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Wedman JJ, Sibon OCM, Mastantuono E, Iuso A. Impaired coenzyme A homeostasis in cardiac dysfunction and benefits of boosting coenzyme A production with vitamin B5 and its derivatives in the management of heart failure. J Inherit Metab Dis 2024. [PMID: 38591231 DOI: 10.1002/jimd.12737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/10/2024]
Abstract
Coenzyme A (CoA) is an essential cofactor required for over a hundred metabolic reactions in the human body. This cofactor is synthesized de novo in our cells from vitamin B5, also known as pantothenic acid, a water-soluble vitamin abundantly present in vegetables and animal-based foods. Neurodegenerative disorders, cancer, and infectious diseases have been linked to defects in de novo CoA biosynthesis or reduced levels of this coenzyme. There is now accumulating evidence that CoA limitation is a critical pathomechanism in cardiac dysfunction too. In the current review, we will summarize our current knowledge on CoA and heart failure, with emphasis on two primary cardiomyopathies, phosphopantothenoylcysteine synthetase and phosphopantothenoylcysteine decarboxylase deficiency disorders biochemically characterized by a decreased level of CoA in patients' samples. Hence, we will discuss the potential benefits of CoA restoration in these diseases and, more generally, in heart failure, by vitamin B5 and its derivatives pantethine and 4'-phosphopantetheine.
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Affiliation(s)
- J J Wedman
- Department of Biomedical Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - O C M Sibon
- Department of Biomedical Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - E Mastantuono
- Regenerative Medicine in Cardiovascular Diseases, First Department of Medicine, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
- First Department of Medicine, Cardiology, Klinikum Rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Germany
| | - A Iuso
- Institute of Neurogenomics, Helmholtz Zentrum München, Neuherberg, Germany
- Institute of Human Genetics, Technical University of Munich, School of Medicine and Health, Munich, Germany
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2
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Sandkuhler SE, Youngs KS, Owlett L, Bandora MB, Naaz A, Kim ES, Wang L, Wojtovich AP, Gupta VA, Sacher M, Mackenzie SJ. Haem's relevance genuine? Re-visiting the roles of TANGO2 homologues including HRG-9 and HRG-10 in C. elegans. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.11.29.569072. [PMID: 38106020 PMCID: PMC10723261 DOI: 10.1101/2023.11.29.569072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Mutations in the TANGO2 gene cause severe illness in humans, including life-threatening metabolic crises; however, the function of TANGO2 protein remains unknown. In a recent publication in Nature, Sun et al. proposed that TANGO2 helps transport haem within and between cells, from areas with high haem concentrations to those with lower concentrations. Caenorhabditis elegans has two versions of TANGO2 that Sun et al. called HRG-9 and HRG-10. They demonstrated that worms deficient in these proteins show increased survival upon exposure to a toxic haem analog, which Sun et al. interpreted as evidence of decreased haem uptake from intestinal cells into the rest of the organism. We repeated several experiments using the same C. elegans strain as Sun et al. and believe that their findings are better explained by reduced feeding behavior in these worms. We demonstrate that hrg-9 in particular is highly responsive to oxidative stress, independent of haem status. Our group also performed several experiments in yeast and zebrafish models of TANGO2 deficiency and was unable to replicate key findings from these models reported in Sun et al.'s original study. Overall, we believe there is insufficient evidence to support haem transport as the primary function for TANGO2.
