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Xie H, Lin S, Chen Y, Wang W, Qi Y, Li J, Chen Q, Feng X. A case of Sandhoff disease caused by a novel β-hexosaminidase B (HEXB) mutation c.118delG (p.A40fs*24): A case report from China. Medicine (Baltimore) 2023; 102:e33890. [PMID: 37327298 PMCID: PMC10270510 DOI: 10.1097/md.0000000000033890] [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: 03/23/2023] [Accepted: 05/10/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Sandhoff disease (SD, Online Mendelian Inheritance in Man: 268800) is an autosomal recessive lysosomal storage disorder caused by variants of the β-hexosaminidase B (HEXB) gene (Online Mendelian Inheritance in Man: 606873). The HEXB gene has been mapped to chromosome 5q13 and contains 14 exons. The symptoms of SD include progressive weakness, intellectual disability, visual and hearing impairment, exaggerated startle response, and seizures; the patients usually die before the age of 3 years.[1]. CASE SUMMARY We present a case of SD caused by a homozygous frameshift mutation in the HEXB gene, c.118delG (p.A40fs*24). The male child, aged 2 years 7 months, showed movement retrogression with orbital hypertelorism at age 2 years, accompanied by seizures. Magnetic resonance imaging of the head showed cerebral atrophy and delayed myelination of the white matter of the brain. CONCLUSION A novel homozygous frameshift c.118delG (p.A40fs*24) variant of HEXB has caused SD in the child. The major symptoms are intellectual disability, visual and hearing impairment, and seizures. Investigation will be continued in the future to comprehensively describe the genotype/phenotype and gain information on other associated features to understand the variable expressivity of this condition.
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Affiliation(s)
- Hongyan Xie
- Diagnosis and Treatment Center for Children, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Shuangzhu Lin
- Diagnosis and Treatment Center for Children, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Yang Chen
- Diagnosis and Treatment Center for Children, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
| | - Wanqi Wang
- Changchun University of Chinese Medicine, Changchun, China
| | - Yangfan Qi
- Changchun University of Chinese Medicine, Changchun, China
| | - Jiayi Li
- Changchun University of Chinese Medicine, Changchun, China
| | - Qiandui Chen
- Changchun University of Chinese Medicine, Changchun, China
| | - Xiaochun Feng
- Diagnosis and Treatment Center for Children, Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, China
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Liu M, Huang D, Wang H, Zhao L, Wang Q, Chen X. Clinical and Molecular Characteristics of Two Chinese Children with Infantile Sandhoff Disease and Review of the Literature. J Mol Neurosci 2020; 70:481-487. [PMID: 31919734 DOI: 10.1007/s12031-019-01409-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
Abstract
Infantile Sandhoff disease is an autosomal recessive inherited disease primarily characterized by cherry red spots in the retina, muscle weakness, seizure, truncal hypotonia, hyperacusis, developmental delay and regression. The pathogenic genetic defects of the HEXB gene, which encodes the β subunit of the hexosaminidase A (ɑβ) and hexosaminidase B (ββ) enzymes, cause deficiency of both the Hex A and Hex B enzymes, resulting in the deposition of GM2 ganglion glycerides in the lysosomes of the central nervous system and somatic cells. The aim of this study was to discover disease-causing variants of the HEXB gene in two Chinese families through the use of exome sequencing. By characterizing three novel variants by molecular genetics, bioinformatics analysis, and three-dimensional structure modeling, we showed that all these novel variants influenced the protein structure. The results broaden the variant spectrum of HEXB in different ethnic groups. Furthermore, not all patients diagnosed with infantile Sandhoff disease had characteristic cranial imaging findings, which can only be used as supplementary information for diagnosis. The results of this study may contribute to clinical management, genetic counseling, and gene-targeted treatments for Sandhoff disease.
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Affiliation(s)
- Min Liu
- Department of Neurology, Children's Hospital of Soochow University, No. 92 Zhongnan Street, Industrial Park, Suzhou, 215003, Jiangsu Province, People's Republic of China
| | - Danping Huang
- Department of Neurology, Children's Hospital of Soochow University, No. 92 Zhongnan Street, Industrial Park, Suzhou, 215003, Jiangsu Province, People's Republic of China
| | - Hongying Wang
- Department of Clinical Laboratory, Children's Hospital of Soochow University, No. 92 Zhongnan Street, Industrial Park, Suzhou, 215003, Jiangsu Province, People's Republic of China
| | - Lei Zhao
- Department of Ophthalmology, Children's Hospital of Soochow University, No. 92 Zhongnan Street, Industrial Park, Suzhou, 215003, Jiangsu Province, People's Republic of China
| | - Qi Wang
- Department of Radiology, Children's Hospital of Soochow University, No. 92 Zhongnan Street, Industrial Park, Suzhou, 215003, Jiangsu Province, People's Republic of China
| | - Xuqin Chen
- Department of Neurology, Children's Hospital of Soochow University, No. 92 Zhongnan Street, Industrial Park, Suzhou, 215003, Jiangsu Province, People's Republic of China.
