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Akgun A, Dogan Y. All aspects of galactosemia: a single center experience. J Pediatr Endocrinol Metab 2023; 36:29-35. [PMID: 36399011 DOI: 10.1515/jpem-2022-0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Classic galactosemia is a galactose metabolism disorder due to galactose-1-phosphate uridyltransferase deficiency. In this study we report the clinical features of a cohort of children with classic galactosemia. METHODS A retrospective evaluation was made of the files of 42 cases followed up for a diagnosis of classic galactosemia between January 2000 and December 2021. The data were collected of clinical, laboratory and genetic characteristics. RESULTS The cases comprised of 25 (59.5%) girls and 17 (40.5%) boys with a median age of 15 days (range, 1 day to 9 years) at diagnosis. In addition, thirty-six cases (92.3%) could be diagnosed before they were 4 months old by hospitalization with various clinical findings, primarily liver dysfunction. The most common complaints on presentation were jaundice (78.4%) and vomiting (27%) and the most frequently seen genetic pathogenic variant was c.563A>G (p.Gln188Arg) (92.4%). CONCLUSIONS It can be emphasized that there is a need for a neonatal screening program for classic galactosemia to be able to increase the possibility of early diagnosis and to be able to start treatment before the development of a severe clinical picture.
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Affiliation(s)
- Abdurrahman Akgun
- Department of Pediatrics, Division of Metabolism, Firat University School of Medicine, Elazig, Turkiye
| | - Yasar Dogan
- Department of Pediatrics, Division of Gastroenterology, Firat University School of Medicine, Elazig, Turkey
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2
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Xu R, Zheng R, Wang Y, Ma R, Tong G, Wei X, Feng D, Hu K. Transcriptome analysis to elucidate the toxicity mechanisms of fenvalerate, sulfide gatifloxacin, and ridomil on the hepatopancreas of Procambarus clarkii. FISH & SHELLFISH IMMUNOLOGY 2021; 116:140-149. [PMID: 34256134 DOI: 10.1016/j.fsi.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/15/2021] [Accepted: 07/09/2021] [Indexed: 06/13/2023]
Abstract
Most antibiotics, insecticides, and other chemicals used in agricultural and fishery production tend to persist in the environment. Fenvalerate, sulfide gatifloxacin, and ridomil are widely used in aquaculture as antibacterial, antifungal, and antiparasitic drugs; however, their toxicity mechanism remains unclear. Thus, we herein analyzed the effects of these three drugs on the hepatopancreas of Procambarus clarkii at the transcriptome level. Twelve normalized cDNA libraries were constructed using RNA extracted from P. clarkii after treatment with fenvalerate, sulfide gatifloxacin, or ridomil and from an untreated control group, followed by Kyoto Encyclopedia of Genes and Genomes pathway analysis. In the control vs fenvalerate and control vs sulfide gatifloxacin groups, 14 and seven pathways were significantly enriched, respectively. Further, the effects of fenvalerate and sulfide gatifloxacin were similar on the hepatopancreas of P. clarkii. We also found that the expression level of genes encoding senescence marker protein-30 and arylsulfatase A was downregulated in the sulfide gatifloxacin group, indicating that sulfide gatifloxacin accelerated the apoptosis of hepatopancreatocytes. The expression level of major facilitator superfamily domain containing 10 was downregulated, implying that it interferes with the ability of the hepatopancreas to metabolize drugs. Interestingly, we found that Niemann pick type C1 and glucosylceramidase-β potentially interact with each other, consequently decreasing the antioxidant capacity of P. clarkii hepatopancreas. In the fenvalerate group, the downregulation of the expression level of xanthine dehydrogenase indicated that fenvalerate affected the immune system of P. clarkii; moreover, the upregulation of the expression level of pancreatitis-associated protein-2 and cathepsin C indicated that fenvalerate caused possible inflammatory pathological injury to P. clarkii hepatopancreas. In the ridomil group, no pathway was significantly enriched. In total, 21 genes showed significant differences in all three groups. To conclude, although there appears to be some overlap in the toxicity mechanisms of fenvalerate, sulfide gatifloxacin, and ridomil, further studies are warranted.
