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Alavanda C, Ceylan Eİ, Kılavuz S, Çıkı K. Comprehensive analyses of phenylalanine hydroxylase variants and phenotypic characteristics of patients in the eastern region of Türkiye. J Pediatr Endocrinol Metab 2024; 0:jpem-2024-0091. [PMID: 38706300 DOI: 10.1515/jpem-2024-0091] [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: 02/18/2024] [Accepted: 04/17/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES Phenylalanine hydroxylase (PAH) is predominantly a hepatic enzyme that catalyzes phenylalanine (Phe) into tyrosine, which is the rate-limiting step in Phe catabolism. Biallelic variants in the PAH gene cause PAH enzyme deficiency. Phenylketonuria (PKU) is an autosomal recessive disorder that causes neurologic, behavioral, and dermatological findings. PKU could be divided clinically into three types based on the blood Phe levels: classic phenylketonuria (cPKU), mild-moderate phenylketonuria (mPKU), and mild hyperphenylalaninemia (MHP). This study aimed to determine the phenotypic and genotypic characteristics of Turkish PKU patients in the eastern region of Türkiye. METHODS Demographic characteristics, serum Phe levels, treatments, and PAH variants of 163 patients with PKU and hyperphenylalaninemia (HPA) were retrospectively evaluated. Blood Phe levels of the patients were analyzed with the high-performance liquid chromatography method. For PAH gene analysis, next-generation sequencing was performed. RESULTS Of the 163 patients included in the study, 38 (23.3 %) had cPKU, 16 (9.8 %) had mPKU, and 109 (66.9 %) had MHP. Homozygous variants in the PAH gene were detected in 66 (40.5 %) of the patients, while compound heterozygous variants were detected in 97 (59.5 %) patients. Two novel and 35 recurrent variants in the PAH gene were detected. Of the two novel variants, one was missense (p.Phe351Leu) and the other was frameshift (p.Met276Cysfs*65). The most frequently detected variants were p.Thr380Met (18 %), p.Arg261Gln (16.8 %), and p.Ala300Ser (12.8 %). All patients with the homozygous c.1066-11G>A variant exhibited cPKU phenotype. The c.898G>T (p.Ala300Ser), c.1139C>T (p.Thr380Met), and c.1208C>T (p.Ala403Val) variants were statistically related to mild phenotype. On the other hand, c.592_613del (p.Tyr198Serfs*136), c.1028A>G (p.Tyr343Cys), and c.782G>A (p.Arg261Gln) variants were more frequently detected in the cPKU group. CONCLUSIONS Our study, conducted with patients from the eastern region of Türkiye, demonstrates the genetic heterogeneity in the Turkish population. Simultaneously, our research contributes to genotype-phenotype correlation and expands the genotypic spectrum by identifying novel variants.
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Affiliation(s)
- Ceren Alavanda
- Department of Medical Genetics, Van Research and Training Hospital, Van, Türkiye
| | - Emine İpek Ceylan
- Department of Medical Genetics, Van Research and Training Hospital, Van, Türkiye
- Department of Medical Genetics, Dr Abdurrahman Yurtaslan Ankara Oncology Education and Research Hospital, Ankara, Türkiye
| | - Sebile Kılavuz
- Division of Child Nutrition and Metabolism, Department of Pediatrics, School of Medicine, Marmara University, İstanbul, Türkiye
- Division of Child Nutrition and Metabolism, Department of Pediatrics, Van Research and Training Hospital, Van, Türkiye
| | - Kısmet Çıkı
- Division of Child Nutrition and Metabolism, Department of Pediatrics, Van Research and Training Hospital, Van, Türkiye
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Bulut FD, Seydaoğlu G, Kor D, Kılavuz S, Boz A, Önenli Mungan N. Perspectives of adult patients with lysosomal storage diseases on the transition from pediatric to adult healthcare in Turkey. Arch Pediatr 2023; 30:450-454. [PMID: 37331832 DOI: 10.1016/j.arcped.2023.04.006] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/13/2023] [Accepted: 04/29/2023] [Indexed: 06/20/2023]
Abstract
