid Decarboxylase Deficiency in At-Risk Populations. Pediatr Neurol 2020; 106:38-42. [PMID: 32111562 DOI: 10.1016/j.pediatrneurol.2019.11.022] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 11/21/2019] [Accepted: 11/29/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Aromatic l-amino acid decarboxylase (AADC) deficiency is an autosomal recessive metabolic disorder that results from disease-causing pathogenic variants of the dopa decarboxylase (DDC) gene. Loss of dopamine and serotonin production in the brain from infancy prevents achievement of motor developmental milestones. METHODS We retrospectively evaluated data obtained from requests to Medical Neurogenetics Laboratories for analyses of neurotransmitter metabolites in the cerebrospinal fluid, AADC enzyme activity in plasma, and/or Sanger sequencing of the DDC gene. Our primary objective was to estimate the prevalence of AADC deficiency in an at-risk population. RESULTS Approximately 20,000 cerebrospinal fluid samples were received with a request for neurotransmitter metabolite analysis in the eight-year study period; 22 samples tested positive for AADC deficiency based on decreased concentrations of 5-hydroxyindoleacetic acid and homovanillic acid, and increased 3-O-methyldopa, establishing an estimated prevalence of approximately 0.112%, or 1:900. Of the 81 requests received for plasma AADC enzyme analysis, 25 samples had very low plasma AADC activity consistent with AADC deficiency, resulting in identification of nine additional cases. A total of five additional patients were identified by Sanger sequencing as the primary request leading to the diagnosis of AADC deficiency. CONCLUSIONS Overall, these analyses identified 36 new cases of AADC deficiency. Sequencing findings showed substantial diversity with identification of 26 different DDC gene variants; five had not previously been associated with AADC deficiency. The results of the present study align with the emerging literature and understanding of the epidemiology and genetics of AADC deficiency.
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Affiliation(s)
- Keith Hyland
- Department of Neurochemistry, Medical Neurogenetics Laboratories, Atlanta, Georgia.
| | - Michael Reott
- Department of Neurochemistry, Medical Neurogenetics Laboratories, Atlanta, Georgia
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Dai W, Lu D, Gu X, Yu Y. Aromatic L-amino acid decarboxylase deficiency in 17 Mainland China patients: Clinical phenotype, molecular spectrum, and therapy overview. Mol Genet Genomic Med 2020; 8:e1143. [PMID: 31975548 PMCID: PMC7057092 DOI: 10.1002/mgg3.1143] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 12/16/2019] [Indexed: 12/12/2022] Open
Abstract
Background Aromatic L‐amino acid decarboxylase deficiency (AADCD) is a rare, autosomal recessive inherited disorder which is characterized by neurological and vegetative symptoms. To date, only 130 patients with AADCD have been reported worldwide. Methods We demonstrated 14 previously undescribed patients together with three reportedly patients in Mainland China. Full clinical information was collected, and disease‐causing variants in the DDC gene were detected. Results The common clinical manifestation of patients, including intermittent oculogyric crises, retarded movement development, and autonomic symptoms. Notably, a patient showed bone‐density loss which have not been reported and two mildly phenotype patients improved psychomotor function after being prescribed medication. The most common genotype of Mainland Chinese AADCD is the splice‐site variant (IVS6+4A> T; c.714+4A> T), which accounts for 58.8%, followed by c.1234C>T variant. Three novel compound heterozygous variants, c. 565G>T, c.170T>C, and c.1021+1G>A, were firstly reported. It is important to recognize the milder phenotypes of the disease as these patients might respond well to therapy. Besides, we discovered that patients may presented with milder if found to be compound heterozygote or homozygote for one of the following variants c.478C>G, c.853C>T, c.1123C>T, c.387G>A, and c.665T>C. Discussion The clinical data of the cohort of 17 patients in Mainland China broaden the clinical, molecular, and treatment spectrum of aromatic L‐amino acid decarboxylase deficiency.
