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Ibarra-González I, Fernández-Lainez C, Vela-Amieva M, Guillén-López S, Belmont-Martínez L, López-Mejía L, Carrillo-Nieto RI, Guillén-Zaragoza NA. A Review of Disparities and Unmet Newborn Screening Needs over 33 Years in a Cohort of Mexican Patients with Inborn Errors of Intermediary Metabolism. Int J Neonatal Screen 2023; 9:59. [PMID: 37873850 PMCID: PMC10594536 DOI: 10.3390/ijns9040059] [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: 08/22/2023] [Revised: 09/26/2023] [Accepted: 10/02/2023] [Indexed: 10/25/2023] Open
Abstract
Advances in an early diagnosis by expanded newborn screening (NBS) have been achieved mainly in developed countries, while populations of middle- and low-income countries have poor access, leading to disparities. Expanded NBS in Mexico is not mandatory. Herein, we present an overview of the differences and unmet NBS needs of a group of Mexican patients with inborn errors of intermediary metabolism (IEiM), emphasizing the odyssey experienced to reach a diagnosis. We conducted a retrospective observational study of a historical cohort of patients with IEiM from a national reference center. A total of 924 patients with IEiM were included. Although 72.5% of the diseases identified are detectable by expanded NBS, only 35.4% of the patients were screened. The mortality in the unscreened group was almost two-fold higher than that in the screened group. Patients experienced a median diagnostic delay of 4 months, which is unacceptably long considering that to prevent disability and death, these disorders must be treated in the first days of life. Patients had to travel long distances to our reference center, contributing to their unacceptable diagnostic odyssey. This study highlights the urgent need to have an updated, expanded NBS program with adequate follow up in Mexico and promote the creation of regional medical care centers. We also provide compelling evidence that could prove valuable to decision makers overseeing public health initiatives for individuals impacted by IEiM from middle- and low-income countries.
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Affiliation(s)
- Isabel Ibarra-González
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de México 04530, Mexico
- Unidad de Genética de la Nutrición, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico
| | - Cynthia Fernández-Lainez
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de México 04530, Mexico
| | - Marcela Vela-Amieva
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de México 04530, Mexico
| | - Sara Guillén-López
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de México 04530, Mexico
| | - Leticia Belmont-Martínez
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de México 04530, Mexico
| | - Lizbeth López-Mejía
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de México 04530, Mexico
| | - Rosa Itzel Carrillo-Nieto
- Laboratorio de Errores Innatos del Metabolismo y Tamiz, Instituto Nacional de Pediatría, Secretaría de Salud, Ciudad de México 04530, Mexico
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Einhorn Y, Einhorn M, Kurolap A, Steinberg D, Mory A, Bazak L, Paperna T, Grinshpun-Cohen J, Basel-Salmon L, Weiss K, Singer A, Yaron Y, Baris Feldman H. Community data-driven approach to identify pathogenic founder variants for pan-ethnic carrier screening panels. Hum Genomics 2023; 17:30. [PMID: 36978159 PMCID: PMC10044388 DOI: 10.1186/s40246-023-00472-w] [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: 08/21/2022] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The American College of Medical Genetics and Genomics (ACMG) recently published new tier-based carrier screening recommendations. While many pan-ethnic genetic disorders are well established, some genes carry pathogenic founder variants (PFVs) that are unique to specific ethnic groups. We aimed to demonstrate a community data-driven approach to creating a pan-ethnic carrier screening panel that meets the ACMG recommendations. METHODS Exome sequencing data from 3061 Israeli individuals were analyzed. Machine learning determined ancestries. Frequencies of candidate pathogenic/likely pathogenic (P/LP) variants based on ClinVar and Franklin were calculated for each subpopulation based on the Franklin community platform and compared with existing screening panels. Candidate PFVs were manually curated through community members and the literature. RESULTS The samples were automatically assigned to 13 ancestries. The largest number of samples was classified as Ashkenazi Jewish (n = 1011), followed by Muslim Arabs (n = 613). We detected one tier-2 and seven tier-3 variants that were not included in existing carrier screening panels for Ashkenazi Jewish or Muslim Arab ancestries. Five of these P/LP variants were supported by evidence from the Franklin community. Twenty additional variants were detected that are potentially pathogenic tier-2 or tier-3. CONCLUSIONS The community data-driven and sharing approaches facilitate generating inclusive and equitable ethnically based carrier screening panels. This approach identified new PFVs missing from currently available panels and highlighted variants that may require reclassification.
