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Crane HM, Asher S, Conway L, Drivas TG, Kallish S. Unraveling a history of overlap: A phenotypic comparison of RBCK1-related disease and glycogen storage disease type IV. Am J Med Genet A 2024:e63574. [PMID: 38436530 DOI: 10.1002/ajmg.a.63574] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
RBCK1-related disease is a rare, multisystemic disorder for which our current understanding of the natural history is limited. A number of individuals initially carried clinical diagnoses of glycogen storage disease IV (GSD IV), but were later found to harbor RBCK1 pathogenic variants, demonstrating challenges of correctly diagnosing RBCK1-related disease. This study carried out a phenotypic comparison between RBCK1-related disease and GSD IV to identify features that clinically differentiate these diagnoses. Literature review and retrospective chart review identified 25 individuals with RBCK1-related disease and 36 with the neuromuscular subtype of GSD IV. Clinical features were evaluated to assess for statistically significant differences between the conditions. At a system level, any cardiac, autoinflammation, immunodeficiency, growth, or dermatologic involvement were suggestive of RBCK1, whereas any respiratory involvement suggested GSD IV. Several features warrant further exploration as predictors of RBCK1, such as generalized weakness, heart transplant, and recurrent infections, among others. Distinguishing RBCK1-related disease will facilitate correct diagnoses and pave the way for accurately identifying affected individuals, as well as for developing management recommendations, treatment, and an enhanced understanding of the natural history. This knowledge may also inform which individuals thought to have GSD IV should undergo reevaluation for RBCK1.
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Affiliation(s)
- Haley M Crane
- Master of Science in Genetic Counseling Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephanie Asher
- Penn Medicine, Department of Medicine, Division of Translational Medicine and Human Genetics, Philadelphia, Pennsylvania, USA
| | - Laura Conway
- Master of Science in Genetic Counseling Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Theodore G Drivas
- Penn Medicine, Department of Medicine, Division of Translational Medicine and Human Genetics, Philadelphia, Pennsylvania, USA
| | - Staci Kallish
- Penn Medicine, Department of Medicine, Division of Translational Medicine and Human Genetics, Philadelphia, Pennsylvania, USA
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2
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Gayed MM, Sgobbi P, Pinto WBVDR, Kishnani PS, Koch RL. Case report: Expanding the understanding of the adult polyglucosan body disease continuum: novel presentations, diagnostic pitfalls, and clinical pearls. Front Genet 2023; 14:1282790. [PMID: 38164512 PMCID: PMC10758020 DOI: 10.3389/fgene.2023.1282790] [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: 08/24/2023] [Accepted: 09/26/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction: Adult polyglucosan body disease (APBD) has long been regarded as the adult-onset form of glycogen storage disease type IV (GSD IV) and is caused by biallelic pathogenic variants in GBE1. Advances in the understanding of the natural history of APBD published in recent years have led to the use of discrete descriptors ("typical" versus "atypical") based on adherence to traditional symptomatology and homozygosity for the p.Y329S variant. Although these general descriptors are helpful in summarizing common findings and symptoms in APBD, they are inherently limited and may affect disease recognition in diverse populations. Methods: This case series includes three American patients (cases 1-3) and four Brazilian patients (cases 4-7) diagnosed with APBD. Patient-reported outcome (PRO) measures were employed to evaluate pain, fatigue, and quality of life in cases 1-3. Results: We describe the clinical course and diagnostic odyssey of seven cases of APBD that challenge the utility and efficacy of discrete descriptors. Cases 1-3 are compound heterozygotes that harbor the previously identified deep intronic variant in GBE1 and presented with "typical" APBD phenotypically, despite lacking two copies of the pathogenic p.Y329S variant. Patient-reported outcome measures in these three cases revealed the moderate levels of pain and fatigue as well as an impacted quality of life. Cases 4-7 have unique genotypic profiles and emphasize the growing recognition of presentations of APBD in diverse populations with broad neurological manifestations. Conclusion: Collectively, these cases underscore the understanding of APBD as a spectrum disorder existing on the GSD IV phenotypic continuum. We draw attention to the pitfalls of commonly used genetic testing methods when diagnosing APBD and highlight the utility of patient-reported outcome questionnaires in managing this disease.