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Ito D, Ishikawa C, Jeffery ND, Ono K, Tsuboi M, Uchida K, Yamato O, Kitagawa M. Two-Year Follow-Up Magnetic Resonance Imaging and Spectroscopy Findings and Cerebrospinal Fluid Analysis of a Dog with Sandhoff's Disease. J Vet Intern Med 2018; 32:797-804. [PMID: 29478290 PMCID: PMC5867010 DOI: 10.1111/jvim.15041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 12/07/2017] [Accepted: 12/14/2017] [Indexed: 11/30/2022] Open
Abstract
A 13‐month‐old female Toy Poodle was presented for progressive ataxia and intention tremors of head movement. The diagnosis of Sandhoff's disease (GM2 gangliosidosis) was confirmed by deficient β‐N‐acetylhexosaminidase A and B activity in circulating leukocytes and identification of the homozygous mutation (HEXB: c.283delG). White matter in the cerebrum and cerebellum was hyperintense on T2‐weighted and fluid‐attenuated inversion recovery magnetic resonance images. Over the next 2 years, the white matter lesions expanded, and bilateral lesions appeared in the cerebellum and thalamus, associated with clinical deterioration. Magnetic resonance spectroscopy showed progressive decrease in brain N‐acetylaspartate, and glycine‐myo‐inositol and lactate‐alanine were increased in the terminal clinical stage. The concentrations of myelin basic protein and neuron specific enolase in cerebrospinal fluid were persistently increased. Imaging and spectroscopic appearance correlated with histopathological findings of severe myelin loss in cerebral and cerebellar white matter and destruction of the majority of cerebral and cerebellar neurons.
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Affiliation(s)
- D Ito
- School of Veterinary Medicine, Nihon University, Kanagawa, Japan
| | - C Ishikawa
- School of Veterinary Medicine, Nihon University, Kanagawa, Japan
| | - N D Jeffery
- Veterinary Medicine and Biomedical Sciences, Texas A&M University, TX
| | - K Ono
- School of Veterinary Medicine, Nihon University, Kanagawa, Japan
| | - M Tsuboi
- Department of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - K Uchida
- Department of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - O Yamato
- Laboratory of Clinical Pathology of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
| | - M Kitagawa
- School of Veterinary Medicine, Nihon University, Kanagawa, Japan
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Nestrasil I, Ahmed A, Utz JM, Rudser K, Whitley CB, Jarnes-Utz JR. Distinct progression patterns of brain disease in infantile and juvenile gangliosidoses: Volumetric quantitative MRI study. Mol Genet Metab 2018; 123:97-104. [PMID: 29352662 PMCID: PMC5832355 DOI: 10.1016/j.ymgme.2017.12.432] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/18/2017] [Accepted: 12/18/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND GM1-gangliosidosis and GM2-gangliosidosis (Tay-Sachs disease and Sandhoff disease) are unrelenting heritable neurodegenerative conditions of lysosomal ganglioside accumulation. Although progressive brain atrophy is characteristic, longitudinal quantification of specific brain structures has not been systematically studied. OBJECTIVES The goal of this longitudinal study has been to quantify and track brain MRI volume changes, including specific structure volume changes, at different times in disease progression of childhood gangliosidoses, and to explore quantitative brain MRI volumetry (qMRI) as a non-invasive marker of disease progression for future treatment trials. METHODS Brain qMRI studies were performed in 14 patients with gangliosidoses (9 infantile, 5 juvenile) yearly. Cerebellar cortex and white matter, caudate, putamen, corpus callosum, ventricles, total brain, and intracranial volumes were measured, as well as total brain volume. Age-matched controls were available for the patients with the juvenile phenotype. RESULTS The infantile phenotype of all gangliosidoses showed a consistent pattern of macrocephaly and rapidly increasing intracranial MRI volume with both (a) brain tissue volume (cerebral cortex and other smaller structures) and (b) ventricular volume (P<0.01 for all). In contrast to apparent enlargement of the total brain volume, and chiefly the enlarged cerebral cortex, a subset of smaller brain substructures generally decreased in size: the corpus callosum, caudate and putamen became smaller with time. The volume of cerebellar cortex also decreased in patients with infantile GM1-gangliosidosis and juvenile GM1- and GM2-gangliosidosis; however, infantile GM2-gangliosidosis cerebellar cortex was the exception, increasing in size. Elevated intracranial pressure (estimated by lumbar spinal pressure) was a common finding in infantile disease and showed continued increases as the disease progressed, yet lacked MRI signs of hydrocephalus except for increasing ventricular size. Notably, in patients with juvenile gangliosidosis, macrocephaly and elevated intracranial pressure were absent and total brain volume decreased with time compared to controls (P=0.004). CONCLUSIONS The disease course of infantile versus juvenile gangliosidoses is clearly distinguished by the rate of brain disease progression as characterized by qMRI. Assessments by qMRI represent a robust non-invasive method for monitoring CNS changes in the clinical course of gangliosidoses and is ideally suited to monitor effects of novel CNS-directed therapies in future clinical trials.