AIM In many countries, adult clinics specifically dedicated to adult patients with lysosomal storage diseases (LSDs) do not exist. In Turkey, these patients are managed either by pediatric metabolic specialists or adult physicians who do not specifically specialize in LSDs. In this study, we aimed to identify the unmet clinical needs of these adult patients and their suggestions. METHODS The focus group participants were 24 adult LSD patients. Interviews were conducted in person. RESULTS A total of 23 LSD patients and parents of a patient with mucopolysaccharidosis type-3b with intellectual deficit were interviewed, with 84.6% of patients diagnosed after the age of 18 years and 18% of patients diagnosed before the age of 18 years desiring management by adult physicians. Patients with particular physical characteristics or severe intellectual deficit declined the transition. Patients reported structural problems in the hospital and social problems associated with pediatric clinics. They made suggestions to facilitate the possible transition. CONCLUSION With improved care, more patients with LSDs survive into adulthood or receive the diagnosis in adulthood. Children with chronic diseases need to transition to the care of adult physicians when they reach adulthood. Thus, there is an increasing need for adult physicians to manage these patients. In this study, most LSD patients accepted a well-planned and organized transition. Problems were related to stigmatization and social isolation in the pediatric clinic or adult issues with which pediatricians are not familiar. There is a need for adult metabolic physicians. Thus, health authorities should adopt necessary regulations for training of physicians in this field.
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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
| | - Aslı Boz
- Çukurova University, Biostatistics Department, Adana, Turkey
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Bako D, Kılavuz S, Yasin Köksoy A, Uzan Tatli Z, Beydogan E. A different approach to cystinosis: ultrasound, doppler, and shear wave elastography findings of thyroid gland. Orphanet J Rare Dis 2023; 18:173. [PMID: 37391835 DOI: 10.1186/s13023-023-02783-6] [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] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/18/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND While thyroid dysfunction develops in about 50% of untreated children with cystinosis, there is no data about how the sonography of thyroid tissue appears in this disease. Therefore, the purpose of this study was to assess the sonographic appearance, color doppler findings in this disease and to evaluate how cystine crystal accumulation affect tissue stiffness using shear wave elastography (SWE). METHODS Sixteen children diagnosed with cystinosis and a control group consisting of 34 healthy children were included in this study. B mode ultrasound, color doppler imaging and real-time SWE of thyroid tissue were performed. RESULTS Ultrasound imaging revealed lower echogenicity and diffuse heterogeneous echotexture in 7 of the 16 cystinosis patients. Thyroid gland volumes were lower in cystinosis patients (p 0.005). Doppler ultrasound demonstrated increased flow in 8 patients. On SWE, the thyroid tissue stiffness was established to be lower in patients compared to healthy children (p 0.003). CONCLUSIONS This is the first study evaluating thyroid gland B mode, color doppler ultrasonography, and SWE findings in cystinosis. Our findings indicate that cysteamine treatment still cannot completely prevent the disease infiltration process of thyroid gland. The other important finding-that thyroid tissue stiffness was established to be lower than that of the controls-also demonstrates the ongoing disease infiltration process.
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Affiliation(s)
- Derya Bako
- Department of Pediatric Radiology, Van Regional Training and Research Hospital, Van, Turkey.
