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Hertzog A, Selvanathan A, Pandithan D, Kim W, Kava MP, Boneh A, Coman D, Tolun AA, Bhattacharya K. 3‐Methylglutaconyl‐CoA
hydratase deficiency: When ascertainment bias confounds a biochemical diagnosis. JIMD Rep 2022; 63:568-574. [DOI: 10.1002/jmd2.12332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Ashley Hertzog
- NSW Biochemical Genetics Service, Western Sydney Genetics Program The Children's Hospital at Westmead Westmead New South Wales Australia
- Disciplines of Genetic Medicine and Child and Adolescent Health The University of Sydney Sydney New South Wales Australia
| | - Arthavan Selvanathan
- Genetic Metabolic Disorders Service Sydney Children's Hospital Network Sydney New South Wales Australia
- Queensland Lifespan Metabolic Medicine Service Queensland Children's Hospital Brisbane Queensland Australia
| | - Dinusha Pandithan
- Department of Metabolic Medicine The Royal Children's Hospital Parkville Victoria Australia
| | - Won‐Tae Kim
- NSW Newborn Screening Programme The Children's Hospital at Westmead Westmead New South Wales Australia
| | - Maina P. Kava
- Metabolic Unit, Department of Rheumatology and Metabolic Medicine Perth Children's Hospital Perth Western Australia Australia
- School of Paediatrics and Child Health University of Western Australia Perth Western Australia Australia
| | - Avihu Boneh
- Department of Paediatrics University of Melbourne Parkville Victoria Australia
| | - David Coman
- Queensland Lifespan Metabolic Medicine Service Queensland Children's Hospital Brisbane Queensland Australia
- School of Medicine University of Queensland Brisbane Queensland Australia
| | - Adviye Ayper Tolun
- NSW Biochemical Genetics Service, Western Sydney Genetics Program The Children's Hospital at Westmead Westmead New South Wales Australia
- Disciplines of Genetic Medicine and Child and Adolescent Health The University of Sydney Sydney New South Wales Australia
| | - Kaustuv Bhattacharya
- Disciplines of Genetic Medicine and Child and Adolescent Health The University of Sydney Sydney New South Wales Australia
- Genetic Metabolic Disorders Service Sydney Children's Hospital Network Sydney New South Wales Australia
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3-Methylglutaconic Aciduria Type I Due to AUH Defect: The Case Report of a Diagnostic Odyssey and a Review of the Literature. Int J Mol Sci 2022; 23:ijms23084422. [PMID: 35457240 PMCID: PMC9029672 DOI: 10.3390/ijms23084422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/10/2022] [Accepted: 04/15/2022] [Indexed: 01/29/2023] Open
Abstract
3-Methylglutaconic aciduria type I (MGCA1) is an inborn error of the leucine degradation pathway caused by pathogenic variants in the AUH gene, which encodes 3-methylglutaconyl-coenzyme A hydratase (MGH). To date, MGCA1 has been diagnosed in 19 subjects and has been associated with a variable clinical picture, ranging from no symptoms to severe encephalopathy with basal ganglia involvement. We report the case of a 31-month-old female child referred to our center after the detection of increased 3-hydroxyisovalerylcarnitine levels at newborn screening, which were associated with increased urinary excretion of 3-methylglutaconic acid, 3-hydroxyisovaleric acid, and 3-methylglutaric acid. A next-generation sequencing (NGS) panel for 3-methylglutaconic aciduria failed to establish a definitive diagnosis. To further investigate the strong biochemical indication, we measured MGH activity, which was markedly decreased. Finally, single nucleotide polymorphism array analysis disclosed the presence of two microdeletions in compound heterozygosity encompassing the AUH gene, which confirmed the diagnosis. The patient was then supplemented with levocarnitine and protein intake was slowly decreased. At the last examination, the patient showed mild clumsiness and an expressive language disorder. This case exemplifies the importance of the biochemical phenotype in the differential diagnosis of metabolic diseases and the importance of collaboration between clinicians, biochemists, and geneticists for an accurate diagnosis.