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Affiliation(s)
| | | | - Alina Kurolap
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
| | | | - Adi Mory
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
| | - Lily Bazak
- Beilinson Hospital, Rabin Medical Center, Recanati Genetics Institute, Petah Tikva, Israel
| | - Tamar Paperna
- Rambam Health Care Campus, The Genetics Institute, Haifa, Israel
| | | | - Lina Basel-Salmon
- Beilinson Hospital, Rabin Medical Center, Recanati Genetics Institute, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Karin Weiss
- Rambam Health Care Campus, The Genetics Institute, Haifa, Israel
- The Ruth and Bruce Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Amihood Singer
- Community Genetic Services, Ministry of Health, Tel Aviv, Israel
| | - Yuval Yaron
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Baris Feldman
- The Genetics Institute and Genomics Center, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Hannibal L, Jacobsen DW. Intracellular processing of vitamin B 12 by MMACHC (CblC). VITAMINS AND HORMONES 2022; 119:275-298. [PMID: 35337623 DOI: 10.1016/bs.vh.2022.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Vitamin B12 (cobalamin, Cbl, B12) is a water-soluble micronutrient synthesized exclusively by a group of microorganisms. Human beings are unable to make B12 and thus obtain the vitamin via intake of animal products, fermented plant-based foods or supplements. Vitamin B12 obtained from the diet comprises three major chemical forms, namely hydroxocobalamin (HOCbl), methylcobalamin (MeCbl) and adenosylcobalamin (AdoCbl). The most common form of B12 present in supplements is cyanocobalamin (CNCbl). Yet, these chemical forms cannot be utilized directly as they come, but instead, they undergo chemical processing by the MMACHC protein, also known as CblC. Processing of dietary B12 by CblC involves removal of the upper-axial ligand (beta-ligand) yielding the one-electron reduced intermediate cob(II)alamin. Newly formed cob(II)alamin undergoes trafficking and delivery to the two B12-dependent enzymes, cytosolic methionine synthase (MS) and mitochondrial methylmalonyl-CoA mutase (MUT). The catalytic cycles of MS and MUT incorporate cob(II)alamin as a precursor to regenerate the coenzyme forms MeCbl and AdoCbl, respectively. Mutations and epimutations in the MMACHC gene result in cblC disease, the most common inborn error of B12 metabolism, which manifests with combined homocystinuria and methylmalonic aciduria. Elevation of metabolites homocysteine and methylmalonic acid occurs because the lack of an active CblC blocks formation of the indispensable precursor cob(II)alamin that is necessary to activate MS and MUT. Thus, in patients with cblC disease, vitamin B12 is absorbed and present in circulation in normal to high concentrations, yet, cells are unable to make use of it. Mutations in seemingly unrelated genes that modify MMACHC gene expression also result in clinical phenotypes that resemble cblC disease. We review current knowledge on structural and functional aspects of intracellular processing of vitamin B12 by the versatile protein CblC, its partners and possible regulators.
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Affiliation(s)
- Luciana Hannibal
- Laboratory of Clinical Biochemistry and Metabolism, Department of General Pediatrics, Adolescent Medicine and Neonatology, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany.
| | - Donald W Jacobsen
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
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Wang P, Shu J, Gu C, Yu X, Zheng J, Zhang C, Cai C. Combined Malonic and Methylmalonic Aciduria Due to ACSF3 Variants Results in Benign Clinical Course in Three Chinese Patients. Front Pediatr 2021; 9:751895. [PMID: 34900860 PMCID: PMC8658908 DOI: 10.3389/fped.2021.751895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/19/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Combined malonic and methylmalonic aciduria (CMAMMA) is a rare metabolic disease caused by biallelic variants in ACSF3 gene. The clinical phenotype is highly heterogeneous in this disorder, ranging from asymptomatic to severe symptoms. No cases with CMAMMA were reported in China. Materials and Methods: In this study, three Chinese pediatric patients were diagnosed with CMAMMA unexpectedly while being treated for other ailments. To better characterize CMAMMA in a Chinese population, we made a multidimensional analysis with detailed clinical phenotype, semi-quantitative detection of urine organic acid, and analysis of ACSF3 gene variants. Results: The clinical presentation of these patients is quite different; their main complaints were anemia, jaundice, or abnormal urine test, respectively. They showed no symptoms of the classic methylmalonic academia, but urine organic acid analysis showed elevated malonic acid and methylmalonic acid in all the patients repeatedly. Variants were found at four sites in ACSF3 gene. Patient 1 carried the compound heterogeneous variant c.689G> A (p.Trp230*)/c.1456G> A (p.Ala486Thr). A compound heterozygous variant c.473C> T (p.Pro158Leu)/c.1456G> A (p.Ala486Thr) was identified in patient 2. Patient 3 harbored a novel homozygous variant c.1447A> G (p.Lys483Glu). Conclusions: Three Chinese patients were diagnosed with CMAMMA caused by ACSF3 variants. Their clinical course revealed that CMAMMA can be a benign condition that does not affect individual growth and development, but severe clinical phenotype may appear when other triggers exist. This study systematically elaborates CMAMMA in a Chinese population for the first time, broadens the spectrum of gene variant, and provides a strong basis for the etiological study of this disorder.
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Affiliation(s)
- Ping Wang
- Tianjin Pediatric Research Institute, Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China.,Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, China
| | - Jianbo Shu
- Tianjin Pediatric Research Institute, Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China.,Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, China
| | - Chunyu Gu
- Tianjin Pediatric Research Institute, Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China.,Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, China.,Graduate College of Tianjin Medical University, Tianjin, China
| | - Xiaoli Yu
- Department of Neurology, Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China
| | - Jie Zheng
- Tianjin Pediatric Research Institute, Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China.,Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, China
| | - Chunhua Zhang
- Matsumoto Institute of Life Science (MILS) International, Yokohama, Japan
| | - Chunquan Cai
- Tianjin Pediatric Research Institute, Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China.,Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin, China.,Department of Neurosurgery, Tianjin Children's Hospital (Tianjin University Children's Hospital), Tianjin, China
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5
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He R, Zhang H, Kang L, Li H, Shen M, Zhang Y, Mo R, Liu Y, Song J, Chen Z, Liu Y, Jin Y, Li M, Dong H, Zheng H, Li D, Qin J, Zhang H, Huang M, Liang D, Tian Y, Yao H, Yang Y. Analysis of 70 patients with hydrocephalus due to cobalamin C deficiency. Neurology 2020; 95:e3129-e3137. [PMID: 32943488 DOI: 10.1212/wnl.0000000000010912] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/23/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To analyze the clinical characteristics of patients with hydrocephalus secondary to cobalamin C (cblC) deficiency and to discuss the optimal strategies for assessing and treating such patients by performing clinical and laboratory studies in 70 patients. METHODS A total of 1,211 patients were clinically diagnosed with methylmalonic acidemia (MMA) from 1998 to 2019. Among them, cblC deficiency was confirmed in 70 patients with hydrocephalus by brain imaging and biochemical and genetic analysis. RESULTS Of the 70 patients, 67 (95.7%) had early-onset MMA and homocystinuria. The patients typically had high blood propionylcarnitine and total homocysteine, low methionine, and methylmalonic aciduria. Signs of intracranial hypertension were relatively rare. We measured ventricular dilatation early in the disease by cranial ultrasound and MRI and/or CT. Eighteen different MMACHC mutations, including 4 novel mutations (c.427C>T, c.568insT, c.599G>A, and c.615C>A), were identified biallelically in all 70 patients. c.609G>A was the most frequent mutation, followed by c.658_660del, c.217C>T, and c.567dupT. Three cases were diagnosed by postmortem study. Metabolic therapy, including cobalamin injections supplemented with oral l-carnitine and betaine, was administered in the remaining 67 cases. A ventriculoperitoneal shunt was performed in 36 cases. During the follow-up, psychomotor development, nystagmus, impaired vision, and sunset eyes improved gradually. CONCLUSION Hydrocephalus is a severe condition with several different causes. In this study, ventriculomegaly was found in 70 patients with cblC deficiency. Early diagnosis, etiologic treatment, and prompt surgical intervention are crucial to improve the prognosis of patients.
