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Cazzorla C, Bensi G, Biasucci G, Leuzzi V, Manti F, Musumeci A, Papadia F, Stoppioni V, Tummolo A, Vendemiale M, Polo G, Burlina A. Living with phenylketonuria in adulthood: The PKU ATTITUDE study. Mol Genet Metab Rep 2018; 16:39-45. [PMID: 30069431 PMCID: PMC6066799 DOI: 10.1016/j.ymgmr.2018.06.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/27/2018] [Indexed: 12/27/2022] Open
Abstract
Dietary treatment is the cornerstone of therapy for phenylketonuria (PKU), but adherence to low- phenylalanine diet progressively decreases after adolescence. We designed a survey to characterize the dietary habits of Italian adult PKU patients and to identify psychological factors influencing disease perception and adherence to diet. Participants to the survey (n = 111; response rate 94%) were asked to complete a structured questionnaire. Patients appeared to have an altered perception and awareness of the disease. About 40% of them did not consider PKU a disease and, despite declaring regular monitoring of phenylalanine levels (85%), nearly half of them reported a high plasma value over the last 6 months (>600 μmol/L, 48%) or were unable to specify it (31%). Adherence to PKU diet was unsatisfactory, with increased consumption of natural protein sources and reduced daily use of amino-acid supplements (<4-5 times/day in 82% patients). In addition to the intrinsic characteristics of AA formula (palatability, ease of use), the most important factor influencing their consumption was the increased social pressure associated with their use (55%). Plasma phenylalanine periodical measurements (61%) and examinations at metabolic centers (49%) were considered relevant for compliance to diet. In Italian adult PKU patients dietary management was found to be inadequate, likely due to inappropriate perception and knowledge of the disease, and lack of awareness of the negative impact of poor metabolic control in adult life. Clinicians should consider implementing more intense and tailored educational measures, as well as structured transitional care processes.
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Affiliation(s)
- Chiara Cazzorla
- Division of Inherited Metabolic Diseases, Reference Centre Expanded Newborn Screening, Department of Woman's and Child's Health - University Hospital, Padova, Italy
| | - Giulia Bensi
- Department of Pediatrics and Neonatology, Regional Referral Clinical Centre for IMD, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Giacomo Biasucci
- Department of Pediatrics and Neonatology, Regional Referral Clinical Centre for IMD, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Vincenzo Leuzzi
- Department of Human Neuroscience, Child Neurology and Psychiatry - Sapienza University, Rome, Italy
| | - Filippo Manti
- Department of Human Neuroscience, Child Neurology and Psychiatry - Sapienza University, Rome, Italy
| | - Antonella Musumeci
- Division of Child Neurology and Psychiatry, Riuniti Hospital Marche Nord Pesaro, Fano, Italy
| | - Francesco Papadia
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Vera Stoppioni
- Division of Child Neurology and Psychiatry, Riuniti Hospital Marche Nord Pesaro, Fano, Italy
| | - Albina Tummolo
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Marcella Vendemiale
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children's Hospital, Bari, Italy
| | - Giulia Polo
- Division of Inherited Metabolic Diseases, Reference Centre Expanded Newborn Screening, Department of Woman's and Child's Health - University Hospital, Padova, Italy
| | - Alberto Burlina
- Division of Inherited Metabolic Diseases, Reference Centre Expanded Newborn Screening, Department of Woman's and Child's Health - University Hospital, Padova, Italy
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Tummolo A, Melpignano L, Carella A, Di Mauro AM, Piccinno E, Vendemiale M, Ortolani F, Fedele S, Masciopinto M, Papadia F. Long-term continuous N-carbamylglutamate treatment in frequently decompensated propionic acidemia: a case report. J Med Case Rep 2018; 12:103. [PMID: 29679984 PMCID: PMC5911373 DOI: 10.1186/s13256-018-1631-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 02/22/2018] [Indexed: 11/10/2022] Open
Abstract
Background Propionic acidemia is a rare autosomal recessive inherited metabolic disorder that can inhibit the synthesis of N-acetylglutamate, the obligatory activator in urea synthesis, leading to hyperammonemia. N-carbamylglutamate ameliorates hyperammonemia in decompensated propionic acidemia. The effects of long-term continuous N-acetylglutamate administration in such patients are unknown. We report our clinical experience with continuous administration of N-acetylglutamate for 6 years in a patient with propionic acidemia frequently presenting with hyperammonemia. Case presentation A male Caucasian patient with frequently decompensated propionic acidemia and hyperammonemia was admitted 78 times for acute attacks during the first 9 years of his life. Continuous daily treatment with oral N-carbamylglutamate 100 mg/kg (50 mg/kg after 6 months) was initiated. During 6 years of treatment, he had a significant decrease in his mean plasma ammonia levels (75.7 μmol/L vs. 140.3 μmol/L before N-carbamylglutamate therapy, p < 0.005 [normal range 50–80 μmol/L]) and fewer acute episodes (two in 6 years). Conclusion Our results suggest a benefit of N-acetylglutamate administration outside the emergency setting. If this observation is confirmed, future studies should aim to optimize the dosage and explore effects of the dosage requirements on other drugs and on protein tolerance.