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Benítez-Burraco A. Aspectos problemáticos del análisis genético de los trastornos específicos del lenguaje: FOXP2 como paradigma. Neurologia 2012; 27:225-33. [DOI: 10.1016/j.nrl.2011.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Revised: 04/01/2011] [Accepted: 04/05/2011] [Indexed: 01/05/2023] Open
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Benítez-Burraco A. Problematic aspects of the genetic analysis of the specific disorders of the language: FOXP2 as paradigm. NEUROLOGÍA (ENGLISH EDITION) 2012. [DOI: 10.1016/j.nrleng.2012.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Neugeborenenscreening als eine Form der prädiktiven genetischen Testung: Prinzipien und Herausforderungen. Wien Med Wochenschr 2012; 162:168-75. [DOI: 10.1007/s10354-012-0062-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2011] [Accepted: 01/26/2012] [Indexed: 10/28/2022]
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Wortmann SB, Kluijtmans LA, Engelke UFH, Wevers RA, Morava E. The 3-methylglutaconic acidurias: what's new? J Inherit Metab Dis 2012; 35:13-22. [PMID: 20882351 PMCID: PMC3249181 DOI: 10.1007/s10545-010-9210-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Revised: 08/27/2010] [Accepted: 09/06/2010] [Indexed: 11/26/2022]
Abstract
The heterogeneous group of 3-methylglutaconic aciduria (3-MGA-uria) syndromes includes several inborn errors of metabolism biochemically characterized by increased urinary excretion of 3-methylglutaconic acid. Five distinct types have been recognized: 3-methylglutaconic aciduria type I is an inborn error of leucine catabolism; the additional four types all affect mitochondrial function through different pathomechanisms. We provide an overview of the expanding clinical spectrum of the 3-MGA-uria types and provide the newest insights into the underlying pathomechanisms. A diagnostic approach to the patient with 3-MGA-uria is presented, and we search for the connection between urinary 3-MGA excretion and mitochondrial dysfunction.
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Affiliation(s)
- Saskia B. Wortmann
- 833 Nijmegen Centre for Mitochondrial Disorders at the Department of Pediatrics and the Institute of Genetic and Metabolic Disease (IGMD), Radboud University Nijmegen Medical Centre, P.O Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Leo A. Kluijtmans
- 830 Department of Laboratory Medicine, Radboud University Nijmegen Medical Center, P.O Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Udo F. H. Engelke
- 830 Department of Laboratory Medicine, Radboud University Nijmegen Medical Center, P.O Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Ron A. Wevers
- 830 Department of Laboratory Medicine, Radboud University Nijmegen Medical Center, P.O Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Eva Morava
- 833 Nijmegen Centre for Mitochondrial Disorders at the Department of Pediatrics and the Institute of Genetic and Metabolic Disease (IGMD), Radboud University Nijmegen Medical Centre, P.O Box 9101, 6500 HB Nijmegen, The Netherlands
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Mercimek-Mahmutoglu S, Tucker T, Casey B. Phenotypic heterogeneity in two siblings with 3-methylglutaconic aciduria type I caused by a novel intragenic deletion. Mol Genet Metab 2011; 104:410-3. [PMID: 21840233 DOI: 10.1016/j.ymgme.2011.07.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Revised: 07/20/2011] [Accepted: 07/20/2011] [Indexed: 11/18/2022]
Abstract
We describe two siblings with 3-methylglutaconic aciduria type I with phenotypic heterogeneity. The index case was a 14-year-old female with learning disability, attention deficit-hyperactivity and early onset subclinical leukoencephalopathy. Her 9-year-old brother had severe expressive speech delay and delay in speech sound development with normal cognitive functions. The diagnosis was confirmed by a demonstration of 3-methylglutaconyl-CoA hydratase enzyme deficiency in the cultured skin fibroblasts and homozygous deletion of exons 1-3 within the AUH gene.
