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Seidelin AS, Nordestgaard BG, Tybjærg-Hansen A, Yaghootkar H, Stender S. A rare genetic variant in the manganese transporter SLC30A10 and elevated liver enzymes in the general population. Hepatol Int 2022; 16:702-711. [PMID: 35397106 DOI: 10.1007/s12072-022-10331-w] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/14/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND A genetic variant in the manganese transporter SLC30A10 (rs188273166, p.Thr95Ile) was associated with increased plasma alanine transaminase (ALT) in a recent genome-wide association study in the UK Biobank (UKB). The aims of the present study were to test the association of rs188273166 with ALT in an independent cohort, and to begin to assess the clinical, hepatic, and biochemical phenotypes associated with the variant. METHODS We included n = 334,886 white participants from UKB, including 14,462 with hepatic magnetic resonance imaging (MRI), and n = 113,612 individuals from the Copenhagen City Heart Study and the Copenhagen General Population Study combined. RESULTS Genotyping SLC30A10 p.Thr95Ile identified 816 heterozygotes in the UKB and 111 heterozygotes in the Copenhagen cohort. Compared to noncarriers, heterozygotes had 4 and 5 U/L higher levels of ALT in the UKB and Copenhagen cohort, respectively, and 3 U/L higher plasma aspartate transaminase and gamma-glutamyl transferase in the UKB. Heterozygotes also had higher corrected T1 on liver MRI, a marker of hepatic inflammation (p = 4 × 10-7), but no change in MRI-quantified steatosis (p = 0.57). Plasma manganese was within the normal range in nine heterozygotes that provided new blood samples. SLC30A10 p.Thr95Ile heterozygotes had an eightfold increased risk of biliary tract cancer in UKB (p = 4 × 10-7), but this association was not replicated in the Copenhagen cohort. CONCLUSIONS SLC30A10 p.Thr95Ile was associated with elevated liver enzymes in two large general population cohorts, and with MRI-quantified hepatic inflammation. A rare genetic variant (p.Thr95Ile) in the manganese transporter SLC30A10 is associated with elevated plasma alanine transaminase (ALT) and higher corrected T1 on liver MRI, markers of liver inflammation. These data support that the variant may increase the risk of liver disease.
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Affiliation(s)
- Anne-Sofie Seidelin
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Børge Grønne Nordestgaard
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Tybjærg-Hansen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hanieh Yaghootkar
- Department of Life Sciences, Centre for Inflammation Research and Translational Medicine (CIRTM), Brunel University London, Uxbridge, UK
- Research Centre for Optimal Health, School of Life Sciences, University of Westminster, London, UK
| | - Stefan Stender
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Department of Clinical Biochemistry, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark.
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Jagadish S, Howard L, Thati Ganganna S. Atypical presentation of SLC30A10 gene mutation with hypermanganesemia, seizures and polycythemia. Epilepsy Behav Rep 2021; 16:100505. [PMID: 34877518 PMCID: PMC8633869 DOI: 10.1016/j.ebr.2021.100505] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/20/2022] Open
Abstract
Seizure was the sole neurological symptom of hereditary hypermanganesemia. In this case. Absence of pyramidal and extrapyramidal signs or liver failure were other outstanding features. Treatment with chelation therapy led to resolution of seizures and T1 hyperintensity on brain MRI.
Manganese is an essential element that is ubiquitously present in our diet and water supply. It is a cofactor for several critical physiological processes. Elevated blood levels of Manganese secondary to SLC30A10 gene mutation presents distinctly with dystonia, polycythemia, chronic liver disease and a characteristic high T1 signal in basal ganglia on brain MRI. The primary treatment for this condition is chelation along with iron therapy. We report a previously healthy boy with compound heterozygous SLC30A10 gene mutations who had a unique clinical presentation with prominent seizures, polycythemia, and characteristic T1 hyperintensity in basal ganglia. Seizures have not been previously reported to be associated with this specific mutation.