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Affiliation(s)
- Matthew M. Gayed
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, United States
| | - Paulo Sgobbi
- Division of Neuromuscular Diseases, Department of Neurology and Neurosurgery, University of São Paulo (UNIFESP), São Paulo, Brazil
| | | | - Priya S. Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, United States
| | - Rebecca L. Koch
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, United States
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Derks TGJ, Peeks F, de Boer F, Fokkert‐Wilts M, van der Doef HPJ, van den Heuvel MC, Szymańska E, Rokicki D, Ryan PT, Weinstein DA. The potential of dietary treatment in patients with glycogen storage disease type IV. J Inherit Metab Dis 2021; 44:693-704. [PMID: 33332610 PMCID: PMC8246821 DOI: 10.1002/jimd.12339] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/30/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022]
Abstract
There is paucity of literature on dietary treatment in glycogen storage disease (GSD) type IV and formal guidelines are not available. Traditionally, liver transplantation was considered the only treatment option for GSD IV. In light of the success of dietary treatment for the other hepatic forms of GSD, we have initiated this observational study to assess the outcomes of medical diets, which limit the accumulation of glycogen. Clinical, dietary, laboratory, and imaging data for 15 GSD IV patients from three centres are presented. Medical diets may have the potential to delay or prevent liver transplantation, improve growth and normalize serum aminotransferases. Individual care plans aim to avoid both hyperglycaemia, hypoglycaemia and/or hyperketosis, to minimize glycogen accumulation and catabolism, respectively. Multidisciplinary monitoring includes balancing between traditional markers of metabolic control (ie, growth, liver size, serum aminotransferases, glucose homeostasis, lactate, and ketones), liver function (ie, synthesis, bile flow and detoxification of protein), and symptoms and signs of portal hypertension.
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Affiliation(s)
- Terry G. J. Derks
- Department of Metabolic DiseasesBeatrix Children's Hospital, University Medical Centre Groningen, University of GroningenGroningenthe Netherlands
| | - Fabian Peeks
- Department of Metabolic DiseasesBeatrix Children's Hospital, University Medical Centre Groningen, University of GroningenGroningenthe Netherlands
| | - Foekje de Boer
- Department of Metabolic DiseasesBeatrix Children's Hospital, University Medical Centre Groningen, University of GroningenGroningenthe Netherlands
| | - Marieke Fokkert‐Wilts
- Department of Metabolic DiseasesBeatrix Children's Hospital, University Medical Centre Groningen, University of GroningenGroningenthe Netherlands
| | - Hubert P. J. van der Doef
- Department of Pediatric Gastroenterology Hepatology and NutritionBeatrix Children's Hospital, University Medical Centre Groningen, University of GroningenGroningenthe Netherlands
| | - Marius C. van den Heuvel
- Department of Pathology & Medical Biology, Pathology Section, University of GroningenUniversity Medical Center GroningenHanzepleinGroningenNetherlands
| | - Edyta Szymańska
- Department of Gastroenterology, Hepatology, Feeding Disorders and PediatricsThe Childrens' Memorial Health InstituteWarsawPoland
| | - Dariusz Rokicki
- Department of Pediatrics, Nutrition and Metabolic DisordersThe Childrens' Memorial Health InstituteWarsawPoland
| | - Patrick T. Ryan
- Glycogen Storage Disease Program, Connecticut Children's Medical CenterHartfordConnecticutUSA
| | - David A. Weinstein
- Glycogen Storage Disease Program, Connecticut Children's Medical CenterHartfordConnecticutUSA
- Department of PediatricsUniversity of Connecticut Health CenterFarmingtonConnecticutUSA
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4
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Abstract
Glycogen storage disease type IV (GSD IV) is a rare autosomal recessive disorder caused by glycogen-branching enzyme (GBE) deficiency, leading to accumulation of amylopectin-like glycogen that may damage affected tissues. The clinical manifestations of GSD IV are heterogeneous; one of which is the classic manifestation of progressive hepatic fibrosis. There is no specific treatment available for GSD IV. Currently, liver transplantation is an option. It is crucial to evaluate long-term outcomes of liver transplantation. We reviewed the published literature for GSD IV patients undergoing liver transplantation. To date, some successful liver transplantations have increased the quantity and quality of life in patients. Although the extrahepatic manifestations of GSD IV may still progress after transplantation, especially cardiomyopathy. Patients with cardiac involvement are candidates for cardiac transplantation. Liver transplantation remains the only effective therapeutic option for treatment of GSD IV. However, liver transplantation may not alter the extrahepatic progression of GSD IV. Patients should be carefully assessed before liver transplantation.
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Affiliation(s)
- Min Liu
- Department of Liver Transplantation Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,National Clinical Research Centre for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Li-Ying Sun
- Department of Liver Transplantation Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,National Clinical Research Centre for Digestive Diseases, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Department of Intensive Care Unit, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Abstract
Glycogen storage disease type IV (GSD IV; Andersen's disease) is a rare autosomal recessive disorder that results from defects in the GBE1 gene (3p12.2) and subsequent deficiencies of glycogen branching. We report a case of GSD IV diagnosed at autopsy in a 35 4/7 weeks gestational age female neonate that died shortly after birth. Multisystem blue, ground glass inclusions initially presumed artefactual were periodic acid-Schiff positive, diastase resistant. Chromosomal microarray analysis identified a deletion of exons 2 through 16 of the GBE1 gene and whole exome sequencing identified a nonsense mutation within exon 14, confirming the diagnosis of GSD IV. A strong index of suspicion was required determine GSD IV as the ultimate cause of death, illustrating the need for critical evaluation of postmortem artifact in the setting of fetal demise of unknown etiology and highlighting the role of postmortem molecular diagnostics in a subset of cases.