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Affiliation(s)
- Ruze Xu
- National Pathogen Collection Center for Aquatic Animals, Shanghai Engineering Research Center of Aquaculture, National Demonstration Center for Experimental Fisheries Science Education, Shanghai Ocean University, Shanghai, 201306, PR China; National Fisheries Technical Extension Center, Beijing, 100125, PR China; Key Laboratory of East China Sea Fishery Resources Exploitation, Ministry of Agriculture, East China Sea Fisheries Research Institute, Chinese Academy of Fishery Sciences, Shanghai, 200090, PR China.
| | - Ruizhou Zheng
- National Pathogen Collection Center for Aquatic Animals, Shanghai Engineering Research Center of Aquaculture, National Demonstration Center for Experimental Fisheries Science Education, Shanghai Ocean University, Shanghai, 201306, PR China; National Fisheries Technical Extension Center, Beijing, 100125, PR China; Key Laboratory of East China Sea Fishery Resources Exploitation, Ministry of Agriculture, East China Sea Fisheries Research Institute, Chinese Academy of Fishery Sciences, Shanghai, 200090, PR China
| | - Yali Wang
- National Pathogen Collection Center for Aquatic Animals, Shanghai Engineering Research Center of Aquaculture, National Demonstration Center for Experimental Fisheries Science Education, Shanghai Ocean University, Shanghai, 201306, PR China; National Fisheries Technical Extension Center, Beijing, 100125, PR China; Key Laboratory of East China Sea Fishery Resources Exploitation, Ministry of Agriculture, East China Sea Fisheries Research Institute, Chinese Academy of Fishery Sciences, Shanghai, 200090, PR China
| | - Rongrong Ma
- National Pathogen Collection Center for Aquatic Animals, Shanghai Engineering Research Center of Aquaculture, National Demonstration Center for Experimental Fisheries Science Education, Shanghai Ocean University, Shanghai, 201306, PR China
| | - Guixiang Tong
- Guangxi Key Laboratory of Aquatic Genetic Breeding and Healthy Aquaculture, Guangxi Academy of Fishery Sciences, Nanning, 530021, PR China
| | - Xinxian Wei
- Guangxi Key Laboratory of Aquatic Genetic Breeding and Healthy Aquaculture, Guangxi Academy of Fishery Sciences, Nanning, 530021, PR China
| | - Dongyue Feng
- National Fisheries Technical Extension Center, Beijing, 100125, PR China.
| | - Kun Hu
- National Pathogen Collection Center for Aquatic Animals, Shanghai Engineering Research Center of Aquaculture, National Demonstration Center for Experimental Fisheries Science Education, Shanghai Ocean University, Shanghai, 201306, PR China; National Fisheries Technical Extension Center, Beijing, 100125, PR China; Key Laboratory of East China Sea Fishery Resources Exploitation, Ministry of Agriculture, East China Sea Fisheries Research Institute, Chinese Academy of Fishery Sciences, Shanghai, 200090, PR China.
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Teke Kisa P, Kose M, Unal O, Er E, Hismi BO, Bulbul FS, Kose E, Gunduz M, Canda E, Kucukcongar A, Arslan N. Clinical and molecular characteristics and time of diagnosis of patients with classical galactosemia in an unscreened population in Turkey. J Pediatr Endocrinol Metab 2019; 32:675-681. [PMID: 31194682 DOI: 10.1515/jpem-2018-0457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/30/2019] [Indexed: 12/23/2022]
Abstract
Classical galactosemia is an autosomal recessive inborn error of metabolism caused by biallelic pathogenic variants in the GALT gene. With the benefit of early diagnosis by newborn screening, the acute presentation of galactosemia can be prevented. In this study, we describe the clinical phenotypes, time of diagnosis and GALT genotypes of 76 galactosemia patients from Turkey, where the disease is not yet included in the newborn screening program. The median age at first symptom was 10 days (range 5-20), while the median age at diagnosis was 30 days (range 17-53). Nearly half of the patients (36 patients, 47.4%) were diagnosed later than age 1 month. Fifty-eight individuals were found to have 18 different pathogenic variants in their 116 mutant alleles. In our sample, Q188R variant has the highest frequency with 53%, the other half of the allele frequency of the patients showed 17 different genotypes. Despite presenting with typical clinical manifestations, classical galactosemia patients are diagnosed late in Turkey. Due to the geographical location of our country, different pathogenic GALT variants may be seen in Turkish patients. In the present study, a clear genotype-phenotype correlation could not be established in patients.