| | - Sebile Kılavuz
- Department of Pediatric Pediatric Metabolism and Nutrition, Van Regional Training and Research Hospital, Van, Turkey
| | - Adem Yasin Köksoy
- Department of Pediatric Pediatric Nephrology, Van Regional Training and Research Hospital, Van, Turkey
| | - Zeynep Uzan Tatli
- Department of Pediatric Pediatric Endocrinology, Zeynep Uzan Tatli, Van Regional Training and Research Hospital, Van, Turkey
| | - Engin Beydogan
- Department of Radiology, Van Regional Training and Research Hospital, Van, Turkey
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kor D, Bulut FD, Kılavuz S, Şeker Yılmaz B, Köşeci B, Kara E, Kaya Ö, Başaran S, Seydaoğlu G, Önenli Mungan N. Evaluation of bone health in patients with mucopolysaccharidosis. J Bone Miner Metab 2022; 40:498-507. [PMID: 35066680 DOI: 10.1007/s00774-021-01304-4] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/12/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This study aimed to evaluate the relationship between clinical findings, height and weight standard deviation scores, 25-hydroxyvitamin D3 (25(OH)D3) level, and dual-energy X-ray absorptiometry (DXA) results in patients diagnosed with mucopolysaccharidosis (MPS), where effective current treatments such as enzyme replacement therapy (ERT) can be accessed. MATERIALS AND METHODS 25(OH)D3 level was measured in 126 patients with MPS (17 with MPS I, 14 with MPS II, 18 with MPS III, 33 with MPS IVA, and 44 with MPS VI; 24-524 months). DXA was performed in 45 of these patients (8 with MPS I, 4 with MPS II, 4 with MPS III, 12 with MPS IVA, and 17 with MPS VI; 62-197 months; all patients were under 18 when DXA was performed) to assess bone mineral density (BMD) of the lumbar spine. RESULTS In total, 67.5% patients had a short stature, and 50% of them were underweight for their age. Of the patients, 13.5% were immobile, 28.6% had 25(OH)D3 deficiency, and 30.2% had an insufficient level of 25(OH)D3. BMD z score of 45 patients was - 2.5 ± 1.7. In 40% patients, it was < - 2. However, after correction for height-for-age z score (HAZ), HAZ-adjusted BMD z score was - 0.1 ± 0.9. In 2.2% patients, it was < - 2. CONCLUSION The low BMD z score prevalence reported with DXA was misleadingly higher in children with MPS and short stature. To prevent exposure to unnecessary antiresorptive treatments in these children, the effect of severe short stature and bone geometry on DXA measurements should be considered; further studies on bone health are warranted.
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Affiliation(s)
- Deniz Kor
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey.
| | - Fatma Derya Bulut
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Sebile Kılavuz
- Division of Pediatric Metabolism and Nutrition, Van Research and Training Hospital, Van, Turkey
| | - Berna Şeker Yılmaz
- Genetics and Genomic Medicine, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Burcu Köşeci
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Esra Kara
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Ömer Kaya
- Department of Radiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Sibel Başaran
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Gülşah Seydaoğlu
- Department of Biostatistics, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Neslihan Önenli Mungan
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey
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Kılavuz S, Basaranoglu M, Epcacan S, Bako D, Ozer A, Donmez YN, Ceylan EI, Tukun A, Ceylaner S, Geylani H, Mungan HNO. A rare cause of hydrops fetalis in two Gaucher disease type 2 patients with a novel mutation. Metab Brain Dis 2022; 37:1283-1287. [PMID: 35254599 DOI: 10.1007/s11011-022-00942-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/22/2022] [Indexed: 01/30/2023]
Abstract
Gaucher disease type 2 is the most progressive and the rarest form of Gaucher disease, defined as the acute neuronopathic type. We presented two GD2 patients who died before three months of age due to severe septicemia, respiratory and liver failure. One was homozygous for a novel GBA variant c.590 T > A (p.197 K), and the second homozygous for the known GBA mutation c.1505G > A (p.R502H). Ichthyosis, hydrops fetalis, apnea, myoclonic seizures, and hepatosplenomegaly occurred in both patients, but hypertrophic cardiomyopathy was observed only in the second and unilateral cataract in the first patient. Due to the disease's early and rapid neurological progression, we did not administer ERT to our patients. It is strongly believed that early diagnosis is essential, and prenatal diagnosis makes genetic counselling possible for future pregnancies.
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Affiliation(s)
- Sebile Kılavuz
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Van Training and Research Hospital, University of Health Sciences, Van, Turkey.