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Affiliation(s)
- Saadet Mercimek-Mahmutoglu
- Division of Biochemical Diseases, Department of Pediatrics, University of British Columbia, Vancouver, Canada.
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Matsumori M, Shoji Y, Takahashi T, Shoji Y, Takada G. A molecular lesion in a Japanese patient with severe phenotype of 3-methylglutaconic aciduria type I. Pediatr Int 2005; 47:684-6. [PMID: 16354225 DOI: 10.1111/j.1442-200x.2005.02130.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Mika Matsumori
- Department of Pediatrics, Akita University School of Medicine, Akita, Japan.
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Illsinger S, Lücke T, Zschocke J, Gibson KM, Das AM. 3-methylglutaconic aciduria type I in a boy with fever-associated seizures. Pediatr Neurol 2004; 30:213-5. [PMID: 15033206 DOI: 10.1016/j.pediatrneurol.2003.09.016] [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] [Received: 07/15/2003] [Accepted: 09/09/2003] [Indexed: 11/27/2022]
Abstract
3-Methylglutaconic-aciduria type I (MGA1, OMIM 250950) resulting from 3-Methylglutaconyl-coenzyme A hydratase deficiency is a rare inherited metabolic disorder of l-leucine catabolism. We diagnosed this condition in a 4-year-old German male with generalized fever-associated seizures from the age of 12 months and normal psychomotor development. First he was considered to suffer from uncomplicated febrile seizures. After his eighth seizure, laboratory investigations were performed to exclude inborn errors of metabolism. Analysis of organic acids in urine indicated highly elevated concentrations of 3-methylglutaconic and 3-hydroxyisovaleric acids. 3-Methylglutaconyl-coenzyme A hydratase activity was markedly decreased in skin fibroblasts. Mutation analysis in the AUH gene revealed homozygosity for a novel splice site mutation IVS9-2A>G. We conclude that MGA1 may be associated with fever-associated seizures even in children without delayed psychomotor development.
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Affiliation(s)
- Sabine Illsinger
- Department of Paediatrics, Medical School Hanover, Hanover, Germany
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Ly TBN, Peters V, Gibson KM, Liesert M, Buckel W, Wilcken B, Carpenter K, Ensenauer R, Hoffmann GF, Mack M, Zschocke J. Mutations in the AUH gene cause 3-methylglutaconic aciduria type I. Hum Mutat 2003; 21:401-7. [PMID: 12655555 DOI: 10.1002/humu.10202] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The conversion of 3-methylglutaconyl-CoA to 3-hydroxy-3-methylglutaryl-CoA is the only step in leucine catametabolism yet to be characterized at enzyme and DNA levels. The deficiency of the putative mitochondrial enzyme 3-methylglutaconyl-CoA hydratase associates with the rare organic aciduria 3-methylglutaconic aciduria type I (MGA1), but neither the enzyme nor its gene have been described in any organism. Here we report that human 3-methylglutaconyl-CoA hydratase is identical with a previously described RNA-binding protein (designated AUH) possessing enoyl-CoA hydratase activity. Molecular analyses in five patients from four independent families revealed homozygosity or compound heterozygosity for mutations in the AUH gene; most mutations are predicted to completely abolish protein function. Mutations identified include c.80delG, R197X, IVS8-1G>A, A240V, and c.613_614insA. Clinical severity of MGA1 in published patients has been quite variable. Included in the present study is an additional patient with MGA1 who was detected by neonatal screening and has remained asymptomatic up to his present age of 2 years. The boy is homozygous for an N-terminal frameshift mutation in the AUH gene. Complete absence of 3-methylglutaconyl-CoA hydratase/AUH appears to be compatible with normal development in some cases. Further work is required to identify external or genetic factors associated with development of clinical problems in patients with MGA1.