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Affiliation(s)
- Ruxuan He
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China
| | - Hongwu Zhang
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China
| | - Lulu Kang
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China
| | - Hui Li
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China
| | - Ming Shen
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China
| | - Yao Zhang
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China
| | - Ruo Mo
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China
| | - Yupeng Liu
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China
| | - Jinqing Song
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China
| | - Zhehui Chen
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China
| | - Yi Liu
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China
| | - Ying Jin
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China
| | - Mengqiu Li
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China
| | - Hui Dong
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China
| | - Hong Zheng
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China
| | - Dongxiao Li
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China
| | - Jiong Qin
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China
| | - Huifeng Zhang
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China
| | - Min Huang
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China
| | - Desheng Liang
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China
| | - Yaping Tian
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China
| | - Hongxin Yao
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China.
| | - Yanling Yang
- From the Departments of Pediatrics (R.H., L.K., Y.Z., R.M., J.S., Z.C., Yi Liu, Y.J., M.L., H.D., Y.Y.) and Pediatric Surgery (H.Z., H.L., H.Y.), Peking University First Hospital; Translational Medicine Center (M.S., Y.T.), Chinese PLA General Hospital; Department of Pediatrics (Yupeng Liu, J.Q.), People's Hospital of Peking University, Beijing; Department of Pediatrics (H.Z.), First Affiliated Hospital of Henan University of Traditional Chinese Medicine; Department of Endocrinology and Genetic (D. Li), Henan Children's Hospital, Zhengzhou; Department of Pediatrics (H.Z.), Hebei Medical University Second Hospital, Shijiazhuang; Similan Clinic, (M.H.) Beijing; and School of Life Sciences (D. Liang), Central South University, Changsha, China.
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6
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Zhan S, Cheng F, He H, Hu S, Feng X. Identification of transcobalamin deficiency with two novel mutations in the TCN2 gene in a Chinese girl with abnormal immunity: a case report. BMC Pediatr 2020; 20:460. [PMID: 33023511 PMCID: PMC7537950 DOI: 10.1186/s12887-020-02357-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/22/2020] [Indexed: 12/22/2022] Open
Abstract
Background Transcobalamin (TC) transports vitamin B12 from blood into cells. TC II deficiency is a rare autosomal recessive disorder. It is characterized by failure to thrive, diarrhoea, pallor, anaemia, pancytopenia or agammaglobulinemia. It is usually confirmed by molecular analysis of the TCN2 gene. We report a 2-month-old girl with two novel mutations, which were first reported in humans. Case presentation We present a 2-month-old Chinese girl with pancytopenia, severe combined immunodeficiency disease, and megaloblastic anaemia. Targeted next-generation sequencing (NGS) was performed, which detected compound heterozygous variants in exon 7 of the TCN2 gene (Mutation 1: c.1033 C > T; Mutation 2: c.1017-1031delinsGTAACAGAGATGGTT). These mutations result in stop codons in TCN2. The c.1033C > T mutation causes a stop at codon 345 (p.Gln345Ter), and the c.1017-1031delinsGTAACAGAGATGGTT mutation causes a stop at codon 340 (p.Leu340Ter). After being diagnosed, she was treated with intramuscular 1 mg hydroxycobalamin (OH-Cbl) every day for 2 months. The CBC value returned to normal after half a month. The peripheral blood lymphocyte subsets and immunoglobulin recovered after 2 months. Then, the dosage of OH-Cbl was gradually reduced. Conclusions TC II deficiency is a serious complication that requires lifelong treatment. Its diagnosis is difficult due to the lack of clearly identifiable symptoms. Genetic testing should be performed as early as possible if this disease is suspected. The specific observations of this case report make a considerable contribution to the literature and provide a reference for the diagnosis and treatment of future cases.
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Affiliation(s)
- Shihong Zhan
- The Neonatal Department, Children's Hospital of Soochow University, No. 92 Zhongnan Road, 215000, Suzhou, Jiangsu Province, China
| | - Fangfang Cheng
- Infectious Diseases Department, Children's Hospital of Soochow University, No. 92 Zhongnan Road, 215000, Suzhou, Jiangsu Province, China
| | - Hailong He
- Hematology-Oncology Department, Children's Hospital of Soochow University, No. 92 Zhongnan Road, 215000, Suzhou, Jiangsu Province, China
| | - Shaoyan Hu
- Hematology-Oncology Department, Children's Hospital of Soochow University, No. 92 Zhongnan Road, 215000, Suzhou, Jiangsu Province, China.
| | - Xing Feng
- The Neonatal Department, Children's Hospital of Soochow University, No. 92 Zhongnan Road, 215000, Suzhou, Jiangsu Province, China.
