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Bulut FD, Kor D, Kılavuz S, Şeker Yılmaz B, Kaplan İ, Ekinci F, Burgaç E, Varol İ, Köşeci B, Tuğ Bozdoğan S, Kara E, Demir F, Deniz A, Temiz F, Önenli Mungan N. Expanding the phenotypic landscape of Gaucher disease type 3c with a novel entity - Transient neonatal cholestasis. Eur J Med Genet 2023; 66:104764. [PMID: 37061027 DOI: 10.1016/j.ejmg.2023.104764] [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: 06/30/2022] [Revised: 01/02/2023] [Accepted: 03/30/2023] [Indexed: 04/17/2023]
Abstract
Gaucher disease (GD) is the most frequent lysosomal storage disorder due to biallelic pathogenic variants in GBA gene. Only homozygous D409H variant has been associated with the cardiovascular phenotype which is also known as Gaucher disease type 3c. In this descriptive study, we presented phenotypic heterogeneity and a novel clinical finding among 13 patients with GD type 3c. Patients presented with varying degrees of cardiac valve and/or aortic calcifications (84,6%) and corneal opacities (76,9%) in addition to visceral (100%), hematological (92,3%), neurological (92,3%), and skeletal (30%) manifestations. Also, cervical dystonia (38,4%) and psychiatric disorders (46,1%) were not infrequent entities with respect to neurological involvement in GD type 3c. In this report, we highlight transient neonatal cholestasis (38,4%) as a novel finding in GD type 3c. Neonatal cholestasis is a finding associated with Gaucher type 2, but transient neonatal cholestasis has not been reported in GD patients, so far. The clinical features of GD type 3c are highly heterogeneous, from disease severity or age of onset to disease progression. Also, we concluded that phenotypic spectrum may be associated with age at onset of clinical symptoms. As, patients presenting in infancy or childhood had mainly visceral and hematological involvement and patients presenting in adolescence and adulthood had mainly cardiac, neurological involvement, and psychiatric behavioral disorders. Identifying the heterogeneous clinical course of these patients in this fatal disease, may lead a sufficient understanding of the pathophysiology which will enable targeted therapeutic interventions.
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Affiliation(s)
- Fatma Derya Bulut
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey.
| | - Deniz Kor
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey
| | - Sebile Kılavuz
- Başakşehir Çam ve Sakura City Research and Education Hospital, Pediatric Metabolism Department, İstanbul, Turkey
| | - Berna Şeker Yılmaz
- University College London, Genetics and Genomics Medicine, Institute of Child Health London, UK
| | - İrem Kaplan
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey
| | - Faruk Ekinci
- Çukurova University, Pediatric Intensive Care Department, Adana, Turkey
| | - Ezgi Burgaç
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey
| | - İlknur Varol
- İnönü University, Pediatric Gastroenterology and Hepatology Department, Malatya, Turkey
| | - Burcu Köşeci
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey
| | | | - Esra Kara
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey
| | - Fadli Demir
- Çukurova University, Pediatric Cardiology Department, Adana, Turkey
| | - Ali Deniz
- Çukurova University, Pediatric Gastroenterology and Hepatology Department, Adana, Turkey
| | - Fatih Temiz
- Sütçü İmam University, Pediatric Endocrinology Department, Kahramanmaraş, Turkey
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Sen Sarma M, Tripathi PR. Natural history and management of liver dysfunction in lysosomal storage disorders. World J Hepatol 2022; 14:1844-1861. [PMID: 36340750 PMCID: PMC9627439 DOI: 10.4254/wjh.v14.i10.1844] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 04/21/2022] [Accepted: 09/21/2022] [Indexed: 02/06/2023] Open
Abstract
Lysosomal storage disorders (LSD) are a rare group of genetic disorders. The major LSDs that cause liver dysfunction are disorders of sphingolipid lipid storage [Gaucher disease (GD) and Niemann-Pick disease] and lysosomal acid lipase deficiency [cholesteryl ester storage disease and Wolman disease (WD)]. These diseases can cause significant liver problems ranging from asymptomatic hepatomegaly to cirrhosis and portal hypertension. Abnormal storage cells initiate hepatic fibrosis in sphingolipid disorders. Dyslipidemia causes micronodular cirrhosis in lipid storage disorders. These disorders must be keenly differentiated from other chronic liver diseases and non-alcoholic steatohepatitis that affect children and young adults. GD, Niemann-Pick type C, and WD also cause neonatal cholestasis and infantile liver failure. Genotype and liver phenotype correlation is variable in these conditions. Patients with LSD may survive up to 4-5 decades except for those with neonatal onset disease. The diagnosis of all LSD is based on enzymatic activity, tissue histology, and genetic testing. Enzyme replacement is possible in GD and Niemann-Pick types A and B though there are major limitations in the outcome. Those that progress invariably require liver transplantation with variable outcomes. The prognosis of Niemann-Pick type C and WD is universally poor. Enzyme replacement therapy has a promising role in cholesteryl ester storage disease. This review attempts to outline the natural history of these disorders from a hepatologist’s perspective to increase awareness and facilitate better management of these rare disorders.
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Affiliation(s)
- Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
| | - Parijat Ram Tripathi
- Department of Pediatric Gastroenterology, Ankura Hospital for Women and Children, Hyderabad 500072, India
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