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Affiliation(s)
- Pelin Teke Kisa
- Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Melis Kose
- Division of Pediatric Metabolism and Nutrition, Dr. Behcet Uz Children's Training and Research Hospital, Izmir, Turkey
| | - Ozlem Unal
- Division of Pediatric Metabolism and Nutrition, Ankara Children's Training and Research Hospital, Ankara, Turkey
| | - Esra Er
- Division of Pediatric Metabolism and Nutrition, Ege University Faculty of Medicine, Izmir, Turkey
| | - Burcu Ozturk Hismi
- Division of Pediatric Metabolism and Nutrition, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Fatma Selda Bulbul
- Division of Pediatric Metabolism and Nutrition, Kirikkale University, Kirikkale, Turkey
| | - Engin Kose
- Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Mehmet Gunduz
- Division of Pediatric Metabolism and Nutrition, Ankara Children's Training and Research Hospital, Ankara, Turkey
| | - Ebru Canda
- Division of Pediatric Metabolism and Nutrition, Ege University Faculty of Medicine, Izmir, Turkey
| | - Aynur Kucukcongar
- Division of Pediatric Metabolism and Nutrition, Ankara Children's Training and Research Hospital, Ankara, Turkey
| | - Nur Arslan
- Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
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Welling L, Boelen A, Derks TGJ, Schielen PCJI, de Vries M, Williams M, Wijburg FA, Bosch AM. Nine years of newborn screening for classical galactosemia in the Netherlands: Effectiveness of screening methods, and identification of patients with previously unreported phenotypes. Mol Genet Metab 2017; 120:223-228. [PMID: 28065439 DOI: 10.1016/j.ymgme.2016.12.012] [Citation(s) in RCA: 28] [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] [Received: 11/14/2016] [Revised: 12/27/2016] [Accepted: 12/27/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Newborn screening (NBS) for classical galactosemia (CG) was introduced in the Netherlands in 2007. Multiple screening methods have been used since, and currently a two-tier system is used, with residual enzyme activity of galactose-1-phosphate-uridyltransferase (GALT) and total galactose concentration in dried blood spots as the primary and secondary markers. As it is essential to monitor effectiveness of NBS programs, we assessed the effectiveness of different screening methods used over time (primary aim), and aimed to identify and investigate patients identified through NBS with previously unreported clinical and biochemical phenotypes (secondary aim). METHODS The effectiveness of different screening methods and their cut-off values (COVs), as used from 2007 through 2015, was determined, and the clinical and biochemical data of all identified patients were retrospectively collected. RESULTS All screening methods and COVs resulted in relatively high false-positive rates and low positive predictive values. Total galactose levels in dried blood spots were far above the COV for NBS in all true positive cases. A total of 31 galactosemia patients were identified, and when corrected for a family with three affected siblings, 14% had a previously unreported phenotype and genotype. These individuals did not demonstrate any symptoms at the time of diagnosis while still being exposed to galactose, had galactose-1-phosphate values below detection limit within months after the start of diet, and had previously unreported genotypes. CONCLUSION Optimization of NBS for CG in the Netherlands is warranted because of the high false-positive rate, which may result in significant harm. Furthermore, a surprising 14% of newborns identified with CG by screening had previously unreported clinical and biochemical phenotypes and genotypes. For them, individualized prognostication and treatment are warranted, in order to avoid unnecessary stringent galactose restriction.
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Affiliation(s)
- Lindsey Welling
- Department of Pediatrics, Academic Medical Center, Amsterdam, The Netherlands.
| | - Anita Boelen
- Department of Clinical Chemistry, Laboratory of Endocrinology, Academic Medical Center, University of Amsterdam, The Netherlands.
| | - Terry G J Derks
- Section of Metabolic Diseases, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Peter C J I Schielen
- Centre for Infectious Diseases Research, Diagnostics and Screening (IDS), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Maaike de Vries
- Department of Pediatrics, University Medical Center St Radboud Nijmegen, Nijmegen, The Netherlands.
| | - Monique Williams
- Department of Pediatrics, Erasmus MC-Sophia children's Hospital, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Frits A Wijburg
- Department of Pediatrics, Academic Medical Center, Amsterdam, The Netherlands.
| | - Annet M Bosch
- Department of Pediatrics, Academic Medical Center, Amsterdam, The Netherlands.