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Affiliation(s)
- T B Nga Ly
- Department of General Paediatrics, Ruprecht-Karls-University, Heidelberg, Germany
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Law LK, Tang NLS, Hui J, Lam CWK, Fok TF. 3-methyglutaconic aciduria in a Chinese patient with glycogen storage disease Ib. J Inherit Metab Dis 2003; 26:705-9. [PMID: 14707520 DOI: 10.1023/b:boli.0000005603.04633.21] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We report elevated urinary excretion of 3-methylglutaconic (3MGC) and 3-methylglutaric acids (3MGR) in a patient with glycogen storage disease Ib. Combined excretion was 10-fold elevated in comparison to control during inadequate glucose maintenance, and still elevated following dietary improvement. 3MGC acid excretion correlated with plasma lactate and glucose. We speculate that imbalanced gluconeogenesis and de novo cholesterol synthesis result in secondarily increased 3MGC/3MGR production.
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Affiliation(s)
- L K Law
- Department of Chemical Pathology, The Chinese University of Hong Kong, Prince of Wales Hospital, N.T., Hong Kong, SAR.
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IJlst L, Loupatty FJ, Ruiter JPN, Duran M, Lehnert W, Wanders RJA. 3-Methylglutaconic aciduria type I is caused by mutations in AUH. Am J Hum Genet 2002; 71:1463-6. [PMID: 12434311 PMCID: PMC378594 DOI: 10.1086/344712] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2002] [Accepted: 09/11/2002] [Indexed: 11/03/2022] Open
Abstract
3-Methylglutaconic aciduria type I is an autosomal recessive disorder clinically characterized by various symptoms ranging from delayed speech development to severe neurological handicap. This disorder is caused by a deficiency of 3-methylglutaconyl-CoA hydratase, one of the key enzymes of leucine degradation. This results in elevated urinary levels of 3-methylglutaconic acid, 3-methylglutaric acid, and 3-hydroxyisovaleric acid. By heterologous expression in Escherichia coli, we show that 3-methylglutaconyl-CoA hydratase is encoded by the AUH gene, whose product had been reported elsewhere as an AU-specific RNA-binding protein. Mutation analysis of AUH in two patients revealed a nonsense mutation (R197X) and a splice-site mutation (IVS8-1G-->A), demonstrating that mutations in AUH cause 3-methylglutaconic aciduria type I.
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Affiliation(s)
- Lodewijk IJlst
- Departments of Clinical Chemistry and Pediatrics, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam; and University Children’s Hospital, Freiburg, Germany
| | - Ference J. Loupatty
- Departments of Clinical Chemistry and Pediatrics, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam; and University Children’s Hospital, Freiburg, Germany
| | - Jos P. N. Ruiter
- Departments of Clinical Chemistry and Pediatrics, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam; and University Children’s Hospital, Freiburg, Germany
| | - Marinus Duran
- Departments of Clinical Chemistry and Pediatrics, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam; and University Children’s Hospital, Freiburg, Germany
| | - Willy Lehnert
- Departments of Clinical Chemistry and Pediatrics, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam; and University Children’s Hospital, Freiburg, Germany
| | - Ronald J. A. Wanders
- Departments of Clinical Chemistry and Pediatrics, Emma Children’s Hospital, Academic Medical Center, University of Amsterdam, Amsterdam; and University Children’s Hospital, Freiburg, Germany
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Gibson KM, Ugarte M, Fukao T, Mitchell GA. Molecular and enzymatic methods for detection of genetic defects in distal pathways of branched-chain amino acid metabolism. Methods Enzymol 2001; 324:432-53. [PMID: 10989451 DOI: 10.1016/s0076-6879(00)24252-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- K M Gibson
- Department of Molecular and Medical Genetics, Oregon Health Sciences University, Portland 97201, USA
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14
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Ensenauer R, Müller CB, Schwab KO, Gibson KM, Brandis M, Lehnert W. 3-Methylglutaconyl-CoA hydratase deficiency: a new patient with speech retardation as the leading sign. J Inherit Metab Dis 2000; 23:341-4. [PMID: 10896289 DOI: 10.1023/a:1005670911799] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- R Ensenauer
- University Children's Hospital Freiburg, Germany
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