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Affiliation(s)
- Weiqian Dai
- Department of Pediatric Endocrinology and Genetic Metabolism, Shanghai Institute for Pediatric Research, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Deyun Lu
- Department of Pediatric Endocrinology and Genetic Metabolism, Shanghai Institute for Pediatric Research, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xuefan Gu
- Department of Pediatric Endocrinology and Genetic Metabolism, Shanghai Institute for Pediatric Research, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yongguo Yu
- Department of Pediatric Endocrinology and Genetic Metabolism, Shanghai Institute for Pediatric Research, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Intricacies of the Molecular Machinery of Catecholamine Biosynthesis and Secretion by Chromaffin Cells of the Normal Adrenal Medulla and in Pheochromocytoma and Paraganglioma. Cancers (Basel) 2019; 11:cancers11081121. [PMID: 31390824 PMCID: PMC6721535 DOI: 10.3390/cancers11081121] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 12/11/2022] Open
Abstract
The adrenal medulla is composed predominantly of chromaffin cells producing and secreting the catecholamines dopamine, norepinephrine, and epinephrine. Catecholamine biosynthesis and secretion is a complex and tightly controlled physiologic process. The pathways involved have been extensively studied, and various elements of the underlying molecular machinery have been identified. In this review, we provide a detailed description of the route from stimulus to secretion of catecholamines by the normal adrenal chromaffin cell compared to chromaffin tumor cells in pheochromocytomas. Pheochromocytomas are adrenomedullary tumors that are characterized by uncontrolled synthesis and secretion of catecholamines. This uncontrolled secretion can be partly explained by perturbations of the molecular catecholamine secretory machinery in pheochromocytoma cells. Chromaffin cell tumors also include sympathetic paragangliomas originating in sympathetic ganglia. Pheochromocytomas and paragangliomas are usually locally confined tumors, but about 15% do metastasize to distant locations. Histopathological examination currently poorly predicts future biologic behavior, thus long term postoperative follow-up is required. Therefore, there is an unmet need for prognostic biomarkers. Clearer understanding of the cellular mechanisms involved in the secretory characteristics of pheochromocytomas and sympathetic paragangliomas may offer one approach for the discovery of novel prognostic biomarkers for improved therapeutic targeting and monitoring of treatment or disease progression.
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8
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Lee NC, Chien YH, Hwu WL. A review of aromatic l
-amino acid decarboxylase (AADC) deficiency in Taiwan. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2019; 181:226-229. [DOI: 10.1002/ajmg.c.31670] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/27/2018] [Accepted: 11/29/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Ni-Chung Lee
- Department of Medical Genetics; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
- Department of Pediatrics; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
| | - Yin-Hsiu Chien
- Department of Medical Genetics; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
- Department of Pediatrics; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
| | - Wuh-Liang Hwu
- Department of Medical Genetics; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
- Department of Pediatrics; National Taiwan University Hospital and National Taiwan University College of Medicine; Taipei Taiwan
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9
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Montioli R, Janson G, Paiardini A, Bertoldi M, Borri Voltattorni C. Heterozygosis in aromatic amino acid decarboxylase deficiency: Evidence for a positive interallelic complementation between R347Q and R358H mutations. IUBMB Life 2018; 70:215-223. [PMID: 29356298 DOI: 10.1002/iub.1718] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/03/2018] [Indexed: 11/08/2022]
Abstract
Aromatic amino acid or Dopa decarboxylase (AADC or DDC) is a homodimeric pyridoxal 5'-phosphate (PLP) enzyme responsible for the generation of the neurotransmitters dopamine and serotonin. AADC deficiency is a rare inborn disease caused by mutations of the AADC gene leading to a defect of AADC enzyme and resulting in impaired dopamine and serotonin synthesis. Until now, only the molecular effects of homozygous mutations were analyzed. However, although heterozygous carriers of AADC deficiency were identified, the molecular aspects of their enzymatic phenotypes are not yet investigated. Here, we focus our attention on the R347Q/R358H and R347Q/R160W heterozygous mutations, and report for the first time the isolation and characterization, in the purified recombinant form, of the R347Q/R358H heterodimer and of the R358H homodimer. The results, integrated with those already known of the R347Q homodimeric variant, provide evidence that (i) the R358H mutation strongly reduces the PLP-binding affinity and the catalytic activity, and (ii) a positive interallelic complementation exists between the R347Q and the R358H mutations. Bioinformatics analyses provide the structural basis for these data. Unfortunately, the R347Q/R160W heterodimer was not obtained in a sufficient amount to allow its purification and characterization. Nevertheless, the biochemical features of the R160W homodimer give a contribution to the enzymatic phenotype of the heterozygous R347Q/R160W and suggest the possible relevance of Arg160 in the proper folding of human DDC. © 2018 IUBMB Life, 70(3):215-223, 2018.