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Varela-Lema L, Paz-Valinas L, Atienza-Merino G, Zubizarreta-Alberdi R, Villares RV, López-García M. Appropriateness of newborn screening for classic galactosaemia: a systematic review. J Inherit Metab Dis 2016; 39:633-649. [PMID: 27116003 DOI: 10.1007/s10545-016-9936-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/28/2016] [Accepted: 04/06/2016] [Indexed: 12/11/2022]
Abstract
Currently, there is no universal agreement on galactosaemia screening, fundamentally because of the risk-benefit uncertainties. We conducted two exhaustive systematic searches in the main electronic databases (PubMed, Embase, Cochrane, etc.) to recover relevant information about the disease and screening test/s in order to support decision making in Spain. All of the 45 studies identified that covered disease issues were retrospective case series or cross-sectional analysis (level-4 evidence). Studies consistently found that the majority of patients presented characteristic symptomatology before diagnosis. Long term disabilities were not significantly correlated with age of diagnosis, onset of dietary restriction or strict diet compliance. The five studies that provided accuracy data used different cut-off points and verification tests, and thus differed in their definitions of a positive case (level-3b evidence). The estimated sensitivity was 100 % and the specificity 99.9 %. The false-positive rate ranged from 0.0005 % to 0.25 %, and the PPV from 0 % to 64.3 %. The comparative clinical effectiveness in relation to not screening or implementation of other programs is unknown. In summary, existing evidence remains insufficient to establish the appropriateness of newborn screening for galactosaemia screening, although health benefits could be expected if early diagnosis and treatment is achieved. If screening is implemented in Spain, it would be important that a pilot programme be implemented to assess false positive rate and ensure that early diagnosis is not delayed.
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Affiliation(s)
- L Varela-Lema
- Scientific-Technical Advice Unit (avalia-t), Galician Agency for Health Knowledge Management, ACIS, Santiago de Compostela, Spain.
| | - L Paz-Valinas
- Scientific-Technical Advice Unit (avalia-t), Galician Agency for Health Knowledge Management, ACIS, Santiago de Compostela, Spain
| | - G Atienza-Merino
- Scientific-Technical Advice Unit (avalia-t), Galician Agency for Health Knowledge Management, ACIS, Santiago de Compostela, Spain
| | - R Zubizarreta-Alberdi
- Department of Innovation and Public Health, Galician Health Authority, Santiago de Compostela, Spain
| | - R Vizoso Villares
- Department of Innovation and Public Health, Galician Health Authority, Santiago de Compostela, Spain
| | - M López-García
- Scientific-Technical Advice Unit (avalia-t), Galician Agency for Health Knowledge Management, ACIS, Santiago de Compostela, Spain
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Garcia DF, Camelo JS, Molfetta GA, Turcato M, Souza CFM, Porta G, Steiner CE, Silva WA. Clinical profile and molecular characterization of Galactosemia in Brazil: identification of seven novel mutations. BMC MEDICAL GENETICS 2016; 17:39. [PMID: 27176039 PMCID: PMC4866286 DOI: 10.1186/s12881-016-0300-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 04/30/2016] [Indexed: 11/17/2022]
Abstract
Background Classical Galactosemia (CG) is an inborn error of galactose metabolism caused by the deficiency of the galactose-1-phosphate uridyltransferase enzyme. It is transmitted as an autosomal recessive disease and is typically characterized by neonatal galactose intolerance, with complications ranging from neonatal jaundice and liver failure to late complications, such as motor and reproductive dysfunctions. Galactosemia is also heterogeneous from a molecular standpoint, with hundreds of different mutations described in the GALT gene, some of them specific to certain populations, reflecting consequence of founder effect. Methods This study reviews the main clinical findings and depicts the spectrum of mutations identified in 19 patients with CG, six with Duarte Galactosemia and one with type 2 Galactosemia in Brazil. Some individuals were diagnosed through expanded newborn screening test, which is not available routinely to all newborns. Results The main classical Galactosemia mutations reported to date were identified in this study, as well as the Duarte variant and seven novel mutations - c.2 T > C (p.M1T), c.97C > A (p.R33S), c.217C > T (p.P73S), c.328 + 1G > A (IVS3 + 1G > A), c.377 + 4A > C (IVS4 + 4A > C), c.287_289delACA (p.N97del) and c.506A > C (p.Q169P). This was expected, given the high miscegenation of the Brazilian population. Conclusions This study expands the mutation spectrum in GALT gene and reinforces the importance of early diagnosis and introduction of dietary treatment, what is possible with the introduction of Galactosemia in neonatal screening programs. Electronic supplementary material The online version of this article (doi:10.1186/s12881-016-0300-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel F Garcia
