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Elola Pastor AI, Prieto García B, Díaz Martín JJ. Evaluation of the first 5 years of a glutaric aciduria type I neonatal screening programme in Asturias. An Pediatr (Barc) 2024; 100:318-324. [PMID: 38714461 DOI: 10.1016/j.anpede.2024.04.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/29/2024] [Indexed: 05/10/2024] Open
Abstract
INTRODUCTION . Neonatal screening of glutaric aciduria type 1 (GA-1) has brought radical changes in the course and outcomes of this disease. This study analyses the outcomes of the first 5 years (2015-2019) of the AGA1 neonatal screening programme in our autonomous community. MATERIAL . We conducted an observational, descriptive and retrospective study. All neonates born between January 1, 2015 and December 31, 2019 that participated in the neonatal screening programme were included in the study. The glutarylcarnitine (C5DC) concentration in dry blood spot samples was measured by means of tandem mass spectrometry applying a cut-off point of 0.25 µmol/L. RESULTS . A total of 30 120 newborns underwent screening. We found differences in the C5DC concentration based on gestational age, type of feeding and hours of life at sample collection. These differences were not relevant for screening purposes. There were no differences between neonates with weights smaller and greater than 1500 g. Screening identified 2 affected patients and there were 3 false positives. There were no false negatives. The diagnosis was confirmed by genetic testing. Patients have been in treatment since diagnosis and have not developed encephalopathic crises in the first 4 years of life. CONCLUSIONS . Screening allowed early diagnosis of two cases of GA-1 in the first 5 years since its introduction in our autonomous community. Although there were differences in C5DC levels based on gestational age, type of feeding and hours of life at blood extraction, they were not relevant for screening.
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Affiliation(s)
| | - Belén Prieto García
- Unidad de Bioquímica Clínica, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Juan José Díaz Martín
- Sección de Gastroenterología y Nutrición Pediátrica, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Asturias, Spain
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Sabi EM, AlMogren M, Sebaa R, Sumaily KM, AlMalki R, Mujamammi AH, Abdel Rahman AM. Comprehensive metabolomics analysis reveals novel biomarkers and pathways in falsely suspected glutaric aciduria Type-1 newborns. Clin Chim Acta 2024; 557:117861. [PMID: 38490341 DOI: 10.1016/j.cca.2024.117861] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/04/2024] [Accepted: 03/05/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Glutaric aciduria type-1 (GA-1) is a rare metabolic disorder due to glutaryl coenzyme A dehydrogenase deficiency, causing elevated levels of glutaryl-CoA and its derivatives. GA-1 exhibits symptoms like macrocephaly, developmental delays, and movement disorders. Timely diagnosis through genetic testing and newborn screening is crucial. However, in some cases, transiently elevated level of glutarylcarnitine (C5DC) challenges accurate diagnosis, highlighting the need for alternative diagnostic methods, like mass spectrometry-based untargeted metabolomics, to identify additional biomarkers for distinguishing falsely suspected GA-1 from healthy newborns. METHODOLOGY DBS samples from falsely suspected GA-1 newborns (n = 47) and matched control were collected through the NBS program. Untargeted metabolomics using liquid chromatography-high-resolution mass spectrometry (LC-HRMS) was performed to enable biomarker and pathway investigations for significantly altered metabolites. RESULTS 582 and 546 were up- and down-regulated metabolites in transient GA-1. 155 endogenous metabolites displayed significant variations compared to the control group. Furthermore, our data identified novel altered metabolic biomarkers, such as N-palmitoylcysteine, heptacarboxyporphyrin, 3-hydroxylinoleoylcarnitine, and monoacylglyceride (MG) (0:0/20:1/0:0), along with perturbed metabolic pathways like sphingolipid and thiamine metabolism associated with the transient elevated C5DC levels in DBS samples. CONCLUSIONS A distinct metabolic pattern linked to the transient C5DC elevation in newborns was reported to enhance the prediction of the falsely positive cases, which could help avoiding unnecessary medical treatments and minimizing the financial burdens in the health sector.
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Affiliation(s)
- Essa M Sabi
- Clinical Biochemistry Unit, Pathology Department, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Maha AlMogren
- Metabolomics Section, Department of Clinical Genomics, Center for Genomics Medicine, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh 11211, KSA, Saudi Arabia
| | - Rajaa Sebaa
- Department of Medical Laboratories, College of Applied Medical Sciences, Shaqra University, Shaqra 11961, Saudi Arabia
| | - Khalid M Sumaily
- Clinical Biochemistry Unit, Pathology Department, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Reem AlMalki
- Metabolomics Section, Department of Clinical Genomics, Center for Genomics Medicine, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh 11211, KSA, Saudi Arabia
| | - Ahmed H Mujamammi
- Clinical Biochemistry Unit, Pathology Department, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
| | - Anas M Abdel Rahman
- Metabolomics Section, Department of Clinical Genomics, Center for Genomics Medicine, King Faisal Specialist Hospital and Research Centre (KFSHRC), Riyadh 11211, KSA, Saudi Arabia; The Department of Biochemistry and Molecular Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
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Tibelius A, Evers C, Oeser S, Rinke I, Jauch A, Hinderhofer K. Compilation of Genotype and Phenotype Data in GCDH-LOVD for Variant Classification and Further Application. Genes (Basel) 2023; 14:2218. [PMID: 38137040 PMCID: PMC10742628 DOI: 10.3390/genes14122218] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
Glutaric aciduria type 1 (GA-1) is a rare but treatable autosomal-recessive neurometabolic disorder of lysin metabolism caused by biallelic pathogenic variants in glutaryl-CoA dehydrogenase gene (GCDH) that lead to deficiency of GCDH protein. Without treatment, this enzyme defect causes a neurological phenotype characterized by movement disorder and cognitive impairment. Based on a comprehensive literature search, we established a large dataset of GCDH variants using the Leiden Open Variation Database (LOVD) to summarize the known genotypes and the clinical and biochemical phenotypes associated with GA-1. With these data, we developed a GCDH-specific variation classification framework based on American College of Medical Genetics and Genomics and the Association for Molecular Pathology guidelines. We used this framework to reclassify published variants and to describe their geographic distribution, both of which have practical implications for the molecular genetic diagnosis of GA-1. The freely available GCDH-specific LOVD dataset provides a basis for diagnostic laboratories and researchers to further optimize their knowledge and molecular diagnosis of this rare disease.
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Affiliation(s)
- Alexandra Tibelius
- Institute of Human Genetics, Heidelberg University, 69120 Heidelberg, Germany
| | - Christina Evers
- Institute of Human Genetics, Heidelberg University, 69120 Heidelberg, Germany
| | - Sabrina Oeser
- Institute of Human Genetics, Heidelberg University, 69120 Heidelberg, Germany
| | - Isabelle Rinke
- Institute of Human Genetics, Heidelberg University, 69120 Heidelberg, Germany
| | - Anna Jauch
- Institute of Human Genetics, Heidelberg University, 69120 Heidelberg, Germany
| | - Katrin Hinderhofer
- Institute of Human Genetics, Heidelberg University, 69120 Heidelberg, Germany
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Gowda VK, Reddy V, Srinivasan VM, Vamyanmane DK. Infantile Tremor Syndrome Masquerading as Glutaric Aciduria Type 1. Indian J Pediatr 2022; 89:625. [PMID: 35353366 DOI: 10.1007/s12098-021-04067-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 09/05/2021] [Accepted: 11/24/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Vykuntaraju K Gowda
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, 560029, India.
| | - Varsha Reddy
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, 560029, India
| | - Varunvenkat M Srinivasan
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, 560029, India
| | - Dhananjaya K Vamyanmane
- Department of Pediatric Radiology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
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Hildebrandt C, Wilson CR, Kritzer A. Standardizing genetic and metabolic consults for non-accidental trauma at a large pediatric academic center. Child Abuse Negl 2022; 125:105480. [PMID: 35033936 DOI: 10.1016/j.chiabu.2021.105480] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/09/2021] [Accepted: 12/29/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Evaluations of suspected non-accidental trauma (NAT) often include consultation with genetic and metabolic teams to assess patients for rare genetic conditions that can mimic or exacerbate child abuse. Diagnoses that may be questioned during court proceedings include osteogenesis imperfecta (OI) and glutaric aciduria type 1 (GA1). Currently there are no official society guidelines for the genetic or metabolic workup of suspected NAT. OBJECTIVE To standardize consult recommendations for suspected NAT through collaboration between the Genetics and Genomics Division and the Child Protection Team (CPT). PARTICIPANTS AND SETTINGS Children evaluated for suspected NAT at a single pediatric referral center. METHODS A year of inpatient consult requests for suspected NAT to the genetics division were reviewed. The most common indications for consult were fractures and subdural hematoma. Consult recommendations for similar indications varied between providers. A standard operating procedure (SOP) with specific recommendations for suspected NAT consults for fractures, intracranial hemorrhage, and other indications was created based on expert reviews and other relevant literature. A questionnaire assessing division practice patterns for these consults was distributed both pre (n = 17) and post-introduction of the SOP (n = 11). RESULTS Adherence to the SOP and impact on suspected NAT consult recommendations were assessed at 18 months after SOP introduction. Consult recommendations were in line with the SOP for 7/11 consults pre-intervention and 6/7 consults post-intervention. Providers were more likely to report feeling extremely or very confident they were using evidence-based medicine for NAT consults post-intervention.