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford, OX1 3QT, UK.
| | - Murat Basaranoglu
- Division of Neonatology, Department of Pediatrics, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Serdar Epcacan
- Division of Pediatric Cardiology Disease, Department of Pediatrics, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Derya Bako
- Divisions of Pediatric Radiology, Department of Radiology, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Arife Ozer
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Yasemin Nuran Donmez
- Division of Pediatric Cardiology Disease, Department of Pediatrics, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Emine Ipek Ceylan
- Department of Medical Genetics, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Ajlan Tukun
- Department of Medical Genetics, Duzen Laboratory, Ankara, Turkey
| | - Serdar Ceylaner
- Intergen Genetic Diagnosis and Research Center, Ankara, Turkey
- Department of Medical Genetics, Medical Faculty, Lokman Hekim University, Ankara, Turkey
| | - Hadi Geylani
- Division of Pediatric Hematology, Department of Pediatrics, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Halise Neslihan Onenli Mungan
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Çukurova University Faculty of Medicine, Adana, Turkey
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Kılavuz S, Bulut D, Kor D, Şeker-Yılmaz B, Özcan N, Incecik F, Onan B, Ceylaner G, Önenli-Mungan N. The outcome of 41 Late-Diagnosed Turkish GA-1 Patients: A Candidate for the Turkish NBS. Neuropediatrics 2021; 52:358-369. [PMID: 33578440 DOI: 10.1055/s-0040-1722691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 10/22/2022]
Abstract
BACKGROUND Glutaric aciduria type 1(GA-1) is an inherited cerebral organic aciduria. Untreated patients with GA-1 have a risk of acute encephalopathic crises during the first 6 years of life. In so far as GA-1 desperately does not exist in Turkish newborn screening (NBS) program, most patients in our study were late-diagnosed. METHOD This study included 41 patients diagnosed with acylcarnitine profile, urinary organic acids, mutation analyses in the symptomatic period. We presented with clinical, neuroradiological, and molecular data of our 41 patients. RESULTS The mean age at diagnosis was 14.8 ± 13.9 (15 days to 72 months) and, high blood glutaconic acid, glutarylcarnitine and urinary glutaric acid (GA) levels in 41 patients were revealed. Seventeen different mutations in the glutaryl-CoA dehydrogenase gene were identified, five of which were novel. The patients, most of whom were late-diagnosed, had a poor neurological outcome. Treatment strategies made a little improvement in dystonia and the frequency of encephalopathic attacks. CONCLUSION All GA-1 patients in our study were severely affected since they were late-diagnosed, while others show that GA-1 is a treatable metabolic disorder if it is diagnosed with NBS. This study provides an essential perspective of the severe impact on GA-1 patients unless it is diagnosed with NBS. We immediately advocate GA-1 to be included in the Turkish NBS.
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Affiliation(s)
- Sebile Kılavuz
- Division of Pediatric Nutrition and Metabolism, Department of Pediatrics, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Derya Bulut
- Division of Pediatric Nutrition and Metabolism, Department of Pediatrics, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Deniz Kor
- Division of Pediatric Nutrition and Metabolism, Department of Pediatrics, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Berna Şeker-Yılmaz
- Division of Pediatric Nutrition and Metabolism, Department of Pediatrics, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Neslihan Özcan
- Division of Pediatric Neurology, Department of Pediatrics, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Faruk Incecik
- Division of Pediatric Neurology, Department of Pediatrics, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Bilen Onan
- Department of Radiology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Gülay Ceylaner
- Department of Medical Genetics, Intergen Genetics Centre, Ankara, Turkey
| | - Neslihan Önenli-Mungan
- Division of Pediatric Nutrition and Metabolism, Department of Pediatrics, Çukurova University Faculty of Medicine, Adana, Turkey