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.,National Institute of Science and Technology in Stem Cell, and Cell Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - José S Camelo
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Greice A Molfetta
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.,National Institute of Science and Technology in Stem Cell, and Cell Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto, SP, Brazil.,Center for Medical Genomics at Clinical Hospital of the Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marlene Turcato
- Department of Neurology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Carolina F M Souza
- Department of Genetics, Clinical Hospital of the Porto Alegre, Porto Alegre, RS, Brazil
| | - Gilda Porta
- Department of Pediatrics, Children's Institute, Medical School of the University of São Paulo, São Paulo, SP, Brazil
| | - Carlos E Steiner
- Department of Medical Genetics, School of Medical Science, State University of Campinas, Campinas, SP, Brazil
| | - Wilson A Silva
- Department of Genetics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil. .,National Institute of Science and Technology in Stem Cell, and Cell Therapy, Regional Blood Center of Ribeirão Preto, Ribeirão Preto, SP, Brazil. .,Center for Medical Genomics at Clinical Hospital of the Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
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7
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Viggiano E, Marabotti A, Burlina AP, Cazzorla C, D'Apice MR, Giordano L, Fasan I, Novelli G, Facchiano A, Burlina AB. Clinical and molecular spectra in galactosemic patients from neonatal screening in northeastern Italy: structural and functional characterization of new variations in the galactose-1-phosphate uridyltransferase (GALT) gene. Gene 2015; 559:112-8. [PMID: 25592817 DOI: 10.1016/j.gene.2015.01.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 12/29/2014] [Accepted: 01/08/2015] [Indexed: 10/24/2022]
Abstract
Classical galactosemia is an autosomal recessive inborn error of metabolism due to mutations of the GALT gene leading to toxic accumulation of galactose and derived metabolites. With the benefit of early diagnosis by neonatal screening and early therapy, the acute presentation of classical galactosemia can be prevented. However, despite early diagnosis and treatment, the long term outcome for these patients is still unpredictable because they may go on to develop cognitive disability, speech problems, neurological and/or movement disorders and, in females, ovarian dysfunction. The objectives of the current study were to report our experience with a group of galactosemic patients identified through the neonatal screening programs in northeastern Italy during the last 30years. No neonatal deaths due to galactosemia complications occurred after the introduction of the neonatal screening program. However, despite the early diagnosis and dietary treatment, the patients with classical galactosemia showed one or more long-term complications. A total of 18 different variations in the GALT gene were found in the patient cohort: 12 missense, 2 frameshift, 1 nonsense, 1 deletion, 1 silent variation, and 1 intronic. Six (p.R33P, p.G83V, p.P244S, p.L267R, p.L267V, p.E271D) were new variations. The most common variation was p.Q188R (12 alleles, 31.5%), followed by p.K285N (6 alleles, 15.7%) and p.N314D (6 alleles, 15.7%). The other variations comprised 1 or 2 alleles. In the patients carrying a new mutation, the biochemical analysis of GALT activity in erythrocytes showed an activity of <1%. In silico analysis (SIFT, PolyPhen-2 and the computational analysis on the static protein structure) showed potentially damaging effects of the six new variations on the GALT protein, thus expanding the genetic spectrum of GALT variations in Italy. The study emphasizes the difficulty in establishing a genotype-phenotype correlation in classical galactosemia and underlines the importance of molecular diagnostic testing prior to making any treatment.
