1
|
Grama A, Blaga L, Nicolescu A, Deleanu C, Militaru M, Căinap SS, Pop I, Tita G, Sîrbe C, Fufezan O, Vințan MA, Vulturar R, Pop TL. Novel Mutation in GALT Gene in Galactosemia Patient with Group B Streptococcus Meningitis and Acute Liver Failure. ACTA ACUST UNITED AC 2019; 55:medicina55040091. [PMID: 30987402 PMCID: PMC6524007 DOI: 10.3390/medicina55040091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/14/2019] [Accepted: 04/01/2019] [Indexed: 02/05/2023]
Abstract
Classic galactosemia is an autosomal recessive disorder caused by the deficiency of the enzyme galactose-1-phosphate uridyltransferase (GALT) involved in galactose metabolism. Bacterial infections are a known cause of early morbidity and mortality in children with classic galactosemia. The most common agent is Escherichia coli, but in rare situations, other bacteria are incriminated. We report a case of a three-week-old female patient with galactosemia, who presented with Group B Streptococcus (GBS) meningitis/sepsis. She received treatment with antibiotics, supportive therapy, and erythrocyte transfusion, but after a short period of improvement, she presented acute liver failure with suspicion of an inborn error of metabolism. Rapid nuclear magnetic resonance (NMR) spectroscopy from urine showed highly elevated values of galactose and galactitol. Under intensive treatment for acute liver failure and with a lactose-free diet, her clinical features and laboratory parameters improved considerably. Genetic testing confirmed compound heterozygous status for GALT mutations: c.563 A>G [p.Q188R] and c. 910 C>T, the last mutation being a novel mutation in GALT gene. In countries without an extensive newborn screening program, a high index of suspicion is necessary for early diagnosis and treatment of galactosemia.
Collapse
Affiliation(s)
- Alina Grama
- Second Pediatric Clinic, Department of Mother and Child, University of Medicine and Pharmacy "Iuliu Hațieganu" Cluj-Napoca, 400012 Cluj-Napoca, Romania.
| | - Ligia Blaga
- Discipline of Neonatology, Department of Mother and Child, University of Medicine and Pharmacy "Iuliu Hațieganu" Cluj-Napoca, 400012 Cluj-Napoca, Romania.
| | - Alina Nicolescu
- NMR Laboratory, "Petru Poni" Institute of Macromolecular Chemistry, Romanian Academy of Sciences, 700487 Iaşi, Romania.
- "Costin D. Neniţescu" Institute of Organic Chemistry, Romanian Academy of Sciences, 060023 Bucharest, Romania.
| | - Călin Deleanu
- NMR Laboratory, "Petru Poni" Institute of Macromolecular Chemistry, Romanian Academy of Sciences, 700487 Iaşi, Romania.
- "Costin D. Neniţescu" Institute of Organic Chemistry, Romanian Academy of Sciences, 060023 Bucharest, Romania.
| | - Mariela Militaru
- Medical Genetics, Department of Molecular Sciences, University of Medicine and Pharmacy "Iuliu Hațieganu" Cluj-Napoca, 400012 Cluj-Napoca, Romania.
- Genetic Center Cluj-Napoca, 400363 Cluj-Napoca, Romania.
| | - Simona Sorana Căinap
- Second Pediatric Clinic, Department of Mother and Child, University of Medicine and Pharmacy "Iuliu Hațieganu" Cluj-Napoca, 400012 Cluj-Napoca, Romania.
| | - Irina Pop
- Second Pediatric Clinic, Department of Mother and Child, University of Medicine and Pharmacy "Iuliu Hațieganu" Cluj-Napoca, 400012 Cluj-Napoca, Romania.
| | - Georgia Tita
- Second Pediatric Clinic, Department of Mother and Child, University of Medicine and Pharmacy "Iuliu Hațieganu" Cluj-Napoca, 400012 Cluj-Napoca, Romania.
| | - Claudia Sîrbe
- Second Pediatric Clinic, Department of Mother and Child, University of Medicine and Pharmacy "Iuliu Hațieganu" Cluj-Napoca, 400012 Cluj-Napoca, Romania.
| | - Otilia Fufezan
- Radiology Department, Children's Emergency Clinical Hospital, Cluj-Napoca, 400378, Romania.
| | - Mihaela Adela Vințan
- Pediatric Neurology Clinic, Children's Emergency Clinical Hospital, Department of Neurosciences, University of Medicine and Pharmacy "Iuliu Hațieganu" Cluj-Napoca, 400012 Cluj-Napoca, Romania.
| | - Romana Vulturar
- Department of Molecular Sciences, University of Medicine and Pharmacy "Iuliu Hațieganu" Cluj-Napoca, 400012 Cluj-Napoca, Romania.
- Cognitive Neuroscience Laboratory, Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, 400084 Cluj-Napoca, Romania.
- Imogen Medical Institute, 400012 Cluj-Napoca, Romania.
| | - Tudor Lucian Pop
- Second Pediatric Clinic, Department of Mother and Child, University of Medicine and Pharmacy "Iuliu Hațieganu" Cluj-Napoca, 400012 Cluj-Napoca, Romania.