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Affiliation(s)
- Albina Tummolo
- Metabolic Diseases and Clinical Genetics Unit, Children's Hospital Giovanni XXIII, Via Amendola 207, 70126, Bari, Italy.
| | - Livio Melpignano
- Metabolic Diseases and Clinical Genetics Unit, Children's Hospital Giovanni XXIII, Via Amendola 207, 70126, Bari, Italy
| | - Antonella Carella
- Metabolic Diseases and Clinical Genetics Unit, Children's Hospital Giovanni XXIII, Via Amendola 207, 70126, Bari, Italy
| | - Anna Maria Di Mauro
- Metabolic Diseases and Clinical Genetics Unit, Children's Hospital Giovanni XXIII, Via Amendola 207, 70126, Bari, Italy
| | - Elvira Piccinno
- Metabolic Diseases and Clinical Genetics Unit, Children's Hospital Giovanni XXIII, Via Amendola 207, 70126, Bari, Italy
| | - Marcella Vendemiale
- Metabolic Diseases and Clinical Genetics Unit, Children's Hospital Giovanni XXIII, Via Amendola 207, 70126, Bari, Italy
| | - Federica Ortolani
- Metabolic Diseases and Clinical Genetics Unit, Children's Hospital Giovanni XXIII, Via Amendola 207, 70126, Bari, Italy
| | - Stefania Fedele
- Metabolic Diseases and Clinical Genetics Unit, Children's Hospital Giovanni XXIII, Via Amendola 207, 70126, Bari, Italy
| | - Maristella Masciopinto
- Metabolic Diseases and Clinical Genetics Unit, Children's Hospital Giovanni XXIII, Via Amendola 207, 70126, Bari, Italy
| | - Francesco Papadia
- Metabolic Diseases and Clinical Genetics Unit, Children's Hospital Giovanni XXIII, Via Amendola 207, 70126, Bari, Italy
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Palumbo O, Palumbo P, Leone MP, Stallone R, Palladino T, Vendemiale M, Palladino S, Papadia F, Carella M, Fischetto R. PARK2 Microduplication: Clinical and Molecular Characterization of a Further Case and Review of the Literature. Mol Syndromol 2016; 7:282-286. [PMID: 27867343 DOI: 10.1159/000448852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2016] [Indexed: 12/22/2022] Open
Abstract
We report on a patient with psychomotor deficits, language delay, dyspraxia, skeletal anomalies, and facial dysmorphisms (hirsutism, right palpebral ptosis, a bulbous nasal tip with enlarged and anteverted nares, and a mild prominent antihelix stem). Using high-resolution SNP array analysis, we identified a 0.49-Mb microduplication in chromosome 6q26 inherited from the mother involving the PARK2 gene: arr[hg19] 6q26(162,672,821-163,163,143)×3 mat. To the best of our knowledge, this is the third patient to date described in whom a 6q26 microduplication encompassing only the PARK2 gene has been reported in medical literature. The PARK2 gene is a neurodevelopmental gene that was initially discovered as one of the causes of autosomal recessive juvenile Parkinson disease and subsequently reported to be linked to autism spectrum disorders and attention-deficit hyperactivity disorders. We provide an overview of the literature on PARK2 microduplications and further delineate the associated phenotype. Taken together, our findings confirm the involvement of this gene in neurodevelopmental disorders and are useful to strengthen the hypothesis that, although with variable expressivity and incomplete penetrance, the PARK2 microduplication is associated with a new emerging neurodevelopmental delay syndrome. However, clinical and molecular evaluations of more patients with the microduplication are needed for full delineation of this syndrome.