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Affiliation(s)
- Clara Hildebrandt
- Boston Children's Hospital, Metabolism Program, Division of Genetics and Genomics, 300 Longwood Ave, Boston, MA, USA
| | - Celeste R Wilson
- Boston Children's Hospital, Child Protection Program, Division of General Pediatrics, 300 Longwood Ave, Boston, MA, USA
| | - Amy Kritzer
- Boston Children's Hospital, Metabolism Program, Division of Genetics and Genomics, 300 Longwood Ave, Boston, MA, USA.
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6
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Simalti AK, Goswami JN. Glutaric Aciduria Type 1: An Atypical Presentation. Neurol India 2022; 70:801-802. [PMID: 35532668 DOI: 10.4103/0028-3886.344642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Ashish K Simalti
- Department of Pediatrics, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, India
| | - Jyotindra N Goswami
- Department of Pediatrics, Army Hospital (Research and Referral), Delhi Cantt, New Delhi, India
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Boy N, Mohr A, Garbade SF, Freisinger P, Heringer-Seifert J, Seitz A, Kölker S, Harting I. Subdural hematoma in glutaric aciduria type 1: High excreters are prone to incidental SDH despite newborn screening. J Inherit Metab Dis 2021; 44:1343-1352. [PMID: 34515344 DOI: 10.1002/jimd.12436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/21/2021] [Accepted: 09/09/2021] [Indexed: 12/19/2022]
Abstract
Subdural hematoma (SDH) was initially reported in 20% to 30% of patients with glutaric aciduria type 1 (GA1). A recent retrospective study found SDH in 4% of patients, but not in patients identified by newborn screening (NBS). 168 MRIs of 69 patients with GA1 (age at MRI 9 days - 73.8 years, median 3.2 years) were systematically reviewed for presence of SDH, additional MR and clinical findings in order to investigate the frequency of SDH and potential risk factors. SDH was observed in eight high-excreting patients imaged between 5.8 and 24.4 months, namely space-occupying SDH in two patients after minor accidental trauma and SDH as an incidental finding in six patients without trauma. In patients without trauma imaged at 3 to 30 months (n = 36, 25 NBS, 27/9 high/low excreters), incidence of SDH was 16.7% (16% in NBS). SDH was more common after acute (33.3%) than insidious onset of dystonia (14.3%) or in asymptomatic patients (5.9%). It was only seen in patients with wide frontoparietal CSF spaces and frontotemporal hypoplasia. High excreters were over-represented among patients with SDH (6/27 vs 0/9 low excreters), acute onset (10/12), and wide frontoparietal CSF spaces (16/19). Incidental SDH occurs despite NBS and early treatment in approximately one in six patients with GA1 imaged during late infancy and early childhood. Greater risk of high excreters is morphologically associated with more frequent enlargement of external CSF spaces including frontotemporal hypoplasia, and may be furthered aggravated by more pronounced alterations of cerebral blood volume and venous pressure.
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Affiliation(s)
- Nikolas Boy
- Centre for Child and Adolescent Medicine, Clinic I, Division of Child Neurology and Metabolic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Alexander Mohr
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Sven F Garbade
- Centre for Child and Adolescent Medicine, Clinic I, Division of Child Neurology and Metabolic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Jana Heringer-Seifert
- Centre for Child and Adolescent Medicine, Clinic I, Division of Child Neurology and Metabolic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Angelika Seitz
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Kölker
- Centre for Child and Adolescent Medicine, Clinic I, Division of Child Neurology and Metabolic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Inga Harting
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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Yasin S, Mehmood K. Toxic Metabolic Encephalopathy presenting as Bilateral Symmetrical Basal Ganglia Lesion. J Coll Physicians Surg Pak 2021; 31:1259-1260. [PMID: 34601860 DOI: 10.29271/jcpsp.2021.10.1259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/11/2020] [Indexed: 06/13/2023]
Affiliation(s)
- Saddam Yasin
- Department of Internal Medicine, Carle Foundation Hospital, Urbana, United States of America
| | - Kanwal Mehmood
- Department of General Medicine, Shalimar Medical and Dental College, Lahore, Pakistan
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Märtner EMC, Maier EM, Mengler K, Thimm E, Schiergens KA, Marquardt T, Santer R, Weinhold N, Marquardt I, Das AM, Freisinger P, Grünert SC, Vossbeck J, Steinfeld R, Baumgartner MR, Beblo S, Dieckmann A, Näke A, Lindner M, Heringer-Seifert J, Lenz D, Hoffmann GF, Mühlhausen C, Ensenauer R, Garbade SF, Kölker S, Boy N. Impact of interventional and non-interventional variables on anthropometric long-term development in glutaric aciduria type 1: A national prospective multi-centre study. J Inherit Metab Dis 2021; 44:629-638. [PMID: 33274439 DOI: 10.1002/jimd.12335] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 12/18/2022]
Abstract
Glutaric aciduria type 1 (GA1) is a rare neurometabolic disorder, caused by inherited deficiency of glutaryl-CoA dehydrogenase, mostly affecting the brain. Early identification by newborn screening (NBS) significantly improves neurologic outcome. It has remained unclear whether recommended therapy, particular low lysine diet, is safe or negatively affects anthropometric long-term outcome. This national prospective, observational, multi-centre study included 79 patients identified by NBS and investigated effects of interventional and non-interventional parameters on body weight, body length, body mass index (BMI) and head circumference as well as neurological parameters. Adherence to recommended maintenance and emergency treatment (ET) had a positive impact on neurologic outcome and allowed normal anthropometric development until adulthood. In contrast, non-adherence to ET, resulting in increased risk of dystonia, had a negative impact on body weight (mean SDS -1.07; P = .023) and body length (mean SDS -1.34; P = -.016). Consistently, longitudinal analysis showed a negative influence of severe dystonia on weight and length development over time (P < .001). Macrocephaly was more often found in female (mean SDS 0.56) than in male patients (mean SDS -0.20; P = .049), and also in individuals with high excreter phenotype (mean SDS 0.44) compared to low excreter patients (mean SDS -0.68; P = .016). In GA1, recommended long-term treatment is effective and allows for normal anthropometric long-term development up to adolescence, with gender- and excreter type-specific variations. Delayed ET and severe movement disorder result in poor anthropometric outcome.