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7
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Tucci S. Brain metabolism and neurological symptoms in combined malonic and methylmalonic aciduria. Orphanet J Rare Dis 2020; 15:27. [PMID: 31969167 PMCID: PMC6977288 DOI: 10.1186/s13023-020-1299-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/09/2020] [Indexed: 01/03/2023] Open
Abstract
Combined malonic and methylmalonic aciduria (CMAMMA) is an inborn error of metabolism which has been proposed being a benign condition. However, older patients may present with neurological manifestations such as seizures, memory problems, psychiatric problems and/ or cognitive decline. In fibroblasts from CMAMMA patients we have recently demonstrated a dysregulation of energy metabolism with increased dependency on β-oxidation for energy production. Because of the inability of the brain to rely efficiently on this pathway to retrieve the required energy to a great extent, we hypothesize an alternative disease-causing mechanism that does not only include the accumulation of the metabolites malonic and methylmalonic acids. Here, we suggest a novel hypothesis on the possible pathophysiological mechanism responsible for the development of neurological symptoms in the long-run.
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Affiliation(s)
- Sara Tucci
- Department of General Pediatrics and Adolescent Medicine, Laboratory of Clinical Biochemistry and Metabolism, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, Mathildenstrasse 1, 79106, Freiburg, Germany.
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8
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Yang H, Zhao C, Tang MC, Wang Y, Wang SP, Allard P, Furtos A, Mitchell GA. Inborn errors of mitochondrial acyl-coenzyme a metabolism: acyl-CoA biology meets the clinic. Mol Genet Metab 2019; 128:30-44. [PMID: 31186158 DOI: 10.1016/j.ymgme.2019.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/30/2019] [Accepted: 05/05/2019] [Indexed: 12/18/2022]
Abstract
The last decade saw major advances in understanding the metabolism of Coenzyme A (CoA) thioesters (acyl-CoAs) and related inborn errors (CoA metabolic diseases, CAMDs). For diagnosis, acylcarnitines and organic acids, both derived from acyl-CoAs, are excellent markers of most CAMDs. Clinically, each CAMD is unique but strikingly, three main patterns emerge: first, systemic decompensations with combinations of acidosis, ketosis, hypoglycemia, hyperammonemia and fatty liver; second, neurological episodes, particularly acute "stroke-like" episodes, often involving the basal ganglia but sometimes cerebral cortex, brainstem or optic nerves and third, especially in CAMDs of long chain fatty acyl-CoA metabolism, lipid myopathy, cardiomyopathy and arrhythmia. Some patients develop signs from more than one category. The pathophysiology of CAMDs is not precisely understood. Available data suggest that signs may result from CoA sequestration, toxicity and redistribution (CASTOR) in the mitochondrial matrix has been suggested to play a role. This predicts that most CAMDs cause deficiency of CoA, limiting mitochondrial energy production, and that toxic effects from the abnormal accumulation of acyl-CoAs and from extramitochondrial functions of acetyl-CoA may also contribute. Recent progress includes the following. (1) Direct measurements of tissue acyl-CoAs in mammalian models of CAMDs have been related to clinical features. (2) Inborn errors of CoA biosynthesis were shown to cause clinical changes similar to those of inborn errors of acyl-CoA degradation. (3) CoA levels in cells can be influenced pharmacologically. (4) Roles for acetyl-CoA are increasingly identified in all cell compartments. (5) Nonenzymatic acyl-CoA-mediated acylation of intracellular proteins occurs in mammalian tissues and is increased in CAMDs.
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Affiliation(s)
- Hao Yang
- Division of Medical Genetics, Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, Canada
| | - Chen Zhao
- Division of Medical Genetics, Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, Canada; College of Animal Science and Technology, Northwest A&F University, China
| | | | - Youlin Wang
- Division of Medical Genetics, Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, Canada
| | - Shu Pei Wang
- Division of Medical Genetics, Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, Canada
| | - Pierre Allard
- Division of Medical Genetics, Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, Canada
| | | | - Grant A Mitchell
- Division of Medical Genetics, Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, Canada.
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9
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Abdrabo LS, Watkins D, Wang SR, Lafond-Lapalme J, Riviere JB, Rosenblatt DS. Genome and RNA sequencing in patients with methylmalonic
aciduria of unknown cause. Genet Med 2019; 22:432-436. [DOI: 10.1038/s41436-019-0640-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/13/2019] [Indexed: 01/13/2023] Open
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Zhang K, Gao M, Wang G, Shi Y, Li X, Lv Y, Zhang G, Gai Z, Liu Y. Hydrocephalus in cblC type methylmalonic acidemia. Metab Brain Dis 2019; 34:451-458. [PMID: 30564975 DOI: 10.1007/s11011-018-0351-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 11/22/2018] [Indexed: 12/29/2022]
Abstract
Methylmalonic acidemia (MMA) is a typical type of organic acidemia caused by defects in methylmalonyl-CoA mutase or adenosyl-cobalamin synthesis. Hydrocephalus (HC), results from an imbalance between production and absorption of cerebrospinal fluid (CSF), causeing enlarged cerebral ventricles and increased intracranial pressure, is a condition that requires urgent clinical decision-making. MMA without treatment could result in brain damage. However, HC in MMA was rarely reported. In this study, 147 MMA were identified from 9117 high risk children by gas chromatography mass spectrometry (GC/MS) for organic acidurias screening in urine samples and liquid chromatography-tandem mass spectrometry (LC-MS/MS) for amino acids detection in blood samples. Totally 10 cases with MMA and HC were determined by brain MRI/CT, as well as gene mutation testing either by high throughput sequencing or Sanger sequencing. Besides, homocysteine was also analyzed for the 10 MMA with HC. Out of them, 9 cases carry out compound heterozygous mutations or homozygous mutation in MMACHC gene, and 1 case has MUTmutation. The mutation c.609G > A in MMACHC was the most common in the cbl type patients. Although MMA has a high incidence in Shandong province of China, especially cblC type. All of the 10 patients were not correctly diagnosed before developing HC. As a result, when a child develops progressive and refractory HC, the screening for inherited metabolic diseases should be immediately conducted.