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Affiliation(s)
- Orazio Palumbo
- Laboratorio di Genetica Medica, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Pietro Palumbo
- Laboratorio di Genetica Medica, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Maria P Leone
- Laboratorio di Genetica Medica, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy; Dipartimento di Scienze del suolo, della pianta e degli alimenti, Università degli Studi di Bari 'Aldo Moro', Bari, Italy
| | - Raffaella Stallone
- Laboratorio di Genetica Medica, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Teresa Palladino
- Laboratorio di Genetica Medica, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Stefano Palladino
- Sevizio di Diagnostica per Immagini, Dipartimento di Medicina Interdisciplinare, Bari, Italy
| | - Francesco Papadia
- U.O.C. Malattie Metaboliche Genetica Medica, PO Giovanni XXIII, A.O.U. Policlinico Consorziale, Bari, Italy
| | - Massimo Carella
- Laboratorio di Genetica Medica, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Rira Fischetto
- U.O.C. Malattie Metaboliche Genetica Medica, PO Giovanni XXIII, A.O.U. Policlinico Consorziale, Bari, Italy
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Ortolani F, Piccinno E, Grasso V, Papadia F, Panzeca R, Cortese C, Felappi B, Tummolo A, Vendemiale M, Barbetti F. Diabetes associated with dominant insulin gene mutations: outcome of 24-month, sensor-augmented insulin pump treatment. Acta Diabetol 2016; 53:499-501. [PMID: 26239141 PMCID: PMC4877418 DOI: 10.1007/s00592-015-0793-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 05/26/2015] [Indexed: 10/25/2022]
Affiliation(s)
- Federica Ortolani
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children's Hospital, Via Amendola 207, 70126, Bari, Italy
| | - Elvira Piccinno
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children's Hospital, Via Amendola 207, 70126, Bari, Italy.
| | - Valeria Grasso
- Department of Experimental Medicine and Surgery, University of Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Francesco Papadia
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children's Hospital, Via Amendola 207, 70126, Bari, Italy
| | - Rossana Panzeca
- Pediatrics Unit and Neonatal Intensive Care, Valduce Hospital, 22100, Como, Italy
| | - Claudio Cortese
- Department of Experimental Medicine and Surgery, University of Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Barbara Felappi
- Department of Pediatrics, University of Brescia, 25123, Brescia, Italy
| | - Albina Tummolo
- Department of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXIII Children's Hospital, Via Amendola 207, 70126, Bari, Italy
| | | | - Fabrizio Barbetti
- Department of Experimental Medicine and Surgery, University of Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
- Bambino Gesù Children's Hospital, IRCCS, 00164, Rome, Italy.
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Castellaneta S, Piccinno E, Oliva M, Cristofori F, Vendemiale M, Ortolani F, Papadia F, Catassi C, Cavallo L, Francavilla R. High rate of spontaneous normalization of celiac serology in a cohort of 446 children with type 1 diabetes: a prospective study. Diabetes Care 2015; 38:760-6. [PMID: 25784659 DOI: 10.2337/dc14-2890] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 01/27/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In children with type 1 diabetes mellitus (T1DM), elevated levels of antitissue transglutaminase (anti-tTG) antibody may spontaneously normalize, despite continued consumption of gluten. We aimed to investigate the prevalence of spontaneous normalization of anti-tTG levels and the existence of factors predictive for this outcome. RESEARCH DESIGN AND METHODS All children referred from 2002 to 2012 were screened for celiac disease (CD) at diabetes onset and at specific intervals. In the presence of a high anti-tTG titer or clinical symptoms, children were offered endoscopy, and asymptomatic patients with a low anti-tTG titer were invited to a second serological test after 6 months of eating a gluten-containing diet. RESULTS The study included 446 children. Of these, 65 (14.5%) became positive for celiac serology: 38 (58%) had a persistently elevated anti-tTG titer and 27 (41%) fluctuating anti-tTG titer; 18 (28%) became negative. The prevalence of positive CD autoimmunity and overt CD was 14.3% (95% CI 11-17) and 8.5% (95% CI 5-10), 15- and 8-times higher than the general pediatric population, respectively. Asymptomatic children older than 9.1 years at T1DM onset had the lowest risk to develop CD. CONCLUSIONS Serum anti-tTG levels decreased spontaneously in 40% of children with T1DM and became negative in 20%, despite gluten consumption. This finding supports the hypothesis of a state of temporary positivity of celiac serology in children with diabetes. In absence of clinical symptoms or signs of CD, histological confirmation of the disease and the gluten-free diet should be postponed to avoid unnecessary procedures and reduce an additional psychological burden.