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Şeker Yılmaz B, Kor D, Bulut FD, Kılavuz S, Ceylaner S, Önenli Mungan HN. Clinical and molecular findings in 37 Turkish patients with isolated methylmalonic acidemia. Turk J Med Sci 2021; 51:1220-1228. [PMID: 33453710 PMCID: PMC8283478 DOI: 10.3906/sag-2001-72] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/16/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim Isolated methylmalonic acidemia (MMA) is caused by complete or partial deficiency of the enzyme methylmalonyl- CoA mutase (mut0 or mut– enzymatic subtype), a defect of its cofactor adenosyl-cobalamin (cblA, cblB, or cblD-MMA), or deficiency of the enzyme methylmalonyl-CoA epimerase. While onset of the disease ranges from the neonatal period to adulthood, most cases present with lethargy, vomiting and ketoacidosis in the early infancy. Major secondary complications are; growth failure, developmental delay, interstitial nephritis with progressive renal failure, basal ganglia injury and cardiomyopathy. We aimed to demonstrate clinical and molecular findings based on long-term follow up in our patient cohort. Materials and methods The study includes 37 Turkish patients with isolated MMA who were followed up for long term complications 1 to 14 years. All patients were followed up regularly with clinical, biochemical and dietary monitoring to determine long term complications. Next Generation Sequencing technique was used for mutation screening in five disease-causing genes including; MUT, MMAA, MMAB, MMADHC, MCEE genes. Mutation screening identified 30 different types of mutations. Results While 28 of these mutations were previously reported, one novel MMAA mutation p.H382Pfs*24 (c.1145delA) and one novel MUT mutation IVS3+1G>T(c.752+1G>T) has been reported. The most common clinical complications were growth retardation, renal involvement, mental motor retardation and developmental delay. Furthermore, one of our patients developed cardiomyopathy, another one died because of hepatic failure and one presented with lactic acidosis after linezolid exposure. Conclusion We have detected two novel mutations, including one splice-site mutation in the MUT gene and one frame shift mutation in the MMAA gene in 37 Turkish patients. We confirm the genotype-phenotype correlation in the study population according to the long-term complications.
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Affiliation(s)
- Berna Şeker Yılmaz
- Department of Pediatric Metabolism, University of Mersin, Faculty of Medicine, Mersin, Turkey,Genetics and Genomics Medicine Department, Institute of Child Health, University College London, London, UK
| | - Deniz Kor
- Department of Pediatric Metabolism, University Hospital Çukurova, Adana, Turkey
| | - Fatma Derya Bulut
- Department of Pediatric Metabolism, Adana City Research and Training Hospital, Adana, Turkey
| | - Sebile Kılavuz
- Department of Pediatric Metabolism, University Hospital Çukurova, Adana, Turkey
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Kılavuz S, Basaran S, Kor D, Bulut FD, Erdem S, Ballı HT, Dağkıran M, Bisgin A, Mungan HNÖ. Morquio A syndrome and effect of enzyme replacement therapy in different age groups of Turkish patients: a case series. Orphanet J Rare Dis 2021; 16:144. [PMID: 33752727 PMCID: PMC7983100 DOI: 10.1186/s13023-021-01761-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 11/05/2020] [Accepted: 02/25/2021] [Indexed: 12/28/2022] Open
Abstract
Background This case series includes longitudinal clinical data of ten patients with Morquio A syndrome from south and southeastern parts of Turkey, which were retrospectively collected from medical records. All patients received enzyme replacement therapy (ERT). Clinical data collected included physical appearance, anthropometric data, neurological and psychological examinations, cardiovascular evaluation, pulmonary function tests, eye and ear-nose-throat examinations, endurance in the 6-min walk test and/or 3-min stair climb test, joint range of motion, and skeletal investigations (X-rays, bone mineral density). Results At the time of ERT initiation, two patients were infants (1.8 and 2.1 years), five were children (3.4–7.1 years), and three were adults (16.5–39.5 years). Patients had up to 4 years follow-up. Most patients had classical Morquio A, based on genotypic and phenotypic data. Endurance was considerably reduced in all patients, but remained relatively stable or increased over time in most cases after treatment initiation. Length/height fell below normal growth curves, except in the two infants who started ERT at ≤ 2.1 years of age. All patients had skeletal and/or joint abnormalities when ERT was started. Follow-up data did not suggest improvements in skeletal abnormalities, except in one of the younger infants. Nine patients had corneal clouding, which resolved after treatment initiation in the two infants, but not in the other patients. Hepatomegaly was reported in seven patients and resolved with treatment in five of them. Other frequent findings at treatment initiation were coarse facial features (N = 9), hearing loss (N = 6), and cardiac abnormalities (N = 6). Cardiac disease deteriorated over time in three patients, but did not progress in the others. Conclusions Overall, this case series with Morquio A patients confirms clinical trial data showing long-term stabilization of endurance after treatment initiation across ages and suggest that very early initiation of ERT optimizes growth outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01761-0.