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Affiliation(s)
- Riccardo Montioli
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giacomo Janson
- Department of Biochemical Sciences "A. Rossi Fanelli,", Sapienza University of Rome, Rome, Italy
| | - Alessandro Paiardini
- Department of Biochemical Sciences "A. Rossi Fanelli,", Sapienza University of Rome, Rome, Italy
| | - Mariarita Bertoldi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Carla Borri Voltattorni
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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10
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Kuster A, Arnoux JB, Barth M, Lamireau D, Houcinat N, Goizet C, Doray B, Gobin S, Schiff M, Cano A, Amsallem D, Barnerias C, Chaumette B, Plaze M, Slama A, Ioos C, Desguerre I, Lebre AS, de Lonlay P, Christa L. Diagnostic approach to neurotransmitter monoamine disorders: experience from clinical, biochemical, and genetic profiles. J Inherit Metab Dis 2018; 41:129-139. [PMID: 28924877 DOI: 10.1007/s10545-017-0079-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 07/10/2017] [Accepted: 07/27/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND AIM To improve the diagnostic work-up of patients with diverse neurological diseases, we have elaborated specific clinical and CSF neurotransmitter patterns. METHODS Neurotransmitter determinations in CSF from 1200 patients revealed abnormal values in 228 (19%) cases. In 54/228 (24%) patients, a final diagnosis was identified. RESULTS We have reported primary (30/54, 56%) and secondary (24/54, 44%) monoamine neurotransmitter disorders. For primary deficiencies, the most frequently mutated gene was DDC (n = 9), and the others included PAH with neuropsychiatric features (n = 4), PTS (n = 5), QDPR (n = 3), SR (n = 1), and TH (n = 1). We have also identified mutations in SLC6A3, FOXG1 (n = 1 of each), MTHFR (n = 3), FOLR1, and MTHFD (n = 1 of each), for dopamine transporter, neuronal development, and folate metabolism disorders, respectively. For secondary deficiencies, we have identified POLG (n = 3), ACSF3 (n = 1), NFU1, and SDHD (n = 1 of each), playing a role in mitochondrial function. Other mutated genes included: ADAR, RNASEH2B, RNASET2, SLC7A2-IT1 A/B lncRNA, and EXOSC3 involved in nuclear and cytoplasmic metabolism; RanBP2 and CASK implicated in post-traductional and scaffolding modifications; SLC6A19 regulating amino acid transport; MTM1, KCNQ2 (n = 2), and ATP1A3 playing a role in nerve cell electrophysiological state. Chromosome abnormalities, del(8)(p23)/dup(12) (p23) (n = 1), del(6)(q21) (n = 1), dup(17)(p13.3) (n = 1), and non-genetic etiologies (n = 3) were also identified. CONCLUSION We have classified the final 54 diagnoses in 11 distinctive biochemical profiles and described them through 20 clinical features. To identify the specific molecular cause of abnormal NT profiles, (targeted) genomics might be used, to improve diagnosis and allow early treatment of complex and rare neurological genetic diseases.
