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Tiwary H, Hecht LE, Brucker WJ, Berry GT, Rodig NM. The development of end stage renal disease in two patients with
PMM2‐CDG. JIMD Rep 2022; 63:131-136. [PMID: 35281664 PMCID: PMC8898725 DOI: 10.1002/jmd2.12269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022] Open
Abstract
We report two patients with PMM2‐CDG who developed end stage renal disease (ESRD). Renal abnormalities of clinical significance have only been reported in about 6% of patients with PMM2‐CDG and have rarely been reported as the cause of death. Given the recurrent episodes of acute kidney injury associated with hospital admissions and the accelerated development of ESRD thereafter in our two patients, we recommend proactively involving Nephrology early in the care of these patients.
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Affiliation(s)
- Henna Tiwary
- Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
| | - Leah E. Hecht
- Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
| | | | - Gerard T. Berry
- Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
| | - Nancy M. Rodig
- Boston Children's Hospital, Harvard Medical School Boston Massachusetts USA
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Brucker WJ, Croteau SE, Prensner JR, Cullion K, Heeney MM, Lo J, McAlvin JB, Peeler K, Shah N, Yee CSK, Berry GT, Bodamer O. An emerging role for endothelial barrier support therapy for congenital disorders of glycosylation. J Inherit Metab Dis 2020; 43:880-890. [PMID: 32064623 DOI: 10.1002/jimd.12225] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/03/2019] [Revised: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 12/23/2022]
Abstract
Congenital disorders of glycosylation (CDGs) are clinically heterogeneous disorders defined by a decreased ability to modify biomolecules with oligosaccharides. Critical disruptions in protein recognition, interaction, binding, and anchoring lead to broad physiological effects. Patients present with endocrinopathy, immunodeficiency, hepatopathy, coagulopathy, and neurodevelopmental impairment. Patients may experience mortality/morbidity associated with shock physiology that is frequently culture negative and poorly responsive to standard care. Oedema, pleural and pericardial effusions, ascites, proteinuria, and protein-losing enteropathy are observed with an exaggerated inflammatory response. The negative serum protein steady state results from several mechanisms including reduced hepatic synthesis and secretion, increased consumption, and extravasation. Disruption of the glycocalyx, a layer of glycosylated proteins that lines the endothelium preventing thrombosis and extravasation, is a suspected cause of endothelial dysfunction in CDG patients. We performed a retrospective review of CDG patients admitted to our institution with acute illness over the past 2 years. Longitudinal clinical and laboratory data collected during the sick and well states were assessed for biomarkers of inflammation and efficacy of interventions. Six patients representing 4 CDG subtypes and 14 hospitalisations were identified. Acute D-dimer elevation, proteinuria, decreased serum total protein levels, coagulation proteins, and albumin were observed with acute illness. Infusion of fresh frozen plasma, and in some cases protein C concentrate, was associated with clinical and biomarker improvement. This was notable with intra-patient comparison of treated vs untreated courses. Use of endothelial barrier support therapy may reduce endothelial permeability by restoring both regulatory serum protein homeostasis and supporting the glycocalyx and is likely a critical component of care for this population.