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Key Words
- ADHD, attention deficit hyperactivity disorder
- ALT, alanine transaminase
- AST, aspartate transaminase
- CBC, complete blood count
- Dystonia
- EEG, electroencephalogram
- Hypermanganesemia
- MCH, mean corpuscular hemoglobin
- MCHC, mean corpuscular hemoglobin concentration
- MCV, mean corpuscular volume
- MRI, magnetic resonance imaging
- Mn, Manganese
- Polycythemia
- RDW, red cell distribution width
- SLC30A10 gene mutation
- Seizures
- T1 hyperintensity
- TIBC, total iron binding capacity
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Ghosh R, Dubey S, Chatterjee S, Ghosh M, Ray BK, Benito-León J. Hypermanganesemia Induced Chorea and Cognitive Decline in a Tea Seller. Tremor Other Hyperkinet Mov (N Y) 2020; 10:45. [PMID: 33178484 PMCID: PMC7597573 DOI: 10.5334/tohm.537] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/06/2020] [Indexed: 01/02/2023] Open
Abstract
Background Manganese associated neurotoxicity and neurodegeneration is quite rare yet established neurological disorder. This neurotoxic element has predilection for depositing in basal ganglia structures, manifesting mainly as parkinsonian and dystonic movement disorders with behavioral abnormalities. Case report We report a 40-year-old man who presented with a subacute onset bilateral, asymmetric hyperkinetic movement disorder (predominantly left sided chorea) with multi-domain cognitive impairment, dysarthria, and generalized rigidity. Clinical history and examination yielded multiple differential diagnoses including deposition and metabolic disorders, autoimmune and paraneoplastic encephalitis involving basal ganglia, and neurodegenerative disorders with chorea and cognitive impairment. However, magnetic resonance imaging was suggestive of paramagnetic substance deposition, which came out to be manganese after laboratory investigations. History, clinical examinations, and investigation results pointed towards a diagnosis of acquired hypermanganesemia due to over-ingestion of manganese containing substance (i.e., black tea). He was treated symptomatically and with chelation therapy (calcium disodium edetate). At the sixth month of follow-up, complete resolution of chorea, dysarthria and partial amelioration of rigidity were observed. His cognitive decline and behavioral abnormalities improved. Discussion This is probably the first reported case of acquired hypermanganesemia that presented as a combination of asymmetric chorea and cognitive dysfunction with atypical imaging characteristics. The clinical picture mimicked that of Huntington's disease. We highlight the potential deleterious effects of an apparently "benign" non-alcoholic beverage (i.e., black tea) on cerebral metabolism.
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Affiliation(s)
- Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, IN
| | - Souvik Dubey
- Department of Neuromedicine, Bangur Institute of Neurosciences, Kolkata, IN
| | - Subhankar Chatterjee
- Department of General Medicine, Rajendra Institute of Medical Sciences, Ranchi, IN
| | - Mrinalkanti Ghosh
- Department of Radiology, Burdwan Medical College, Burdwan, West Bengal, IN
| | - Biman Kanti Ray
- Department of Neuromedicine, Bangur Institute of Neurosciences, Kolkata, IN
| | - Julián Benito-León
- Department of Neurology, University Hospital “12 de Octubre”, Madrid, ES
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, ES
- Department of Medicine, Complutense University, Madrid, ES
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Lambrianides S, Nicolaou P, Michaelidou M, Kakouris P, Votsi C, Petrou PP, Drousiotou A, Minaidou A, Demetriou P, Voulgaris C, Christodoulou K, Tanteles GA, Pantzaris M. A novel SLC30A10 missense variant associated with parkinsonism and dystonia without hypermanganesemia. J Neurol Sci 2020; 418:117101. [PMID: 32866815 DOI: 10.1016/j.jns.2020.117101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 07/25/2020] [Accepted: 08/14/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Paschalis Nicolaou
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus; Cyprus School of Molecular Medicine, Nicosia, Cyprus
| | | | | | - Christina Votsi
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus; Cyprus School of Molecular Medicine, Nicosia, Cyprus
| | - Petros P Petrou
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus; Cyprus School of Molecular Medicine, Nicosia, Cyprus
| | - Anthi Drousiotou
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus; Cyprus School of Molecular Medicine, Nicosia, Cyprus
| | - Anna Minaidou
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus; Cyprus School of Molecular Medicine, Nicosia, Cyprus
| | - Praxitelis Demetriou