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Affiliation(s)
- Sarah E. Sandkuhler
- Department of Pathology, University of Rochester Medical Center, Rochester, NY
| | - Kayla S. Youngs
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Laura Owlett
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | | | - Aaliya Naaz
- Department of Anatomy and Cell Biology, Concordia, Montreal, Canada
| | - Euri S. Kim
- Department of Medicine, Brigham and Women’s Hospital Harvard Medical School, Boston, MA
| | - Lili Wang
- Department of Pharmacology, Vanderbilt University, Nashville, TN
| | - Andrew P. Wojtovich
- Department of Anesthesiology and Perioperative Medicine, University of Rochester Medical Center, Rochester, NY
| | - Vandana A. Gupta
- Department of Medicine, Brigham and Women’s Hospital Harvard Medical School, Boston, MA
| | - Michael Sacher
- Department of Anatomy and Cell Biology, Concordia, Montreal, Canada
- Department of Biology, McGill University, Montreal, Canada
| | - Samuel J. Mackenzie
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
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3
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Dias JV, Carvalho AA, Freixo JP, Antunes D, Martins AA, Painho T, Jacinto S. TANGO2 Deficiency Disorder: Two Cases of Developmental Delay Preceding Metabolic Crisis. Pediatr Neurol 2023; 147:52-55. [PMID: 37562170 DOI: 10.1016/j.pediatrneurol.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/07/2023] [Accepted: 07/09/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND TANGO2 deficiency disorder is a rare genetic disease caused by biallelic defects in TANGO2 gene. METHODS We report the clinical phenotype of two children with TANGO2 deficiency disorder. RESULTS Patient 1 is a female child presenting with developmental delay and microcephaly during the second year of life, who evolved with severe cognitive impairment, facial dysmorphisms, spastic paraparesis, and atonic seizures. At age 13 years, she was hospitalized due to an episode of rhabdomyolysis complicated with cardiac arrhythmia and hypothyroidism. Patient 2 is a female child with dysmorphic facial features, cleft palate, and developmental delay who was diagnosed with DiGeorge syndrome. At age three years, she presented with an acute episode of severe rhabdomyolysis in the context of human herpesvirus 6 infection. After the resolution of this acute episode, she maintained recurrent muscle weakness with axial hypotonia and progressive spasticity of the lower extremities. In both patients, diagnosis of TANGO2 deficiency disorder was only confirmed after an acute metabolic crisis. CONCLUSIONS A high index of suspicion for TANGO2 deficiency disorder is needed in patients with developmental delay or other neurological symptoms and episodic rhabdomyolysis.
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Affiliation(s)
| | - Ana Araújo Carvalho
- Pediatric Department, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - João Parente Freixo
- Center for Predictive and Preventive Genetics, Institute of Molecular and Cell Biology, Porto, Portugal; i3S - Instituto de Investigação e Inovação em Saúde da Universidade do Porto, Porto, Portugal
| | - Diana Antunes
- Medical Genetics Department, Centro Hospital Universitário de Lisboa Central, Lisbon, Portugal
| | - Ana Antunes Martins
- Pediatric Neurology Department, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal; Pediatric Neurology Unit, Hospital da Luz, Lisbon, Portugal
| | - Teresa Painho
- Pediatric Neurology Department, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Sandra Jacinto
- Pediatric Neurology Department, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
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4
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Kim ES, Casey JG, Tao BS, Mansur A, Mathiyalagan N, Wallace ED, Ehrmann BM, Gupta VA. Intrinsic and extrinsic regulation of rhabdomyolysis susceptibility by Tango2. Dis Model Mech 2023; 16:dmm050092. [PMID: 37577943 PMCID: PMC10499024 DOI: 10.1242/dmm.050092] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023] Open
Abstract
Rhabdomyolysis is a clinical emergency characterized by severe muscle damage, resulting in the release of intracellular muscle components, which leads to myoglobinuria and, in severe cases, acute kidney failure. Rhabdomyolysis is caused by genetic factors linked to increased disease susceptibility in response to extrinsic triggers. Recessive mutations in TANGO2 result in episodic rhabdomyolysis, metabolic crises, encephalopathy and cardiac arrhythmia. The underlying mechanism contributing to disease onset in response to specific triggers remains unclear. To address these challenges, we created a zebrafish model of Tango2 deficiency. Here, we demonstrate that the loss of Tango2 in zebrafish results in growth defects, early lethality and increased susceptibility of skeletal muscle defects in response to extrinsic triggers, similar to TANGO2-deficient patients. Using lipidomics, we identified alterations in the glycerolipid pathway in tango2 mutants, which is critical for membrane stability and energy balance. Therefore, these studies provide insight into key disease processes in Tango2 deficiency and have increased our understanding of the impacts of specific defects on predisposition to environmental triggers in TANGO2-related disorders.