- Center of Expertise for Pediatric Liver Rare Disorders, Children's Emergency Clinical Hospital, 400177 Cluj-Napoca, Romania.
| |
Collapse
|
2
|
Krabbi K, Uudelepp ML, Joost K, Zordania R, Õunap K. Long-term complications in Estonian galactosemia patients with a less strict lactose-free diet and metabolic control. Mol Genet Metab 2011; 103:249-53. [PMID: 21501963 DOI: 10.1016/j.ymgme.2011.03.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 03/29/2011] [Indexed: 11/29/2022]
Abstract
The main aim of our study was to retrospectively evaluate long-term complications and measure urinary galactose and galactitol excretion in classical galactosemia patients in Estonia who have been treated with a less restricted lactose-free diet and metabolic control. Our study group consisted of five classical galactosemia patients aged 7-14 years and diagnosed since 1996 in Estonia. Their diet eliminates lactose present in dairy foods, but we did not restrict the consumption of mature cheeses, fruits and vegetables. All patients had normal growth, except for one patient who was overweight at the last evaluation. In three patients mental and speech development was normal. One patient, number 1, who was diagnosed latest (at 6 weeks of age), had moderate mental retardation, verbal dyspraxia, extrapyramidal signs and bilateral cataracts. In both patients with developmental problems, a brain MRI showed bilateral subcortical changes in the cerebral white matter. Of four females, only patient 4 (p.Q188R homozygote) has premature ovarian insufficiency. Urinary galactose and galactitol content were retrospectively measured using high-performance liquid chromatography and refractive-index detection from urinary samples that were preserved during the years 1996-2009. Galactose ranged from 60 to 600 mmol/mol creatinine (normal=4-6), and galactitol ranged from 70 to 1200 mmol/mol creatinine (normal=2-4), which was 10-100 and 17-300 times higher than the respective reference ranges for galactose and galactitol. We conclude that a less strict lactose-free diet and metabolic control performed in Estonian classical galactosemia patients does not change long-term outcome compared to previously published studies.
Collapse
Affiliation(s)
- K Krabbi
- Institute of Chemistry, Faculty of Sciences, Tallinn University of Technology, Tallinn, Estonia.
| | | | | | | | | |
Collapse
|
3
|
Hughes J, Ryan S, Lambert D, Geoghegan O, Clark A, Rogers Y, Hendroff U, Monavari A, Twomey E, Treacy EP. Outcomes of siblings with classical galactosemia. J Pediatr 2009; 154:721-6. [PMID: 19181333 DOI: 10.1016/j.jpeds.2008.11.052] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 09/12/2008] [Accepted: 11/21/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine the long-term outcome of dietary intervention in siblings from 14 Irish families with classical galactosemia (McKusick 230400), an autosomal recessive disorder of carbohydrate metabolism and galactose-1-phosphate uridyltransferase (GALT) deficiency. STUDY DESIGN Outcomes in siblings on dietary galactose restriction were studied to evaluate whether birth order (ie, time of commencement of diet) and compliance with lactose-restricted diet (galactose intake > or < 20 mg /day), assessed by dietary recall and biochemical monitoring of galactose-1-phosphate [Gal-1-P] and galactitol values, affected outcomes. The outcome variables assessed were IQ, speech, and language assessment scores, neurologic examination results, and magnetic resonance imaging (MRI) of the brain. RESULTS There was a high incidence of complications in the overall group, particularly speech and language delay (77%) and low IQ (71%). There was no significant difference in outcome between earlier-treated and later-treated siblings or any correlation with mean Gal-1-P or galactitol values. In most cases, cerebral white matter disease was evident on MRI scanning, with evidence of progressive cerebellar degeneration seen in 2 highly compliant families. CONCLUSION The subjects with a higher galactose intake did not exhibit an increased incidence of complications; conversely, those who were very compliant with dietary restrictions did not have more favorable outcomes.
Collapse
Affiliation(s)
- Joanne Hughes
- National Centre for Inherited Metabolic Disorders, Children's University Hospital, Dublin, Ireland
| | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Ficicioglu C, Thomas N, Yager C, Gallagher PR, Hussa C, Mattie A, Day-Salvatore DL, Forbes BJ. Duarte (DG) galactosemia: a pilot study of biochemical and neurodevelopmental assessment in children detected by newborn screening. Mol Genet Metab 2008; 95:206-12. [PMID: 18976948 DOI: 10.1016/j.ymgme.2008.09.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2008] [Revised: 09/22/2008] [Accepted: 09/22/2008] [Indexed: 11/21/2022]
Abstract
UNLABELLED Newborn screening for galactosemia has shown a high prevalence of partial galactose uridyl transferase deficiencies such as Duarte (DG) galactosemia. STUDY OBJECTIVE To determine whether (a) there is any clinical impact of DG galactosemia on development (b) there is a relationship between outcome and biochemical parameters in patients who receive no treatment. STUDY POPULATION Twenty-eight children with DG galactosemia. Group-I-17 children had a lactose restricted diet in the first year of life. Group-II-11 children had a regular diet since birth. METHODS Developmental, physical, and ophthalmologic assessments were completed on both DG groups. RBC gal-1-p and urine galactitol were monitored during the follow-up visits in every child with DG galactosemia. Gal-1-p, urine galactitol, liver function tests, and FSH were tested at the time of study visit. RESULTS The groups had statistically significant differences on RBC gal-1-p and urine galactitol at the 2 week, 1 month, 6 month, and 1 year time points. There was no statistical difference of gal-1-p or urine galactitol in group-I and -II at the time of study. The groups had statistically significant differences on adaptive scores, but not on language or IQ. None of the DG subjects had abnormal liver function at the time of diagnosis or the study visit. The FSH levels were normal. There were no statistically significant relationships between the first year metabolic values and developmental outcomes. CONCLUSIONS The data presented here indicate that clinical and developmental outcomes in DG galactosemics are good regardless of any diet changes.
Collapse
Affiliation(s)
- Can Ficicioglu
- Department of Pediatrics, Section of Biochemical Genetics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 34th and Civic Boulevard 9S23, Philadelphia, PA 19104, USA.