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Affiliation(s)
- E M Charlotte Märtner
- Division of Child Neurology and Metabolic Medicine, Centre for Child and Adolescent Medicine, University Hospital Heidelberg, Germany
| | - Esther M Maier
- Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Katharina Mengler
- Division of Child Neurology and Metabolic Medicine, Centre for Child and Adolescent Medicine, University Hospital Heidelberg, Germany
| | - Eva Thimm
- Division of Experimental Paediatrics and Metabolism, Department of General Paediatrics, Neonatology and Paediatric Cardiology, University Children's Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Thorsten Marquardt
- Department of General Paediatrics, Metabolic Diseases, University Children's Hospital Muenster, Muenster, Germany
| | - René Santer
- University Children's Hospital, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Natalie Weinhold
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Chronically Sick Children, Berlin, Germany
| | - Iris Marquardt
- Department of Child Neurology, Children's Hospital Oldenburg, Oldenburg, Germany
| | - Anibh M Das
- Department of Paediatrics, Paediatric Metabolic Medicine, Hannover Medical School, Hannover, Germany
| | | | - Sarah C Grünert
- Department of General Paediatrics, Adolescent Medicine and Neonatology, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Judith Vossbeck
- Department of Paediatric and Adolescent Medicine, Ulm University Medical School, Ulm, Germany
| | - Robert Steinfeld
- Division of Paediatric Neurology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Matthias R Baumgartner
- Division of Metabolism and Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - Skadi Beblo
- Department of Women and Child Health, Hospital for Children and Adolescents, Centre for Paediatric Research Leipzig (CPL), University Hospitals, University of Leipzig, Leipzig, Germany
| | - Andrea Dieckmann
- Centre for Inborn Metabolic Disorders, Department of Neuropaediatrics, Jena University Hospital, Jena, Germany
| | - Andrea Näke
- Children's Hospital Carl Gustav Carus, Technical University Dresden, Germany
| | - Martin Lindner
- Division of Paediatric Neurology, University Children's Hospital Frankfurt, Frankfurt, Germany
| | - Jana Heringer-Seifert
- Division of Child Neurology and Metabolic Medicine, Centre for Child and Adolescent Medicine, University Hospital Heidelberg, Germany
| | - Dominic Lenz
- Division of Child Neurology and Metabolic Medicine, Centre for Child and Adolescent Medicine, University Hospital Heidelberg, Germany
| | - Georg F Hoffmann
- Division of Child Neurology and Metabolic Medicine, Centre for Child and Adolescent Medicine, University Hospital Heidelberg, Germany
| | - Chris Mühlhausen
- Department of Paediatrics and Adolescent Medicine, University Medical Centre, Göttingen, Germany
| | - Regina Ensenauer
- Division of Experimental Paediatrics and Metabolism, Department of General Paediatrics, Neonatology and Paediatric Cardiology, University Children's Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sven F Garbade
- Division of Child Neurology and Metabolic Medicine, Centre for Child and Adolescent Medicine, University Hospital Heidelberg, Germany
| | - Stefan Kölker
- Division of Child Neurology and Metabolic Medicine, Centre for Child and Adolescent Medicine, University Hospital Heidelberg, Germany
| | - Nikolas Boy
- Division of Child Neurology and Metabolic Medicine, Centre for Child and Adolescent Medicine, University Hospital Heidelberg, Germany
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Sitta A, Guerreiro G, de Moura Coelho D, da Rocha VV, Dos Reis BG, Sousa C, Vilarinho L, Wajner M, Vargas CR. Clinical, biochemical and molecular findings of 24 Brazilian patients with glutaric acidemia type 1: 4 novel mutations in the GCDH gene. Metab Brain Dis 2021; 36:205-212. [PMID: 33064266 DOI: 10.1007/s11011-020-00632-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/11/2020] [Indexed: 11/25/2022]
Abstract
Glutaric aciduria type 1 (GA-1) is a rare but treatable inherited disease caused by deficiency of glutaryl-CoA dehydrogenase activity due to GCDH gene mutations. In this study, we report 24 symptomatic GA-1 Brazilian patients, and present their clinical, biochemical, and molecular findings. Patients were diagnosed by high levels of glutaric and/or 3-hydroxyglutaric and glutarylcarnitine. Diagnosis was confirmed by genetic analysis. Most patients had the early-onset severe form of the disease and the main features were neurological deterioration, seizures and dystonia, usually following an episode of metabolic decompensation. Despite the early symptomatology, diagnosis took a long time for most patients. We identified 13 variants in the GCDH gene, four of them were novel: c.91 + 5G > A, c.167T > G, c.257C > T, and c.10A > T. The most common mutation was c.1204C > T (p.R402W). Surprisingly, the second most frequent mutation was the new mutation c.91 + 5G > A (IVS1 ds G-A + 5). Our results allowed a complete characterization of the GA-1 Brazilian patients. Besides, they expand the mutational spectrum of GA-1, with the description of four new mutations. This work reinforces the importance of awareness of GA-1 among doctors in order to allow early diagnosis and treatment in countries like Brazil where the disease has not been included in newborn screening programs.
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Affiliation(s)
- Angela Sitta
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, 90035-003, Porto Alegre, RS, Brazil.
| | - Gilian Guerreiro
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Sul, Ipiranga, 2752, 90610-000, Porto Alegre, RS, Brazil
| | - Daniella de Moura Coelho
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, 90035-003, Porto Alegre, RS, Brazil
| | - Vitoria Volfart da Rocha
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, 90035-003, Porto Alegre, RS, Brazil
| | - Bianca Gomes Dos Reis
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, 90035-003, Porto Alegre, RS, Brazil
| | - Carmen Sousa
- Newborn Screening, Metabolism & Genetics Unit, Human Genetics Department, National Institute of Health Dr Ricardo Jorge, Alexandre Herculano, 321, 4000-055, Porto, Portugal
| | - Laura Vilarinho
- Newborn Screening, Metabolism & Genetics Unit, Human Genetics Department, National Institute of Health Dr Ricardo Jorge, Alexandre Herculano, 321, 4000-055, Porto, Portugal
| | - Moacir Wajner
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, 90035-003, Porto Alegre, RS, Brazil
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal de Rio Grande do Sul, Ramiro Barcelos, 2600, Porto Alegre, RS, 90035-003, Brazil
| | - Carmen Regla Vargas
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Ramiro Barcelos, 2350, 90035-003, Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Sul, Ipiranga, 2752, 90610-000, Porto Alegre, RS, Brazil.
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal de Rio Grande do Sul, Ramiro Barcelos, 2600, Porto Alegre, RS, 90035-003, Brazil.
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Han L, Yang Y, Yang R, Chen R, Huang X. [Expert consensus for the diagnosis and treatment of glutaricacidemia type 1]. Zhonghua Yi Xue Yi Chuan Xue Za Zhi 2021; 38:1-6. [PMID: 33423247 DOI: 10.3760/cma.j.cn511374-20200705-00495] [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: 11/05/2022]
Abstract
Glutaricacidemia type 1(GA1) is an autosomal recessive disease caused by reduced or missing glutaryl-CoA dehydrogenase activity which hamps metabolism of lysine, hydroxylysine and tryptophan. The catabolic products of glutarylcarnitine and glutaric acid are abnormally accumulated in the body, resulting in metabolic disorders which primarily lead to damage to the nervous system. Clinical manifestations of patients include macrocephaly, dystonia, dyskinesia, and developmental retardation. Acute encephalopathy may be induced in infants and young children due to infection, vaccination and surgery. For GA1 is a rare disease and its clinical manifestations are similar to other neurological diseases, it may be easily missed or misdiagnosed. To facilitate early diagnosis and treatment and improve the prognosis, this consensus was formulated by pediatric experts from the fields of endocrinology and genetic metabolism through full discussion and reference to the latest literature and guidelines home and abroad.
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Affiliation(s)
- Lianshu Han
- Shanghai Institute of Pediatrics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China.
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Mohamed S, Elsheikh W, Al-Aqeel AI, Alhashem AM, Alodaib A, Alahaideb L, Almashary M, Alharbi F, AlMalawi H, Ammari A, Almohaimeed S. Incidence of newborn screening disorders among 56632 infants in Central Saudi Arabia. A 6-year study. Saudi Med J 2020; 41:703-708. [PMID: 32601637 PMCID: PMC7502916 DOI: 10.15537/smj.2020.7.25147] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Objectives: To determine the incidence of newborn screening (NBS) disorders and to study the key performance indicators of the program. Methods: This retrospective single-center study enrolled all infants who underwent NBS from January 2012 to December 2017 at Prince Sultan Military Medical City, Riyadh, Saudi Arabia. We screened 17 NBS disorders. Blood samples were collected 24 hours after birth. If the initial result was positive, a second sample was collected. True positive cases were immediately referred for medical management. Data were extracted from laboratory computerized and non-computerized records using case report forms. Results: During the study period, 56632 infants underwent NBS with a coverage rate of 100%. Thirty-eight cases were confirmed. The incidence of congenital hypothyroidism was 1:3775. The positive predictive value for the detection of congenital hypothyroidism was 11.8%. Propionic aciduria was the most common metabolic disorder, with an incidence of 1:14158. Very long-chain acyl CoA dehydrogenase deficiency and glutaric aciduria type 1 had an incidence of 1:18877 each. Phenylketonuria, biotinidase deficiency, maple syrup urine disease, and citrullinemia had an incidence of 1:28316 each. However, galactosemia and 3-methyl crotonyl carboxylase deficiency had the lowest incidence of 1:56632. Conclusion: The NBS coverage rate at our facility was 100%. Congenital hypothyroidism was the most frequently detected disorder with an incidence that matches worldwide figures. The incidence of other inherited disorders was consistent with regional figures.