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Affiliation(s)
- Kaihui Zhang
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, 23976 Jingshi Road, Jinan, 250022, Shandong, China
| | - Min Gao
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, 23976 Jingshi Road, Jinan, 250022, Shandong, China
| | - Guangyu Wang
- Department of Neurosurgery, Qilu Children's Hospital of Shandong University, Jinan, 250022, Shandong, China
| | - Yingying Shi
- Department of Imaging, Qilu Children's Hospital of Shandong University, Jinan, 250022, Shandong, China
| | - Xiaoying Li
- Department of Neonatology, Qilu Children's Hospital of Shandong University, Jinan, 250022, Shandong, China
| | - Yvqiang Lv
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, 23976 Jingshi Road, Jinan, 250022, Shandong, China
| | - Guangye Zhang
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, 23976 Jingshi Road, Jinan, 250022, Shandong, China
| | - Zhongtao Gai
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, 23976 Jingshi Road, Jinan, 250022, Shandong, China.
| | - Yi Liu
- Pediatric Research Institute, Qilu Children's Hospital of Shandong University, 23976 Jingshi Road, Jinan, 250022, Shandong, China.
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Levtova A, Waters PJ, Buhas D, Lévesque S, Auray-Blais C, Clarke JTR, Laframboise R, Maranda B, Mitchell GA, Brunel-Guitton C, Braverman NE. Combined malonic and methylmalonic aciduria due to ACSF3 mutations: Benign clinical course in an unselected cohort. J Inherit Metab Dis 2019; 42:107-116. [PMID: 30740739 DOI: 10.1002/jimd.12032] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The clinical significance of combined malonic and methylmalonic aciduria due to ACSF3 deficiency (CMAMMA) is controversial. In most publications, affected patients were identified during the investigation of various complaints. METHODS Using a cross-sectional multicenter retrospective natural history study, we describe the course of all known CMAMMA individuals in the province of Quebec. RESULTS We identified 25 CMAMMA patients (6 months to 30 years old) with a favorable outcome regardless of treatment. All but one came to clinical attention through the Provincial Neonatal Urine Screening Program (screening on day 21 of life). Median methylmalonic acid (MMA) levels ranged from 107 to 857 mmol/mol creatinine in urine (<10) and from 8 to 42 μmol/L in plasma (<0.4); median urine malonic acid (MA) levels ranged from 9 to 280 mmol/mol creatinine (<5). MMA was consistently higher than MA. These findings are comparable to those previously reported in CMAMMA. Causal ACSF3 mutations were identified in all patients for whom genotyping was performed (76% of cases). The most common ACSF3 mutations in our cohort were c.1075G > A (p.E359K) and c.1672C > T (p.R558W), representing 38.2 and 20.6% of alleles in genotyped families, respectively; we also report several novel mutations. CONCLUSION Because our province still performs urine newborn screening, our patient cohort is the only one free of selection bias. Therefore, the favorable clinical course observed suggests that CMAMMA is probably a benign condition, although we cannot exclude the possibility that a small minority of patients may present symptoms attributable to CMAMMA, perhaps as a result of interactions with other genetic or environmental factors.
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Affiliation(s)
- Alina Levtova
- Division of Medical Genetics, Department of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM) and Université de Montréal, Tour Viger, 900 rue St-Denis, R07-462, Montreal, Quebec H2X 0A9, Canada
- Division of Medical Genetics, Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, 3175 Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Paula J Waters
- Division of Medical Genetics, Department of Pediatrics, Université de Sherbrooke, CHUS, 3001 12th Avenue North, Sherbrooke, Quebec J1H 5N4, Canada
| | - Daniela Buhas
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
- Departments of Medical Genetics and Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Sébastien Lévesque
- Division of Medical Genetics, Department of Pediatrics, Université de Sherbrooke, CHUS, 3001 12th Avenue North, Sherbrooke, Quebec J1H 5N4, Canada
| | - Christiane Auray-Blais
- Division of Medical Genetics, Department of Pediatrics, Université de Sherbrooke, CHUS, 3001 12th Avenue North, Sherbrooke, Quebec J1H 5N4, Canada
| | - Joe T R Clarke
- Division of Medical Genetics, Department of Pediatrics, Université de Sherbrooke, CHUS, 3001 12th Avenue North, Sherbrooke, Quebec J1H 5N4, Canada
| | - Rachel Laframboise
- Department of Pediatrics, Laval University Hospital Centre, Quebec, Quebec, Canada
| | - Bruno Maranda
- Division of Medical Genetics, Department of Pediatrics, Université de Sherbrooke, CHUS, 3001 12th Avenue North, Sherbrooke, Quebec J1H 5N4, Canada
- Department of Pediatrics, Laval University Hospital Centre, Quebec, Quebec, Canada
| | - Grant A Mitchell
- Division of Medical Genetics, Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, 3175 Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Catherine Brunel-Guitton
- Division of Medical Genetics, Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, 3175 Côte-Sainte-Catherine, Montreal, Quebec H3T 1C5, Canada
| | - Nancy E Braverman
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
- Departments of Medical Genetics and Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