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Affiliation(s)
- Igor Nestrasil
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Alia Ahmed
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Josephine M Utz
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Kyle Rudser
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Chester B Whitley
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Advanced Therapies Department, University of Minnesota, Fairview, Minneapolis, MN, USA; Gene Therapy Center, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA
| | - Jeanine R Jarnes-Utz
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Advanced Therapies Department, University of Minnesota, Fairview, Minneapolis, MN, USA; Gene Therapy Center, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Experimental and Clinical Pharmacology, University of Minnesota, Minneapolis, MN, USA.
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5
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Wang P, Henthorn PS, Galban E, Lin G, Takedai T, Casal M. Canine GM2-Gangliosidosis Sandhoff Disease Associated with a 3-Base Pair Deletion in the HEXB Gene. J Vet Intern Med 2017; 32:340-347. [PMID: 29106755 PMCID: PMC5787214 DOI: 10.1111/jvim.14862] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/02/2017] [Accepted: 09/21/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND GM2-gangliosidosis is a fatal neurodegenerative lysosomal storage disease (LSD) caused by deficiency of either β-hexosaminidase A (Hex-A) and β-hexosaminidase B (Hex-B) together, or the GM2 activator protein. Clinical signs can be variable and are not pathognomonic for the specific, causal deficiency. OBJECTIVES To characterize the phenotype and genotype of GM2-gangliosidosis disease in an affected dog. ANIMALS One affected Shiba Inu and a clinically healthy dog. METHODS Clinical and neurologic evaluation, brain magnetic resonance imaging (MRI), assays of lysosomal enzyme activities, and sequencing of all coding regions of HEXA, HEXB, and GM2A genes. RESULTS A 14-month-old, female Shiba Inu presented with clinical signs resembling GM2-gangliosidosis in humans and GM1-gangliosidosis in the Shiba Inu. Magnetic resonance imaging (MRI) of the dog's brain indicated neurodegenerative disease, and evaluation of cerebrospinal fluid (CSF) identified storage granules in leukocytes. Lysosomal enzyme assays of plasma and leukocytes showed deficiencies of Hex-A and Hex-B activities in both tissues. Genetic analysis identified a homozygous, 3-base pair deletion in the HEXB gene (c.618-620delCCT). CONCLUSIONS AND CLINICAL IMPORTANCE Clinical, biochemical, and molecular features are characterized in a Shiba Inu with GM2-gangliosidosis. The deletion of 3 adjacent base pairs in HEXB predicts the loss of a leucine residue at amino acid position 207 (p.Leu207del) supporting the hypothesis that GM2-gangliosidosis seen in this dog is the Sandhoff type. Because GM1-gangliosidosis also exists in this breed with almost identical clinical signs, genetic testing for both GM1- and GM2-gangliosidosis should be considered to make a definitive diagnosis.
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Affiliation(s)
- P Wang
- Section of Medical Genetics, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - P S Henthorn
- Section of Medical Genetics, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - E Galban
- Section of Neurology & Neurosurgery, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - G Lin
- Section of Medical Genetics, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - T Takedai
- Section of Medical Genetics, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - M Casal
- Section of Medical Genetics, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
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6
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Beker-Acay M, Elmas M, Koken R, Unlu E, Bukulmez A. Infantile Type Sandhoff Disease with Striking Brain MRI Findings and a Novel Mutation. Pol J Radiol 2016; 81:86-9. [PMID: 26985245 PMCID: PMC4780271 DOI: 10.12659/pjr.895911] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 09/17/2015] [Indexed: 11/12/2022] Open
Abstract
Background Sandhoff disease is an autosomal recessive disorder caused by β-hexosaminidase deficiency in which the ganglioside GM2 and other glycolipids accumulate intracellularly within lysosomes. This process results in progressive motor neuron manifestations, death from respiratory failure and infections in infantiles. Case Report This report presents a 22-month-old girl with infantile type Sandhoff disease that was hospitalized for generalized seizures and psychomotor retardation. She was diagnosed with a genetically proven novel mutation and by demonstrating it’s specific imaging findings. Conclusions Determination of spesific changes in neuroimaging which are initial findings for GM2 gangliosidosis is important from the point of diagnosis and follow-up in infants suspected of having a neurodegenerative disease.