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Affiliation(s)
- Alice Kuster
- Neurometabolism department, Nantes Hospital and University, Nantes, France
| | - Jean-Baptiste Arnoux
- Reference center for inherited metabolic diseases, Necker Enfants-Malades Hospital, Assistance Publique Hôpitaux de Paris, Imagine Institute, Paris Descartes University, Paris, France
| | - Magalie Barth
- Neurometabolism department, Angers Hospital and University, Angers, France
| | - Delphine Lamireau
- Neuropediatric and Neurogenetic department, MRGM laboratory, National institute for health and medical research U1211, Pellegrin Hospital and University, Bordeaux, France
| | - Nada Houcinat
- Neuropediatric and Neurogenetic department, MRGM laboratory, National institute for health and medical research U1211, Pellegrin Hospital and University, Bordeaux, France
| | - Cyril Goizet
- Neuropediatric and Neurogenetic department, MRGM laboratory, National institute for health and medical research U1211, Pellegrin Hospital and University, Bordeaux, France
| | - Bérénice Doray
- Genetic department, Félix Guyon Hospital and University, Saint-Denis de la Réunion, France
| | - Stéphanie Gobin
- Genetic department, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Manuel Schiff
- Neurometabolism and Biochemical department, Robert Debré Hospital and University, Paris, France
| | - Aline Cano
- Reference center for inherited metabolic diseases, la Timone-Marseille Hospital and University, Marseille, France
| | - Daniel Amsallem
- Neuropediatric department, Jean Minjoz Hospital, Besançon, France
| | - Christine Barnerias
- Neurology department, Necker Enfants Malades Hospital and Paris Descartes University, Paris, France
| | - Boris Chaumette
- Sainte Anne Hospital, University Hospital Department (SHU), Paris Descartes University and Institut National de la Santé et de la Recherche Médicale INSERM U894, CNRS GDR, 3557, Paris, France
| | - Marion Plaze
- Sainte Anne Hospital, University Hospital Department (SHU), Paris Descartes University and Institut National de la Santé et de la Recherche Médicale INSERM U894, CNRS GDR, 3557, Paris, France
| | - Abdelhamid Slama
- Biochemical department, Bicêtre Hospital, Assistance Publique Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - Christine Ioos
- Neuropediatric department, Raymond Poincaré Hospital, Garches, France
| | - Isabelle Desguerre
- Neurology department, Necker Enfants Malades Hospital and Paris Descartes University, Paris, France
| | - Anne-Sophie Lebre
- Genetic and Biological department, Reims University, Maison Blanche Hospital, F-51092, Reims, France
| | - Pascale de Lonlay
- Reference center for inherited metabolic diseases, Necker Enfants-Malades Hospital, Assistance Publique Hôpitaux de Paris, Imagine Institute, Paris Descartes University, Paris, France
| | - Laurence Christa
- Metabolomic and proteomic Biochemical department, Necker Enfants-Malades Hospital, Paris Descartes University, Paris, France.
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郝 晓, 段 志. 五羟色胺信号系统与胃肠道疾病的研究进展. Shijie Huaren Xiaohua Zazhi 2017; 25:1697-1704. [DOI: 10.11569/wcjd.v25.i19.1697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
五羟色胺(5-hydroxytryptamine, 5-HT)是脑肠轴调控路径中的一个重要组成部分. 5-HT信号系统在多种胃肠道疾病的发病机制中扮演重要的角色, 参与调节胃肠运动、感觉及分泌等功能. 5-HT的合成、释放、与特异性受体结合及再摄取过程中任意一个环节发生异常, 均与胃肠道功能紊乱的发生密切相关, 其不仅在功能性疾病中存在作用, 与器质性疾病也有很大的关系. 临床上5-HT受体激动剂、拮抗剂及选择性再摄取抑制剂已被广泛运用到多种胃肠道疾病的治疗中. 本文阐述了5-HT信号系统与胃肠道疾病病理生理的关系, 从而研究5-HT受体在胃肠道中的作用及其相关药物的临床效用, 为胃肠道疾病的防治提供理论依据.