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Affiliation(s)
- Daniel C Butler
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - W Bailey Glen
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Cynthia Schandl
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Angelina Phillips
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, South Carolina
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Sreekantam S, Rizvi H, Brown R, Santra S, Raiman J, Vijay S, Mckiernan PJ, Gupte GL. An uncommon cause of early infantile liver disease and raised chitotriosidase. JIMD Rep 2020; 54:22-24. [PMID: 32685346 PMCID: PMC7358662 DOI: 10.1002/jmd2.12123] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/05/2020] [Accepted: 04/07/2020] [Indexed: 11/06/2022] Open
Abstract
Our subject presented at 11 months of age, following a varicella zoster infection, with acute on chronic liver disease and was found to have raised serum chitotriosidase. White cell enzyme analysis for Gaucher, Niemann Pick A, B and lysosomal acid lipase deficiency were normal. Niemann Pick type C (NPC) disease was considered as a provisional diagnosis and liver transplantation assessment deferred until recovery from varicella and results of mutational analysis of NPC gene were available. Liver biopsy at a later date showed findings suggestive of glycogen storage disease (GSD) type IV but he was too unstable for an urgent liver transplantation and sadly passed away at the age of 13 months. The classic hepatic subtype of glycogen storage disorder type IV (GSD IV) is a rare metabolic cause of early-onset liver disease and raised chitotriosidase. There are very few reports of raised chito in GSD IV. Liver transplantation has a favourable outcome for the hepatic subtype of GSD IV and early diagnosis in our subject could have potentially altered the outcome.
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Affiliation(s)
- Srividya Sreekantam
- Department of Clinical Inherited Metabolic DisordersBirmingham Women's and Children's Hospital NHS TrustUK
| | - Hina Rizvi
- Department of HepatologyBirmingham Women's and Children's Hospital NHS TrustUK
| | - Rachel Brown
- Department of HistopathologyBirmingham Women's and Children's Hospital NHS TrustUK
| | - Saikat Santra
- Department of Clinical Inherited Metabolic DisordersBirmingham Women's and Children's Hospital NHS TrustUK
| | - Julian Raiman
- Department of Clinical Inherited Metabolic DisordersBirmingham Women's and Children's Hospital NHS TrustUK
| | - Suresh Vijay
- Department of Clinical Inherited Metabolic DisordersBirmingham Women's and Children's Hospital NHS TrustUK
| | - Patrick J. Mckiernan
- Department of Gastroenterology, Hepatology, and NutritionChildren's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Girish L. Gupte
- Department of HepatologyBirmingham Women's and Children's Hospital NHS TrustUK
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Yi H, Zhang Q, Brooks ED, Yang C, Thurberg BL, Kishnani PS, Sun B. Systemic Correction of Murine Glycogen Storage Disease Type IV by an AAV-Mediated Gene Therapy. Hum Gene Ther 2016; 28:286-294. [PMID: 27832700 DOI: 10.1089/hum.2016.099] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Deficiency of glycogen branching enzyme (GBE) causes glycogen storage disease type IV (GSD IV), which is characterized by the accumulation of a less branched, poorly soluble form of glycogen called polyglucosan (PG) in multiple tissues. This study evaluates the efficacy of gene therapy with an adeno-associated viral (AAV) vector in a mouse model of adult form of GSD IV (Gbe1ys/ys). An AAV serotype 9 (AAV9) vector containing a human GBE expression cassette (AAV-GBE) was intravenously injected into 14-day-old Gbe1ys/ys mice at a dose of 5 × 1011 vector genomes per mouse. Mice were euthanized at 3 and 9 months of age. In the AAV-treated mice at 3 months of age, GBE enzyme activity was highly elevated in heart, which is consistent with the high copy number of the viral vector genome detected. GBE activity also increased significantly in skeletal muscles and the brain, but not in the liver. The glycogen content was reduced to wild-type levels in muscles and significantly reduced in the liver and brain. At 9 months of age, though GBE activity was only significantly elevated in the heart, glycogen levels were significantly reduced in the liver, brain, and skeletal muscles of the AAV-treated mice. In addition, the AAV treatment resulted in an overall decrease in plasma activities of alanine transaminase, aspartate transaminase, and creatine kinase, and a significant increase in fasting plasma glucose concentration at 9 months of age. This suggests an alleviation of damage and improvement of function in the liver and muscles by the AAV treatment. This study demonstrated a long-term benefit of a systemic injection of an AAV-GBE vector in Gbe1ys/ys mice.
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Affiliation(s)
- Haiqing Yi
- 1 Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center , Durham, North Carolina
| | - Quan Zhang
- 1 Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center , Durham, North Carolina
| | - Elizabeth D Brooks
- 1 Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center , Durham, North Carolina
| | - Chunyu Yang
- 1 Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center , Durham, North Carolina
| | - Beth L Thurberg
- 2 Department of Pathology, Sanofi Genzyme , Framingham, Massachusetts
| | - Priya S Kishnani
- 1 Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center , Durham, North Carolina
| | - Baodong Sun
- 1 Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center , Durham, North Carolina
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