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Affiliation(s)
- Mehtap Beker-Acay
- Department of Radiology, Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey
| | - Muhsin Elmas
- Department of Medical Genetics, Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey
| | - Resit Koken
- Department of Pediatrics, Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey
| | - Ebru Unlu
- Department of Radiology, Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey
| | - Aysegul Bukulmez
- Department of Pediatrics, Afyon Kocatepe University, Faculty of Medicine, Afyonkarahisar, Turkey
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7
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Muralidharan CG, Tomar RPS. Infantile Sandhoff Disease: Unusual presentation. Med J Armed Forces India 2016; 72:S91-S93. [PMID: 28050081 DOI: 10.1016/j.mjafi.2015.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 11/16/2015] [Indexed: 10/22/2022] Open
Affiliation(s)
- C G Muralidharan
- Senior Adviser (Radiodiagnosis & Imaging), Command Hospital (Southern Command), Pune 411040, India
| | - R P S Tomar
- Senior Adviser (Paediatrics) & Neonatologist, Base Hospital, Delhi Cantt, India
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8
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Zuccoli G, Yannes MP, Nardone R, Bailey A, Goldstein A. Bilateral symmetrical basal ganglia and thalamic lesions in children: an update (2015). Neuroradiology 2015; 57:973-89. [DOI: 10.1007/s00234-015-1568-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/15/2015] [Indexed: 01/09/2023]
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9
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Freeman A, Platt S, Vandenberg M, Holmes S, Kent M, Rech R, Howerth E, Mishra S, O'Brien D, Wenger D. GM2 Gangliosidosis (B Variant) in Two Japanese Chins: Clinical, Magnetic Resonance Imaging and Pathological Characteristics. J Vet Intern Med 2013; 27:771-6. [DOI: 10.1111/jvim.12118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 04/01/2013] [Accepted: 04/18/2013] [Indexed: 11/26/2022] Open
Affiliation(s)
- A.C. Freeman
- College of Veterinary Medicine; University of Georgia; Athens GA
| | - S.R. Platt
- College of Veterinary Medicine; University of Georgia; Athens GA
| | - M. Vandenberg
- Southern New Hampshire Veterinary Referral Hospital; Manchester NH
| | - S. Holmes
- College of Veterinary Medicine; University of Georgia; Athens GA
| | - M. Kent
- College of Veterinary Medicine; University of Georgia; Athens GA
| | - R. Rech
- College of Veterinary Medicine; University of Georgia; Athens GA
| | - E. Howerth
- College of Veterinary Medicine; University of Georgia; Athens GA
| | - S. Mishra
- College of Veterinary Medicine; University of Georgia; Athens GA
| | - D.P. O'Brien
- College of Veterinary Medicine; University of Missouri; Columbia MO
| | - D. Wenger
- Department of Neurology; Jefferson Medical College; Philadelphia PA
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Hasegawa D, Yamato O, Nakamoto Y, Ozawa T, Yabuki A, Itamoto K, Kuwabara T, Fujita M, Takahashi K, Mizoguchi S, Orima H. Serial MRI features of canine GM1 gangliosidosis: a possible imaging biomarker for diagnosis and progression of the disease. ScientificWorldJournal 2012; 2012:250197. [PMID: 22536126 PMCID: PMC3334264 DOI: 10.1100/2012/250197] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 11/20/2011] [Indexed: 11/17/2022] Open
Abstract
GM1 gangliosidosis is a fatal neurodegenerative lysosomal storage disease caused by an autosomal recessively inherited deficiency of β-galactosidase activity. Effective therapies need to be developed to treat the disease. In Shiba Inu dogs, one of the canine GM1 gangliosidosis models, neurological signs of the disease, including ataxia, start at approximately 5 months of age and progress until the terminal stage at 12 to 15 months of age. In the present study, serial MR images were taken of an affected dog from a model colony of GM1 gangliosidosis and 4 sporadic clinical cases demonstrating the same mutation in order to characterize the MRI features of this canine GM1 gangliosidosis. By 2 months of age at the latest and persisting until the terminal stage of the disease, the MR findings consistently displayed diffuse hyperintensity in the white matter of the entire cerebrum on T2-weighted images. In addition, brain atrophy manifested at 9 months of age and progressed thereafter. Although a definitive diagnosis depends on biochemical and genetic analyses, these MR characteristics could serve as a diagnostic marker in suspect animals with or without neurological signs. Furthermore, serial changes in MR images could be used as a biomarker to noninvasively monitor the efficacy of newly developed therapeutic strategies.