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MESH Headings
- Acyl-CoA Dehydrogenase, Long-Chain/deficiency
- Amino Acid Metabolism, Inborn Errors/diagnosis
- Amino Acid Metabolism, Inborn Errors/epidemiology
- Biomarkers/blood
- Brain Diseases, Metabolic/diagnosis
- Brain Diseases, Metabolic/epidemiology
- Congenital Bone Marrow Failure Syndromes/diagnosis
- Congenital Bone Marrow Failure Syndromes/epidemiology
- Glutaryl-CoA Dehydrogenase/deficiency
- Humans
- Hypothyroidism/diagnosis
- Hypothyroidism/epidemiology
- Incidence
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/epidemiology
- Lipid Metabolism, Inborn Errors/diagnosis
- Lipid Metabolism, Inborn Errors/epidemiology
- Mitochondrial Diseases/diagnosis
- Mitochondrial Diseases/epidemiology
- Muscular Diseases/diagnosis
- Muscular Diseases/epidemiology
- Neonatal Screening
- Predictive Value of Tests
- Propionic Acidemia/diagnosis
- Propionic Acidemia/epidemiology
- Retrospective Studies
- Saudi Arabia/epidemiology
- Time Factors
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Affiliation(s)
- Sarar Mohamed
- Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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13
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Yahyaoui R, Blasco-Alonso J, Gonzalo-Marín M, Benito C, Serrano-Nieto J, González-Gallego I, Ruiz-Sala P, Pérez B, González-Lamuño D. Metabolic Serendipities of Expanded Newborn Screening. Genes (Basel) 2020; 11:genes11091018. [PMID: 32872442 PMCID: PMC7565434 DOI: 10.3390/genes11091018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/20/2020] [Accepted: 08/27/2020] [Indexed: 01/11/2023] Open
Abstract
Incidental findings on newborn screening (NBS) are results that are not the target of screening within a given NBS program, but rather are found as a result of the screening and resulting diagnostic workup for that target. These findings may not have an immediate clinical impact on the newborn, but are sometimes an additional benefit of NBS programs and may be considered secondary targets of NBS programs. This work describes four case reports that had incidental findings on the NBS, which eventually led to the diagnosis of another metabolic disease instead of the one that was initially suspected. The first case was a new defect in the cationic amino acid transporter-2 (CAT-2), which was oriented as an arginase-1 deficiency in the newborn. The second case was a maternal glutaric aciduria type 1 (GA-1) that mimicked a carnitine transporter deficiency in the newborn. The third report was a case of lysinuric protein intolerance (LPI), which appeared as high levels of citrulline on the NBS. The fourth case was a mother with homocystinuria that was diagnosed during the biochemical study of vitamin B12 status. All cases provide new or interesting data that will help guide differential diagnosis in the future.
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Affiliation(s)
- Raquel Yahyaoui
- Laboratory of Metabolic Disorders, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain; (J.B.-A.); (M.G.-M.)
- Correspondence: ; Tel.: +34-687806035
| | - Javier Blasco-Alonso
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain; (J.B.-A.); (M.G.-M.)
- Pediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain;
| | - Montserrat Gonzalo-Marín
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain; (J.B.-A.); (M.G.-M.)
- Endocrinology and Nutrition Unit, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain
| | - Carmen Benito
- Department of Genetics, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain;
| | - Juliana Serrano-Nieto
- Pediatric Gastroenterology, Hepatology and Nutrition Unit, Hospital Regional Universitario de Málaga, 29011 Málaga, Spain;
| | - Inmaculada González-Gallego
- Unit of Metabolic Disorders, Centro de Bioquímica y Genética Clínica, Hospital Universitario Virgen de la Arrixaca, 30120 Murcia, Spain;
| | - Pedro Ruiz-Sala
- Centro Diagnóstico de Enfermedades Moleculares (CEDEM), Centro de Biología Molecular, Universidad Autónoma de Madrid, CIBERER, IdiPAZ, 28049 Madrid, Spain; (P.R.-S.); (B.P.)
| | - Belén Pérez
- Centro Diagnóstico de Enfermedades Moleculares (CEDEM), Centro de Biología Molecular, Universidad Autónoma de Madrid, CIBERER, IdiPAZ, 28049 Madrid, Spain; (P.R.-S.); (B.P.)
| | - Domingo González-Lamuño
- Department of Pediatrics, University of Cantabria-University Hospital Marqués de Valdecilla, 39008 Santander, Spain;
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14
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Kurkina MV, Mihaylova SV, Baydakova GV, Saifullina EV, Korostelev SA, Pyankov DV, Kanivets IV, Yunin MA, Pechatnikova NL, Zakharova EY. Molecular and biochemical study of glutaric aciduria type 1 in 49 Russian families: nine novel mutations in the GCDH gene. Metab Brain Dis 2020; 35:1009-1016. [PMID: 32240488 DOI: 10.1007/s11011-020-00554-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 02/18/2020] [Indexed: 11/24/2022]
Abstract
Glutaric aciduria type 1 (GA1, deficiency of glutaryl CoA dehydrogenase, glutaric acidemia type 1) (ICD-10 code: E72.3; MIM 231670) is an autosomal recessive disease caused by mutations in the gene encoding the enzyme glutaryl CoA dehydrogenase (GCDH). Herein, we present the biochemical and molecular genetic characteristics of 51 patients diagnosed with GA1 from 49 unrelated families in Russia. We identified a total of 21 variants, 9 of which were novel: c.127 + 1G > T, с.471_473delCGA, c.161 T > C (p.Leu54Pro), c.531C > A (р.Phe177Leu), c.647C > T (p.Ser216Leu), c.705G > A (р.Gly235Asp), c.898 G > A (р.Gly300Ser), c.1205G > C (р.Arg402Pro), c.1178G > A (р.Gly393Glu). The most commonly detected missense variants were c.1204C > T (p.Arg402Trp) and с.1262C > T (р.Ala421Val), which were identified in 56.38% and 11.7% of mutated alleles. A heterozygous microdeletion of the short arm (p) of chromosome 19 from position 12,994,984-13,003,217 (8233 b.p.) and from position 12,991,506-13,003,217 (11,711 b.p.) were detected in two patients. Genes located in the area of imbalance were KLF1, DNASE2, and GCDH. Patients presented typical GA1 biochemical changes in the biological fluids, except one patient with the homozygous mutation p.Val400Met. No correlation was found between the GCDH genotype and glutaric acid (GA) concentration in the cohort of our patients.
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Affiliation(s)
- Marina V Kurkina
- Federal State Budgetary Scientific Institution, Research Centre for Medical Genetics (FSBI, RCMG), Moskvorechie 1, Moscow, 115522, Russia.
| | - Svetlana V Mihaylova
- Russian Children's Clinical Hospital of the Federal Autonomous Educational Institute of Higher Education, Russian National Medical Research University named after N.I. Pyrogov, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Galina V Baydakova
- Federal State Budgetary Scientific Institution, Research Centre for Medical Genetics (FSBI, RCMG), Moskvorechie 1, Moscow, 115522, Russia
| | | | - Sergey A Korostelev
- Federal State Autonomous Educational Institution of Higher Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation (Sechenovskiy University), Moscow, Russia
| | - Denis V Pyankov
- Ministry of Health of the Russian Federation, Genomed ltd, Moscow, Russia
| | - Ilya V Kanivets
- Ministry of Health of the Russian Federation, Genomed ltd, Moscow, Russia
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Maksim A Yunin
- Federal State Budgetary Scientific Institution, Research Centre for Medical Genetics (FSBI, RCMG), Moskvorechie 1, Moscow, 115522, Russia
| | | | - Ekaterina Y Zakharova
- Federal State Budgetary Scientific Institution, Research Centre for Medical Genetics (FSBI, RCMG), Moskvorechie 1, Moscow, 115522, Russia
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15
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Mingirulli N, Pyle A, Hathazi D, Alston CL, Kohlschmidt N, O'Grady G, Waddell L, Evesson F, Cooper SBT, Turner C, Duff J, Topf A, Yubero D, Jou C, Nascimento A, Ortez C, García‐Cazorla A, Gross C, O'Callaghan M, Santra S, Preece MA, Champion M, Korenev S, Chronopoulou E, Anirban M, Pierre G, McArthur D, Thompson K, Navas P, Ribes A, Tort F, Schlüter A, Pujol A, Montero R, Sarquella G, Lochmüller H, Jiménez‐Mallebrera C, Taylor RW, Artuch R, Kirschner J, Grünert SC, Roos A, Horvath R. Clinical presentation and proteomic signature of patients with TANGO2 mutations. J Inherit Metab Dis 2020; 43:297-308. [PMID: 31339582 PMCID: PMC7078914 DOI: 10.1002/jimd.12156] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 04/25/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 12/20/2022]
Abstract
Transport And Golgi Organization protein 2 (TANGO2) deficiency has recently been identified as a rare metabolic disorder with a distinct clinical and biochemical phenotype of recurrent metabolic crises, hypoglycemia, lactic acidosis, rhabdomyolysis, arrhythmias, and encephalopathy with cognitive decline. We report nine subjects from seven independent families, and we studied muscle histology, respiratory chain enzyme activities in skeletal muscle and proteomic signature of fibroblasts. All nine subjects carried autosomal recessive TANGO2 mutations. Two carried the reported deletion of exons 3 to 9, one homozygous, one heterozygous with a 22q11.21 microdeletion inherited in trans. The other subjects carried three novel homozygous (c.262C>T/p.Arg88*; c.220A>C/p.Thr74Pro; c.380+1G>A), and two further novel heterozygous (c.6_9del/p.Phe6del); c.11-13delTCT/p.Phe5del mutations. Immunoblot analysis detected a significant decrease of TANGO2 protein. Muscle histology showed mild variation of fiber diameter, no ragged-red/cytochrome c oxidase-negative fibers and a defect of multiple respiratory chain enzymes and coenzyme Q10 (CoQ10 ) in two cases, suggesting a possible secondary defect of oxidative phosphorylation. Proteomic analysis in fibroblasts revealed significant changes in components of the mitochondrial fatty acid oxidation, plasma membrane, endoplasmic reticulum-Golgi network and secretory pathways. Clinical presentation of TANGO2 mutations is homogeneous and clinically recognizable. The hemizygous mutations in two patients suggest that some mutations leading to allele loss are difficult to detect. A combined defect of the respiratory chain enzymes and CoQ10 with altered levels of several membrane proteins provides molecular insights into the underlying pathophysiology and may guide rational new therapeutic interventions.