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Affiliation(s)
- William J Brucker
- Division of Genetics and Genomics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Stacy E Croteau
- Dana Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts
| | - John R Prensner
- Dana Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts
| | - Kate Cullion
- Division of Medical Critical Care, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matthew M Heeney
- Dana Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, Massachusetts
| | - Jeffrey Lo
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - James B McAlvin
- Division of Medical Critical Care, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Katherine Peeler
- Division of Medical Critical Care, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Nidhi Shah
- Division of Genetics and Genomics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Christina S K Yee
- Division of Immunology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gerard T Berry
- Division of Genetics and Genomics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Olaf Bodamer
- Division of Genetics and Genomics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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D'Gama AM, Brucker WJ, Zhang T, Gubbels CS, Ferdinandusse S, Shi J, Grant PE, VanNoy G, Genetti CA, Juusola J, Yu TW, Kritzer A, Agrawal PB. A phenotypically severe, biochemically "silent" case of HIBCH deficiency in a newborn diagnosed by rapid whole exome sequencing and enzymatic testing. Am J Med Genet A 2020; 182:780-784. [PMID: 32022391 DOI: 10.1002/ajmg.a.61498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/06/2019] [Revised: 01/03/2020] [Accepted: 01/12/2020] [Indexed: 12/28/2022]
Abstract
3-Hydroxyisobutyryl-CoA dehydrogenase (HIBCH) deficiency is a rare error in valine catabolism associated with a Leigh syndrome-like phenotype, mitochondrial dysfunction, and increased C4-OH. We report the most severe case to date in a full-term female who presented with poor feeding and nystagmus on day of life (DOL) 1. Although initial neuroimaging findings were concerning for metabolic disease, further metabolic testing was nondiagnostic and she was discharged on DOL 18. She was readmitted on DOL 22 after severe apneic episodes requiring intubation, with EEG demonstrating multifocal seizures and MRI/MRS demonstrating worsening findings. Care was withdrawn DOL 27 and she expired. Rapid whole exome sequencing (WES) demonstrated compound heterozygous variants in HIBCH with a paternal pathogenic variant (c.852delA, p.L284FfsX10) and a maternal likely pathogenic variant (c.488G>T, p.C163F). Fibroblast enzymatic testing demonstrated marked reduction in HIBCH levels. This case demonstrates the importance of rapid WES and follow-up functional testing in establishing a diagnosis when metabolic disease is suspected but lacks an expected biochemical signature.
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Affiliation(s)
- Alissa M D'Gama
- Division of Genetics and Genomics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
- The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - William J Brucker
- Division of Genetics and Genomics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Tian Zhang
- Division of Genetics and Genomics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
- The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts
| | - Cynthia S Gubbels
- Division of Genetics and Genomics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
- The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Sacha Ferdinandusse
- Department of Clinical Chemistry, Laboratory Genetic Metabolic Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Jiahai Shi
- Department of Biomedical Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Patricia Ellen Grant
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Grace VanNoy
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Casie A Genetti
- Division of Genetics and Genomics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
- The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts
| | - Jane Juusola
- Clinical Genomics, GeneDx, Inc., Gaithersburg, Maryland
| | - Timothy W Yu
- Division of Genetics and Genomics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
- The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - Amy Kritzer
- Division of Genetics and Genomics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pankaj B Agrawal
- Division of Genetics and Genomics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
- The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts
- The Broad Institute of MIT and Harvard, Cambridge, Massachusetts
- Division of Newborn Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Abstract
The alpha7 nicotinic acetylcholine receptor (nAChR) is well established as the principal high-affinity alpha-bungarotoxin-binding protein in the mammalian brain. We isolated carbachol-sensitive alpha-bungarotoxin-binding complexes from total mouse brain tissue by affinity immobilization followed by selective elution, and these proteins were fractionated by SDS-PAGE. The proteins in subdivided gel lane segments were tryptically digested, and the resulting peptides were analyzed by standard mass spectrometry. We identified 55 proteins in wild-type samples that were not present in comparable brain samples from alpha7 nAChR knockout mice that had been processed in a parallel fashion. Many of these 55 proteins are novel proteomic candidates for interaction partners of the alpha7 nAChR, and many are associated with multiple signaling pathways that may be implicated in alpha7 function in the central nervous system. The newly identified potential protein interactions, together with the general methodology that we introduce for alpha-bungarotoxin-binding protein complexes, form a new platform for many interesting follow-up studies aimed at elucidating the physiological role of neuronal alpha7 nAChRs.
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Affiliation(s)
- Joao A Paulo
- Graduate Program in Molecular Biology, Cell Biology and Biochemistry and Department of Molecular Pharmacology, Physiology and Biotechnology, Brown University, Providence, Rhode Island 02912, USA
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