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Maas RP, Wassenberg T, Lin JP, van de Warrenburg BP, Willemsen MA. l-Dopa in dystonia. Neurology 2017; 88:1865-1871. [DOI: 10.1212/wnl.0000000000003897] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 01/26/2017] [Indexed: 11/15/2022] Open
Abstract
“Every child exhibiting dystonia merits anl-dopa trial, lest the potentially treatable condition of dopa-responsive dystonia (DRD) is missed” has been a commonly cited and highly conserved adage in movement disorders literature stemming from the 1980s. We here provide a historical perspective on this statement, discuss the current diagnostic and therapeutic applications ofl-dopa in everyday neurologic practice, contrast these with its approved indications, and finish with our view on both a diagnostic and therapeutic trial in children and adults with dystonia. In light of the relatively low prevalence of DRDs, the large interindividual variation in the requiredl-dopa dose, the uncertainty about an adequate trial duration, the substantial advances in knowledge on etiology and pathophysiology of these disorders, and the availability of various state-of-the-art diagnostic tests, we think that a diagnosticl-dopa trial as a first step in the approach of early-onset dystonia (≤25 years) is outdated. Rather, in high-resource countries, we suggest to usel-dopa after biochemical corroboration of a defect in dopamine biosynthesis, in genetically confirmed DRD, or if nigrostriatal degeneration has been demonstrated by nuclear imaging in adult patients presenting with lower limb dystonia. Furthermore, our literature study on the effect of a therapeutic trial to gain symptomatic relief revealed thatl-dopa has occasionally proven beneficial in several established “non-DRDs” and may therefore be considered in selected cases of dystonia due to other causes. In summary, we argue against the application ofl-dopa in every patient with early-onset dystonia and support a more rational therapeutic use.
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Wassenberg T, Molero-Luis M, Jeltsch K, Hoffmann GF, Assmann B, Blau N, Garcia-Cazorla A, Artuch R, Pons R, Pearson TS, Leuzzi V, Mastrangelo M, Pearl PL, Lee WT, Kurian MA, Heales S, Flint L, Verbeek M, Willemsen M, Opladen T. Consensus guideline for the diagnosis and treatment of aromatic l-amino acid decarboxylase (AADC) deficiency. Orphanet J Rare Dis 2017; 12:12. [PMID: 28100251 PMCID: PMC5241937 DOI: 10.1186/s13023-016-0522-z] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 10/04/2016] [Indexed: 01/17/2023] Open
Abstract
Aromatic L-amino acid decarboxylase deficiency (AADCD) is a rare, autosomal recessive neurometabolic disorder that leads to a severe combined deficiency of serotonin, dopamine, norepinephrine and epinephrine. Onset is early in life, and key clinical symptoms are hypotonia, movement disorders (oculogyric crisis, dystonia, and hypokinesia), developmental delay, and autonomic symptoms.In this consensus guideline, representatives of the International Working Group on Neurotransmitter Related Disorders (iNTD) and patient representatives evaluated all available evidence for diagnosis and treatment of AADCD and made recommendations using SIGN and GRADE methodology. In the face of limited definitive evidence, we constructed practical recommendations on clinical diagnosis, laboratory diagnosis, imaging and electroencephalograpy, medical treatments and non-medical treatments. Furthermore, we identified topics for further research. We believe this guideline will improve the care for AADCD patients around the world whilst promoting general awareness of this rare disease.
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Affiliation(s)
- Tessa Wassenberg
- Department of Neurology and Child Neurology, Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Marta Molero-Luis
- Department of Clinical Biochemistry, CIBERER-ISCIII, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Kathrin Jeltsch
- Department of Child Neurology and Metabolic Disorders, University Children’s Hospital, Heidelberg, Germany
| | - Georg F. Hoffmann
- Department of Child Neurology and Metabolic Disorders, University Children’s Hospital, Heidelberg, Germany
| | - Birgit Assmann
- Department of Child Neurology and Metabolic Disorders, University Children’s Hospital, Heidelberg, Germany
| | - Nenad Blau
- Dietmar-Hopp Metabolic Center, University Children’s Hospital Heidelberg, Heidelberg, Germany
| | - Angeles Garcia-Cazorla
- Department of Child Neurology, CIBERER-ISCIII, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Rafael Artuch
- Department of Clinical Biochemistry, CIBERER-ISCIII, Hospital Sant Joan de Déu Barcelona, Barcelona, Spain
| | - Roser Pons
- First Department of Pediatrics, Pediatric Neurology Unit, Agia Sofia Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Toni S. Pearson
- Department of Neurology, Washington University School of Medicine, St. Louis, USA
| | - Vincenco Leuzzi