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Affiliation(s)
- Nadja Mingirulli
- Department of Neuropediatrics and Muscle DisordersMedical Center – University of Freiburg, Faculty of MedicineBreisgauGermany
- Department of General PediatricsAdolescent Medicine and Neonatology, Medical Center – University of Freiburg, Faculty of MedicineBreisgauGermany
| | - Angela Pyle
- Wellcome Centre for Mitochondrial ResearchInstitute of Genetic Medicine, Newcastle UniversityNewcastle upon TyneUK
| | - Denisa Hathazi
- Biomedical Research DepartmentLeibniz‐Institut für Analytische Wissenschaften – ISAS – e.VDortmundGermany
| | - Charlotte L. Alston
- Wellcome Centre for Mitochondrial ResearchInstitute of Neuroscience, Newcastle UniversityNewcastle upon TyneUK
| | | | - Gina O'Grady
- Kid's Neuroscience Centre, Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Leigh Waddell
- Kid's Neuroscience Centre, Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Frances Evesson
- Kid's Neuroscience Centre, Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of Child and Adolescent HealthThe University of SydneySydneyNew South WalesAustralia
| | - Sandra B. T. Cooper
- Kid's Neuroscience Centre, Children's Hospital at WestmeadSydneyNew South WalesAustralia
- Discipline of Child and Adolescent HealthThe University of SydneySydneyNew South WalesAustralia
| | - Christian Turner
- Discipline of Child and Adolescent HealthThe University of SydneySydneyNew South WalesAustralia
- CardiologyThe Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Jennifer Duff
- Wellcome Centre for Mitochondrial ResearchInstitute of Genetic Medicine, Newcastle UniversityNewcastle upon TyneUK
| | - Ana Topf
- John Walton Muscular Dystrophy Research CentreInstitute of Genetic Medicine, Newcastle UniversityNewcastle upon TyneUK
| | - Delia Yubero
- Department of Clinical Biochemistry, Genetics, Pediatric Neurology and Cardiology and BiobankInstitut de Recerca Sant Joan de Déu and CIBERER, Instituto de Salud Carlos III BarcelonaBarcelonaSpain
| | - Cristina Jou
- Department of Clinical Biochemistry, Genetics, Pediatric Neurology and Cardiology and BiobankInstitut de Recerca Sant Joan de Déu and CIBERER, Instituto de Salud Carlos III BarcelonaBarcelonaSpain
| | - Andrés Nascimento
- Department of Clinical Biochemistry, Genetics, Pediatric Neurology and Cardiology and BiobankInstitut de Recerca Sant Joan de Déu and CIBERER, Instituto de Salud Carlos III BarcelonaBarcelonaSpain
| | - Carlos Ortez
- Department of Clinical Biochemistry, Genetics, Pediatric Neurology and Cardiology and BiobankInstitut de Recerca Sant Joan de Déu and CIBERER, Instituto de Salud Carlos III BarcelonaBarcelonaSpain
| | - Angels García‐Cazorla
- Department of Clinical Biochemistry, Genetics, Pediatric Neurology and Cardiology and BiobankInstitut de Recerca Sant Joan de Déu and CIBERER, Instituto de Salud Carlos III BarcelonaBarcelonaSpain
| | - Claudia Gross
- Wellcome Centre for Mitochondrial ResearchInstitute of Neuroscience, Newcastle UniversityNewcastle upon TyneUK
| | - Maria O'Callaghan
- Department of Clinical Biochemistry, Genetics, Pediatric Neurology and Cardiology and BiobankInstitut de Recerca Sant Joan de Déu and CIBERER, Instituto de Salud Carlos III BarcelonaBarcelonaSpain
| | - Saikat Santra
- Birmingham Women's and Children's NHS Foundation TrustBirminghamUK
| | | | | | - Sergei Korenev
- Department of Inherited DiseaseSt Thomas HospitalLondonUK
| | | | - Majumdar Anirban
- South West Regional Metabolic DepartmentBristol Royal Hospital for ChildrenBristolUK
| | - Germaine Pierre
- South West Regional Metabolic DepartmentBristol Royal Hospital for ChildrenBristolUK
| | - Daniel McArthur
- Center for Mendelian Genomics and Program in Medical and Population GeneticsBroad Institute of MIT and HarvardCambridgeMassachusetts
- Analytic and Translational Genetics UnitMassachusetts General HospitalBostonMassachusetts
| | - Kyle Thompson
- Kid's Neuroscience Centre, Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Placido Navas
- Centro Andaluz de Biología del DesarrolloUníversidad Pablo de Olavide‐CSIC‐JA and CIBERER, Instituto de Salud Carlos IIIMadridSpain
| | - Antonia Ribes
- Secció d'Errors Congènits del Metabolisme – IBCServei de Bioquímica I Genètìca Molecular, Hospital Clínìc, IDIBAPS, CIBERERBarcelonaSpain
| | - Frederic Tort
- Secció d'Errors Congènits del Metabolisme – IBCServei de Bioquímica I Genètìca Molecular, Hospital Clínìc, IDIBAPS, CIBERERBarcelonaSpain
| | - Agatha Schlüter
- Neurometabolic Diseases Laboratory, Institut d'Investìgacío Biomedíca de Bellvitge (IDIBELL), and Centre for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos IIIMadridSpain
| | - Aurora Pujol
- Catalan Institution of Research and Advanced Studies (ICREA)BarcelonaSpain
| | - Raquel Montero
- Department of Clinical Biochemistry, Genetics, Pediatric Neurology and Cardiology and BiobankInstitut de Recerca Sant Joan de Déu and CIBERER, Instituto de Salud Carlos III BarcelonaBarcelonaSpain
| | - Georgia Sarquella
- Department of Clinical Biochemistry, Genetics, Pediatric Neurology and Cardiology and BiobankInstitut de Recerca Sant Joan de Déu and CIBERER, Instituto de Salud Carlos III BarcelonaBarcelonaSpain
| | - Hanns Lochmüller
- Department of Neuropediatrics and Muscle DisordersMedical Center – University of Freiburg, Faculty of MedicineBreisgauGermany
- Children's Hospital of Eastern Ontario Research Institute, University of OttawaOttawaOntarioCanada
- Division of Neurology, Department of MedicineThe Ottawa HospitalOttawaOntarioCanada
| | - Cecilia Jiménez‐Mallebrera
- Department of Clinical Biochemistry, Genetics, Pediatric Neurology and Cardiology and BiobankInstitut de Recerca Sant Joan de Déu and CIBERER, Instituto de Salud Carlos III BarcelonaBarcelonaSpain
| | - Robert W. Taylor
- Kid's Neuroscience Centre, Children's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Rafael Artuch
- Department of Clinical Biochemistry, Genetics, Pediatric Neurology and Cardiology and BiobankInstitut de Recerca Sant Joan de Déu and CIBERER, Instituto de Salud Carlos III BarcelonaBarcelonaSpain
| | - Janbernd Kirschner
- Department of Neuropediatrics and Muscle DisordersMedical Center – University of Freiburg, Faculty of MedicineBreisgauGermany
| | - Sarah C. Grünert
- Department of General PediatricsAdolescent Medicine and Neonatology, Medical Center – University of Freiburg, Faculty of MedicineBreisgauGermany
| | - Andreas Roos
- Biomedical Research DepartmentLeibniz‐Institut für Analytische Wissenschaften – ISAS – e.VDortmundGermany
- Pediatric NeurologyUniversity Children's Hospital, University of Duisburg‐Essen, Faculty of MedicineEssenGermany
| | - Rita Horvath
- Wellcome Centre for Mitochondrial ResearchInstitute of Genetic Medicine, Newcastle UniversityNewcastle upon TyneUK
- Department of Clinical NeurosciencesUniversity of CambridgeCambridgeUK
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16