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Affiliation(s)
- Euri S. Kim
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital Harvard Medical School, Boston, MA 02115, USA
| | - Jennifer G. Casey
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital Harvard Medical School, Boston, MA 02115, USA
| | - Brian S. Tao
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital Harvard Medical School, Boston, MA 02115, USA
| | - Arian Mansur
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital Harvard Medical School, Boston, MA 02115, USA
| | - Nishanthi Mathiyalagan
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital Harvard Medical School, Boston, MA 02115, USA
| | - E. Diane Wallace
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Brandie M. Ehrmann
- Department of Chemistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Vandana A. Gupta
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital Harvard Medical School, Boston, MA 02115, USA
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Miyake CY, Ehsan SA, Zhang L, Mackenzie SJ, Azamian MS, Scott DA, Hernandez-Garcia A, Lalani SR. Early initiation of B-vitamin supplementation may reduce symptoms and explain intrafamilial variability: Insights from two sibling pairs from the TANGO2 natural history study. Am J Med Genet A 2023; 191:2433-2439. [PMID: 37421366 PMCID: PMC10612108 DOI: 10.1002/ajmg.a.63331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 05/07/2023] [Accepted: 05/26/2023] [Indexed: 07/10/2023]
Abstract
TANGO2-deficiency disorder (TDD) is an autosomal recessive condition arising from pathogenic biallelic variants in the TANGO2 gene. TDD is characterized by symptoms typically beginning in late infancy including delayed developmental milestones, cognitive impairment, dysarthria, expressive language deficits, and gait abnormalities. There is wide phenotypic variability where some are severely affected while others have mild symptoms. This variability has been documented even among sibling pairs who share the same genotype, but reasons for this variability have not been well understood. Emerging data suggest a potential link between B-complex or multivitamin supplementation and decreased metabolic crises in TDD. In this report, we describe two sibling pairs from unreladiagnosed with TDD with marked differences in symptoms. In both families, the older siblings suffered multiple metabolic crises and are clinically more affected than their younger siblings who have very mild to no symptoms; they are the least impaired among 70 other patients in our ongoing international natural history study. Unlike their older siblings, the two younger siblings started taking B-complex vitamins early between 9 and 16 months. This report delineates the mildest presentation of TDD in two families. These data may support a role for early diagnosis and initiation of vitamin supplementation to not only prevent metabolic crises but also improve neurologic outcomes in this life-threatening disorder.
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Affiliation(s)
- Christina Y. Miyake
- Department of Pediatrics, Division of Cardiology, Texas Children’s Hospital, Houston, TX, 77030, USA
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, 77030, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Saad A. Ehsan
- Baylor College School of Medicine, Houston, TX, 77030, USA
| | - Lilei Zhang
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, 77030, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, 77030, USA
| | - Samuel J. Mackenzie
- Department of Neurology, University of Rochester Medical Center, Rochester, NY USA, 14642, USA
| | - Mahshid S. Azamian
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, 77030, USA
| | - Daryl A. Scott
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, 77030, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, 77030, USA
| | - Andres Hernandez-Garcia
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, 77030, USA
| | - Seema R. Lalani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, 77030, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, 77030, USA
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Miyake CY, Lay EJ, Soler-Alfonso C, Glinton KE, Houck KM, Tosur M, Moran NE, Stephens SB, Scaglia F, Howard TS, Kim JJ, Pham TD, Valdes SO, Li N, Murali CN, Zhang L, Kava M, Yim D, Beach C, Webster G, Liberman L, Janson CM, Kannankeril PJ, Baxter S, Singer-Berk M, Wood J, Mackenzie SJ, Sacher M, Ghaloul-Gonzalez L, Pedroza C, Morris SA, Ehsan SA, Azamian MS, Lalani SR. Natural history of TANGO2 deficiency disorder: Baseline assessment of 73 patients. Genet Med 2023; 25:100352. [PMID: 36473599 PMCID: PMC10306319 DOI: 10.1016/j.gim.2022.11.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE TANGO2 deficiency disorder (TDD), an autosomal recessive disease first reported in 2016, is characterized by neurodevelopmental delay, seizures, intermittent ataxia, hypothyroidism, and life-threatening metabolic and cardiac crises. The purpose of this study was to define the natural history of TDD. METHODS Data were collected from an ongoing natural history study of patients with TDD enrolled between February 2019 and May 2022. Data were obtained through phone or video based parent interviews and medical record review. RESULTS Data were collected from 73 patients (59% male) from 57 unrelated families living in 16 different countries. The median age of participants at the time of data collection was 9.0 years (interquartile range = 5.3-15.9 years, range = fetal to 31.8 years). A total of 24 different TANGO2 alleles were observed. Patients showed normal development in early infancy, with progressive delay in developmental milestones thereafter. Symptoms included ataxia, dystonia, and speech difficulties, typically starting between the ages of 1 to 3 years. A total of 46/71 (65%) patients suffered metabolic crises, and of those, 30 (65%) developed cardiac crises. Metabolic crises were significantly decreased after the initiation of B-complex or multivitamin supplementation. CONCLUSION We provide the most comprehensive review of natural history of TDD and important observational data suggesting that B-complex or multivitamins may prevent metabolic crises.