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12
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Brasil S, Leal F, Vega A, Navarrete R, Ecay MJ, Desviat LR, Riera C, Padilla N, de la Cruz X, Couce ML, Martin-Hernández E, Morais A, Pedrón C, Peña-Quintana L, Rigoldi M, Specola N, de Almeida IT, Vives I, Yahyaoui R, Rodríguez-Pombo P, Ugarte M, Pérez-Cerda C, Merinero B, Pérez B. Improving the diagnosis of cobalamin and related defects by genomic analysis, plus functional and structural assessment of novel variants. Orphanet J Rare Dis 2018; 13:125. [PMID: 30041674 PMCID: PMC6057060 DOI: 10.1186/s13023-018-0862-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 06/29/2018] [Indexed: 12/04/2022] Open
Abstract
Background Cellular cobalamin defects are a locus and allelic heterogeneous disorder. The gold standard for coming to genetic diagnoses of cobalamin defects has for some time been gene-by-gene Sanger sequencing of individual DNA fragments. Enzymatic and cellular methods are employed before such sequencing to help in the selection of the gene defects to be sought, but this is time-consuming and laborious. Furthermore some cases remain undiagnosed because no biochemical methods have been available to test for cobalamin absorption and transport defects. Results This paper reports the use of massive parallel sequencing of DNA (exome analysis) for the accurate and rapid genetic diagnosis of cobalamin-related defects in a cohort of affected patients. The method was first validated in an initial cohort with different cobalamin defects. Mendelian segregation, the frequency of mutations, and the comprehensive structural and functional analysis of gene variants, identified disease-causing mutations in 12 genes involved in the absorption and synthesis of active cofactors of vitamin B12 (22 cases), and in the non-cobalamin metabolism-related genes ACSF3 (in four biochemically misdiagnosed patients) and SUCLA2 (in one patient with an unusual presentation). We have identified thirteen new variants all classified as pathogenic according to the ACGM recommendation but four were classified as variant likely pathogenic in MUT and SUCLA2. Functional and structural analysis provided evidences to classify them as pathogenic variants. Conclusions The present findings suggest that the technology used is sufficiently sensitive and specific, and the results it provides sufficiently reproducible, to recommend its use as a second-tier test after the biochemical detection of cobalamin disorder markers in the first days of life. However, for accurate diagnoses to be made, biochemical and functional tests that allow comprehensive clinical phenotyping are also needed. Electronic supplementary material The online version of this article (10.1186/s13023-018-0862-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sandra Brasil
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular, Universidad Autónoma de Madrid, CIBERER, IdiPAZ, Madrid, Spain
| | - Fátima Leal
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular, Universidad Autónoma de Madrid, CIBERER, IdiPAZ, Madrid, Spain
| | - Ana Vega
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular, Universidad Autónoma de Madrid, CIBERER, IdiPAZ, Madrid, Spain
| | - Rosa Navarrete
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular, Universidad Autónoma de Madrid, CIBERER, IdiPAZ, Madrid, Spain
| | - María Jesús Ecay
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular, Universidad Autónoma de Madrid, CIBERER, IdiPAZ, Madrid, Spain
| | - Lourdes R Desviat
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular, Universidad Autónoma de Madrid, CIBERER, IdiPAZ, Madrid, Spain
| | - Casandra Riera
- Grupo de Bioinformática Translacional Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Natàlia Padilla
- Grupo de Bioinformática Translacional Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier de la Cruz
- Grupo de Bioinformática Translacional Vall d'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain.,ICREA, Barcelona, Spain
| | - Mari Luz Couce
- Hospital Clínico Universitario de Santiago, Santiago de Compostela, CIBERER, Santiago de Compostela, Spain
| | | | - Ana Morais
- Hospital Universitario La Paz, Madrid, Spain
| | | | - Luis Peña-Quintana
- Hospital Universitario Materno Infantil, CIBEROBN, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Miriam Rigoldi
- Center for Rare Disorders, ASST- Monza, Ospedale San Gerardo, Monza, Italy
| | - Norma Specola
- Unidad de Metabolismo Hospital de Niños de La Plata, La Plata, Argentina
| | | | | | - Raquel Yahyaoui
- Hospital Universitario Regional de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - Pilar Rodríguez-Pombo
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular, Universidad Autónoma de Madrid, CIBERER, IdiPAZ, Madrid, Spain
| | - Magdalena Ugarte
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular, Universidad Autónoma de Madrid, CIBERER, IdiPAZ, Madrid, Spain
| | - Celia Pérez-Cerda
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular, Universidad Autónoma de Madrid, CIBERER, IdiPAZ, Madrid, Spain
| | - Begoña Merinero
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular, Universidad Autónoma de Madrid, CIBERER, IdiPAZ, Madrid, Spain
| | - Belén Pérez
- Centro de Diagnóstico de Enfermedades Moleculares, Centro de Biología Molecular, Universidad Autónoma de Madrid, CIBERER, IdiPAZ, Madrid, Spain.