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Ohlsson A, Nasiell J, von Döbeln U. Pregnancy and lactation in a woman with classical galactosaemia heterozygous for p.Q188R and p.R333W. J Inherit Metab Dis 2007; 30:105. [PMID: 17143577 DOI: 10.1007/s10545-006-0383-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 09/27/2006] [Accepted: 10/04/2006] [Indexed: 10/23/2022]
Abstract
A 31-year old patient who is compound heterozygous for the two galactose-1-phosphate uridyltransferase mutations p.Q188R and p.R333W delivered two healthy boys after uneventful spontaneous pregnancies. The patient chose to breast-feed her first baby and her galactose metabolites in blood and urine were monitored closely. A temporary increase in her galactose-1-phosphate (gal-1-P) levels with a maximum of 0.30 mmol/L on day 2 after delivery was observed. Galactose-1-phosphate was normalized 10 days after delivery. At the time of weaning, 8 months after delivery, her menses returned and she had normal sex steroid levels. She became pregnant again 2 months later. The second baby was also breast-fed. This time an increase in her gal-1-P values could be seen for 3 weeks with a maximum gal-1-P level of of 0.25 mmol/L at day 7. Only minor changes in her urine galactitol values were noted during the study period but the values stayed in the range of treated galactosaemia patients. We thus report that breast-feeding has been possible with only small adverse effects on the levels of galactose metabolites in a patient with classical galactosaemia.
Collapse
Affiliation(s)
- A Ohlsson
- Division of Metabolic Diseases, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
| | | | | |
Collapse
|
6
|
Brunetti-Pierri N, Opekun AR, Craigen WJ. Two familial cases of high blood galactose of unknown aetiology. J Inherit Metab Dis 2006; 29:762. [PMID: 16988899 DOI: 10.1007/s10545-006-0405-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2006] [Revised: 07/12/2006] [Accepted: 08/21/2006] [Indexed: 11/28/2022]
Abstract
We report two male siblings presenting as newborns with increased blood galactose, urinary excretion of galactitol, and normal galactose 1-phosphate on a breast milk diet. A lactose-free diet led to normalization of all metabolites, while reintroduction of galactose in the diet resulted in an accumulation of metabolites. Potential causes of galactosaemia include: (1) activities of three enzymes of galactose metabolism: galactokinase (GALK), galactose-1-phosphate uridyltransferase (GALT), and uridine diphosphate galactose 4'-epimerase (GALE), (2) portosystemic shunting, (3) Fanconi-Bickel syndrome, (4) tyrosinaemia. Each was excluded with appropriate tests. These two familial cases may represent a novel autosomal or X-linked recessive disorder of galactose metabolism, possibly due to a novel defect in the transport of galactose across the plasma membrane.
Collapse
Affiliation(s)
- Nicola Brunetti-Pierri
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | | | | |
Collapse
|
7
|
Yager C, Wehrli S, Segal S. Urinary galactitol and galactonate quantified by isotope-dilution gas chromatography-mass spectrometry. Clin Chim Acta 2006; 366:216-24. [PMID: 16336956 DOI: 10.1016/j.cca.2005.10.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Revised: 10/11/2005] [Accepted: 10/11/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND Measurements of urine galactitol have been used to monitor the adequacy of diet therapy in the treatment of galactosemia. We have devised a gas chromatographic mass spectrometry (GC/MS) isotope-dilution method for the simultaneous quantification of urine galactitol and another alternate pathway product, galactonate. METHODS We prepared trimethylsilyl (TMS) derivatives and used D-[UL-13C]galactitol and D-[UL-13C]galactonate as the internal standard for GC/MS. Results obtained with this method were compared with those determined by the established GC method for galactitol and the NMR method for galactonate. Thirty-three normal urine specimens were analyzed by the isotope dilution technique for galactitol and galactonate. Results of galactitol in 6 of these urine specimens along with 18 from classic galactosemics and 19 variant galactosemics were compared with the established GC method. Results for galactonate in 15 urine specimens from galactosemics were compared to the established NMR technique. RESULTS The method was linear up to 200 nmol with lower limits of detection of 1.1 nmol (1.75 mmol/mol creatinine) (Cr) and 0.8 nmol (1.28 mmol/mol Cr) for galactitol and galactonate, respectively. Intra- and Interassay imprecision ranged from 2.1-6.7% for galactitol and 3.5-8.0% for galactonate. The excretion of both metabolites was age dependent in both normal and galactosemics. In 12 normal urines from subjects under 1 year, values for galactitol ranged from 8-107 mmol/mol Cr, and in 7 over age 6, ranged from 2-5 mmol/mol Cr. Under 1 year, the range for galactonate was non-detectable to 231 and in the over 6 years group non-detectable to 25 mmol/mol Cr. In galactosemics under 1 year, the value for galactitol ranged from 397-743 and for galactonate 92-132 mmol/mol Cr while in nine patients over age 6 the range was 125-274 mmol/mol Cr for galactitol and 17-46 mmol/mol Cr for galactonate. CONCLUSIONS The GC/MS method enables the simultaneous determination of urine galactitol and galactonate and is precise and useful over the wide range of concentrations needed to assess the galactose burden in patients with galactosemia.
Collapse
Affiliation(s)
- Claire Yager
- Metabolic Research Laboratory, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | | | | |
Collapse
|
8
|
Otaduy MCG, Leite CC, Lacerda MTC, Costa MOR, Arita F, Prado E, Rosemberg S. Proton MR spectroscopy and imaging of a galactosemic patient before and after dietary treatment. AJNR Am J Neuroradiol 2006; 27:204-7. [PMID: 16418384 PMCID: PMC7976095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
We describe how proton MR spectroscopy ((1)H-MR spectroscopy) was useful in elucidating the diagnosis of galactosemia in an undiagnosed 6-month-old infant. In vivo (1)H-MR spectroscopy of the brain showed a doublet at 3.7 parts per million, which was identified as galactitol (Gal-ol) by in vitro (1)H-MR spectroscopy of the urine. Galactosemia was subsequently confirmed by laboratory tests and treatment was initiated. A follow-up brain MR imaging and (1)H-MR spectroscopy study revealed resolution of white matter lesions and disappearance of Gal-ol peaks.