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Affiliation(s)
- Christina Y Miyake
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX; Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston TX.
| | - Erica J Lay
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | | | - Kevin E Glinton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Kimberly M Houck
- Division of Neurology and Developmental Neuroscience, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Mustafa Tosur
- Division of Diabetes and Endocrinology, Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Nancy E Moran
- USDA/ARS Children's Nutrition Research Center, Division of Nutrition, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Sara B Stephens
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Fernando Scaglia
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX; BCM-CUHK Center of Medical Genetics, Prince of Wales Hospital, Hong Kong, Special Administrative Region
| | - Taylor S Howard
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Jeffrey J Kim
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Tam Dam Pham
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Santiago O Valdes
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Na Li
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston TX; Department of Medicine, Section of Cardiovascular Research, Baylor College of Medicine, Houston, TX
| | - Chaya N Murali
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Lilei Zhang
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston TX; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Maina Kava
- Department of Neurology, Perth Children's Hospital, Perth, Western Australia, Australia; Departments of Metabolic Medicine and Rheumatology, Perth Children's Hospital, Perth, Western Australia, Australia; Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Deane Yim
- Department of Cardiology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Cheyenne Beach
- Division of Cardiology, Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, CT
| | - Gregory Webster
- Division of Cardiology, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Nortwestern University Feinberg School of Medicine, Chicago, IL
| | - Leonardo Liberman
- Division of Cardiology, Department of Pediatrics, New York Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Christopher M Janson
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Prince J Kannankeril
- Center for Pediatric Precision Medicine, Department of Pediatrics, Vanderbilt University Medical Center and the Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
| | | | | | - Jordan Wood
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Samuel J Mackenzie
- Department of Neurology, University of Rochester Medical Center, Rochester, NY
| | - Michael Sacher
- Department of Biology, Concordia University, Montreal, Quebec, Canada; Department of Anatomy and Cell Biology, McGill University, Montreal, Quebec, Canada
| | - Lina Ghaloul-Gonzalez
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA
| | - Claudia Pedroza
- Department of Pediatrics, McGovern Medical School, University of Texas Health Center at Houston, Houston, TX
| | - Shaine A Morris
- Division of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | | | - Mahshid S Azamian
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
| | - Seema R Lalani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX
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7
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Restrepo-Vera JL, Muñoz-Cabello P, Pérez-Rodon J, Rovira-Moreno E, Codina-Solà M, Llauradó A, Salvadó M, Sánchez-Tejerina D, Sotoca J, Martínez-Sáez E, García-Arumí E, Juntas-Morales R. Limb-girdle myopathy and mild intellectual disability: the expanding spectrum of TANGO2-related disease. Neuromuscul Disord 2023; 33:463-467. [PMID: 37119590 DOI: 10.1016/j.nmd.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/29/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023]
Abstract
TANGO2-related disease is an autosomal recessive multisystem disease associated with developmental delay and infancy-onset recurrent metabolic crises with early mortality. Several studies have reported dysfunction in endoplasmic reticulum-to-Golgi traffic and mitochondrial homoeostasis as the underlying pathophysiology. We report a 40-year-old woman affected by limb-girdle weakness and mild intellectual disability caused by the recurrent deletion of exons 3-9 in homozygosity in the TANGO2 gene. Physical examination revealed hyperlordosis, waddling gait, calf pseudohypertrophy, and Aquilian tendon retractions. Laboratory investigations revealed elevation of serum biomarkers suggestive of mitochondrial dysfunction together with hypothyroidism. At the age of 24, the patient suffered a metabolic crisis with severe rhabdomyolysis and malignant cardiac arrhythmia. After recovery, no metabolic or arrhythmic crisis has recurred. Muscle histology two years later revealed increased endomysial fibrosis and other myopathic changes. Our findings illustrate the mildest end of the phenotypic spectrum of TANGO2-related disease and reveal further aspects related to chronic muscle damage in this disorder.