- Department of Pediatrics and Child Neuropsychiatry, Sapienza Università di Roma, Rome, Italy
| | - Mario Mastrangelo
- Department of Pediatrics and Child Neuropsychiatry, Sapienza Università di Roma, Rome, Italy
| | - Phillip L. Pearl
- Department of Epilepsy and Clinical Neurophysiology, Boston Children’s Hospital, Harvard Medical School, Boston, USA
| | - Wang Tso Lee
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Manju A. Kurian
- Developmental Neurosciences, UCL- Institute of Child Health and Department of Neurology, Great Ormond Street Hospital for Children NHS Foundations Trust, London, UK
| | - Simon Heales
- Laboratory Medicine, Great Ormond Street Hospital and Neurometabolic Unit, National Hospital, London, UK
| | | | - Marcel Verbeek
- Department of Neurology and Child Neurology, Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Department Laboratory Medicine, Alzheimer Centre, Radboud university medical center, Nijmegen, The Netherlands
| | - Michèl Willemsen
- Department of Neurology and Child Neurology, Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Thomas Opladen
- Department of Child Neurology and Metabolic Disorders, University Children’s Hospital, Heidelberg, Germany
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14
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Spitz MA, Nguyen MA, Roche S, Heron B, Milh M, de Lonlay P, Lion-François L, Testard H, Napuri S, Barth M, Fournier-Favre S, Christa L, Vianey-Saban C, Corne C, Roubertie A. Chronic Diarrhea in L-Amino Acid Decarboxylase (AADC) Deficiency: A Prominent Clinical Finding Among a Series of Ten French Patients. JIMD Rep 2016; 31:85-93. [PMID: 27147232 DOI: 10.1007/8904_2016_550] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 02/09/2016] [Accepted: 02/29/2016] [Indexed: 12/13/2022] Open
Abstract
UNLABELLED Aromatic L-amino acid decarboxylase (AADC) deficiency is an autosomal recessive inborn error of metabolism, affecting catecholamines and serotonin biosynthesis. Cardinal signs consist in psychomotor delay, hypotonia, oculogyric crises, dystonia, and extraneurological symptoms. PATIENTS AND METHODS We present a retrospective descriptive multicentric study concerning ten French children with a biochemical and molecular confirmed diagnosis of AADC deficiency. RESULTS Clinical presentation of most of our patients was consistent with the previous descriptions from the literature (hypotonia (nine children), autonomic signs (nine children), sleep disorders (eight children), oculogyric crises (eight children), motor disorders like hypertonia and involuntary movements (seven children)). We described however some phenotypic particularities. Two patients exhibited normal intellectual abilities (patients already described in the literature). We also underlined the importance of digestive symptoms like diarrhea, which occurred in five among the ten patients. We report in particular two children with chronic diarrhea, complicated by severe failure to thrive. Vanillactic acid (VLA) elevation in urines of one of these two patients led to suspect the diagnosis of AADC deficiency, as in two other patients from our population. CONCLUSION Some symptoms like chronic diarrhea were atypical and have been poorly described in the literature up to now. Diagnosis of the AADC deficiency is sometimes difficult because of the phenotypic heterogeneity of the disease and VLA elevation in urines should suggest the diagnosis.
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Affiliation(s)
- M A Spitz
- Département de Pédiatrie, Strasbourg, France
| | - M A Nguyen
- Département de Pédiatrie, Grenoble, France
| | - S Roche
- Service de Neuropédiatrie et Maladies Métaboliques Hôpital Robert Debré, Paris, France
| | - B Heron
- Département de Pédiatrie Hôpital Jean Verdier, Bondy, France.,Service de Neuropédiatrie et Maladies Métaboliques Hôpital Armand Trousseau, Paris, France.,Service de Pédiatrie, Hôpital Jean Verdier, Bondy, France.,Service de Neurologie Pédiatrique, Hôpital Armand Trousseau, Paris, France
| | - M Milh
- Service de Neuropédiatrie et Maladies Métaboliques Hôpital La Timone, Marseille, France
| | - P de Lonlay
- Service de Neuropédiatrie et Maladies Métaboliques Hôpital Necker Enfants Malades, Paris, France
| | - L Lion-François
- Service de Neuropédiatrie Hôpital Femme Mère Enfant, Lyon, France
| | - H Testard
- Département de Pédiatrie, Grenoble, France.,Département de Pédiatrie, Annemasse, France
| | - S Napuri
- Département de Pédiatrie, Rennes, France
| | - M Barth
- Service de Génétique et centres de compétence Maladies Métaboliques, Angers, France
| | - S Fournier-Favre
- Service d'Hépato-gastro-entérologie pédiatrique, Montpellier, France
| | - L Christa
- Service de Biochimie Métabolique Hôpital Necker Enfants Malades, Paris, France
| | - C Vianey-Saban
- Service de Biochimie Métabolique Hôpital Femme Mère Enfant, Lyon, France
| | - C Corne
- Service de Biochimie Métabolique, Grenoble, France
| | - A Roubertie
- Service de Neuropédiatrie Hôpital Gui de Chauliac, Montpellier, France.