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Population Reference Values for Serum Methylmalonic Acid Concentrations and Its Relationship with Age, Sex, Race-Ethnicity, Supplement Use, Kidney Function and Serum Vitamin B12 in the Post-Folic Acid Fortification Period. Nutrients 2018; 10:nu10010074. [PMID: 29329201 PMCID: PMC5793302 DOI: 10.3390/nu10010074] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 12/26/2017] [Accepted: 12/29/2017] [Indexed: 01/29/2023] Open
Abstract
Serum methylmalonic acid (MMA) is elevated in vitamin B-12 deficiency and in kidney dysfunction. Population reference values for serum MMA concentrations in post-folic acid fortification period are lacking. Aims of this study were to report the population reference values for serum MMA and to evaluate the relation between serum MMA and sex, age, race-ethnicity, kidney dysfunction and vitamin B-12. We used data from three National Health and Nutrition Examination Surveys, 1999–2000, 2001–2002 and 2003–2004 conducted after folic acid fortification commenced (n = 18,569). Geometric mean MMA was ≈22.3% higher in non-Hispanic white compared to non-Hispanic black (141.2 vs. 115.5 nmol/L) and was ≈62.7% higher in >70 years old persons compared to 21–30 years old persons (196.9 vs. 121.0 nmol/L). Median serum MMA was ≈28.5% higher in the 1st the quartile of serum vitamin B-12 than in the 4th quartile of serum vitamin B-12 and was ≈35.8% higher in the 4th quartile of serum creatinine than in the 1st quartile of serum creatinine. Multivariate-adjusted serum MMA concentration was significantly associated with race-ethnicity (p < 0.001) and age (p < 0.001) but not with sex (p = 0.057). In this large US population based study, serum MMA concentrations presented here reflect the post-folic acid fortification scenario. Serum MMA concentrations begin to rise at the age of 18–20 years and continue to rise afterwards. Age-related increase in serum MMA concentration is likely to be due to a concomitant decline in kidney function and vitamin B-12 status.
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14
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van Egmond ME, Lugtenberg CHA, Brouwer OF, Contarino MF, Fung VSC, Heiner-Fokkema MR, van Hilten JJ, van der Hout AH, Peall KJ, Sinke RJ, Roze E, Verschuuren-Bemelmans CC, Willemsen MA, Wolf NI, Tijssen MA, de Koning TJ. A post hoc study on gene panel analysis for the diagnosis of dystonia. Mov Disord 2017; 32:569-575. [PMID: 28186668 DOI: 10.1002/mds.26937] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Revised: 12/21/2016] [Accepted: 01/08/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Genetic disorders causing dystonia show great heterogeneity. Recent studies have suggested that next-generation sequencing techniques such as gene panel analysis can be effective in diagnosing heterogeneous conditions. The objective of this study was to investigate whether dystonia patients with a suspected genetic cause could benefit from the use of gene panel analysis. METHODS In this post hoc study, we describe gene panel analysis results of 61 dystonia patients (mean age, 31 years; 72% young onset) in our tertiary referral center. The panel covered 94 dystonia-associated genes. As comparison with a historic cohort was not possible because of the rapidly growing list of dystonia genes, we compared the diagnostic workup with and without gene panel analysis in the same patients. The workup without gene panel analysis (control group) included theoretical diagnostic strategies formulated by independent experts in the field, based on detailed case descriptions. The primary outcome measure was diagnostic yield; secondary measures were cost and duration of diagnostic workup. RESULTS Workup with gene panel analysis led to a confirmed molecular diagnosis in 14.8%, versus 7.4% in the control group (P = 0.096). In the control group, on average 3 genes/case were requested. The mean costs were lower in the gene panel analysis group (€1822/case) than in the controls (€2660/case). The duration of the workup was considerably shorter with gene panel analysis (28 vs 102 days). CONCLUSIONS Gene panel analysis facilitates molecular diagnosis in complex cases of dystonia, with a good diagnostic yield (14.8%), a quicker diagnostic workup, and lower costs, representing a major improvement for patients and their families. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Martje E van Egmond
- University of Groningen, University Medical Centre Groningen, Department of Neurology, Groningen, the Netherlands.,Ommelander Ziekenhuis Groningen, Department of Neurology, Delfzijl and Winschoten, the Netherlands
| | - Coen H A Lugtenberg
- University of Groningen, University Medical Centre Groningen, Department of Neurology, Groningen, the Netherlands
| | - Oebele F Brouwer
- University of Groningen, University Medical Centre Groningen, Department of Neurology, Groningen, the Netherlands
| | - Maria Fiorella Contarino
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Neurology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Victor S C Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital & Sydney Medical School, University of Sydney, Sydney, Australia
| | - M Rebecca Heiner-Fokkema
- University of Groningen, University Medical Centre Groningen, Department of Laboratory Medicine, Groningen, the Netherlands
| | - Jacobus J van Hilten
- Department of Neurology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Annemarie H van der Hout
- University of Groningen, University Medical Centre Groningen, Department of Genetics, Groningen, the Netherlands
| | - Kathryn J Peall
- MRC Centre for Neuropsychiatric Genetics and Genomics, Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
| | - Richard J Sinke
- University of Groningen, University Medical Centre Groningen, Department of Genetics, Groningen, the Netherlands
| | - Emmanuel Roze
- Département de Neurologie, AP-HP, Hôpital Pitié-Salpêtrière and Sorbonne Universités, Université Pierre and Marie Curie, Institut du Cerveau et de la Moelle épinière, Paris, France
| | | | - Michel A Willemsen
- Radboud University Medical Centre, Department of Paediatric Neurology, Nijmegen, the Netherlands
| | - Nicole I Wolf
- VU University Medical Centre, Department of Child Neurology and Neuroscience Campus Amsterdam, Amsterdam, the Netherlands
| | - Marina A Tijssen
- University of Groningen, University Medical Centre Groningen, Department of Neurology, Groningen, the Netherlands
| | - Tom J de Koning