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Affiliation(s)
- Juan Luis Restrepo-Vera
- Department of Neurology, Neuromuscular Diseases Unit, European Reference Network on Rare Neuromuscular Diseases (ERN EURO-NMD), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron, 119-135, Barcelona 08035, Spain
| | - Patricia Muñoz-Cabello
- Department of Clinical and Molecular Genetics, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona 08035, Spain; Medicine Genetics Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona 08035, Spain
| | - Jordi Pérez-Rodon
- Department of Cardiology, Hospital Universitari Vall d'Hebrón, Universitat Autònoma de Barcelona, Vall d'Hebrón Institut de Recerca, CIBER-CV, Barcelona, Spain
| | - Eulàlia Rovira-Moreno
- Department of Clinical and Molecular Genetics, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona 08035, Spain; Medicine Genetics Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona 08035, Spain
| | - Marta Codina-Solà
- Department of Clinical and Molecular Genetics, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona 08035, Spain; Medicine Genetics Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona (UAB), Barcelona 08035, Spain
| | - Arnau Llauradó
- Department of Neurology, Neuromuscular Diseases Unit, European Reference Network on Rare Neuromuscular Diseases (ERN EURO-NMD), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron, 119-135, Barcelona 08035, Spain
| | - Maria Salvadó
- Department of Neurology, Neuromuscular Diseases Unit, European Reference Network on Rare Neuromuscular Diseases (ERN EURO-NMD), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron, 119-135, Barcelona 08035, Spain
| | - Daniel Sánchez-Tejerina
- Department of Neurology, Neuromuscular Diseases Unit, European Reference Network on Rare Neuromuscular Diseases (ERN EURO-NMD), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron, 119-135, Barcelona 08035, Spain
| | - Javier Sotoca
- Department of Neurology, Neuromuscular Diseases Unit, European Reference Network on Rare Neuromuscular Diseases (ERN EURO-NMD), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron, 119-135, Barcelona 08035, Spain
| | - Elena Martínez-Sáez
- Department of Pathology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona 08035, Spain
| | - Elena García-Arumí
- Department of Clinical and Molecular Genetics, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona 08035, Spain; Research Group on Neuromuscular and Mitochondrial Diseases, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain; Biomedical Network Research Centre on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Raul Juntas-Morales
- Department of Neurology, Neuromuscular Diseases Unit, European Reference Network on Rare Neuromuscular Diseases (ERN EURO-NMD), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d'Hebron, 119-135, Barcelona 08035, Spain.
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8
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Gomes SA, Laranjo S, Trigo C, Pinto FF. The TANGO2 disease and the therapeutic challenge of acute arrhythmia management: a case report. Eur Heart J Case Rep 2023; 7:ytad044. [PMID: 36819889 PMCID: PMC9927555 DOI: 10.1093/ehjcr/ytad044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/28/2022] [Accepted: 01/25/2023] [Indexed: 02/01/2023]
Abstract
Background TANGO2-related metabolic encephalopathy and arrhythmia are a rare, newly recognized, and likely under-diagnosed condition. First described in 2016, it is characterized by developmental delay and recurrent metabolic crisis. During these episodes, patients may present QTc prolongation and ventricular arrhythmias. Case summary A 13-year-old female, with developmental delay, presented with severe rhabdomyolysis and an initially normal electrocardiogram (ECG). Due to the worsening of rhabdomyolysis, QTc prolongation was identified (QTc 570 ms) and oral β-blocker therapy started. A non-sustained ventricular tachycardia developed, initially managed with magnesium and lidocaine. After a short period, an arrhythmic storm of polymorphic ventricular extrasystoles induced Torsade de Pointes (TdP) was triggered. A temporary percutaneous pacing lead was placed and esmolol infusion started. The electrical instability ran in parallel with the increasing severity of rhabdomyolysis and systolic ventricular function decline. Genetic testing identified a pathogenic variant in homozygosity in the TANGO2 gene. A stable sinus rhythm was achieved with metabolic and serum electrolytes optimization. ECG showed normalization of the QTc interval. Discussion The full TANGO2-related phenotype emerges over time and the prognosis is linked to the appearance of ECG abnormalities. QT interval prolongation can lead to life-threatening ventricular tachycardias. The arrhythmia mechanism seems to be secondary to metabolite build-up in cardiomyocytes, which can explain the cardiac phenotype during the crisis which subsides after their resolution. In these patients, avoiding bradycardia is fundamental, since long QT-related TdP seems to be triggered by bradycardia and short-long-short ventricular premature beats (VPB). During an acute metabolic crisis, the management of arrhythmias relies on metabolic control.
