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Cai L, Vu HS, Gu W, Chen H, Franklin J, Haidar LA, Wu Z, Pan C, Cai F, Nguyen P, Ko B, Yang C, Zacharias LG, Sudderth J, Montgomery S, Uhles C, Fisher H, Hudnall J, Hornbuckle C, Quinn C, Michel D, Umaña L, Scheuerle A, McNutt MC, Gotway GK, Afroze B, Ni M, DeBerardinis R. An interactive web application for exploring human plasma and fibroblast metabolomics data from patients with inborn errors of metabolism. bioRxiv 2023:2023.12.11.571124. [PMID: 38168314 PMCID: PMC10760037 DOI: 10.1101/2023.12.11.571124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Metabolomic profiling is instrumental in understanding the systemic and cellular impact of inborn errors of metabolism (IEMs), monogenic disorders caused by pathogenic genomic variants in genes involved in metabolism. This study encompasses untargeted metabolomics analysis of plasma from 474 individuals and fibroblasts from 67 subjects, incorporating healthy controls, patients with 65 different monogenic diseases, and numerous undiagnosed cases. We introduce a web application designed for the in-depth exploration of this extensive metabolomics database. The application offers a user-friendly interface for data review, download, and detailed analysis of metabolic deviations linked to IEMs at the level of individual patients or groups of patients with the same diagnosis. It also provides interactive tools for investigating metabolic relationships and offers comparative analyses of plasma and fibroblast profiles. This tool emphasizes the metabolic interplay within and across biological matrices, enriching our understanding of metabolic regulation in health and disease. As a resource, the application provides broad utility in research, offering novel insights into metabolic pathways and their alterations in various disorders.
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Abou Haidar L, Harris RC, Pachnis P, Chen H, Gotway GK, Ni M, DeBerardinis RJ. Novel pathogenic UQCRC2 variants in a female with normal neurodevelopment. Cold Spring Harb Mol Case Stud 2023; 9:a006295. [PMID: 37709555 PMCID: PMC10815277 DOI: 10.1101/mcs.a006295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/25/2023] [Indexed: 09/16/2023] Open
Abstract
Electron transport chain (ETC) disorders are a group of rare, multisystem diseases caused by impaired oxidative phosphorylation and energy production. Deficiencies in complex III (CIII), also known as ubiquinol-cytochrome c reductase, are particularly rare in humans. Ubiquinol-cytochrome c reductase core protein 2 (UQCRC2) encodes a subunit of CIII that plays a crucial role in dimerization. Several pathogenic UQCRC2 variants have been identified in patients presenting with metabolic abnormalities that include lactic acidosis, hyperammonemia, hypoglycemia, and organic aciduria. Almost all previously reported UQCRC2-deficient patients exhibited neurodevelopmental involvement, including developmental delays and structural brain anomalies. Here, we describe a girl who presented at 3 yr of age with lactic acidosis, hyperammonemia, and hypoglycemia but has not shown any evidence of neurodevelopmental dysfunction by age 15. Whole-exome sequencing revealed compound heterozygosity for two novel variants in UQCRC2: c.1189G>A; p.Gly397Arg and c.437T>C; p.Phe146Ser. Here, we discuss the patient's clinical presentation and the likely pathogenicity of these two missense variants.