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Affiliation(s)
- E Viggiano
- Division of Inborn Metabolic Diseases, Department of Paediatrics, University Hospital of Padova, Italy
| | - A Marabotti
- Department of Chemistry and Biology, University of Salerno, via Giovanni Paolo II 132, 84084 Fisciano, SA, Italy
| | - A P Burlina
- Neurological Unit, St. Bassiano Hospital, Bassano del Grappa, Consultant in Neurometabolic Hereditary Diseases at the University Hospital of Padova, Italy
| | - C Cazzorla
- Division of Inborn Metabolic Diseases, Department of Paediatrics, University Hospital of Padova, Italy
| | - M R D'Apice
- Department of Biomedicine and Prevention, School of Medicine, University of Rome "Tor Vergata" and Fondazione PTV "Policlinico Tor Vergata", Rome, Italy
| | - L Giordano
- Division of Inborn Metabolic Diseases, Department of Paediatrics, University Hospital of Padova, Italy
| | - I Fasan
- Division of Inborn Metabolic Diseases, Department of Paediatrics, University Hospital of Padova, Italy
| | - G Novelli
- Department of Biomedicine and Prevention, School of Medicine, University of Rome "Tor Vergata" and Fondazione PTV "Policlinico Tor Vergata", Rome, Italy
| | - A Facchiano
- National Research Council, Institute of Food Science, via Roma 64, 83100 Avellino, Italy
| | - A B Burlina
- Division of Inborn Metabolic Diseases, Department of Paediatrics, University Hospital of Padova, Italy.
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Abstract
Galactosemia is a secondary glycosylation disorder characterized by galactose deficiency of glycoproteins and glycolipids. Abnormal glycosylation of coagulation factors and evidence of liver disease are associated with coagulopathy in galactosemic infants. We report a case of a neonate with galactosemia presenting with bilateral vitreous hemorrhage (VH). During the follow-up, hemorrhage in the right eye resolved; however, it persisted in the left eye. Vitrectomy was planned for the left eye. In addition to cataract, VH is another ophthalmic finding in galactosemia with serious sequelae such as amblyopia. Serious complications of coagulopathy in galactosemic infants can be prevented with early diagnosis and prompt treatment. Inclusion of galactosemia in the neonatal screening program offers an opportunity to prevent early severe symptoms.
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9
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Abstract
Classic galactosemia results from mutations in the galactose-1-phosphate uridyl transferase gene and causes infants to present with jaundice after initiation of lactose containing formulas. Jaundice associated with galactosemia is often thought to have a prominent direct fraction. We report an infant with galactosemia who presented with severe jaundice from indirect hyperbilirubinemia and met criteria for an exchange transfusion within 48 h after milk ingestion.
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10
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Camelo JS, Fernandes MIM, Maciel LMZ, Scrideli CA, Santos JLF, Camargo AS, Passador CS, Leite PC, Resende DR, de Souza LO, Giugliani R, Jorge SM. Galactosaemia in a Brazilian population: high incidence and cost-benefit analysis. J Inherit Metab Dis 2009; 32 Suppl 1:S141-9. [PMID: 19418240 DOI: 10.1007/s10545-009-1112-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 03/20/2009] [Accepted: 03/25/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To study the incidence of galactosaemia in the state of São Paulo and the benefit/cost (B/C) ratio of the introduction of neonatal screening for galactosaemia, comparing it with a selective approach. METHODS An enzymatic-colorimetric assay was used for the screening of total galactose (TG) in a sample of 10% of the births in São Paulo in one year and positive cases were confirmed by the activity of galactose-1-phosphate uridyltransferase (GALT). Detected and referred cases were genotyped using enzyme restriction studies for Q188R, N314D and S135L mutations of the GALT gene. The economic analysis was determined by calculating the B/C ratio and by analysis of sensitivity as a function of the incidence of the disease detected and the variation of the interest rate in the economy. RESULTS 59 953 newborns were screened for TG, with 3 cases of galactosaemia being identified (0.26% false positives), corresponding to a frequency of 1:19 984 liveborns (95% confidence interval: 1:7494 to 1:59 953). One classical case and one Duarte 2 variant referred to as a selective approach were confirmed. With an incidence of 1:19 984, the B/C ratio was 1.04 for the 11.75% interest rate in effect in Brazil, with values already decapitalized. With a maximum possible incidence of 1:7494, the B/C ratio was 2.79. DISCUSSION There is an economic advantage in introducing neonatal screening for galactosaemia in the national neonatal screening programme. This advantage could increase with a reduction of the current interest rates in the economy.
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Affiliation(s)
- J S Camelo
- Department of Pediatrics, School of Medicine of Ribeirão Preto, University of São Paulo, Bandeirantes Avenue, 3900, Clinics Hospital, Monte Alegre Campus, Ribeirão Preto, São Paulo, Brazil.