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Affiliation(s)
- Sílvia A Gomes
- Corresponding author. Tel: +351 213594332, Fax: +351 218841023,
| | - Sérgio Laranjo
- Serviço de Cardiologia Pediátrica, Hospital de Santa Marta, Centro Hospitalar e Universitário de Lisboa Central, Rua de Santa Marta 50, 1169-024 Lisboa, Portugal,Centro de Referência de Cardiopatias Congénitas do Centro Hospitalar e Universitário de Lisboa Central, Member of the European Reference Network for rare, low-prevalence, or complex diseases of the heart (ERN Guard-Heart), Rua de Santa Marta, nº 50.1169-024 Lisboa, Portugal
| | - Conceição Trigo
- Serviço de Cardiologia Pediátrica, Hospital de Santa Marta, Centro Hospitalar e Universitário de Lisboa Central, Rua de Santa Marta 50, 1169-024 Lisboa, Portugal,Centro de Referência de Cardiopatias Congénitas do Centro Hospitalar e Universitário de Lisboa Central, Member of the European Reference Network for rare, low-prevalence, or complex diseases of the heart (ERN Guard-Heart), Rua de Santa Marta, nº 50.1169-024 Lisboa, Portugal
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Yokoi K, Nakajima Y, Takahashi Y, Hamajima T, Tajima G, Saito K, Miyai S, Inagaki H, Yoshikawa T, Kurahashi H, Ito T. Transport and Golgi organization 2 deficiency with a prominent elevation of C14:1 during a metabolic crisis: A case report. JIMD Rep 2023; 64:3-9. [PMID: 36636595 PMCID: PMC9830013 DOI: 10.1002/jmd2.12275] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 01/16/2023] Open
Abstract
Mutations in transport and Golgi organization 2 homolog (TANGO2) have recently been described as a cause of an autosomal recessive syndrome characterized by episodes of metabolic crisis associated with rhabdomyolysis, cardiac arrhythmias, and neurodegeneration. Herein, we report a case of a one-and-a-half-year-old Japanese girl, born to nonconsanguineous parents, who presented with metabolic crisis characterized by hypoglycemia with hypoketonemia, rhabdomyolysis, lactic acidosis, and prolonged corrected QT interval (QTc) at the age of 6 months. Acylcarnitine analysis during the episode of crisis showed prominent elevation of C14:1, suggesting very-long-chain acyl-CoA dehydrogenase (VLCAD) deficiency. In addition, worsening rhabdomyolysis was observed after intravenous administration of L-carnitine. VLCAD deficiency was initially suspected; however, the enzyme activity in lymphocytes was only mildly decreased at the gene carrier level, and no mutation in the VLCAD gene (ADADVL) was detected. Subsequently, acylcarnitine analysis was nonspecific at 17-h fasting and almost normal during the stable phase. Eventually, a trio whole-exome sequencing revealed a compound heterozygous variant of two novel variants in the TANGO2 gene, a missense variant, and a deletion of exon 7. This is the first case of TANGO2 deficiency in Asians. Our case suggests that elevated C14:1 may be seen in severe metabolic crises and that the use of L-carnitine should be avoided during metabolic crises.