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Affiliation(s)
- Lea Abou Haidar
- Children's Medical Center Research Institute, UT Southwestern Medical Center, Dallas, Texas 75390, USA
- Howard Hughes Medical Institute, UT Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Robert C Harris
- Children's Medical Center Research Institute, UT Southwestern Medical Center, Dallas, Texas 75390, USA
- Howard Hughes Medical Institute, UT Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Panayotis Pachnis
- Children's Medical Center Research Institute, UT Southwestern Medical Center, Dallas, Texas 75390, USA
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Hongli Chen
- Children's Medical Center Research Institute, UT Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Garrett K Gotway
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas 75390, USA
- Eugene McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, Texas 75390, USA
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Min Ni
- Children's Medical Center Research Institute, UT Southwestern Medical Center, Dallas, Texas 75390, USA
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas 75390, USA
| | - Ralph J DeBerardinis
- Children's Medical Center Research Institute, UT Southwestern Medical Center, Dallas, Texas 75390, USA;
- Howard Hughes Medical Institute, UT Southwestern Medical Center, Dallas, Texas 75390, USA
- Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas 75390, USA
- Eugene McDermott Center for Human Growth and Development, UT Southwestern Medical Center, Dallas, Texas 75390, USA
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Abou Haidar L, Pachnis P, Gotway GK, Ni M, DeBerardinis RJ, McNutt MC. Partial N-acetyl glutamate synthase deficiency presenting as postpartum hyperammonemia: Diagnosis and subsequent pregnancy management. JIMD Rep 2023; 64:403-409. [PMID: 37927481 PMCID: PMC10623101 DOI: 10.1002/jmd2.12388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 11/07/2023] Open
Abstract
N-acetyl glutamate synthase (NAGS) deficiency (OMIM #: 237310) is a rare urea cycle disorder that usually presents early in life with hyperammonemia. NAGS catalyzes the synthesis of N-acetyl glutamate (NAG) which functions as an activator of the carbamoyl phosphate synthetase-1 mediated conversion of ammonia to carbamoyl phosphate. The absence of NAG results in a proximal urea cycle disorder which can result in severe neurologic sequelae secondary to hyperammonemia and even death. Unlike the other urea cycle disorders, a specific pharmacological treatment for NAGS deficiency exists in the form of carglumic acid, an analog of NAG. Here we present a 29-year-old previously healthy female who presented with hyperammonemia and obtundation just after the birth of her first child. Exome sequencing revealed two novel variants in the NAGS gene, and plasma metabolomics revealed extremely low levels of NAG. Carglumic acid treatment led to prompt resolution of her biochemical abnormalities and symptoms. She tolerated two subsequent pregnancies, 2 years and 6 years after her initial presentation, while taking carglumic acid, and breastfed her third child, all without complications in the mother or children. This case report emphasizes the importance of considering urea cycle disorders in previously-healthy adults presenting with neurological symptoms during periods of metabolic stress, including the postpartum period. It also highlights the efficacious and safe use of carglumic acid during pregnancy and while breastfeeding.
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Affiliation(s)
- Lea Abou Haidar
- Children's Medical Center Research InstituteThe University of Texas Southwestern Medical CenterDallasTexasUSA
- Howard Hughes Medical InstituteThe University of Texas Southwestern Medical CenterDallasTexasUSA
| | - Panayotis Pachnis
- Children's Medical Center Research InstituteThe University of Texas Southwestern Medical CenterDallasTexasUSA
- Department of PediatricsThe University of Texas Southwestern Medical CenterDallasTexasUSA
| | - Garrett K. Gotway
- Department of PediatricsThe University of Texas Southwestern Medical CenterDallasTexasUSA
- Eugene McDermott Center for Human Growth and DevelopmentThe University of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Internal MedicineThe University of Texas Southwestern Medical CenterDallasTexasUSA
| | - Min Ni
- Children's Medical Center Research InstituteThe University of Texas Southwestern Medical CenterDallasTexasUSA
- Department of PediatricsThe University of Texas Southwestern Medical CenterDallasTexasUSA
| | - Ralph J. DeBerardinis
- Children's Medical Center Research InstituteThe University of Texas Southwestern Medical CenterDallasTexasUSA
- Howard Hughes Medical InstituteThe University of Texas Southwestern Medical CenterDallasTexasUSA
- Department of PediatricsThe University of Texas Southwestern Medical CenterDallasTexasUSA
- Eugene McDermott Center for Human Growth and DevelopmentThe University of Texas Southwestern Medical CenterDallasTexasUSA
| | - Markey C. McNutt
- Department of PediatricsThe University of Texas Southwestern Medical CenterDallasTexasUSA
- Eugene McDermott Center for Human Growth and DevelopmentThe University of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Internal MedicineThe University of Texas Southwestern Medical CenterDallasTexasUSA