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Zayed H, El Khayat H, Tomoum H, Khalifa O, Siddiq E, Mohammad SA, Gamal R, Shi Z, Mosailhy A, Zaki OK. Clinical, biochemical, neuroradiological and molecular characterization of Egyptian patients with glutaric acidemia type 1. Metab Brain Dis 2019; 34:1231-1241. [PMID: 31062211 PMCID: PMC6617250 DOI: 10.1007/s11011-019-00422-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 02/08/2019] [Accepted: 04/21/2019] [Indexed: 12/02/2022]
Abstract
Glutaric acidemia type 1 (GA1) is an inherited metabolic autosomal recessive disorder that is caused by a deficiency in glutaryl-CoA dehydrogenase (GCDH). Untreated patients suffer primarily from severe striatal damage. More than 250 variants in the GCDH gene have been reported with a variable frequency among different ethnic groups. In this study, we aimed to characterize 89 Egyptian patients with GA1 and identify the variants in the 41 patients who were available for genotyping. All of our patients demonstrated clinical, neuroradiological, and biochemical characteristics that are consistent with a diagnosis of GA1. All patients presented with variable degrees of developmental delay ranging from mild to severe. Most of the 89 patients presented with acute onset type (71.9%), followed by insidious (19%) and asymptomatic (9%). A delay in diagnosis was inversely associated with macrocephaly. The prevalence rate ratio (PR) for macrocephaly that was associated with each 6-month delay was 0.95 (95%CI 0.91-0.99). However, high body weight was associated with a higher likelihood of having macrocephaly (PR 1.16, 95%CI 1.06-1.26 per 1 SD increment of Z score weight). However, body weight was inversely associated with the morbidity score. Consanguinity level was 64% among our patient's cohort and was positively associated with the C5DC level (β (95%CI) 1.06 (0.12-1.99)). Forty-one patients were available for genotyping and were sequenced for the GCDH gene. We identified a total of 25 variants, of which the following six novel variants were identified: three missense variants, c.320G > T (p.Gly107Val), c.481C > T (p.Arg161Trp) and c.572 T > G (p.Met191Arg); two deletions, c.78delG (p.Ala27Argfs34) and c.1035delG (p.Gly346Alafs*11); and one indel, c.272_331del (p.Val91_Lys111delinsGlu). All of the novel variants were absent in the 300 normal chromosomes. The most common variant, c.*165A > G, was detected in 42 alleles, and the most commonly detected missense variant, c.1204C > T (p.Arg402Trp), was identified in 29 mutated alleles in 15/41 (34.2%) of patients. Our findings suggest that GA1 is not uncommon organic acidemia disease in Egypt; therefore, there is a need for supporting neonatal screening programs in Egypt.
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MESH Headings
- Amino Acid Metabolism, Inborn Errors/diagnosis
- Amino Acid Metabolism, Inborn Errors/diagnostic imaging
- Amino Acid Metabolism, Inborn Errors/genetics
- Amino Acid Metabolism, Inborn Errors/metabolism
- Body Weight/physiology
- Brain/diagnostic imaging
- Brain Diseases, Metabolic/diagnosis
- Brain Diseases, Metabolic/diagnostic imaging
- Brain Diseases, Metabolic/genetics
- Brain Diseases, Metabolic/metabolism
- Child
- Child, Preschool
- Egypt
- Female
- Genotype
- Glutaryl-CoA Dehydrogenase/deficiency
- Glutaryl-CoA Dehydrogenase/genetics
- Glutaryl-CoA Dehydrogenase/metabolism
- Humans
- Magnetic Resonance Imaging
- Male
- Mutation, Missense
- Severity of Illness Index
- Symptom Assessment
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Affiliation(s)
- Hatem Zayed
- Department of Biomedical Sciences, College of Health Sciences, Qatar University, Doha, Qatar.
| | - Hamed El Khayat
- Medical Genetics Unit, Pediatric Department, Faculty of Medicine, Ain Shams Pediatrics Hospital, Ain-Shams University, Cairo, 11665, Egypt
| | - Hoda Tomoum
- Medical Genetics Unit, Pediatric Department, Faculty of Medicine, Ain Shams Pediatrics Hospital, Ain-Shams University, Cairo, 11665, Egypt
| | - Ola Khalifa
- Medical Genetics Unit, Pediatric Department, Faculty of Medicine, Ain Shams Pediatrics Hospital, Ain-Shams University, Cairo, 11665, Egypt
| | - Ehab Siddiq
- Medical Genetics Unit, Pediatric Department, Faculty of Medicine, Ain Shams Pediatrics Hospital, Ain-Shams University, Cairo, 11665, Egypt
| | - Shaimaa A Mohammad
- Medical Genetics Unit, Pediatric Department, Faculty of Medicine, Ain Shams Pediatrics Hospital, Ain-Shams University, Cairo, 11665, Egypt
| | - Radwa Gamal
- Medical Genetics Unit, Pediatric Department, Faculty of Medicine, Ain Shams Pediatrics Hospital, Ain-Shams University, Cairo, 11665, Egypt
| | - Zumin Shi
- Department of Biomedical Sciences, College of Health Sciences, Qatar University, Doha, Qatar
| | - Ahmed Mosailhy
- Medical Genetics Unit, Pediatric Department, Faculty of Medicine, Ain Shams Pediatrics Hospital, Ain-Shams University, Cairo, 11665, Egypt
| | - Osama K Zaki
- Medical Genetics Unit, Pediatric Department, Faculty of Medicine, Ain Shams Pediatrics Hospital, Ain-Shams University, Cairo, 11665, Egypt.
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17
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Abstract
INTRODUCTION Metabolic encephalopathy is a rare but potentially devastating complication of diabetic ketoacidosis (DKA). This case highlights the dramatic cognitive decline of a young man due to metabolic encephalopathy complicating DKA. The aims of this case report are to highlight metabolic encephalopathy as a complication of DKA and to explore the current research in diabetic related brain injury. The importance of investigation and treatment of reversible causes of encephalopathy is also demonstrated. CASE PRESENTATION A 35-year-old man with a background of type 1 diabetes mellitus (T1DM) and relapsing remitting multiple sclerosis (RRMS) presented to the emergency department (ED) in a confused and agitated state. Prior to admission he worked as a caretaker in a school, smoked ten cigarettes per day, took excess alcohol and smoked cannabis twice per week. Following initial investigations, he was found to be in DKA. Despite timely and appropriate management his neurological symptoms and behavioural disturbance persisted. Neuroimaging revealed temporal lobe abnormalities consistent with an encephalopathic process. The patient underwent extensive investigation looking for evidence of autoimmune, infective, metabolic, toxic and paraneoplastic encephalopathy, with no obvious cause demonstrated. Due to persistent radiological abnormalities a temporal lobe biopsy was performed which showed marked astrocytic gliosis without evidence of vasculitis, inflammation, infarction or neoplasia. A diagnosis of metabolic encephalopathy secondary to DKA was reached. The patient's cognitive function remained impaired up to 18 months post presentation and he ultimately required residential care. CONCLUSIONS Metabolic encephalopathy has been associated with acute insults such as DKA, but importantly, the risk of cerebral injury is also related to chronic hyperglycaemia. Mechanisms of cerebral injury in diabetes mellitus continue to be investigated. DKA poses a serious and significant neurological risk to patients with diabetes mellitus. To our knowledge this is the second case report describing this acute complication.