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Affiliation(s)
- Katsuyuki Yokoi
- Department of PediatricsFujita Health University School of MedicineToyoakeJapan
- Division of Molecular GeneticsInstitute for Comprehensive Medical Science, Fujita Health UniversityToyoakeJapan
| | - Yoko Nakajima
- Department of PediatricsFujita Health University School of MedicineToyoakeJapan
| | - Yoshihisa Takahashi
- Department of Endocrinology and MetabolismAichi Children's Health and Medical CenterOhbuJapan
| | - Takashi Hamajima
- Department of Endocrinology and MetabolismAichi Children's Health and Medical CenterOhbuJapan
| | - Go Tajima
- Division of Neonatal ScreeningResearch Institute, National Center for Child Health and DevelopmentTokyoJapan
| | - Kazuyoshi Saito
- Department of PediatricsFujita Health University School of MedicineToyoakeJapan
| | - Shunsuke Miyai
- Division of Molecular GeneticsInstitute for Comprehensive Medical Science, Fujita Health UniversityToyoakeJapan
| | - Hidehito Inagaki
- Division of Molecular GeneticsInstitute for Comprehensive Medical Science, Fujita Health UniversityToyoakeJapan
| | - Tetsushi Yoshikawa
- Department of PediatricsFujita Health University School of MedicineToyoakeJapan
| | - Hiroki Kurahashi
- Division of Molecular GeneticsInstitute for Comprehensive Medical Science, Fujita Health UniversityToyoakeJapan
| | - Tetsuya Ito
- Department of PediatricsFujita Health University School of MedicineToyoakeJapan
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10
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HRG-9 homologues regulate haem trafficking from haem-enriched compartments. Nature 2022; 610:768-774. [PMID: 36261532 PMCID: PMC9810272 DOI: 10.1038/s41586-022-05347-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/14/2022] [Indexed: 02/05/2023]
Abstract
Haem is an iron-containing tetrapyrrole that is critical for a variety of cellular and physiological processes1-3. Haem binding proteins are present in almost all cellular compartments, but the molecular mechanisms that regulate the transport and use of haem within the cell remain poorly understood2,3. Here we show that haem-responsive gene 9 (HRG-9) (also known as transport and Golgi organization 2 (TANGO2)) is an evolutionarily conserved haem chaperone with a crucial role in trafficking haem out of haem storage or synthesis sites in eukaryotic cells. Loss of Caenorhabditis elegans hrg-9 and its paralogue hrg-10 results in the accumulation of haem in lysosome-related organelles, the haem storage site in worms. Similarly, deletion of the hrg-9 homologue TANGO2 in yeast and mammalian cells induces haem overload in mitochondria, the site of haem synthesis. We demonstrate that TANGO2 binds haem and transfers it from cellular membranes to apo-haemoproteins. Notably, homozygous tango2-/- zebrafish larvae develop pleiotropic symptoms including encephalopathy, cardiac arrhythmia and myopathy, and die during early development. These defects partially resemble the symptoms of human TANGO2-related metabolic encephalopathy and arrhythmias, a hereditary disease caused by mutations in TANGO24-8. Thus, the identification of HRG-9 as an intracellular haem chaperone provides a biological basis for exploring the aetiology and treatment of TANGO2-related disorders.
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11
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Miyake CY, Lay EJ, Beach CM, Ceresnak SR, Delauz CM, Howard TS, Janson CM, Jardine K, Kannankeril PJ, Kava M, Kim JJ, Liberman L, Macicek SL, Pham TD, Robertson T, Valdes SO, Webster G, Stephens SB, Milewicz DM, Azamian M, Ehsan SA, Houck KM, Soler-Alfonso C, Glinton KE, Tosur M, Li N, Xu W, Lalani SR, Zhang L. Cardiac crises: Cardiac arrhythmias and cardiomyopathy during TANGO2 deficiency related metabolic crises. Heart Rhythm 2022; 19:1673-1681. [PMID: 35568137 PMCID: PMC10642301 DOI: 10.1016/j.hrthm.2022.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND TANGO2 deficiency disorder (TDD) is an autosomal recessive disease associated with metabolic crisis, lethal cardiac arrhythmias, and cardiomyopathy. Data regarding treatment, management, and outcomes of cardiac manifestations of TDD are lacking. OBJECTIVE The purpose of this study was to describe TDD-related cardiac crises. METHODS Retrospective multicenter chart review was made of TDD patients admitted with cardiac crises, defined as development of ventricular tachycardia (VT), cardiomyopathy, or cardiac arrest during metabolic crises. RESULTS Twenty-seven children were admitted for 43 cardiac crises (median age 6.4 years; interquartile range [IQR] 2.4-9.8 years) at 14 centers. During crisis, QTc prolongation occurred in all (median 547 ms; IQR 504-600 ms) and a type I Brugada pattern in 8 (26%). Arrhythmias included VT in 21 (78%), supraventricular tachycardia in 3 (11%), and heart block in 1 (4%). Nineteen patients (70%) developed cardiomyopathy, and 20 (74%) experienced a cardiac arrest. There were 10 deaths (37%), 6 related to arrhythmias. In 5 patients, recalcitrant VT occurred despite use of antiarrhythmic drugs. In 6 patients, arrhythmias were controlled after extracorporeal membrane oxygenation (ECMO) support; 5 of these patients survived. Among 10 patients who survived VT without ECMO, successful treatment included intravenous magnesium, isoproterenol, and atrial pacing in multiple cases and verapamil in 1 patient. Initiation of feeds seemed to decrease VT events. CONCLUSION TDD-related cardiac crises are associated with a high risk of arrhythmias, cardiomyopathy, cardiac arrest, and death. Although further studies are needed, early recognition and appropriate treatment are critical. Acutely, intravenous magnesium, isoproterenol, atrial pacing, and ECMO as a last resort seem to be the best current treatment options, and early initiation of feeds may prevent VT events.