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Affiliation(s)
| | - Elvira Piccinno
- Unit of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXII Children's Hospital, Bari, Italy
| | - Marica Oliva
- Pediatric Gastroenterology and Hepatology Unit, Interdisciplinary Department of Medicine, Giovanni XXII Children's Hospital, University of Bari "A. Moro," Bari, Italy
| | - Fernanda Cristofori
- Pediatric Gastroenterology and Hepatology Unit, Interdisciplinary Department of Medicine, Giovanni XXII Children's Hospital, University of Bari "A. Moro," Bari, Italy
| | - Marcella Vendemiale
- Unit of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXII Children's Hospital, Bari, Italy
| | - Federica Ortolani
- Unit of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXII Children's Hospital, Bari, Italy
| | - Francesco Papadia
- Unit of Metabolic Diseases, Clinical Genetics and Diabetology, Giovanni XXII Children's Hospital, Bari, Italy
| | - Carlo Catassi
- Department of Paediatrics, University Politecnica delle Marche, Ancona, Italy
| | - Luciano Cavallo
- Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro," Bari, Italy
| | - Ruggiero Francavilla
- Pediatric Gastroenterology and Hepatology Unit, Interdisciplinary Department of Medicine, Giovanni XXII Children's Hospital, University of Bari "A. Moro," Bari, Italy
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Piccinno E, Ortolani F, Vendemiale M, Tummolo A, Masciopinto M, Natale M, De Luca A, Agolini E, Aloi C, Salina A, D'Annunzio G, Fischetto R, Papadia F. Novel homozygous mutation in exon 5 ofWFS1gene in an Apulian family with mild phenotypic expression of Wolfram syndrome. Clin Genet 2013; 86:197-8. [DOI: 10.1111/cge.12260] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/04/2013] [Accepted: 08/20/2013] [Indexed: 11/28/2022]
Affiliation(s)
- E. Piccinno
- O. U. Metabolic Diseases, Clinical Genetics and Diabetes; Pediatric Hospital Giovanni XXIII; Bari Italy
| | - F. Ortolani
- O. U. Metabolic Diseases, Clinical Genetics and Diabetes; Pediatric Hospital Giovanni XXIII; Bari Italy
| | - M. Vendemiale
- Clinical Psychology, Medical Direction; Pediatric Hospital Giovanni XXIII; Bari Italy
| | - A. Tummolo
- O. U. Metabolic Diseases, Clinical Genetics and Diabetes; Pediatric Hospital Giovanni XXIII; Bari Italy
| | - M. Masciopinto
- O. U. Metabolic Diseases, Clinical Genetics and Diabetes; Pediatric Hospital Giovanni XXIII; Bari Italy
| | - M.P. Natale
- O. U. Metabolic Diseases, Clinical Genetics and Diabetes; Pediatric Hospital Giovanni XXIII; Bari Italy
| | - A. De Luca
- Casa Sollievo della Sofferenza Hospital; IRCCS; San Giovanni Rotondo Italy
| | - E. Agolini
- Casa Sollievo della Sofferenza Hospital; IRCCS; San Giovanni Rotondo Italy
| | - C. Aloi
- Laboratory of Diabetology-LABSIEM; Giannina Gaslini Institute; Genoa Italy
| | - A. Salina
- Laboratory of Diabetology-LABSIEM; Giannina Gaslini Institute; Genoa Italy
| | - G. D'Annunzio
- Laboratory of Diabetology-LABSIEM; Giannina Gaslini Institute; Genoa Italy
| | - R. Fischetto
- O. U. Metabolic Diseases, Clinical Genetics and Diabetes; Pediatric Hospital Giovanni XXIII; Bari Italy
| | - F. Papadia
- O. U. Metabolic Diseases, Clinical Genetics and Diabetes; Pediatric Hospital Giovanni XXIII; Bari Italy
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