Collapse
Affiliation(s)
- M C G Otaduy
- Department of Radiology, School of Medicine of the University of São Paulo, São Paulo, Brazil
| | | | | | | | | | | | | |
Collapse
|
9
|
Wamelink MMC, Smith DEC, Jakobs C, Verhoeven NM. Analysis of polyols in urine by liquid chromatography-tandem mass spectrometry: a useful tool for recognition of inborn errors affecting polyol metabolism. J Inherit Metab Dis 2005; 28:951-63. [PMID: 16435188 DOI: 10.1007/s10545-005-0233-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Accepted: 10/04/2005] [Indexed: 11/30/2022]
Abstract
Several inborn errors of metabolism with abnormal polyol concentrations in body fluids are known to date. Most of these defects can be diagnosed by the assessment of urinary concentrations of polyols. We present two methods using tandem mass spectrometry for screening for inborn errors affecting polyol metabolism. Urine samples supplemented with internal standards ([13C4]erythritol, [13C2]arabitol and [2H3]sorbitol) were desalted by a mixed-bed ion-exchange resin. Separation was achieved by two different columns. Sugar isomers could not be separated using a Prevail Carbohydrate ES 54 column (method 1), whereas with the other column (Aminex HPX-87C) separation of the isomers was achieved (method 2). Multiple reaction monitoring polyol detection was achieved by tandem mass spectrometry with an electron ion-spray source operating in the negative mode. Age-related reference ranges of polyols (erythritol, treitol, arabitol, ribitol, xylitol, galactitol, mannitol, sorbitol, sedoheptitol and perseitol) in urine were established. The applicability of the method was demonstrated by the abnormal polyol concentrations observed in patients with transaldolase deficiency, ribose-5-phosphate isomerase deficiency and classical galactosaemia. This paper describes two methods for the analysis of urinary polyols by liquid chromatography-tandem mass spectrometry. Method 1 is a fast screening method with the quantification of total isomers and method 2 is a more selective method with the separate quantification of the polyols. Both methods can be used for diagnosing inborn errors of metabolism affecting polyol metabolism.
Collapse
Affiliation(s)
- M M C Wamelink
- Department of Clinical Chemistry, Metabolic Unit, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | | |
Collapse
|
10
|
Abstract
AIM To study the relevance of restricting the exogenous intake of small amounts of galactose, such as from fruit and vegetables, in patients with classical galactosaemia. METHODS For a period of six weeks, increasing doses of oral galactose to a maximum of 600 mg per day, were added to a very strict galactose restricted diet in three adolescent patients homozygous for the Q188R mutation. During the study, physical examination, including an extended ophthalmic examination, and laboratory studies were performed on a weekly basis. RESULTS No significant change in any of the studied clinical or biochemical parameters was observed. CONCLUSIONS These findings provide further evidence that attempts to exclude trace amounts of galactose from the diet are not justified. Once the diet is made more liberal, a long term follow up study will be necessary.
Collapse
Affiliation(s)
- A M Bosch
- Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands
| | | | | | | | | |
Collapse
|
11
|
Schadewaldt P, Hammen HW, Stolpmann S, Kamalanathan L, Wendel U. Galactonate determination in urine by stable isotope dilution gas chromatography-mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2004; 801:249-55. [PMID: 14751793 DOI: 10.1016/j.jchromb.2003.11.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A stable isotope dilution assay was developed for the sensitive determination of D-galactonic acid. D-[U-13C(6)]galactono-1,4-lactone was prepared as internal standard. Unlabelled and U-13C-labelled D-galactonic acid species were converted to the N-(1-butyl)galactonamide pentaacetate derivatives and assessed by gas chromatography-mass spectrometry (GC-MS). Positive chemical ionisation and monitoring of the [MH-60](+)-ions in the galactonate chromatographic peak at m/z 402 and m/z 408 were used for quantification. The procedure was applied to study the variability of D-galactonate excretion in healthy subjects and galactosemic patients and to monitor the D-galactonate-D-galactitol ratio in human urine.
Collapse
Affiliation(s)
- Peter Schadewaldt
- Klinik für Allgemeine Pädiatrie, Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Metabolic Unit, Moorenstrasse 5, D-40225 Düsseldorf, Germany.
| | | | | | | | | |
Collapse
|
12
|
Abstract
The age dependence of endogenous galactose formation was investigated in Q188R homozygous galactosemic patients (n=18; 4-38 years) using the primed continuous infusion approach with D-[1-13C]galactose as a substrate. Studies were conducted under postabsorptive conditions (fasting >10h) and good metabolic control. In the patients, the release of galactose from endogenous sources into plasma (R(a)) decreased with age and ranged from 4.6 to 2.0 micromol/kg body weight per h. Galactitol and galactonate release rates paralleled the galactose R(a) but at a lower level. The mean relation of galactose, galactitol, and galactonate release was 10:5:1. Statistically, there was a highly significant (p<0.0001) inverse correlation between total galactose release (i.e., sum of R(a) plus galactitol and galactonate release) and age. The data (total galactose=y, age=t) were best fitted to the simple exponential model y=y(0)+axexp(-bt) by non-linear regression analysis. The parameter estimates were y(0)=3.0+/-0.2, a=6.5+/-0.4, and b=0.11+/-0.02. The value of y(0) provides an estimate of total galactose release in adult patients (i.e., approximately 13 mg/kg body weight per day), summation operator (y(0)+a) provides an estimate for galactosemic newborns (i.e., approximately 41 mg/kg body weight per day). The data show that significant amounts of endogenous galactose are formed in galactosemic patients with release rates being several fold higher in infants than in adults. The present findings can explain the persistently elevated galactose-1-phosphate levels in erythrocytes-and its age dependence-in galactosemic patients even when under strict dietary treatment.