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Affiliation(s)
- Christina Y Miyake
- Department of Pediatrics, Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas; Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston Texas.
| | - Erica J Lay
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | | | - Scott R Ceresnak
- Lucile Packard Children's Hospital, Stanford University, Palo Alto, California
| | | | - Taylor S Howard
- Department of Pediatrics, Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | | | - Kate Jardine
- John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | | | - Maina Kava
- Department of Neurology and Metabolic Medicine, Perth Children's Hospital, Perth, Western Australia
| | - Jeffrey J Kim
- Department of Pediatrics, Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Leonardo Liberman
- New York Presbyterian, Morgan Stanley Children's Hospital, New York, New York
| | | | - Tam Dam Pham
- Department of Pediatrics, Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | | | - Santiago O Valdes
- Department of Pediatrics, Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | | | - Sara B Stephens
- Department of Pediatrics, Division of Pediatric Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Diana M Milewicz
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Center at Houston, Houston, Texas
| | - Mahshid Azamian
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Saad A Ehsan
- Baylor College School of Medicine, Houston, Texas
| | - Kimberly M Houck
- Department of Pediatrics, Division of Neurology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Claudia Soler-Alfonso
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Kevin E Glinton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Mustafa Tosur
- Department of Pediatrics, Division of Endocrinology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Na Li
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Center at Houston, Houston, Texas
| | - Weiyi Xu
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Seema R Lalani
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Lilei Zhang
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston Texas; Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
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12
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Schymick J, Leahy P, Cowan T, Ruzhnikov MRZ, Gates R, Fernandez L, Pramanik G, Yarlagadda V, Wheeler M, Bernstein JA, Enns GM, Lee C. Variable clinical severity in TANGO2 deficiency: Case series and literature review. Am J Med Genet A 2021; 188:473-487. [PMID: 34668327 DOI: 10.1002/ajmg.a.62543] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/21/2021] [Accepted: 09/29/2021] [Indexed: 11/10/2022]
Abstract
Biallelic pathogenic variants in the TANGO2 (transport and Golgi organization 2 homolog) gene have been identified as causing a rare metabolic disorder characterized by susceptibility to recurrent rhabdomyolysis, lactic acidosis, encephalopathy, and life-threatening tachyarrhythmias. Recently published reports suggest variable clinical severity and phenotypes. This study details five new patients from two families with biallelic pathogenic variants in the TANGO2 gene identified by whole exome sequencing and includes the largest number of affected individuals from a single family reported to date. We document significant intrafamilial variability and highlight that milder phenotypes may be underrecognized. We present biochemical and clinical data to help highlight the features that aid in consideration of this condition in the differential with disorders of fatty acid oxidation. We also present a comprehensive literature review summarizing the molecular, clinical, and biochemical findings for 92 individuals across 13 publications. Of the 27 pathogenic variants reported to date, the recurrent exons 3-9 deletion represents the most common variant seen in 42% of individuals with TANGO2 deficiency. Common clinical features seen in >70% of all individuals include acute metabolic crisis, rhabdomyolysis, neurologic abnormalities, developmental delay, and intellectual disability. Findings such as elevated creatine kinase, hypothyroidism, ketotic hypoglycemia, QT prolongation, or abnormalities of long-chain acylcarnitines and urine dicarboxylic acids should raise clinical suspicion for this life-threatening condition.
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Affiliation(s)
- Jennifer Schymick
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Department of Pediatrics, Santa Clara Valley Health and Hospital System, San Jose, California, USA
| | - Peter Leahy
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Tina Cowan
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Maura R Z Ruzhnikov
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA.,Stanford Center for Undiagnosed Diseases, Stanford, California, USA
| | - Ryan Gates
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | | | - Gopal Pramanik
- Stanford Center for Undiagnosed Diseases, Stanford, California, USA
| | | | - Vamsi Yarlagadda
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Matthew Wheeler
- Stanford Center for Undiagnosed Diseases, Stanford, California, USA.,Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Jonathan A Bernstein
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.,Stanford Center for Undiagnosed Diseases, Stanford, California, USA
| | - Gregory M Enns
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Chung Lee
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
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