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Affiliation(s)
- Daisuke Hasegawa
- Division of Veterinary Radiology, Department of Veterinary Science, Nippon Veterinary and Life Science University, Tokyo 180-8602, Japan
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Cakir B, Teksam M, Kosehan D, Akin K, Koktener A. Inborn Errors of Metabolism Presenting in Childhood. J Neuroimaging 2011; 21:e117-33. [DOI: 10.1111/j.1552-6569.2011.00575.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Saouab R, Mahi M, Abilkacem R, Boumdin H, Chaouir S, Agader O, Amil T, Hanine A. A case report of Sandhoff disease. Clin Neuroradiol 2010; 21:83-5. [PMID: 21153386 PMCID: PMC3145082 DOI: 10.1007/s00062-010-0035-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Accepted: 09/09/2010] [Indexed: 11/26/2022]
Abstract
Sandhoff disease is a rare and severe lysosomal storage disorder representing 7% of GM2 gangliosidoses. Bilateral thalamic involvement has been suggested as a diagnostic marker of Sandhoff disease. A case of an 18-month-old infant admitted for psychomotor regression and drug resistant myoclonic epilepsy is presented. Cerebral CT scan showed bilateral and symmetrical thalamic hyperdensity. MRI revealed that the thalamus was hyperintense on T(1)-weighted images and hypointense on T2-weighted images with a hypersignal T2 of the white matter. Enzymatic assays objectified a deficiency of both hexosaminidases A and B confirming the diagnosis of Sandhoff disease.
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Affiliation(s)
- R. Saouab
- Department of Radiology, Mohamed 5th Military Hospital, Rabat, Morocco
- CYM, Hay el Fath, IM 198 – App 8, Rabat, Morocco
| | - M. Mahi
- Department of Radiology, Mohamed 5th Military Hospital, Rabat, Morocco
| | - R. Abilkacem
- Department of Pediatrics, Mohamed 5th Military Hospital, Rabat, Morocco
| | - H. Boumdin
- Department of Radiology, Mohamed 5th Military Hospital, Rabat, Morocco
| | - S. Chaouir
- Department of Radiology, Mohamed 5th Military Hospital, Rabat, Morocco
| | - O. Agader
- Department of Pediatrics, Mohamed 5th Military Hospital, Rabat, Morocco
| | - T. Amil
- Department of Radiology, Mohamed 5th Military Hospital, Rabat, Morocco
| | - A. Hanine
- Department of Radiology, Mohamed 5th Military Hospital, Rabat, Morocco
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Tamura S, Tamura Y, Uchida K, Nibe K, Nakaichi M, Hossain MA, Chang HS, Rahman MM, Yabuki A, Yamato O. GM2 gangliosidosis variant 0 (Sandhoff-like disease) in a family of toy poodles. J Vet Intern Med 2010; 24:1013-9. [PMID: 20695991 DOI: 10.1111/j.1939-1676.2010.0564.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND GM2 gangliosidosis variant 0 (human Sandhoff disease) is a lysosomal storage disorder caused by deficiencies of acid β-hexosaminidase (Hex) A and Hex B because of an abnormality of the β-subunit, a common component in these enzyme molecules, which is coded by the HEXB gene. OBJECTIVE To describe the clinical, pathological, biochemical, and magnetic resonance imaging (MRI) findings of Sandhoff-like disease identified in a family of Toy Poodles. ANIMALS Three red-haired Toy Poodles demonstrated clinical signs including motor disorders and tremor starting between 9 and 12 months of age. The animals finally died of neurological deterioration between 18 and 23 months of age. There were some lymphocytes with abnormal cytoplasmic vacuoles detected. METHODS Observational case study. RESULTS The common MRI finding was diffuse T2-hyperintensity of the subcortical white matter in the cerebrum. Bilateral T2-hyperintensity and T1-hypointensity in the nucleus caudatus, and atrophic findings of the cerebrum and cerebellum, were observed in a dog in the late stage. Histopathologically, swollen neurons with pale to eosinophilic granular materials in the cytoplasm were observed throughout the central nervous system. Biochemically, GM2 ganglioside had accumulated in the brain, and Hex A and Hex B were deficient in the brain and liver. Pedigree analysis demonstrated that the 3 affected dogs were from the same family line. CONCLUSIONS AND CLINICAL IMPORTANCE The Sandhoff-like disease observed in this family of Toy Poodles is the 2nd occurrence of the canine form of this disease and the 1st report of its identification in a family of dogs.