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Singhal V, Kaur S, Haidar LA, Lee H, Bredella MA, Misra M. Differences in bone accrual over one year in young girls with obesity compared to Normal weight controls. Bone 2023; 172:116757. [PMID: 37030498 DOI: 10.1016/j.bone.2023.116757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/14/2023] [Accepted: 03/31/2023] [Indexed: 04/10/2023]
Abstract
Despite higher bone mineral density (BMD), women with obesity are at an increased risk of fracture compared to normal-weight women. Optimal adolescent bone accrual is critical for normal peak bone mass acquisition and future bone health. Whereas several studies have examined the impact of low body weight on bone accrual in youth, data are lacking regarding the impact of obesity on bone accrual. We examined bone accrual over one year in young women with moderate to severe obesity (OB) (n = 21) versus normal-weight controls (NWC) (n = 50). Participants were 13-25 years old. We used dual-energy X-ray absorptiometry to assess areal BMD (aBMD) and high resolution peripheral quantitative computed tomography (distal radius and tibia) to assess volumetric BMD (vBMD), bone geometry, and microarchitecture. Analyses were controlled for age and race. The mean age was 18.7 ± 2.7 years. OB and NWC were similar for age, race, height, and physical activity. OB had a higher BMI (p < 0.0001) and younger menarchal age (p = 0.022) than NWC. Over one year, OB did not demonstrate the increase in total hip BMD observed in NWC (p = 0.03). Increases in percent cortical area and cortical thickness, and cortical and total vBMD at the radius were lower in OB than in NWC (p ≤ 0.037). Groups did not differ for tibial bone accrual. We demonstrate that longitudinal bone accrual is impaired at the total hip and radial cortex in young women with obesity, raising concerns regarding their future bone health.
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Affiliation(s)
- Vibha Singhal
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America; MGH Weight Center, Boston, MA, United States of America; Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America.
| | - Snimarjot Kaur
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Lea Abou Haidar
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Hang Lee
- MGH Biostatistics Center and Harvard Medical School, Boston, MA, United States of America; Department of Medicine and Harvard Medical School, Boston, MA, United States of America
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Madhusmita Misra
- Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America; Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
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Abou Diwan E, Zeitoun RI, Abou Haidar L, Cascorbi I, Khoueiry Zgheib N. Implementation and obstacles of pharmacogenetics in clinical practice: An international survey. Br J Clin Pharmacol 2019; 85:2076-2088. [PMID: 31141189 DOI: 10.1111/bcp.13999] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/07/2019] [Accepted: 05/19/2019] [Indexed: 12/17/2022] Open
Abstract
AIMS Eight years ago, a paper-based survey was administered during the World Pharma 2010 meeting, asking about the challenges of implementing pharmacogenetics (PGx) in clinical practice. The data collected at the time gave an idea about the progress of this implementation and what still needs to be done. Since then, although there have been major initiatives to push PGx forward, PGx clinical implementation may still be facing different challenges in different parts of the world. Our aim was therefore to distribute a follow-up international survey in electronic format to elucidate an overview on the current stage of implementation, acceptance and challenges of PGx in academic institutions around the world. METHODS This is an online anonymous LimeSurvey-based study launched on 11 November 2018. Survey questions were adapted from the initially published manuscript in 2010. An extensive web search for worldwide scientists potentially involved in PGx research resulted in a total of 1973 names. Countries were grouped based on the Human Development Index. RESULTS There were 204 respondents from 43 countries. Despite the wide availability of PGx tests, the consistently positive attitude towards their applications and advances in the field, progress of the clinical implementation of PGx still faces many challenges all around the globe. CONCLUSIONS Clinical implementation of PGx started over a decade ago but there is a gap in progress around the globe and discrepancies between the challenges reported by different countries, despite some challenges being universal. Further studies on ways to overcome these challenges are warranted.
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Affiliation(s)
| | - Ralph I Zeitoun
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Lea Abou Haidar
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ingolf Cascorbi
- Institute of Experimental and Clinical Pharmacology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Nathalie Khoueiry Zgheib
- Department of Pharmacology and Toxicology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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