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Affiliation(s)
- Sebile Kılavuz
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Faculty of Medicine, Çukurova University,, Adana, Turkey
| | - Sibel Basaran
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Deniz Kor
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Faculty of Medicine, Çukurova University,, Adana, Turkey
| | - Fatma Derya Bulut
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Faculty of Medicine, Çukurova University,, Adana, Turkey
| | - Sevcan Erdem
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Hüseyin Tuğsan Ballı
- Department of Radiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Muhammed Dağkıran
- Department of Ear, Nose and Throat Diseases, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Atil Bisgin
- Medical Genetics Department of Medical Faculty, Cukurova University AGENTEM (Adana Genetic Diseases Diagnosis and Treatment Center), Adana, Turkey
| | - Halise Neslihan Önenli Mungan
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Faculty of Medicine, Çukurova University, 01130, Sarıçam, Adana, Turkey.
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Kör D, Şeker-Yılmaz B, Bulut FD, Kılavuz S, Öktem M, Ceylaner S, Yıldızdaş D, Önenli-Mungan N. Clinical features of 27 Turkish Propionic acidemia patients with 12 novel mutations. Turk J Pediatr 2020; 61:330-336. [PMID: 31916709 DOI: 10.24953/turkjped.2019.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Kör D, Şeker-Yılmaz B, Bulut FD, Kılavuz S, Öktem M, Ceylaner S, Yıldızdaş D, Önenli-Mungan N. Clinical features of 27 Turkish Propionic acidemia patients with 12 novel mutations. Turk J Pediatr 2019; 61: 330-336. Propionic acidemia (PA) is an inherited metabolic disease caused by the deficiency of one of the four biotin-dependent enzymes propionyl-CoA carboxylase (PCC), and is characterized by coma and death in unrecognized patients, additionally late diagnosis leads to severe developmental delay and neurological sequels. Manifestations of PA over time can include growth impairment, intellectual disability, seizures, basal ganglia lesions, pancreatitis, and cardiomyopathy. Other rarely reported complications include optic atrophy, hearing loss, premature ovarian insufficiency, and chronic renal failure. Mutations in PCCA-PCCB genes cause the clinically heterogeneous disease of PA. In this study, we investigate the mutation spectrum of PCCAPCCB genes and phenotypic features of 27 Turkish patients with PA from the South and Southeast parts of Turkey. We report 12 novel PA mutations, five affecting the PCCA gene and 7 affecting the PCCB gene.