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Affiliation(s)
- Maria Tomkins
- Department of Diabetes and Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - Richard McCormack
- Department of Rehabilitation, National Rehabilitation Hospital, Dublin, Ireland
| | | | - Amar Agha
- Department of Diabetes and Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - Áine Merwick
- Department of Neurology, Beaumont Hospital, Dublin, Ireland
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18
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Arya S, Melton K. Case 2: Seizures, Apnea, Lethargy, and Persistent Hiccups in a Full-Term Newborn. Neoreviews 2019; 20:e295-e297. [PMID: 31261082 DOI: 10.1542/neo.20-5-e295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Shreyas Arya
- Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kristin Melton
- Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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19
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Pokora P, Jezela-Stanek A, Różdżyńska-Świątkowska A, Jurkiewicz E, Bogdańska A, Szymańska E, Rokicki D, Ciara E, Rydzanicz M, Stawiński P, Płoski R, Tylki-Szymańska A. Mild phenotype of glutaric aciduria type 1 in polish patients - novel data from a group of 13 cases. Metab Brain Dis 2019; 34:641-649. [PMID: 30570710 PMCID: PMC6428789 DOI: 10.1007/s11011-018-0357-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/25/2018] [Indexed: 11/27/2022]
Abstract
Glutaric aciduria type 1 is a neurometabolic disorder, caused by riboflavin-dependent glutaryl-CoA dehydrogenase deficiency. As its consequence, accumulation of the putatively neurotoxic metabolites (glutaric and 3-hydroxyglutaric acids) in body tissues, but especially within the brain, is observed. Estimated incidence of the disease is 1 in 110,000 newborns, The prevalence however may be higher, depending on a specific ethnic group, and result in phenotypic variation as well. In this paper we present clinical data of 13 patients of Polish nationality. They all present a mild phenotype and clinical course of glutaric aciduria type 1. Based on their clinical data, presented herein, we like to pay attention to the phenotypic and neuroimaging features important for the diagnosis of mild form of this disease. Moreover, we present novel molecular data, which may correlate with such a manifestation.
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Affiliation(s)
- Paulina Pokora
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children's Memorial Health Institute, Warsaw, Poland
| | - Aleksandra Jezela-Stanek
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
- State Tertiary Vocational School in Oswiecim, Oswiecim, Poland
| | | | - Elżbieta Jurkiewicz
- Department of Diagnostic Imaging, The Children's Memorial Health Institute, Warsaw, Poland
| | - Anna Bogdańska
- Department of Biochemistry, Radioimmunology and Experimental Medicine, The Children's Memorial Health Institute, Warsaw, Poland
| | - Edyta Szymańska
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children's Memorial Health Institute, Warsaw, Poland
| | - Dariusz Rokicki
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children's Memorial Health Institute, Warsaw, Poland
| | - Elżbieta Ciara
- Department of Medical Genetics, The Children's Memorial Health Institute, Warsaw, Poland
| | | | - Piotr Stawiński
- Department of Medical Genetics, Medical University of Warsaw, Warsaw, Poland
| | - Rafał Płoski
- Department of Medical Genetics, Medical University of Warsaw, Warsaw, Poland
| | - Anna Tylki-Szymańska
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children's Memorial Health Institute, Warsaw, Poland.
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20
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Shi X, Ke Z, Zheng A, Xie W, Mo G. [Clinical and variation analysis of three Chinese families affected with glutaric acidemia type 1]. Zhonghua Yi Xue Yi Chuan Xue Za Zhi 2018; 35:796-799. [PMID: 30512148 DOI: 10.3760/cma.j.issn.1003-9406.2018.06.004] [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: 06/09/2023]
Abstract
OBJECTIVE To detect potential variation in glutaryl-CoA dehydrogenase (GCDH) gene among three Chinese families affected with glutaric acidemia type Ⅰ(GA-1) and correlate the genotypes with phenotypes. METHODS Genomic DNA was extracted from peripheral blood samples derived from three patients with GA-1 and their family members. The coding regions of the GCDH gene were amplified with PCR and subjected to Sanger sequencing. RESULTS The clinical manifestation of the patients varied from macrocephaly to severe encephalopathy, with notable phenotypic difference between siblings carrying the same variation. In pedigrees 1 and 2, the probands have carried compound heterozygous variations c.1133C>T(p.Ala378Val) and c.1244-2A>C, which were derived their fathers and mothers, respectively. In pedigree 3, the proband has carried compound heterozygous variation c.339delT (p.Tyr113) and c.406G>T (p.Gly136Cys). Among these, variations c.339delT and c.1133C>T were verified as novel by retrieval of dsSNP, HGMD and 1000 genome database. Bioinformatic analysis suggested that above variations can affect protein function and are probably pathogenic. CONCLUSION Above discovery has expanded the mutation spectrum of the GCDH gene. No correlation was found between the clinical phenotype and genotype of GA-1 patients.
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Affiliation(s)
- Xiaorong Shi
- Department of Pediatrics, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, China.
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Mankovsky B, Zherdova N, van den Berg E, Biessels GJ, de Bresser J. Cognitive functioning and structural brain abnormalities in people with Type 2 diabetes mellitus. Diabet Med 2018; 35:1663-1670. [PMID: 30230019 DOI: 10.1111/dme.13800] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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] [Accepted: 08/09/2018] [Indexed: 12/11/2022]
Abstract
AIMS Type 2 diabetes mellitus is associated with cognitive dysfunction, but the underlying structural brain correlates are uncertain. This study examined the association between cognitive functioning and structural brain abnormalities in people with long-standing Type 2 diabetes. METHODS Ninety-three people with Type 2 diabetes (age 62.3 ± 5.4 years, diabetes duration 9.7 ± 6.7 years; HbA1c 65 ± 10 mmol/mol, 8.1 ± 1.3%) were included. Cognitive functioning was assessed by a test battery covering the domains memory, processing speed and executive functioning. Brain tissue volumes and white matter hyperintensity volumes were automatically determined on MRI. Linear regression analyses were performed adjusted for age, sex and education. RESULTS In people with Type 2 diabetes, increased white matter hyperintensity volume was associated with decreased processing speed [regression B coefficient = -0.22 (-0.38 to -0.06), P = 0.009], but not with memory or executive function (P > 0.05). Brain tissue volumes were not significantly related to cognitive functioning (P > 0.05). CONCLUSIONS In people with long-standing, less strictly controlled Type 2 diabetes, white matter hyperintensities volumes were associated with decreased processing speed. This suggests that cerebral small vessel disease is an underlying disease mechanism of cognitive dysfunction in these individuals.
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Affiliation(s)
- B Mankovsky
- Department of Diabetology, National Medical Academy for Postgraduate Education, Kiev, Ukraine
| | - N Zherdova
- Department of Diabetology, National Medical Academy for Postgraduate Education, Kiev, Ukraine
| | - E van den Berg
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, Leiden, The Netherlands
| | - G-J Biessels
- Department of Neurology, Rudolf Magnus Institute of Neuroscience, Leiden, The Netherlands
| | - J de Bresser
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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22
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Peng HH, Shaw SW, Huang KG. Prenatal diagnosis of fetal glutaric aciduria type 1 with rare compound heterozygous mutations in GCDH gene. Taiwan J Obstet Gynecol 2018; 57:137-140. [PMID: 29458885 DOI: 10.1016/j.tjog.2017.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Glutaric aciduria type 1 is a rare disease, with the estimated prevalence about 1 in 100,000 newborns. GCDH gene mutation can lead to glutaric acid and 3- OH glutaric acid accumulation, with clinical manifestation of neuronal damage, brain atrophy, microencephalic macrocephaly, decreased coordination of swallowing, poor muscle coordination, spasticity, and severe dystonic movement disorder. CASE REPORT A 22-year-old female, Gravida 4 Para 2, is pregnancy at 13 weeks of gestational age. Her first child is normal, however, the second child was diagnosed as glutaric aciduria type I after birth. She came to our hospital for prenatal genetic counselling of her fetus at 13 weeks of gestational age. We performed GCDH gene mutation analysis of maternal blood showed IVS 3 + 1 G > A heterozygous mutation, GCDH gene mutation analysis of paternal blood showed c. 1240 G > A heterozygous mutation, and the second child has compound heterozygous IVS 3 + 1 G > A and c. 1240 G > A mutations. Later, we performed amniocentesis at 16 weeks of gestational age for chromosome study and GCDH gene mutation analysis for the fetus. The fetal chromosome study showed normal karyotype, however, GCDH gene mutation analysis showed compound heterozygous IVS 3 + 1 G > A and c. 1240 G > A mutations. The couple decided to termination of pregnancy thereafter. CONCLUSION Glutaric acidemia type 1 is an autosomal recessive disorder because of pathogenic mutations in the GCDH gene. Early diagnosis and therapy of glutaric acidemia type 1 can reduce the risk of neuronal damage and acute dystonia. We report a case of prenatal diagnosis of fetal glutaric aciduria type 1 with rare compound heterozygous GCDH gene mutation at IVS 3 + 1 G > A and c. 1240 G > A mutations, which provide better genetic counselling for the couples.