- Neuroradiology and Head & Neck Radiology Department, Karolinska University Hospital, Sweden
| | | | - Kyproula Christodoulou
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus; Cyprus School of Molecular Medicine, Nicosia, Cyprus
| | - George A Tanteles
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus; Cyprus School of Molecular Medicine, Nicosia, Cyprus
| | - Marios Pantzaris
- The Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus; Cyprus School of Molecular Medicine, Nicosia, Cyprus
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Takama Y, Nakamura T, Santo K, Yoneda A. Liver resection for a congenital intrahepatic portosystemic shunt in a child with hyperammonemia and hypermanganesemia: a case report. Surg Case Rep 2020; 6:73. [PMID: 32303849 PMCID: PMC7165232 DOI: 10.1186/s40792-020-00838-5] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/07/2020] [Indexed: 01/14/2023] Open
Abstract
Background Congenital portosystemic shunt (CPSS) is a rare malformation that leads to hyperammonemia, hypermanganesemia, and various symptoms. CPSSs are divided into intrahepatic and extrahepatic shunts. In patients with persistent CPSS including an intrahepatic portosystemic shunt (IPSS), early intervention to occlude the shunt reverses the associated complications. Case presentation The patient was a 1-year-and-7-month-old girl. She presented with hypergalactosemia and elevation of blood ammonia level (75 μg/dL) and total bile acid levels (68.2 μmol/L) during the neonatal period. Two IPSSs were detected using ultrasound and enhanced computerized tomography. Magnetic resonance imaging (MRI) at 1 year and 3 months of age showed abnormally high signal intensity in the pallidum of her brain. Spontaneous closure was not observed. We performed a right hepatectomy at 1 year and 7 months of age. The portal vein pressure was 16 mmHg after temporary occlusion of the right portal vein. Blood ammonia and serum manganese levels decreased immediately after the operation. The abnormal signal on brain MRI disappeared. She had a favorable course with no sign of recurrence of IPSS 5 years postoperatively. Conclusion Liver resection for an IPSS to control the symptoms of a portosystemic shunt is reasonable in a child for whom interventional radiological treatment is not indicated.
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Affiliation(s)
- Yuichi Takama
- Department of Pediatric Surgery, Osaka City General Hospital, Osaka, Japan. .,Department of Pediatric Surgery, Kindai University Nara Hospital, Nara, Japan.
| | - Tetsuro Nakamura
- Department of Pediatric Surgery, Osaka City General Hospital, Osaka, Japan
| | - Kenji Santo
- Department of Pediatric Surgery, Osaka City General Hospital, Osaka, Japan
| | - Akihiro Yoneda
- Department of Pediatric Surgery, Osaka City General Hospital, Osaka, Japan
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Zeglam A, Abugrara A, Kabuka M. Autosomal-recessive iron deficiency anemia, dystonia and hypermanganesemia caused by new variant mutation of the manganese transporter gene SLC39A14. Acta Neurol Belg 2019; 119:379-84. [PMID: 30232769 DOI: 10.1007/s13760-018-1024-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
This inborn error of manganese metabolism has only recently been identified. A total of 28 affected individuals from ten families are known worldwide. Mutations in SLC39A14, encoding a Mn uptake transporter, have recently been recognized to cause excessive Mn concentrations in the blood which is believed to be neurotoxic and lead to a parkinsonian-like movement disorder caused by accumulation of Mn in the basal ganglia. We are reporting a new variant of SLC39A14 gene mutation (OMIM 608736 8p21.3) that has never been described in the literature so far. The index case is a 3-year-old female who was born at 30 weeks' gestation by emergency lower segment caesarean section, the second of twins, weighing 1.4 kg. Parents have a consanguineous marriage (first cousins) and have four healthy male children. She presented at 30 months of age with history of unsteady gait of 4 months duration and is progressively worsening. She became stiff and has lost all of her locomotor skills. Apart from low serum iron and iron deficiency anemia, her initial work up was unremarkable. T1-weighted MRI brain showed bilateral hyperintense signal in basal ganglia, mid-brain and pontine tegmentum giving rise to the characteristic eye-of-the-tiger sign. Genetic DNA evaluation (Whole Exome Sequencing WES) identified the homozygous missense variant c.1136.T in exon 7 of SLC39A14 gene which is associated with hypermanganesemia. Whole blood Mn was markedly raised at 150 nmol/L (8 mg/L) (normal 10 nmol/L, 0.7 mg/Bioscientia). This young girl has just started treatment with intravenous disodium calcium edetate and oral iron.