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Affiliation(s)
- Deniz Kör
- Divisions of Pediatric Metabolism and Nutrition, Adana, Turkey
| | - Berna Şeker-Yılmaz
- Department of Pediatric Metabolism, Mersin City Hospital, Mersin, Turkey
| | - Fatma Derya Bulut
- Department of Pediatric Metabolism, Adana City Hospital, Adana, Turkey
| | - Sebile Kılavuz
- Divisions of Pediatric Metabolism and Nutrition, Adana, Turkey
| | - Murat Öktem
- Düzen Biochemistry Laboratories, Ankara, Turkey
| | | | - Dinçer Yıldızdaş
- Divisions of Pediatric Intensive Care Unit, Çukurova University Faculty of Medicine, Adana, Turkey
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11
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Ciftci V, Kılavuz S, Bulut FD, Mungan HN, Bisgin A, Dogan MC. Congenital erythropoietic porphyria with erythrodontia: A case report. Int J Paediatr Dent 2019; 29:542-548. [PMID: 30706587 DOI: 10.1111/ipd.12473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 10/25/2018] [Revised: 01/02/2019] [Accepted: 01/24/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND The causes for intrinsic tooth discoloration can be separated into two categories as systemic and local. Systemic causes are either genetic or drug-induced effects. The development of dentition can also be affected by a number of systemic factors and metabolic diseases such as porphyria. Congenital erythropoietic porphyria (CEP), also known as Gunther's disease, is a metabolic disease caused by a transformation in the gene that codifies uroporphyrinogen-3 synthesis, leading to porphyrin aggregation in urine, skin, bone, and dentin. CASE REPORT A 21-month-old girl with erythrodontia was referred to Paediatric Dentistry Department in September 2017. A physical examination revealed blisters on her face, nose, hands, and feet. Laboratory findings showed highly elevated urine total uroporphyrin and total coproporphyrin I and III levels. Next-generation sequencing multigene panel testing for porphyria demonstrated a homozygous c.10C>T (p.L4F) mutation in the UROS gene. For curative therapy, the patient was admitted to the allogeneic bone marrow transplantation program. CONCLUSION Congenital erythropoietic porphyria most commonly presents in the first few years of life. Manifestations can include reddish-colored urine, skin blistering, scarring, and erythrodontia. A timely diagnosis can prevent undesirable skin findings of the disease and death due to hematological involvement before a curative allogeneic bone marrow transplantation is performed.
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Affiliation(s)
- Volkan Ciftci
- Department of Pediatric Dentistry, Faculty of Dentistry, Cukurova University, Adana, Turkey
| | - Sebile Kılavuz
- Division of Pediatric Metabolism and Nutrition, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Fatma Derya Bulut
- Division of Pediatric Metabolism and Nutrition, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Halise Neslihan Mungan
- Division of Pediatric Metabolism and Nutrition, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Atil Bisgin
- Medical Genetics Department of Balcali Hospital and Clinics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Muharrem Cem Dogan
- Department of Pediatric Dentistry, Faculty of Dentistry, Cukurova University, Adana, Turkey
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12
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Kılıç M, Kasapkara ÇS, Kılavuz S, Mungan NÖ, Biberoğlu G. A possible biomarker of neurocytolysis in infantile gangliosidoses: aspartate transaminase. Metab Brain Dis 2019; 34:495-503. [PMID: 30712135 DOI: 10.1007/s11011-019-0391-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/27/2019] [Indexed: 10/27/2022]
Abstract
Gangliosidoses (GM1 and GM2 gangliosidosis) are rare, autosomal recessive progressive neurodegenerative lysosomal storage disorders caused by defects in the degradation of glycosphingolipids. We aimed to investigate clinical, biochemical and molecular genetic spectrum of Turkish patients with infantile gangliosidoses and examined the potential role of serum aspartate transaminase levels as a biomarker. We confirmed the diagnosis of GM1 and GM2 gangliosidosis based on clinical findings with specific enzyme and/or molecular analyses. We retrospectively reviewed serum aspartate transaminase levels of patients with other biochemical parameters. Serum aspartate transaminase level was elevated in all GM1 and GM2 gangliosidosis patients in whom the test was performed, along with normal alanine transaminase. Aspartate transaminase can be a biochemical diagnostic clue for infantile gangliosidoses. It might be a simple but important biomarker for diagnosis, follow up, prognosis and monitoring of the response for the future therapies in these patients.
