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Tamhankar PM, Vasudevan L, Kondurkar P, Niazi S, Christopher R, Solanki D, Dholakia P, Muranjan M, Kamate M, Kalane U, Sheth J, Tamhankar V, Gulati R, Vasikarla M, Danda S, Naushad SM, Girisha KM, Patil S. Clinical Characteristics, Molecular Profile, and Outcomes in Indian Patients with Glutaric Aciduria Type 1. J Pediatr Genet 2021; 10:213-221. [PMID: 34504725 DOI: 10.1055/s-0040-1715528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/27/2020] [Indexed: 10/23/2022]
Abstract
Glutaric acidemia type 1 (GA-1, OMIM 231670) is an autosomal recessive inborn error of metabolism caused by the deficiency of glutaryl-coenzyme A (CoA) dehydrogenase with most children presenting in infancy with encephalopathy, dystonia, and macrocephaly. In this article, we presented the clinical characteristics, molecular profile, and outcomes in 29 unrelated families with affected children (30 cases total). The mean age at onset of illness was 10 months (±14.58), whereas the mean age at referral for molecular diagnosis was 29.44 months (±28.11). Patients were residents of nine different states of India. Clinical presentation varied from acute encephalitis followed by neuroregression and chronic/insidious developmental delay. Neurological sequelae varied from asymptomatic (no sequelae, 2 patients) to moderate (5 patients) and severe (23 patients) sequelae. All patients underwent blood tandem mass spectrometry (TMS on dried blood spots) and/or urine gas chromatography mass spectrometry (GCMS). Neuroimaging demonstrated batwing appearance in 95% cases. Sanger's sequencing of GCDH , covering all exons and exon-intron boundaries, was performed for all patients. Variants identified include 15 novel coding variants: p.Met100Thr, p.Gly107Ser, p.Leu179Val, p.Pro217Ser, p. Phe236Leufs*107, p.Ser255Pro, p.Met266Leufs*2, p.Gln330Ter, p.Thr344Ile, p.Leu345Pro, p.Lys377Arg, p.Leu424Pro, p.Asn373Lys, p.Lys377Arg, p.Asn392Metfs*9, and nine known genetic variants such as p.Arg128Gln, p.Leu179Arg, p.Trp225Ter, p.Met339Val, p.Gly354Ser, p.Arg402Gln, p.Arg402Trp, p.His403Tyr, and p.Ala433Val (Ensembl transcript ID: ENST00000222214). Using in silico analysis, genetic variants were shown to be affecting the residues responsible for homotetramer formation of the glutaryl-CoA dehydrogenase protein. Treatment included oral carnitine, riboflavin, protein-restricted diet, lysine-deficient special formulae, and management of acute crises with intravenous glucose and hydration. However, the mortality (9/30, 27.58%) and morbidity was high in our cohort with only two patients affording the diet. Our study is the largest multicentric, genetic variant-proven series of glutaric aciduria type 1 from India till date.
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Affiliation(s)
- Parag M Tamhankar
- Genetic Research Center, National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India.,Centre for Medical Genetics, Mumbai, Maharashtra, India.,Sandor Life Sciences Pvt. Ltd., Hyderabad, Andhra Pradesh, India
| | - Lakshmi Vasudevan
- Genetic Research Center, National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Pratima Kondurkar
- Genetic Research Center, National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Sarfaraj Niazi
- Biomedical Informatics Center of Indian Council of Medical Research, National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
| | - Rita Christopher
- Department of Neurochemistry, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Dhaval Solanki
- Mantra Child and Neurology and Epilepsy Clinic, Bhavnagar, Gujarat, India
| | | | - Mamta Muranjan
- Department of Pediatrics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial hospital, Mumbai, Maharashtra, India
| | - Mahesh Kamate
- Department of Pediatric Neurology, Jawaharlal Nehru Medical College, Karnataka Lingayat Education University, Belgaum, Karnataka, India
| | - Umesh Kalane
- Pediatric Neurology Centre, Swargate, Pune, Maharashtra, India
| | - Jayesh Sheth
- Foundation for Research in Genetics and Endocrinology Institute of Human Genetics, Foundation for Research in Genetics and Endocrinology House, Satellite, Ahmedabad, Gujarat, India
| | | | - Reena Gulati
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Gorimedu, Puducherry, India
| | | | - Sumita Danda
- Department of Medical Genetics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shaik M Naushad
- Sandor Life Sciences Pvt. Ltd., Hyderabad, Andhra Pradesh, India
| | - Katta M Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Huang L, Shi T, Li Y, Li X. Rhabdomyolysis, Acute Kidney Injury, and a Novel Frameshift Mutation in a Child with Glutaric Acidemia Type I. Nephron Clin Pract 2021; 145:770-775. [PMID: 34247178 DOI: 10.1159/000515012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 02/03/2021] [Indexed: 11/19/2022] Open
Abstract
This is a case report of a girl with glutaric acidemia type I (GA-I) who experienced rhabdomyolysis and acute kidney injury (AKI). Her first acute metabolic crisis occurred at the age of 5 months, which mainly manifested as irritable crying, poor appetite, and hyperlactatemia. Mutation analysis showed 2 pathogenic mutations in the glutaryl-CoA dehydrogenase (GCDH) gene, which were c.383G>A (p.R128Q) and c.873delC (p.N291Kfs*41), the latter of which is a novel frameshift mutation of GA-I. She had a febrile illness at the age of 12 months, followed by AKI and severe rhabdomyolysis. Four days of continuous venovenous hemodiafiltration (CVVHDF) helped to overcome this acute decompensation. This case report describes a novel mutation in the GCDH gene, that is, c.873delC (p.N291Kfs*41). Also, it highlights the fact that patients with GA-I have a high risk of rhabdomyolysis and AKI, which may be induced by febrile diseases and hyperosmotic dehydration; CVVHDF can help to overcome this acute decompensation.