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Affiliation(s)
- S Tamura
- Tamura Animal Clinic, Hiroshima, Japan Laboratory of Veterinary Pathology, Graduate School of Agriculture and Life Sciences, University of Tokyo, Tokyo, Japan
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Infantile Sandhoff's disease with peripheral neuropathy. Pediatr Neurol 2010; 42:459-61. [PMID: 20472204 DOI: 10.1016/j.pediatrneurol.2010.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 01/13/2010] [Accepted: 02/11/2010] [Indexed: 11/20/2022]
Abstract
Sandhoff's disease is a rare autosomal-recessive disorder of sphingolipid metabolism that results from a deficiency of lysosomal enzyme beta-hexosaminidase A and B. The resultant accumulation of GM2 gangliosides within both grey matter and the myelin sheath of white matter results in essential, severe neurodegeneration. We describe a 14-month-old boy with seizures and severe neurodegeneration. His diagnosis was confirmed by neuroimaging and enzyme assay. In addition to the classic features of Sandhoff's disease, the child's clinical features were suggestive of neuropathy as supported by nerve conduction studies indicating that the bilateral median, ulnar, and common peroneal nerves were affected. Peripheral nervous system involvement is not consistently observed in infantile Sandhoff's disease, prompting us to report this case.
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Hu L, Sun Y, Villasana LE, Paylor R, Klann E, Pautler RG. Early changes in the apparent diffusion coefficient (ADC) in a mouse model of Sandhoff's disease occur prior to disease symptoms and behavioral deficits. Magn Reson Med 2010; 62:1175-84. [PMID: 19780154 DOI: 10.1002/mrm.22138] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Sandhoff's disease is a lysosomal storage disease in which the ganglioside GM2 accumulates in lysosomes. It has been reported that MRI cannot detect abnormalities in spin echo images in clinically presymptomatic Sandhoff's disease patients. Because one of the results of GM2 accumulation is cell swelling and lysosomal distension, our goal was to determine if changes in the diffusion of water is perturbed. We utilized the MRI imaging modality diffusion-weighted imaging to measure the apparent diffusion coefficient in a mouse models of Sandhoff's disease, the hexb-/- mouse, and determined if diffusion-weighted imaging could be utilized to detect early changes prior to behavioral or overt disease symptom onset. Here we report for the first time a comprehensive behavioral characterization of the hexb-/- mouse in conjunction with the apparent diffusion coefficient measurement. Our data indicate that the apparent diffusion coefficient decreases in the hexb-/- mouse in many but not all brain regions prior to disease symptoms (<3.5 to 4 months of age) and behavioral deficits (3 months of age). The magnitude of the decrease ranged from 4-18%.
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Affiliation(s)
- Lingyun Hu
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, Texas, USA
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Autti T, Joensuu R, Aberg L. Decreased T2 signal in the thalami may be a sign of lysosomal storage disease. Neuroradiology 2007; 49:571-8. [PMID: 17334752 DOI: 10.1007/s00234-007-0220-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Accepted: 01/23/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Lysosomal disorders are rare and are caused by genetically transmitted lysosomal enzyme deficiencies. A decreased T2 signal in the thalamus has occasionally been reported. AIMS Because the finding of bilateral abnormal signal intensity of the thalamus on T2-weighted images has not been systematically reviewed, and its value as a diagnostic tool critically evaluated, we carried out a systematic review of the literature. METHODS Articles in English with 30 trios of keywords were collected from PubMed. Exclusion criteria were lack of conventional T2-weighted images in the protocol and not being a human study. Finally, 111 articles were included. The thalamus was considered affected only if mentioned in the text or in the figure legends. RESULTS Some 117 patients with various lysosomal diseases and five patients with ceruloplasmin deficiency were reported to have a bilateral decrease in T2 signal intensity. At least one article reported a bilateral decrease in signal intensity of the thalami on T2-weighted images in association with GM1 and GM2 gangliosidosis and with Krabbe's disease, aspartylglucosaminuria, mannosidosis, fucosidosis, and mucolipidosis IV. Furthermore, thalamic alteration was a consistent finding in several types of neuronal ceroid lipofuscinosis (NCL) including CLN1 (infantile NCL), CLN2 (classic late infantile NCL), CLN3 (juvenile NCL), CLN5 (Finnish variant late infantile NCL), and CLN7 (Turkish variant late infantile NCL). CONCLUSION A decrease in T2 signal intensity in the thalami seems to be a sign of lysosomal disease.
