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Zaki MS, Issa MY, Elbendary HM, El-Karaksy H, Hosny H, Ghobrial C, El Safty A, El-Hennawy A, Oraby A, Selim L, Abdel-Hamid MS. Hypermanganesemia with dystonia, polycythemia and cirrhosis in 10 patients: Six novel SLC30A10 mutations and further phenotype delineation. Clin Genet 2018; 93:905-912. [PMID: 29193034 DOI: 10.1111/cge.13184] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 10/15/2017] [Revised: 11/21/2017] [Accepted: 11/22/2017] [Indexed: 01/15/2023]
Abstract
Biallelic mutations in the SLC30A10 gene cause an inborn error of Mn metabolism characterized by hypermanganesemia, polycythemia, early-onset dystonia, and liver cirrhosis (HMDPC). To date, only 14 families from various ethnic groups have been reported. Here, we describe 10 patients from 7 unrelated Egyptian families with HMDPC. Markedly elevated blood Mn levels, the characteristic basal ganglia hyperintensity on T1-weighted images, and variable degrees of extrapyramidal manifestations with or without liver disease were cardinal features in all patients. Eight patients presented with striking early diseased onset (≤2 years). Unexpectedly, early hepatic involvement before the neurological regression was noted in 3 patients. Mutational analysis of SLC30A10 gene revealed 6 novel homozygous mutations (c.77T > C (p.Leu26Pro), c.90C > G (p.Tyr30*), c.119A > C (p.Asp40Ala), c.122_124delCCT (p.Ser41del), c.780_782delCAT (p.Iso260del) and c.957 + 1G > C). Treatment using 2,3 dimercaptosuccinic acid as a manganese chelating agent showed satisfactory results with improvement of biochemical markers, hepatic manifestations and relative amelioration of the neurological symptoms. Our findings present a large cohort of patients with HMDPC from same ethnic group. The majority of our patients showed severe and early presentation with clear phenotypic variability among sibship. Moreover, we extend the phenotypic and mutational spectrum and emphasize the importance of early diagnosis and treatment of this potentially fatal disorder.
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Affiliation(s)
- M S Zaki
- Human Genetics and Genome Research Division, Clinical Genetics Department, National Research Centre, Cairo, Egypt
| | - M Y Issa
- Human Genetics and Genome Research Division, Clinical Genetics Department, National Research Centre, Cairo, Egypt
| | - H M Elbendary
- Medical Research Division, Child Health Department, National Research Centre, Cairo, Egypt
| | - H El-Karaksy
- Pediatric Hepatology Department, Kasr Alainy Medical School, Cairo University, Cairo, Egypt
| | - H Hosny
- Pediatric Neurology Department, National Institute of Neuromotor System, Cairo, Egypt
| | - C Ghobrial
- Pediatric Hepatology Department, Kasr Alainy Medical School, Cairo University, Cairo, Egypt
| | - A El Safty
- Department of Occupational and Environmental Medicine, Kasr Alainy Medical School, Cairo University, Egypt
| | - A El-Hennawy
- Pathology Department, Kasr Alainy Medical School, Cairo University, Cairo, Egypt
| | - A Oraby
- Pediatric Neurology Department, Kasr Alainy Medical School, Cairo University, Cairo, Egypt
| | - L Selim
- Pediatric Neurology Department, Kasr Alainy Medical School, Cairo University, Cairo, Egypt
| | - M S Abdel-Hamid
- Human Genetics and Genome Research Division, Medical Molecular Genetics Department, National Research Centre, Cairo, Egypt
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