Collapse
Affiliation(s)
- Peter Schadewaldt
- Klinik für Allgemeine Pädiatrie, Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany.
| | | | | | | |
Collapse
|
13
|
Abstract
Classical galactosemia is an autosomal recessive disorder resulting from deficient galactose-1-phosphateuridyl transferase (GALT) activity. Verbal dyspraxia is an unusual outcome in galactosemia. Here we validated a simplified breath test of total body galactose oxidation against genotype and evaluated five potential biochemical risk indicators for verbal dyspraxia in galactosemia: cumulative percentage dose (CUMPCD) of (13)CO(2) in breath, mean erythrocyte galactose-1-phosphate, highest erythrocyte galactose-1-phosphate, mean urinary galactitol, and erythrocyte GALT activity. Thirteen controls and 42 patients with galactosemia took a (13)C-galactose bolus, and the (CUMPCD) of (13)CO(2) in expired air was determined. Patients with <5% CUMPCD had mutant alleles that severely impaired human GALT enzyme catalysis. Patients with > or =5% CUMPCD had milder mutant human GALT alleles. Twenty-four patients consented to formal speech evaluation; 15 (63%) had verbal dyspraxia. Dyspraxic patients had significantly lower CUMPCD values (2.84 +/- 5.76% versus 11.51 +/- 7.67%; p < 0.008) and significantly higher mean erythrocyte galactose-1-phosphate (3.38 +/- 0.922 mg/dL versus 1.92 +/- 1.28 mg/dL; p = 0.019) and mean urinary galactitol concentrations (192.4 +/- 75.8 mmol/mol creatinine versus 122.0 +/- 56.4; p = 0.048) than patients with normal speech. CUMPCD values <5%, mean erythrocyte galactose-1-phosphate levels >2.7 mg/dL, and mean urinary galactitol levels >135 mmol/mol creatinine were associated with dyspraxic outcome with odds ratios of 21, 13, and 5, respectively. We conclude that total body oxidation of galactose to CO(2) in expired air reflects genotype and that this breath test is a sensitive predictor of verbal dyspraxia in patients with galactosemia.
Collapse
Affiliation(s)
- Amy Leigh Webb
- Emory University Graduate School of Arts and Sciences, Department of Biological and Biomedical Sciences, Division of Nutrition and Health Sciences, Atlanta, Georgia 30322, USA
| | | | | | | |
Collapse
|
14
|
Schadewaldt P, Killius S, Kamalanathan L, Hammen HW, Strassburger K, Wendel U. Renal excretion of galactose and galactitol in patients with classical galactosaemia, obligate heterozygous parents and healthy subjects. J Inherit Metab Dis 2003; 26:459-79. [PMID: 14518827 DOI: 10.1023/a:1025173311030] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The age dependence of galactose and galactitol excretion was assessed in overnight-fasted galactose-1-phosphate uridyltransferase-deficient patients under dietary treatment (ages 4-34 years; n = 51), obligate heterozygous parents (ages 25-71 years; n = 49) and healthy subjects (ages 3-58 years; n = 215). Urine concentrations were analysed by stable-isotope dilution gas chromatography mass spectrometry. There was considerable interindividual variability. The intraindividual variation, however, was not age-dependent and was rather low. Excretion estimates were calculated from the creatinine-related concentrations using weight-, age- and sex-related creatinine excretion rates. Experimental evidence is presented underscoring the problems inherent in random sampling and substantiating the primary endogenous origin of galactose and galactitol in postabsorptive urine samples. Age-dependent excretion estimates were best fitted to a simple growth-related model assuming an exponential decrease with age until adulthood. According to the model, mean postabsorptive galactose and galactitol excretion in healthy subjects was similar and decreased exponentially from about 1.2 micromol/kg body weight per day in infants to about 0.2 micromol/kg body weight per day in adults. Excretion in heterozygotes was normal. In galactosaemic patients, galactose excretion was in the normal range. Galactitol excretion, however, was enhanced over 50-fold and decreased from a mean estimate of about 64 micromol/kg body weight per day in infants to about 23 micromol/kg body weight per day in adults. The results are discussed with respect to the significance of galactose and galactitol excretion for whole-body galactose removal and with respect to the applicability of urinary galactitol analysis for metabolic monitoring in galactosaemia.
Collapse
Affiliation(s)
- P Schadewaldt
- Klinik für Allgemeine Pädiatrie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.