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Tavasoli A, Arjmandi Rafsanjani K, Hemmati S, Mojbafan M, Zarei E, Hosseini S. A case of dystonia with polycythemia and hypermanganesemia caused by SLC30A10 mutation: a treatable inborn error of manganese metabolism. BMC Pediatr 2019; 19:229. [PMID: 31288771 PMCID: PMC6615235 DOI: 10.1186/s12887-019-1611-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 07/02/2019] [Indexed: 11/21/2022] Open
Abstract
Background Manganese is a critical trace element that not only has antioxidant properties, but also is essential for various metabolic pathways and neurotransmitters production. However, it can be toxic at high levels, particularly in the central nervous system. Manganese intoxication can be acquired, but an inherited form due to autosomal-recessive mutations in the SLC30A10 gene encoding a Mn transporter protein has also been reported recently. These mutations are associated with significant failure of manganese excretion and its storage in the liver, brain (especially basal ganglia), and other peripheral tissues, resulting in toxicity. Case presentation A 10-year-old boy from consanguineous parents presented with a history of progressive truncal instability, gait difficulty, and frequent falls for 2 months. He had dystonia, rigidity, ataxia, dysarthria, bradykinesia and a plethoric skin. Investigations showed polycythemia, low serum iron and ferritin levels, and increased total iron binding capacity. A brain MRI revealed symmetric hyperintensities in the basal ganglia and dentate nucleuses on TI images that were suggestive of brain metal deposition together with clinical manifestations. Serum calcium and copper levels were normal, while the manganese level was significantly higher than normal values. There was no history of environmental overexposure to manganese. Genetic testing showed a homozygous missense mutation in SLC30A10 (c.C1006T, p.His336Tyr) and Sanger sequencing confirmed a homozygous state in the proband and a heterozygous state in the parents. Regular treatment with monthly infusions of disodium calcium edetate and oral iron compounds resulted in decreased serum manganese and hemoglobin levels to normal values, significant resolution of MRI lesions, and partial improvement of neurological symptoms during 6 months of follow-up. Conclusion The syndrome of hepatic cirrhosis, dystonia, polycythemia, and hypermanganesemia caused by SLC30A10 mutation is a treatable inherited metal deposition syndrome. The patient may only have pure neurological without hepatic manifestations. Although this is a rare and potentially fatal inborn error of metabolism, early diagnosis and continuous chelation therapy might improve the symptoms and prevent disease progression.