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Velázquez-Aragón J, Alcántara-Ortigoza MA, Vela-Amieva M, Monroy S, Martínez-Cruz V, Todd-Quiñones C, González-del Angel A. Low allelic heterogeneity in a sample of Mexican patients with classical galactosaemia. J Inherit Metab Dis 2008; 31 Suppl 2:S333-7. [PMID: 18956253 DOI: 10.1007/s10545-008-0905-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Revised: 09/03/2008] [Accepted: 09/08/2008] [Indexed: 11/27/2022]
Abstract
Classical galactosaemia is an autosomal recessive disease of galactose metabolism caused by a deficiency of the enzyme galactose-1-phosphate uridyltransferase (GALT). Galactosaemia is not included in the neonatal screening programme in Mexico and it is necessary to implement methodologies for prompt diagnosis of these patients to establish treatment. To date, more than 190 mutations in the GALT gene have been reported, most in caucasian populations, but there have been no reports of mutations in Latin-American populations. We report here the mutational spectrum in 19 Mexican galactosaemic patients. The most frequent mutations were p.Q188R, p.N314D and IVS2-2A>G, which together represented 71% of detected mutations. The mutation IVS2-2A>G, which has been detected only in Hispanics, was thought to generate a null allele; we identified one patient with a homozygous IVS2-2A>G mutation who showed a mild deficiency of enzyme value in erythrocytes. One patient homozygous for Duarte 2 (p.N314D, IVS5+62G>A) is probably due to a partial uniparental disomy of chromosome 9. In addition, a novel mutation c.336T>C (p.S112R) was detected in one patient with severe enzymatic deficiency. Despite the small number of patients studied, our results suggest that classical galactosaemia shows low allelic heterogeneity in Mexican patients, in contrast what is observed in other Mendelian disorders such as cystinosis or autosomal dominant hypercholesterolaemia. This low allelic heterogeneity might be explained by a "population of origin" effect in the central region of Mexico, as has been described for phenylketonuria.
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Affiliation(s)
- J Velázquez-Aragón
- Molecular Biology Laboratory, Genetics Department, Instituto Nacional de Pediatría, D.F., México
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12
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Jama M, Nelson L, Pont-Kingdon G, Mao R, Lyon E. Simultaneous amplification, detection, and analysis of common mutations in the galactose-1-phosphate uridyl transferase gene. J Mol Diagn 2007; 9:618-23. [PMID: 17884932 PMCID: PMC2049049 DOI: 10.2353/jmoldx.2007.070027] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Classic galactosemia is an autosomal recessive inherited error of galactose metabolism. It is caused by lack of galactose-1-phosphate uridyl transferase, an enzyme that is required to metabolize galactose-1-phosphate to uridine diphosphate galactose. The build up of galactose-1-phosphate is toxic at high levels and can damage the liver, brain, eyes, and other vital organs. Over 200 mutations have been identified in affected individuals. We describe an assay to identify nine target mutations or variants in the galactose-1-phosphate uridyl transferase gene, namely p.Q188R, p.S135L, p.K285N, p.L195P, p.T138M, p.Y209C, IVS2-2 A>G, p.L218L, and p.N314D. A single long-range PCR is followed by a multiplexed nucleotide extension assay (single nucleotide extension) and capillary electrophoresis to detect simultaneously all nine target mutations/variants. Fifty-four previously characterized samples (47 clinical samples and seven controls) gave a 100% concordance. We also report a nontarget novel mutation, p.L192X, and its profile using single nucleotide extension. This assay can complement the enzyme activity assay and identify familial mutations for testing additional family members.