| | | | | | | | | | | |
Collapse
|
15
|
Affiliation(s)
- Ismail Kurt
- Department of Clinical Biochemistry, Gulhane Medical School, Ankara, Turkey
| | | | | | | | | | | |
Collapse
|
16
|
Palmieri M, Mazur A, Berry GT, Ning C, Wehrli S, Yager C, Reynolds R, Singh R, Muralidharan K, Langley S, Elsas L, Segal S. Urine and plasma galactitol in patients with galactose-1-phosphate uridyltransferase deficiency galactosemia. Metabolism 1999; 48:1294-302. [PMID: 10535394 DOI: 10.1016/s0026-0495(99)90271-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Urinary excretion of galactitol was determined in 95 normals (N/N), 67 galactosemic (G/G), and 39 compound heterozygotes for the Duarte and galactosemia genotype (D/G). Galactitol excretion is age-dependent in both normal individuals and patients with classic galactosemia on lactose-restricted diets. In galactosemic patients who are homozygous for the Q188R mutation, urinary galactitol levels were fivefold to 10-fold higher than those of normal subjects of comparable age. All but a few patients with classic galactosemia with the Q188R mutation and another mutant G allele had urinary excretion comparable to the Q188R homozygous patients. African-American galactosemic patients with the S135L mutation of the galactose-1-phosphate uridyltransferase (GALT) gene also excreted abnormal quantities of galactitol. Most subjects with a Duarte allele and a G allele excrete normal amounts of the sugar alcohol. There is a correlation between galactitol excretion and red blood cell (RBC) galactose-1-phosphate (gal-1-P). Plasma galactitol was also elevated in galactosemic patients (3.4 to 23.2 micromol/L; undetectable in normal individuals). In contrast to the decrease in urinary galactitol with age, plasma levels remain in a narrow concentration range with no significant difference with age. Urine and plasma galactitol distinguish galactosemic patients from normals. In addition, urinary galactitol excretion may be an important parameter for the assessment of steady-state galactose metabolism in galactosemia.
Collapse
Affiliation(s)
- M Palmieri
- Department of Pediatrics, University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia, 19104, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Hutchesson AC, Murdoch-Davis C, Green A, Preece MA, Allen J, Holton JB, Rylance G. Biochemical monitoring of treatment for galactosaemia: biological variability in metabolite concentrations. J Inherit Metab Dis 1999; 22:139-48. [PMID: 10234609 DOI: 10.1023/a:1005493701913] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Red cell galactose 1-phosphate (Gal-1-P) concentrations and urinary galactitol excretion have been suggested as biochemical indices of dietary compliance in classical transferase-deficient galactosaemia. We report our experience of measuring both in 32 patients over 0-10.9 years (median 3.45). A total of 438 blood specimens for Gal-1-P and 383 urine specimens for galacitol assay were received; 317 pairs of specimens were collected at the same time. Concentrations of both analytes fell rapidly over the first 2-3 months following dietary intervention, to mean (geometric SD) levels of 225 (1.60) mumol/L red cells for Gal-1-P and 388 (1.19) mumol/mmol creatinine for galactitol. Concentrations then fell exponentially over the next 7-8 years, with times to half-disappearance of 6.3 years for Gal-1-P and 6.4 years for galactitol, to levels of 104 (1.58) and 193 (1.36) respectively in patients aged over 10 years. Concentrations of both analytes were independent of the presence of the common Q188R mutation. Mean intra- and inter-individual coefficients of variation (CV) across the range of values studied were 36% and 61% for Gal-1-P, and 37% and 42% for galactitol. Analytical CVs were 3.6% for Gal-1-P and 5.5% for galactitol, indicating that the major source of variability is biological. The correlation coefficient between Gal-1-P and galactitol in paired samples overall was 0.33; the regression equation being [Galactitol] = 0.84[Gal-1-P] + 176. Serial measurements of both Gal-1-P and galactitol may be valuable in monitoring galactosaemia, but high intra-individual biological variability limits their usefulness. Standardization of sample collection times may improve this. Further work is needed to assess the predictive values of both analytes for long-term outcome.
Collapse
Affiliation(s)
- A C Hutchesson
- Department of Clinical Chemistry, Children's Hospital, Birmingham, UK
| | | | | | | | | | | | | |
Collapse
|
18
|
Abstract
Urinary galactose and galactitol excretion in controls is age-dependent with the highest concentrations at a younger age. Untreated patients with classical galactosemia excreted highly elevated amounts of galactitol (8000-69,000 mmol/mol creatinine; controls 3-81) which did not correlate with galactose excretion. After treatment, galactose excretion returned to normal in all patients whereas galactitol excretion (45-900 mmol/mol creatinine) remained above the age-matched control range. The excretion of galactitol (96-170 mmol/mol creatinine) in untreated compound heterozygotes was much lower although still above the age-matched control levels, and it returned to normal after treatment. In untreated classical galactosemia patients the galactitol in plasma (120-500 mumol/l) was markedly elevated (controls 0.08-0.86 mumol/l); under treatment, the galactitol concentrations (4.7-20 mumol/l) remained above the control range in all. There was no correlation with age nor with galactose-1-phosphate and UDP-galactose levels. Two untreated compound heterozygotes had elevated plasma galactitol (6.0 and 63 mumol/l) which, when treated, returned to normal.
Collapse
Affiliation(s)
- C Jakobs
- Department of Paediatrics, Free University Hospital, Amsterdam, The Netherlands
| | | | | |
Collapse
|
19
|
Abstract
The effect of starch and sugars on blood sugar level and renal excretion of sugars and galactitol was investigated. Fifty-nine adult cats were divided into seven dietary groups (carbohydrate content in dry matter): STARCH (29-37% starch, decomposed or raw), SUC (36% sucrose), LAC1 and LAC2 (11 and 28% lactose, respectively), GLUC (40% glucose), GAL (39% galactose) and a carbohydrate-free control diet, FAT. Diet STARCH did not significantly influence postprandial blood glucose level (3.65 +/- 0.68 mmol/l +/- SD, n = 16) compared with diet FAT (3.20 +/- 0.77 mmol/l, n = 14) 1, 3 or 6 h after feeding (weighted means). Diet GLUC led to a steep rise in blood glucose concentration 1 h after feeding (5.08 +/- 0.69 mmol/l, n = 6). Diet SUC induced a mild persistent hyperglycemia without marked postprandial changes (4.52 +/- 0.52 mmol/l, n = 15, weighted mean of 0, 3 and 6 h post-prandially). Diet GAL induced persistent hypoglycemia before and after feeding (2.58 +/- 0.38 mmol/l, n = 13) and considerable postprandial galactosemia (3.26 +/- 1.38 mmol/l, n = 7). In the groups STARCH and FAT, glucose was only detectable in traces in urine, whereas all diets containing sugars led to glucosuria. In group SUC, fructose and sucrose were found in urine and in both lactose groups galactose and lactose were found. Diet GAL led to galactosuria (140 mmol galactose/l). In group LAC1, and especially in group GAL, galactitol was detected in urine. These results point to a rather limited capacity of the cat to metabolize sugars.