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Affiliation(s)
- Azita Tavasoli
- Department of Pediatric Neurology, Ali Asghar Children's Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Khadije Arjmandi Rafsanjani
- Department of Pediatric Hematology, Ali Asghar Children's Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Saba Hemmati
- Department of Pediatrics, Ali Asghar Children's Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Marziyeh Mojbafan
- Department of Medical Genetics and Molecular Biology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Zarei
- Department of Radiology, Ali Asghar Children's Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Soudabeh Hosseini
- Ali Asghar Children's Hospital, Iran University of Medical Sciences, Tehran, Iran
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Takama Y, Ueno T, Umeda S, Saka R, Tazuke Y, Okuyama H. Laparoscopic ligation of a congenital extrahepatic portosystemic shunt for children with hyperammonemia: a single-institution experience. Surg Today 2019; 49:323-7. [PMID: 30392166 DOI: 10.1007/s00595-018-1731-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/06/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE A congenital extrahepatic portosystemic shunt (CEPS) associated with hyperammonemia requires occlusion of the shunt vessels. We evaluated the effectiveness and safety of laparoscopic ligation of a CEPS in children with hyperammonemia. METHODS The subjects of this retrospective study were seven children with hyperammonemia who underwent laparoscopic ligation of a CEPS. Their median age was 5.2 years (range 1-16 years). Before the laparoscopic procedure, a catheter was inserted through the femoral vein and placed in the portal vein via the shunt vessel. The shunt vessel was dissected and taped laparoscopically. After measuring the portal vein pressure under temporal occlusion, the shunt vessels were ligated. RESULTS The types of shunts according to location were patent ductus venosus (n = 2), splenorenal shunt (n = 2), gastrorenal shunt (n = 2), and superior mesenteric vein-inferior vena cava shunt (n = 1). Laparoscopic ligation of the shunt vessel was completed uneventfully in all patients. The median portal vein pressure was 19 mmHg after ligation. The median preoperative blood ammonia level was 94 µg/dL (range 71-259 µg/dL), which decreased after ligation in all patients. There was no incidence of postoperative liver failure. CONCLUSION Laparoscopic ligation of a CEPS is safe and effective for children with hyperammonemia.
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Marti-Sanchez L, Ortigoza-Escobar JD, Darling A, Villaronga M, Baide H, Molero-Luis M, Batllori M, Vanegas MI, Muchart J, Aquino L, Artuch R, Macaya A, Kurian MA, Dueñas P. Hypermanganesemia due to mutations in SLC39A14: further insights into Mn deposition in the central nervous system. Orphanet J Rare Dis 2018; 13:28. [PMID: 29382362 PMCID: PMC5791243 DOI: 10.1186/s13023-018-0758-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [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: 03/22/2017] [Accepted: 01/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background The SLC39A14, SLC30A10 and SLC39A8 are considered to be key genes involved in manganese (Mn) homeostasis in humans. Mn levels in plasma and urine are useful tools for early recognition of these disorders. We aimed to explore further biomarkers of Mn deposition in the central nervous system in two siblings presenting with acute dystonia and hypermanganesemia due to mutations in SLC39A14. These biomarkers may help clinicians to establish faster and accurate diagnosis and to monitor disease progression after chelation therapy is administered. Results A customized gene panel for movement disorders revealed a novel missense variant (c.311G > T; p.Ser104Ile) in SLC39A14 gene in two siblings presenting at the age of 10 months with acute dystonia and motor regression. Mn concentrations were analyzed using inductively coupled mass spectrometry in plasma and cerebrospinal fluid, disclosing elevated Mn levels in the index case compared to control patients. Surprisingly, Mn values were 3-fold higher in CSF than in plasma. We quantified the pallidal index, defined as the ratio between the signal intensity in the globus pallidus and the subcortical frontal white matter in axial T1-weighted MRI, and found significantly higher values in the SLC39A14 patient than in controls. These values increased over a period of 10 years, suggesting the relentless pallidal accumulation of Mn. Following genetic confirmation, a trial with the Mn chelator Na2CaEDTA led to a reduction in plasma Mn, zinc and selenium levels. However, parents reported worsening of cervical dystonia, irritability and sleep difficulties and chelation therapy was discontinued. Conclusions Our study expands the very few descriptions of patients with SLC39A14 mutations. We report for the first time the elevation of Mn in CSF of SLC39A14 mutated patients, supporting the hypothesis that brain is an important organ of Mn deposition in SLC39A14-related disease. The pallidal index is an indirect and non-invasive method that can be used to rate disease progression on follow-up MRIs. Finally, we propose that patients with inherited defects of manganese transport should be initially treated with low doses of Na2CaEDTA followed by gradual dose escalation, together with a close monitoring of blood trace elements in order to avoid side effects.