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Affiliation(s)
- Taina Autti
- Helsinki Medical Imaging Center, Helsinki University Central Hospital, P.O. Box 340, 00029-HUS, Helsinki, Finland.
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Maegawa GHB, Stockley T, Tropak M, Banwell B, Blaser S, Kok F, Giugliani R, Mahuran D, Clarke JTR. The natural history of juvenile or subacute GM2 gangliosidosis: 21 new cases and literature review of 134 previously reported. Pediatrics 2006; 118:e1550-62. [PMID: 17015493 PMCID: PMC2910078 DOI: 10.1542/peds.2006-0588] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Juvenile GM2 gangliosidosis is a group of inherited neurodegenerative diseases caused by deficiency of lysosomal beta-hexosaminidase resulting in GM2 ganglioside accumulation in brain. The purpose of this study was to delineate the natural history of the condition and identify genotype-phenotype correlations that might be helpful in predicting the course of the disease in individual patients. METHODS A cohort of 21 patients with juvenile GM2 gangliosidosis, 15 with the Tay-Sachs variant and 6 with the Sandhoff variant, was studied prospectively in 2 centers. Our experience was compared with previously published reports on 134 patients. Information about clinical features, beta-hexosaminidase enzyme activity, and mutation analysis was collected. RESULTS In our cohort of patients, the mean (+/-SD) age of onset of symptoms was 5.3 +/- 4.1 years, with a mean follow-up time of 8.4 years. The most common symptoms at onset were gait disturbances (66.7%), incoordination (52.4%), speech problems (28.6%), and developmental delay (28.6%). The age of onset of gait disturbances was 7.1 +/- 5.6 years. The mean time for progression to becoming wheelchair-bound was 6.2 +/- 5.5 years. The mean age of onset of speech problems was 7.0 +/- 5.6 years, with a mean time of progression to anarthria of 5.6 +/- 5.3 years. Muscle wasting (10.6 +/- 7.4 years), proximal weakness (11.1 +/- 7.7 years), and incontinence of sphincters (14.6 +/- 9.7 years) appeared later in the course of the disease. Psychiatric disturbances and neuropathy were more prevalent in patients with the Sandhoff variant than in those with the Tay-Sachs variant. However, dysphagia, sphincter incontinence, and sleep problems occurred earlier in those with the Tay-Sachs variant. Cerebellar atrophy was the most common finding on brain MRI (52.9%). The median survival time among the studied and reviewed patients was 14.5 years. The genotype-phenotype correlation revealed that in patients with the Tay-Sachs variant, the presence of R178H and R499H mutations was predictive of an early onset and rapidly progressive course. The presence of either G269S or W474C mutations was associated with a later onset of symptoms along with a more slowly progressive disease course. CONCLUSIONS Juvenile GM2 gangliosidosis is clinically heterogeneous, not only in terms of age of onset and clinical features but also with regard to the course of the disease. In general, the earlier the onset of symptoms, the more rapidly the disease progresses. The Tay-Sachs and Sandhoff variants differed somewhat in the frequency of specific clinical characteristics. Speech deterioration progressed more rapidly than gait abnormalities in both the Tay-Sachs variant and Sandhoff variant groups. Among patients with the Tay-Sachs variant, the HEXA genotype showed a significant correlation with the clinical course.