Collapse
Affiliation(s)
- E Kienzle
- Institute of Animal Nutrition, Tierärztliche Hochschule Hannover, Germany
| |
Collapse
|
20
|
Abstract
In a retrospective study 134 galactosaemic patients, born between 1955 and 1989 in the Federal Republic of Germany were traced and their long-term outcome evaluated. We investigated 83 galactosaemic patients (78 homozygotes, 5 compound heterozygotes) by clinical, psychometric and laboratory testing; 31 patients were evaluated by medical history, the remaining 20 patients had died due to sequelae of the underlying disease. In 48 out of 78 classical galactosaemia patients galactose-free therapy had been started before the 15th day, in 19 between days 15 and 56 and in 11 patients after the 56th day. Physical findings revealed that puberty was delayed in 1 out of 18 males and 6 out of 11 females. Neurological abnormalities included ataxia (n = 6), intention tremor (n = 11) and microcephaly (n = 10). Speech abnormalities were found in 43 out of 66 patients over 3 years of age and disturbance of visual perception and/or arithmetic deficits in 29. Intelligence declined with age, i.e., a DQ or IQ less than 85 was found in 4 out of 34 patients less than 6 years of age (12%), in 10 out of 18 between 7 and 12 years (56%) and in 20 out of 24 older than 12 years (83%). Metabolite patterns (RBC galactose-1-phosphate and UDP-galactose, plasma and urinary galactitol) did not correlate with DQ or IQ. Dietary compliance was good in almost all patients. Compound heterozygotes (n = 5) had normal mental and growth development and all laboratory parameters were in the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- S Schweitzer
- Department of Paediatric Nephrology and Metabolic Disorders, Children's Hospital, Medical School Hannover, Federal Republic of Germany
| | | | | | | |
Collapse
|
21
|
Berry GT, Palmieri M, Gross KC, Acosta PB, Henstenburg JA, Mazur A, Reynolds R, Segal S. The effect of dietary fruits and vegetables on urinary galactitol excretion in galactose-1-phosphate uridyltransferase deficiency. J Inherit Metab Dis 1993; 16:91-100. [PMID: 8487507 DOI: 10.1007/bf00711320] [Citation(s) in RCA: 57] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Even on a lactose-restricted diet, urinary galactitol excretion and erythrocyte galactose-1-phosphate levels are persistently elevated in patients with galactose-1-phosphate uridyltransferase deficiency. In order to determine the contribution of galactose in dietary fruits and vegetables to this phenomenon, (1) the content of galactose in a lactose-free diet was directly measured when a galactosaemic patient's diet was specifically enriched in those fruits and vegetables which contain relatively large amounts of free galactose and (2) galactitol excretion was determined during ingestion of this diet for 3 weeks and while on a synthetic diet for 1 week that provided < 8 mg galactose/day. For comparison the effect of a 3-week supplementation of 200 mg galactose/day was determined. The measured intake in total foodstuffs matched the theoretical content of galactose in the patient's diet based on amounts in fruits and vegetables alone, thus supporting the concept that fruits and vegetables are primarily responsible for galactose intake in a lactose-free diet. All of the dietary manipulations, however, had relatively little effect on metabolite levels, suggesting that endogenous galactose production is primarily responsible for the elevated levels of galactose metabolites routinely detected in patients on lactose-restricted diets.
Collapse
Affiliation(s)
- G T Berry
- Division of Biochemical Development and Molecular Diseases, Children's Hospital of Philadelphia, PA 19104
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Gao G, Eguchi T, Matsumoto T, Sakura N, Ueda K. Estimation of the urinary galactitol level in children by capillary gas chromatography. Hiroshima J Med Sci 1992; 41:61-4. [PMID: 1293069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A rapid and efficient capillary gas chromatography was utilized to measure urinary galactitol in 133 non-galactosemic children on a free diet. The children aged from 12 days to 14 years were divided by age into six groups. The urinary galactitol concentration was found to be the highest (64.04 mmol/mol creatinine) in the neonatal group and the lowest (7.12 mmol/mol creatinine) in the group over 2 years old. It is concluded that the urinary concentration of galactitol is strongly age-dependent.
Collapse
Affiliation(s)
- G Gao
- Department of Pediatrics, Hiroshima University School of Medicine, Japan
| | | | | | | | | |
Collapse
|
23
|
Rakotomanga S, Baillet A, Pellerin F, Baylocq-Ferrier D. Simultaneous determination of gluconolactone, galactonolactone and galactitol in urine by reversed-phase liquid chromatography: application to galactosemia. J Chromatogr 1991; 570:277-84. [PMID: 1797843 DOI: 10.1016/0378-4347(91)80530-p] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A reversed-phase liquid chromatographic assay was developed for the specific evaluation of metabolic by-products in the urine of galactosemic patients and based on the simultaneous determination of gluconolactone, galactonolactone and galactitol. The procedure involved a lyophilization step and the formation of phenylisocyanate derivatives, followed by injection directly into the chromatograph. Analytical results showed good selectivity, linearity, precision and accuracy. The method enabled the detection of levels as low as 0.05-0.1 ng, and compared favourably with other published techniques for the estimation of aldonic acids in biological fluids.