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Affiliation(s)
- Linlin Huang
- Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, China
| | - Ting Shi
- Department of Epidemiology, Children's Hospital of Soochow University, Suzhou, China
| | - Ying Li
- Pediatric Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, China
| | - Xiaozhong Li
- Department of Nephrology and Immunology, Children's Hospital of Soochow University, Suzhou, China
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Xiao B, Qiu W, Ye J, Zhang H, Zhu H, Wang L, Liang L, Xu F, Chen T, Xu Y, Yu Y, Gu X, Han L. Prenatal Diagnosis of Glutaric Acidemia I Based on Amniotic Fluid Samples in 42 Families Using Genetic and Biochemical Approaches. Front Genet 2020; 11:496. [PMID: 32508882 PMCID: PMC7251148 DOI: 10.3389/fgene.2020.00496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/21/2020] [Indexed: 11/18/2022] Open
Abstract
Direct mutation analysis is the major method for glutaric acidemia I (GA-I) prenatal diagnosis, while systemic application of a biochemical strategy is rare. We describe our experiences with metabolite measurement together with mutation analysis in GA-I prenatal diagnosis at a single center over 10 years. The data of genetic analysis and metabolite measurement using gas chromatography/mass spectrometry(GC/MS) and tandem mass spectrometry(MS/MS) in amniotic fluid samples of 44 fetuses from 42 GA-I families referred to our center from 2009 to 2019 were retrospectively analyzed. Among these 44 fetuses, genetic and biochemical results were both available in 39 fetuses. Of these, 6 fetuses were judged as affected and 33 fetuses as unaffected by mutation analysis. The levels of glutarylcarnitine (C5DC), C5DC/octanoylcarnitine (C8), and glutaric acid in the supernatant of amniotic fluid from affected fetuses were significantly higher than those in unaffected fetuses [1.73μmol/L (0.89–4.19) vs. 0.16μmol/L (0.06–0.37), 26.26 (12.4–55.55) vs. 2.23 (1.04–8.44), and 103.94 mmol/mol creatinine (30.37–148.31) vs. 1.01mmol/mol creatinine (0–9.81), respectively; all P < 0.0001]. Among all families, two were found to have one causative mutation in the proband, in four pregnancies from these two families, three fetuses were judged as “unaffected” and one was judged as “affected” according to metabolites results. Postnatal follow-up showed a normal phenotype in all unaffected fetuses judged by mutation or metabolite analysis. C5DC, C5DC/C8, and glutaric acid levels in the supernatant of amniotic fluid showed significant differences and no overlap between the affected and unaffected fetuses. Biochemical strategy could be implemented as a quick and convenient method for the prenatal diagnosis of GA-I.
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Affiliation(s)
- Bing Xiao
- Department of Pediatric Endocrinology and Genetic Metabolism, Institute of Pediatric Research, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Center for Prenatal Diagnosis, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenjuan Qiu
- Department of Pediatric Endocrinology and Genetic Metabolism, Institute of Pediatric Research, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Center for Prenatal Diagnosis, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Ye
- Department of Pediatric Endocrinology and Genetic Metabolism, Institute of Pediatric Research, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Center for Prenatal Diagnosis, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Huiwen Zhang
- Department of Pediatric Endocrinology and Genetic Metabolism, Institute of Pediatric Research, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Center for Prenatal Diagnosis, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hong Zhu
- Center for Prenatal Diagnosis, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Wang
- Center for Prenatal Diagnosis, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lili Liang
- Department of Pediatric Endocrinology and Genetic Metabolism, Institute of Pediatric Research, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Center for Prenatal Diagnosis, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Xu
- Department of Pediatric Endocrinology and Genetic Metabolism, Institute of Pediatric Research, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Center for Prenatal Diagnosis, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ting Chen
- Department of Pediatric Endocrinology and Genetic Metabolism, Institute of Pediatric Research, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Center for Prenatal Diagnosis, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Xu
- Department of Pediatric Endocrinology and Genetic Metabolism, Institute of Pediatric Research, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Center for Prenatal Diagnosis, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yongguo Yu
- Department of Pediatric Endocrinology and Genetic Metabolism, Institute of Pediatric Research, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Center for Prenatal Diagnosis, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xuefan Gu
- Department of Pediatric Endocrinology and Genetic Metabolism, Institute of Pediatric Research, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Center for Prenatal Diagnosis, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lianshu Han
- Department of Pediatric Endocrinology and Genetic Metabolism, Institute of Pediatric Research, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Center for Prenatal Diagnosis, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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