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Affiliation(s)
- Mustafa Kılıç
- Metabolism Unit, Sami Ulus Children Hospital, Babur cad. No: 44, 06080 Altındağ, Ankara, Turkey.
| | - Çiğdem Seher Kasapkara
- Metabolism Unit, Sami Ulus Children Hospital, Babur cad. No: 44, 06080 Altındağ, Ankara, Turkey
| | - Sebile Kılavuz
- Department of Pediatrics, Metabolism Unit, Cukurova University, Adana, Turkey
| | | | - Gürsel Biberoğlu
- Department of Pediatrics, Metabolism Unit, Gazi University, Ankara, Turkey
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13
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Bulut FD, Kör D, Şeker-Yılmaz B, Hergüner Ö, Ceylaner S, Özkınay F, Kılavuz S, Önenli-Mungan N. Four Gaucher disease type II patients with three novel mutations: a single centre experience from Turkey. Metab Brain Dis 2018; 33:1223-1227. [PMID: 29656334 DOI: 10.1007/s11011-018-0236-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/06/2018] [Indexed: 12/29/2022]
Abstract
Gaucher disease is the most common lysosomal storage disorder due to glucosylceramidase enzyme deficiency. There are three subtypes of the disease. Neurological involvement accompanies visceral and haematological findings only in type II and type III Gaucher patients. Type II is the acute progressive neuronopathic form which is the most severe and rare subtype. Clinical findings are recognized prenatally or in the first months of life and followed by death within the first two years of age. Among our 81 Gaucher patients, we identified 4 (4,9%) type II patients in our metabolic centre. This rate is significantly higher than the rate reported in the literature (<1%). Three of the patients had novel mutations, one of them was a collodion baby and the other one was mistyped as type III due to its atypical presentation at the beginning and he was treated with ERT for 8 months. In this report, we present our type II Gaucher patients with three novel mutations and one perinatal lethal form with generalized ichthyosis which is a very rare disorder. Additionally, we would like to highlight the phenotypic heterogeneity not only between the subtypes, also even in the same type.
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Affiliation(s)
- Fatma Derya Bulut
- Department of Pediatrics, Division of Metabolism and Nutrition, Çukurova University Medical Faculty, Adana, Turkey.
| | - Deniz Kör
- Department of Pediatrics, Division of Metabolism and Nutrition, Çukurova University Medical Faculty, Adana, Turkey
| | | | - Özlem Hergüner
- Department of Pediatrics, Division of Pediatric Neurology, Çukurova University Medical Faculty, Adana, Turkey
| | | | - Ferda Özkınay
- Department of Genetics, Ege University Medical Faculty, İzmir, Turkey
| | - Sebile Kılavuz
- Department of Pediatrics, Division of Metabolism and Nutrition, Çukurova University Medical Faculty, Adana, Turkey
| | - Neslihan Önenli-Mungan
- Department of Pediatrics, Division of Metabolism and Nutrition, Çukurova University Medical Faculty, Adana, Turkey
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Kılavuz S, Bulut FD, Kör D, Şeker Yılmaz B, Başaran S, Sarpel T, Önenli Mungan N. Demographic, Phenotypic and Genotypic Features of Alkaptonuria Patients: A Single Centre Experience. jpr 2018. [DOI: 10.4274/jpr.20982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bulut FD, Kör D, Şeker-Yılmaz B, Gül-Mert G, Kılavuz S, Önenli-Mungan N. Turkish case of ethylmalonic encephalopathy misdiagnosed as short chain acyl-CoA dehydrogenase deficiency. Metab Brain Dis 2018; 33:977-979. [PMID: 29159724 DOI: 10.1007/s11011-017-0152-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
Abstract
Ethylmalonic encephalopathy is a very rare autosomal recessively inherited inborn error of metabolism; characterized by encephalopathy, recurrent petechiae without bleeding diathesis, chronic diarrhea, and orthostatic acrocyanosis. Here, we describe a case of ethylmalonic encephalopathy with late onset neurologic symptoms and a confusing family history of two deceased brothers with the wrong suspicion of short chain acyl-CoA dehydrogenase deficiency.
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Affiliation(s)
- Fatma Derya Bulut
- Department of Pediatric Metabolism and Nutrition, Çukurova University, Adana, Turkey.
| | - Deniz Kör
- Adana Numune Teaching and Research Hospital, Adana, Turkey
| | | | - Gülen Gül-Mert
- Adana Numune Teaching and Research Hospital, Adana, Turkey
| | - Sebile Kılavuz
- Department of Pediatric Metabolism and Nutrition, Çukurova University, Adana, Turkey
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