Collapse
Affiliation(s)
- S Rakotomanga
- Centre d'Etudes Pharmaceutiques, Laboratoire de Chimie Analytique, Chatenay-Malabry, France
| | | | | | | |
Collapse
|
24
|
Abstract
Serum and urinary galactitol levels were examined in two patients with classical galactosemia. Even under strict dietary therapy, galactitol levels were much higher than those of healthy controls. In a 6-day-old patient who had eaten large amounts of galactose before diagnosis, it took more than two weeks for urinary galactitol to decrease to the stable value. In an 8-year-old case, more than ten days were required for urinary galactitol to reach the base line level after a galactose load of 1.25 g/kg. In both patients, the urinary galactose levels decreased rapidly. After loading with a small amount of galactose (5 g, equivalent to 200 ml of milk) in the latter patient, higher levels of urinary and serum galactitol were maintained for a long time, as compared with galactose, but they returned to baseline level after 24 hours. From these results, we discussed the use of urinary galactitol as an index to check galactose intake.
Collapse
Affiliation(s)
- T Yamazaki
- Department of Pediatrics, Osaka Medical College, Takatsuki, Japan
| | | | | |
Collapse
|
25
|
Allen JT, Holton JB, Lennox AC, Hodges IC. Early morning urine galactitol levels in relation to galactose intake: a possible method of monitoring the diet in galactokinase deficiency. J Inherit Metab Dis 1988; 11 Suppl 2:243-5. [PMID: 3141712 DOI: 10.1007/bf01804247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- J T Allen
- Clinical Chemistry Department, Southmead Hospital, Bristol, UK
| | | | | | | |
Collapse
|
26
|
Hämäläinen MM, Mäkinen KK. Alterations in electrolyte and iron metabolism in the rat in relation to peroral administration of galactitol, mannitol and xylitol. J Nutr 1986; 116:599-609. [PMID: 3083056 DOI: 10.1093/jn/116.4.599] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Groups of 12 Long-Evans male rats were exposed to diets containing 20% galactitol (G), mannitol (M) or xylitol (X) for 5 wk. Serum electrolyte concentrations were within normal ranges for rats in all groups compared to control rats. All polyol-fed animals exhibited diuresis and a lower urinary pH (6.2-5.3) with a concomitant lower excretion of Na+, Cl- and protein (40% of controls). The excretion of K+ was lower in the X-fed rats than in any other group. Urinary Ca2+ excretion was sixfold higher and Mg2+ excretion, twofold higher in all polyol-fed rats than in controls. PO4 and NH4+ excretions were higher than controls in G- and M-fed animals only. Serum aldosterone concentrations in all polyol rats were 60% of those in controls. The serum corticosterone and parathyroid hormone levels were normal. Urinary citric acid was significantly higher in rats fed polyols but oxalic acid excretion was either normal (X) or lower (G,M) than in controls. Concentrations of serum and liver iron were higher in polyol-fed rats than in controls. Nevertheless, the normal serum creatinine and electrolyte concentrations and normal urinary creatinine levels established healthy kidney function. The diuretic effect of the polyols was considered responsible for the changes in the monovalent ion metabolism. The alterations in the excretion of multivalent cations most likely resulted from their increased intestinal absorption facilitated by the general chelating action of these polyols.
Collapse
|
27
|
Schwarz HP, Schaefer T, Bachmann C. Galactose and galactitol in the urine of children with compound heterozygosity for Duarte variant and classical galactosemia (GtD/gt) after an oral galactose load. Clin Chem 1985; 31:420-2. [PMID: 3971562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
An oral dose of galactose, 1 g/kg of body weight, was administered to 24 children with the Duarte variant/classical galactosemia genetic compound (GtD/gt) and to 16 controls ranging in age from 0.3 to 10.7 years. Urine was then collected for 3h. Excreted amounts of galactose and galactitol increased with age in all subjects, but were consistently greater in the compound heterozygotes. If related to urinary creatinine, galactosuria and galactitoluria were no longer age-dependent, although as compared with the controls, urinary galactose was about three times and urine galactitol twice as high in the patients (p less than 0.01 for both). We found a statistically significant correlation between urinary galactitol and galactose in these patients. Moreover, urinary galactitol and galactose each correlated positively with the area under the plasma galactose curve, as well as with the peak value for plasma galactose after galactose ingestion.
Collapse
|
28
|
|
29
|
Abstract
The development of a selected ion monitoring assay is described for the analysis of polyols as their per-acetyl derivatives, using L-iditol as an internal standard. Concentrations of mannitol, galactitol, sorbitol and inositol have been determined in the serum, urine and amniotic fluid from women during the second trimester of uncomplicated pregnancies. Two samples of amniotic fluid from galactosaemic pregnancies showed elevated levels of galactitol, 8.1 and 7.7 mu mol l-1 compared with normal concentrations of 0.46 +/- 0.26 mu mol l-1, whereas a normal homozygous pregnancy of heterozygous parents showed normal levels.
Collapse
|
30
|
|
31
|
Monteleone JA, Monteleone PL, Bert M, Hilliard R. Letter: Galactokinase deficiency in twins. Pediatrics 1974; 54:656-8. [PMID: 4375802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
|
32
|
|
33
|
Belej MA, Troetel WM, Weiss AJ, Stambaugh JE, Manthei RW. The absorption and metabolism of dibromodulcitol in patients with advanced cancer. Clin Pharmacol Ther 1972; 13:563-72. [PMID: 5042371 DOI: 10.1002/cpt1972134563] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|