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Affiliation(s)
- Mohamed Jama
- ARUP Institute for Clinical and Experimental Pathology, 500 Chipeta Way, Salt Lake City, UT 84108, USA
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13
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Pertierra A, Salvia MD, Casals E, Figueras J. Falsas hiperglucemias en las pruebas rápidas usadas en las unidades de neonatología. An Pediatr (Barc) 2005; 62:291-2. [PMID: 15737295 DOI: 10.1157/13071849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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14
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Holub M, Bodamer OA, Item C, Mühl A, Pollak A, Stöckler-Ipsiroglu S. Lack of correlation between fatty acid oxidation disorders and haemolysis, elevated liver enzymes, low platelets (HELLP) syndrome? Acta Paediatr 2005; 94:48-52. [PMID: 15858960 DOI: 10.1111/j.1651-2227.2005.tb01787.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Fatty acid beta-oxidation defects comprise a heterogeneous group of disorders that may precipitate acute life threatening metabolic crises particularly during catabolic episodes. Several studies have demonstrated a possible association between fatty acid beta-oxidation defects, including long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency and severe pregnancy complications. However, the precise percentage of women with haemolysis, elevated liver enzymes, low platelets (HELLP) syndrome associated with foetal fatty acid beta-oxidation defects is not known. METHODS We carried out a multicentre retrospective study on 88 infants, born to women with HELLP syndrome. Acylcarnitine profiles from blood dried on filter paper cards were analysed by tandem mass spectrometry for the diagnosis of fatty acid beta-oxidation defects. In addition, we screened for the common long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency mutation using a standard restriction fragment length polymorphism polymerase chain reaction method. RESULTS None of the infants studied carried the common long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency mutation. There was no evidence of fatty acid beta-oxidation defects, including long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency, as expected by unremarkable acylcarnitine profiles, while three infants with fatty acid beta-oxidation defects were diagnosed in the control group. CONCLUSIONS Neither foetal long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency, including heterozygosity for the common long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency mutation, nor fatty acid beta-oxidation defects in general are a major risk factor for HELLP syndrome in Austria.
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Affiliation(s)
- M Holub
- Department of Neonatology and Paediatric Intensive Care Medicine, University Hospital Vienna, Austria
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15
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Infusionstherapie und Ernährung von Risikogruppen. INFUSIONSTHERAPIE UND DIÄTETIK IN DER PÄDIATRIE 2005. [PMCID: PMC7136897 DOI: 10.1007/3-540-27897-4_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Besondere Situationen erfordern ein besonderes Vorgehen. Während bisher das »Standardvorgehen« bezüglich der Ernährung von pädiatrischen Patienten dargestellt wurde, beschäftigt sich das vorliegende Kapitel mit »Sondersituationen« der pädiatrischen Infusionstherapie und Ernährung. Behandlungssituationen, die ein besonderes Vorgehen bei der Therapie oder spezielle Aufmerksamkeit bei der Anpassung der Ernährung erfordern, entstehen in der Regel durch 4 mögliche Situationen:
spezifische Physiologie von Patientengruppen (z. B. Früh- oder Neugeborene), Auswirkungen von therapeutischen Maßnahmen (z. B. Operationen), Pathophysiologie von Erkrankungen (z. B. angeborene Stoffwechselerkrankungen, Erkrankungen des onkologischen, rheumatischen oder atopischen Formenkreises, Anorexia nervosa, Bulimie oder Adipositas) oder besondere körperliche Belastungen [z. B. (Leistungs-)Sport].
Bekannte Strategien werden systematisch und prägnant dargestellt und diskutiert. Die Beschäftigung mit der Ernährung von »Risikogruppen« übt das Erkennen und den Umgang von potenziellen Gefahrensituationen bei der Verordnung von bilanzierter Ernährung. So sollte auch derjenige von dem Kapitel profitieren, der sich mit den behandelten Patientengruppen, Situationen, Erkrankungen üblicherweise nicht beschäftigen muss.
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16
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Easley CJ, Jin LJ, Presto Elgstoen KB, Jellum E, Landers JP, Ferrance JP. Capillary electrophoresis with laser-induced fluorescence detection for laboratory diagnosis of galactosemia. J Chromatogr A 2003; 1004:29-37. [PMID: 12929958 DOI: 10.1016/s0021-9673(03)00767-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Galactosemia, a metabolic disorder associated with the intolerance to dietary galactose due to an inherited enzymatic deficiency, is indicated by heightened levels of galactose in urine (galactosuria). In this report, capillary electrophoresis (CE) with laser-induced fluorescence detection was evaluated for its ability to screen urinary carbohydrates, particularly galactose. Neonatal urine samples with normal and abnormal levels of galactose were analyzed with galactose concentrations quantitated relative to urinary creatinine concentrations to account for variable urinary dilution. Analysis of nine samples by CE in a single-blind manner defined four as negative (normal) and five as positive for galactosuria with galactose levels as high as 146.8 +/- 5.9 mM. Galactosuria was correlated with clinical galactosemia diagnoses for four of the positive samples, while the remaining positive was associated with a patient diagnosed with Hurler's syndrome.
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Affiliation(s)
- Christopher J Easley
- University of Virginia, Department of Chemistry, McCormick Road, Charlottesville, VA 22904, USA
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