- University of Groningen, University Medical Centre Groningen, Department of Neurology, Groningen, the Netherlands.,University of Groningen, University Medical Centre Groningen, Department of Genetics, Groningen, the Netherlands.,University of Groningen, University Medical Centre Groningen, Department of Paediatrics, Groningen, the Netherlands
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15
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Chu J, Pupavac M, Watkins D, Tian X, Feng Y, Chen S, Fenter R, Zhang VW, Wang J, Wong LJ, Rosenblatt DS. Next generation sequencing of patients with mut methylmalonic aciduria: Validation of somatic cell studies and identification of 16 novel mutations. Mol Genet Metab 2016; 118:264-71. [PMID: 27233228 DOI: 10.1016/j.ymgme.2016.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/18/2016] [Accepted: 05/18/2016] [Indexed: 12/13/2022]
Abstract
Mutations in the MUT gene, which encodes the mitochondrial enzyme methylmalonyl-CoA mutase, are responsible for the mut form of methylmalonic aciduria (MMA). In this study, a next generation sequencing (NGS) based gene panel was used to analyze 53 patients that had been diagnosed with mut MMA by somatic cell complementation analysis. A total of 54 different mutations in MUT were identified in 48 patients; 16 novel mutations were identified, including 1 initiation site mutation (c.2T>C [p.M1?]), 1 missense mutation (c.566A>T [p.N189I]), 2 nonsense mutations (c.129G>A [p.W43*] and c.1975C>T [p.Q659*]), 2 mutations affecting splice sites (c.753+3A>G and c.754-2A>G), 8 small insertions, deletions, and duplications (c.29dupT [p.L10Ffs*39], c.55dupG [p.V19Gfs*30], c.631_633delGAG [p.E211del], c.795_796insT [p.M266Yfs*7], c.1061delCinsGGA [p.S354Wfs*20], c.1065_1068dupATGG [p.S357Mfs*5], c.1181dupT [p.L394Ffs*30], c.1240delG [p.E414Kfs*17]), a large insertion (c.146_147ins279), and a large deletion involving exon 13. Phenotypic rescue and cDNA analysis were used to confirm that the c.146_147ins279 and c.631_633delGAG mutations were associated with the decreased methylmalonyl-CoA mutase function observed in the patient fibroblasts. In five patients, the NGS panel did not confirm the diagnosis made by complementation analysis. One of these patients was found to carry 2 novel mutations (c.433G > A [p.E145K] and c.511A>C [p.N171H]) in the SUCLG1 gene.
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Affiliation(s)
- Jordan Chu
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Mihaela Pupavac
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - David Watkins
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Xia Tian
- Department of Molecular Genetics, Baylor College of Medicine, Houston, TX, United States
| | - Yanming Feng
- Department of Molecular Genetics, Baylor College of Medicine, Houston, TX, United States
| | - Stella Chen
- Department of Molecular Genetics, Baylor College of Medicine, Houston, TX, United States
| | - Remington Fenter
- Department of Molecular Genetics, Baylor College of Medicine, Houston, TX, United States
| | - Victor W Zhang
- Department of Molecular Genetics, Baylor College of Medicine, Houston, TX, United States
| | - Jing Wang
- Department of Molecular Genetics, Baylor College of Medicine, Houston, TX, United States
| | - Lee-Jun Wong
- Department of Molecular Genetics, Baylor College of Medicine, Houston, TX, United States
| | - David S Rosenblatt
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada.
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16
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Hannibal L, Lysne V, Bjørke-Monsen AL, Behringer S, Grünert SC, Spiekerkoetter U, Jacobsen DW, Blom HJ. Biomarkers and Algorithms for the Diagnosis of Vitamin B12 Deficiency. Front Mol Biosci 2016; 3:27. [PMID: 27446930 PMCID: PMC4921487 DOI: 10.3389/fmolb.2016.00027] [Citation(s) in RCA: 164] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/07/2016] [Indexed: 12/12/2022] Open
Abstract
Vitamin B12 (cobalamin, Cbl, B12) is an indispensable water-soluble micronutrient that serves as a coenzyme for cytosolic methionine synthase (MS) and mitochondrial methylmalonyl-CoA mutase (MCM). Deficiency of Cbl, whether nutritional or due to inborn errors of Cbl metabolism, inactivate MS and MCM leading to the accumulation of homocysteine (Hcy) and methylmalonic acid (MMA), respectively. In conjunction with total B12 and its bioactive protein-bound form, holo-transcobalamin (holo-TC), Hcy, and MMA are the preferred serum biomarkers utilized to determine B12 status. Clinically, vitamin B12 deficiency leads to neurological deterioration and megaloblastic anemia, and, if left untreated, to death. Subclinical vitamin B12 deficiency (usually defined as a total serum B12 of <200 pmol/L) presents asymptomatically or with rather subtle generic symptoms that oftentimes are mistakenly ascribed to unrelated disorders. Numerous studies have now established that serum vitamin B12 has limited diagnostic value as a stand-alone marker. Low serum levels of vitamin B12 not always represent deficiency, and likewise, severe functional deficiency of the micronutrient has been documented in the presence of normal and even high levels of serum vitamin B12. This review discusses the usefulness and limitations of current biomarkers of B12 status in newborn screening, infant and adult diagnostics, the algorithms utilized to diagnose B12 deficiency and unusual findings of vitamin B12 status in various human disorders.
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Affiliation(s)
- Luciana Hannibal
- Laboratory of Clinical Biochemistry and Metabolism, Department for Pediatrics, Medical Center, University of Freiburg Freiburg, Germany
| | - Vegard Lysne
- Department of Clinical Sciences, University of Bergen Bergen, Norway
| | | | - Sidney Behringer
- Laboratory of Clinical Biochemistry and Metabolism, Department for Pediatrics, Medical Center, University of Freiburg Freiburg, Germany
| | - Sarah C Grünert
- Laboratory of Clinical Biochemistry and Metabolism, Department for Pediatrics, Medical Center, University of Freiburg Freiburg, Germany
| | - Ute Spiekerkoetter
- Laboratory of Clinical Biochemistry and Metabolism, Department for Pediatrics, Medical Center, University of Freiburg Freiburg, Germany
| | - Donald W Jacobsen
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic Cleveland, OH, USA
| | - Henk J Blom
- Laboratory of Clinical Biochemistry and Metabolism, Department for Pediatrics, Medical Center, University of Freiburg Freiburg, Germany
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