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Affiliation(s)
- Gustavo H. B. Maegawa
- Division of Clinical and Metabolic Genetics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Tracy Stockley
- Department of Paediatrics, Paediatric Laboratory Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Michael Tropak
- Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Brenda Banwell
- Division of Neurology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Susan Blaser
- Department of Paediatrics, Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Fernando Kok
- Centro do Genoma Humano, University of Sao Paulo, Sao Paulo, Brazil
| | - Roberto Giugliani
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Don Mahuran
- Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Joe T. R. Clarke
- Division of Clinical and Metabolic Genetics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Research Institute, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Lowe JP, Stuckey DJ, Awan FR, Jeyakumar M, Neville DCA, Platt FM, Griffin JL, Styles P, Blamire AM, Sibson NR. MRS reveals additional hexose N-acetyl resonances in the brain of a mouse model for Sandhoff disease. NMR IN BIOMEDICINE 2005; 18:517-26. [PMID: 16206131 DOI: 10.1002/nbm.984] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Sandhoff disease, one of several related lysosomal storage disorders, results from the build up of N-acetyl-containing glycosphingolipids in the brain and is caused by mutations in the genes encoding the hexosaminidase beta-subunit. Affected individuals undergo progressive neurodegeneration in response to the glycosphingolipid storage. (1)H magnetic resonance spectra of perchloric acid extracts of Sandhoff mouse brain exhibited several resonances ca 2.07 ppm that were not present in the corresponding spectra from extracts of wild-type mouse brain. High-performance liquid chromatography and mass spectrometry of the Sandhoff extracts post-MRS identified the presence of N-acetylhexosamine-containing oligosaccharides, which are the likely cause of the additional MRS resonances. MRS of intact brain tissue with magic angle spinning also showed additional resonances at ca 2.07 ppm in the Sandhoff case. These resonances appeared to increase with disease progression and probably arise, for the most part, from the stored glycosphingolipids, which are absent in the aqueous extracts. Hence in vivo MRS may be a useful tool for detecting early-stage Sandhoff disease and response to treatment.
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Affiliation(s)
- J P Lowe
- Experimental Neuroimaging Group, University Laboratory of Physiology, University of Oxford, Parks Road, Oxford, UK
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Patay Z. Diffusion-weighted MR imaging in leukodystrophies. Eur Radiol 2005; 15:2284-303. [PMID: 16021451 DOI: 10.1007/s00330-005-2846-2] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2005] [Revised: 05/23/2005] [Accepted: 05/31/2005] [Indexed: 11/30/2022]
Abstract
Leukodystrophies are genetically determined metabolic diseases, in which the underlying biochemical abnormality interferes with the normal build-up and/or maintenance of myelin, which leads to hypo- (or arrested) myelination, or dysmyelination with resultant demyelination. Although conventional magnetic resonance imaging has significantly contributed to recent progress in the diagnostic work-up of these diseases, diffusion-weighted imaging has the potential to further improve our understanding of underlying pathological processes and their dynamics through the assessment of normal and abnormal diffusion properties of cerebral white matter. Evaluation of conventional diffusion-weighted and ADC map images allows the detection of major diffusion abnormalities and the identification of various edema types, of which the so-called myelin edema is particularly relevant to leukodystrophies. Depending on the nature of histopathological changes, stage and progression gradient of diseases, various diffusion-weighted imaging patterns may be seen in leukodystrophies. Absent or low-grade myelin edema is found in mucopolysaccharidoses, GM gangliosidoses, Zellweger disease, adrenomyeloneuropathy, L-2-hydroxyglutaric aciduria, non-ketotic hyperglycinemia, classical phenylketonuria, Van der Knaap disease and the vanishing white matter, medium grade myelin edema in metachromatic leukodystrophy, X-linked adrenoleukodystrophy and HMG coenzyme lyase deficiency and high grade edema in Krabbe disease, Canavan disease, hyperhomocystinemias, maple syrup urine disease and leukodystrophy with brainstem and spinal cord involvement and high lactate.
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Affiliation(s)
- Zoltan Patay
- Department of Radiology, MBC 28, King Faisal Specialist Hospital and Research Centre, P.O. Box 3354, 11211, Riyadh, Kingdom of Saudi Arabia.
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Alkan A, Kutlu R, Yakinci C, Sigirci A, Aslan M, Sarac K. Infantile Sandhoff's disease: multivoxel magnetic resonance spectrosecopy findings. J Child Neurol 2003; 18:425-8. [PMID: 12886980 DOI: 10.1177/08830738030180061201] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sandhoff's disease is a rare, genetic lysosomal storage disease leading to delayed myelination or demyelination. Although neuroimaging findings in this disease have been reported previously, magnetic resonance spectroscopy findings have not been reported. In this report, we present magnetic resonance imaging and magnetic resonance spectrscopy features of two cases with Sandhoff's disease. Magnetic resonance spectroscopy revealed findings indicating widespread demyelination in both cases and neuroaxonal loss and anaerobic metabolism in the second case. Magnetic resonance spectroscopy could provide useful information in the explanation of the clinical picture of cases with Sandhoff's disease.
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Affiliation(s)
- Alpay Alkan
- Department of Radiology, Turgut Ozal Medical Center, Inonu University School of Medicine, Malatya, Turkey.
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