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Smit M, Bartels AL, van Faassen M, Kuiper A, Niezen-Koning KE, Kema IP, Dierckx RA, de Koning TJ, Tijssen MA. Serotonergic perturbations in dystonia disorders-a systematic review. Neurosci Biobehav Rev 2016; 65:264-75. [PMID: 27073048 DOI: 10.1016/j.neubiorev.2016.03.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/02/2016] [Accepted: 03/22/2016] [Indexed: 11/26/2022]
Abstract
Dystonia is a hyperkinetic movement disorder characterized by sustained or intermittent muscle contractions. Emerging data describe high prevalences of non-motor symptoms, including psychiatric co-morbidity, as part of the phenotype of dystonia. Basal ganglia serotonin and serotonin-dopamine interactions gain attention, as imbalances are known to be involved in extrapyramidal movement and psychiatric disorders. We systematically reviewed the literature for human and animal studies relating to serotonin and its role in dystonia. An association between dystonia and the serotonergic system was reported with decreased levels of 5-hydroxyindolacetic acid, the main metabolite of serotonin. A relation between dystonia and drugs affecting the serotonergic system was described in 89 cases in 49 papers. Psychiatric co-morbidity was frequently described, but likely underestimated as it was not systematically examined. Currently, there are no good (pharmaco)therapeutic options for most forms of dystonia or associated non-motor symptoms. Further research using selective serotonergic drugs in appropriate models of dystonia is required to establish the role of the serotonergic system in dystonia and to guide us to new therapeutic strategies.
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Affiliation(s)
- M Smit
- University of Groningen, University Medical Center Groningen, Department of Neurology, PO Box 30.001, 9700, RB Groningen, The Netherlands.
| | - A L Bartels
- University of Groningen, University Medical Center Groningen, Department of Neurology, PO Box 30.001, 9700, RB Groningen, The Netherlands; Ommelander Hospital Group, Department of Neurology, PO Box 30.000, 9930 RA Delfzijl, The Netherlands.
| | - M van Faassen
- University of Groningen, University Medical Center Groningen, Department of Laboratory Medicine, PO Box 30.001, 9700, RB Groningen, The Netherlands.
| | - A Kuiper
- University of Groningen, University Medical Center Groningen, Department of Neurology, PO Box 30.001, 9700, RB Groningen, The Netherlands.
| | - K E Niezen-Koning
- University of Groningen, University Medical Center Groningen, Department of Laboratory Medicine, PO Box 30.001, 9700, RB Groningen, The Netherlands.
| | - I P Kema
- University of Groningen, University Medical Center Groningen, Department of Laboratory Medicine, PO Box 30.001, 9700, RB Groningen, The Netherlands.
| | - R A Dierckx
- University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, PO Box 30.001, 9700 RB Groningen, The Netherlands.
| | - T J de Koning
- University of Groningen, University Medical Center Groningen, Department of Genetics, PO Box 30.001, 9700 RB Groningen, The Netherlands.
| | - M A Tijssen
- University of Groningen, University Medical Center Groningen, Department of Neurology, PO Box 30.001, 9700, RB Groningen, The Netherlands.
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The chaperone role of the pyridoxal 5′-phosphate and its implications for rare diseases involving B6-dependent enzymes. Clin Biochem 2014; 47:158-65. [DOI: 10.1016/j.clinbiochem.2013.11.021] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 11/28/2013] [Accepted: 11/30/2013] [Indexed: 02/06/2023]
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