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Affiliation(s)
- L Marti-Sanchez
- Department of Biochemistry, Institut de Recerca - Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - J D Ortigoza-Escobar
- Department of Child Neurology, Institut de Recerca - Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - A Darling
- Department of Child Neurology, Institut de Recerca - Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - M Villaronga
- Department of Pharmacy, Institut de Recerca - Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - H Baide
- Department of Child Neurology, Institut de Recerca - Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - M Molero-Luis
- Department of Biochemistry, Institut de Recerca - Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - M Batllori
- Department of Biochemistry, Institut de Recerca - Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - M I Vanegas
- Department of Child Neurology, Institut de Recerca - Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - J Muchart
- Department of Radiology, Institut de Recerca - Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - L Aquino
- Deparment of Pediatrics, Hospital de Mataró, Barcelona, Spain
| | - R Artuch
- Department of Biochemistry, Institut de Recerca - Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - A Macaya
- Pediatric Neurology Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Catalonia, Spain
| | - M A Kurian
- Molecular Neurosciences, Developmental Neurosciences Programme, UCL-Great Ormond Street Institute of Child Health, London, UK
| | - Pérez Dueñas
- Department of Child Neurology, Institut de Recerca - Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain. .,Pediatric Neurology Research Group, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Catalonia, Spain.
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Kim Y. μSex, pregnancy, and age-specific differences of blood manganese levels in relation to iron status; what does it mean? Toxicol Rep 2017; 5:28-30. [PMID: 29270364 PMCID: PMC5734794 DOI: 10.1016/j.toxrep.2017.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 11/19/2017] [Accepted: 12/04/2017] [Indexed: 12/25/2022] Open
Abstract
The interaction of iron with manganese (Mn) is the major factor affecting blood Mn level in general population. Children and pregnant women had no adverse effects from blood Mn levels associated with adverse effects in adult workers. The differences between a physiological and a pathological hypermanganesemia complicate the dose-response relationship.
The objective of the present study was to evaluate sex, menopause, pregnancy, and age-specific differences of blood manganese (Mn) levels in relation to iron status, and to assess the toxicological implications of these relationships. Females of childbearing age have higher concentrations of blood Mn than males because women have lower concentrations of ferritin. Previous studies indicated significant increases in blood Mn levels throughout pregnancy, and that the geometric mean of blood Mn was significantly higher in premenopausal women than postmenopausal women. This may be due to the enhanced absorption of Mn because of upregulation of iron absorption, which is especially important during late pregnancy. Mn concentrations are highest in infancy, decreased with age up to adolescence, and did not change during adulthood. Thus, the relationship of iron with Mn may be the major factor affecting blood Mn levels according to menstrual stage, reproductive status, menopausal factors, and age. However, Mn absorbed via the gastrointestinal system seems to be less neurotoxic than inhaled or parenteral Mn, due to the tight enterohepatic homeostatic control of this essential element. Furthermore, children and pregnant women had no adverse health effects from blood levels of Mn that were associated with adverse effects in adult workers. In conclusion, the differences between a physiological and a pathological hypermanganesemia complicate interpretation of the dose-response relationship.
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Avelino MA, Fusão EF, Pedroso JL, Arita JH, Ribeiro RT, Pinho RS, Tuschl K, Barsottini OGP, Masruha MR. Inherited manganism: the "cock-walk" gait and typical neuroimaging features. J Neurol Sci 2014; 341:150-2. [PMID: 24746291 DOI: 10.1016/j.jns.2014.03.057] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 01/07/2014] [Revised: 03/27/2014] [Accepted: 03/28/2014] [Indexed: 01/31/2023]
Abstract
Manganese (Mn) toxicity causes an extrapyramidal, parkinsonian-type movement disorder with characteristic magnetic resonance images of Mn accumulation in the basal ganglia. This letter highlights the neurological manifestations and neuroimaging features of inherited manganism (IMn), an unusual and treatable inborn error of Mn homeostasis. Early-onset dystonia with "cock-walk" gait and hyperintense signal in basal ganglia, associated to polycythemia, chronic liver disease and hypermanganesemia, promptly suggest IMn, and a genetic evaluation should be performed.
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Affiliation(s)
- Marcela Amaral Avelino
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil.
| | | | - José Luiz Pedroso
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Juliana Harumi Arita
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Ricardo Silva Pinho
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Karin Tuschl
- Clinical and Molecular Genetics Unit, UCL Institute of Child Health, London, UK
| | - Orlando G P Barsottini
- Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
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