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Affiliation(s)
- Hsiu-Huei Peng
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan
| | - Sheng-Wen Shaw
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan.
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Xue J, Chang X, Zhang Y, Yang Z. Novel phenotypes of pyridox(am)ine-5'-phosphate oxidase deficiency and high prevalence of c.445_448del mutation in Chinese patients. Metab Brain Dis 2017; 32:1081-1087. [PMID: 28349276 DOI: 10.1007/s11011-017-9995-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 03/13/2017] [Indexed: 01/11/2023]
Abstract
To analyze the clinical and genetic characteristics of Chinese patients with pyridox(am)ine-5'-phosphate oxidase (PNPO) deficiency. The clinical presentations and the responses to treatments were analyzed in 4 patients. Blood and urinary metabolic screenings, electroencephalogram (EEG), brain magnetic resonance imaging (MRI) and epilepsy-related genes detection were performed in all patients. Patient 1 and 2 were identical twin brothers, who were born at 35+5 w gestation with a sign of encephalopathy. Their seizures started within the first day and could not be controlled by pyridoxine or pyridoxal-5'-phosphate (PLP) completely. Patient 3 presented seizures at 5 months, responding well to pyridoxine. Seizures in patient 4 began at 40 days after birth and were controlled by valproic acid and topiramate. EEG showed atypical hypsarrhythmia or multifocal epileptiform discharges in 3 patients, and showed normality in patient 4. MRI showed nonspecific abnormality or normality. Blood metabolic screening showed multiple amino acids level abnormalities in all cases. Urinary metabolic screening showed vanillactic acid prominently elevated in 3 patients. Genetic analysis revealed 5 mutations of PNPO, three of which were novel. The mutation c.445_448del was carried by the twins and patient 3. Assessment of psychomotor development indicated severe delay in 3 patients and borderline to mild delay in patient 3. This is the first time to report patients with PNPO deficiency diagnosed by gene analysis in China. The novel clinical characteristics and novel mutations found here expanded the phenotypes and genotypes of this disease. Further, the frameshift mutation c.445_448del might be high prevalence in PNPO deficiency in Chinese patients.
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Affiliation(s)
- Jiao Xue
- Department of Pediatrics, Peking University First Hospital, No.1, Xi'anmen Street, Xicheng District, Beijing, 100034, China
| | - Xingzhi Chang
- Department of Pediatrics, Peking University First Hospital, No.1, Xi'anmen Street, Xicheng District, Beijing, 100034, China
| | - Yuehua Zhang
- Department of Pediatrics, Peking University First Hospital, No.1, Xi'anmen Street, Xicheng District, Beijing, 100034, China.
| | - Zhixian Yang
- Department of Pediatrics, Peking University First Hospital, No.1, Xi'anmen Street, Xicheng District, Beijing, 100034, China.
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Tsai FC, Lee HJ, Wang AG, Hsieh SC, Lu YH, Lee MC, Pai JS, Chu TH, Yang CF, Hsu TR, Lai CJ, Tsai MT, Ho PH, Lin MC, Cheng LY, Chuang YC, Niu DM. Experiences during newborn screening for glutaric aciduria type 1: Diagnosis, treatment, genotype, phenotype, and outcomes. J Chin Med Assoc 2017; 80:253-261. [PMID: 28302372 DOI: 10.1016/j.jcma.2016.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/27/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Glutaric aciduria type 1 (GA-1) is an organic acidemia with potentially severe neurological sequelae. In Taiwan, newborn screening (NBS) for GA-1 began in 2001, but large-scale reporting is lacking. This study describes Taiwan's largest newborn screening population to date. METHODS Between 2001 and 2015, 1,490,636 newborns were screened for GA-1. Confirmatory examinations included the carnitine loading test. Confirmed patients were treated with a low lysine diet, carnitine, and high-energy intake during illness. Clinical, laboratory, and neuroimaging data were analyzed. RESULTS Fourteen newborns were diagnosed with GA-1 (incidence: 1/106,474). C5DC concentration was clearly increased after carnitine loading in the affected newborns, but not in false-positive newborns (p = 0.004), indicating that this test is useful as an adjuvant diagnostic method. Eleven patients followed in our hospital were enrolled, namely nine NBS patients and two patients diagnosed clinically. IVS10-2A>C was the most common mutation. Two novel mutations (T36fs and N291K) were identified. Pendular nystagmus was found in two pediatric GA-1 patients. The corresponding pathology was optic atrophy in one patient, but remained undetermined in the other patient. The frequency of encephalopathic crisis decreased substantially following NBS. Among patients diagnosed by NBS, cognitive functioning was better among patients with good compliance than patients with poor compliance (p = 0.03). Abnormalities were detected by brain MRI including diffusion-weighted imaging and apparent diffusion coefficient maps; these affected various brain regions at different stages of the disease. Basal ganglion injuries occurred after an encephalopathic crisis. White matter disease was prevalent among older patients, either with or without an encephalopathic crisis. CONCLUSION Early diagnosis by newborn screening followed by full compliance with treatment guidelines is important to a good outcome.
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Affiliation(s)
- Fang-Chih Tsai
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Han-Jui Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - An-Guor Wang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Ophthalmology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shu-Chen Hsieh
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yung-Hsiu Lu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ming-Che Lee
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC; Genomics Research Center, Academia Sinica, Taipei, Taiwan, ROC
| | - Ju-Shan Pai
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tzu-Hung Chu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chia-Feng Yang
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ting-Rong Hsu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chih-Jou Lai
- Physical Medicine and Rehabilitation Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ming-Tzu Tsai
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ping-Hsun Ho
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Min-Chieh Lin
- Department of Food and Nutrition, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ling-Yee Cheng
- Physical Medicine and Rehabilitation Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ya-Chin Chuang
- Physical Medicine and Rehabilitation Department, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Dau-Ming Niu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
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25
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Boy N, Mühlhausen C, Maier EM, Heringer J, Assmann B, Burgard P, Dixon M, Fleissner S, Greenberg CR, Harting I, Hoffmann GF, Karall D, Koeller DM, Krawinkel MB, Okun JG, Opladen T, Posset R, Sahm K, Zschocke J, Kölker S. Proposed recommendations for diagnosing and managing individuals with glutaric aciduria type I: second revision. J Inherit Metab Dis 2017; 40:75-101. [PMID: 27853989 DOI: 10.1007/s10545-016-9999-9] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [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: 08/03/2016] [Revised: 10/18/2016] [Accepted: 10/19/2016] [Indexed: 10/20/2022]
Abstract
Glutaric aciduria type I (GA-I; synonym, glutaric acidemia type I) is a rare inherited metabolic disease caused by deficiency of glutaryl-CoA dehydrogenase located in the catabolic pathways of L-lysine, L-hydroxylysine, and L-tryptophan. The enzymatic defect results in elevated concentrations of glutaric acid, 3-hydroxyglutaric acid, glutaconic acid, and glutaryl carnitine in body tissues, which can be reliably detected by gas chromatography/mass spectrometry (organic acids) and tandem mass spectrometry (acylcarnitines). Most untreated individuals with GA-I experience acute encephalopathic crises during the first 6 years of life that are triggered by infectious diseases, febrile reaction to vaccinations, and surgery. These crises result in striatal injury and consequent dystonic movement disorder; thus, significant mortality and morbidity results. In some patients, neurologic disease may also develop without clinically apparent crises at any age. Neonatal screening for GA-I us being used in a growing number of countries worldwide and is cost effective. Metabolic treatment, consisting of low lysine diet, carnitine supplementation, and intensified emergency treatment during catabolism, is effective treatment and improves neurologic outcome in those individuals diagnosed early; treatment after symptom onset, however, is less effective. Dietary treatment is relaxed after age 6 years and should be supervised by specialized metabolic centers. The major aim of this second revision of proposed recommendations is to re-evaluate the previous recommendations (Kölker et al. J Inherit Metab Dis 30:5-22, 2007b; J Inherit Metab Dis 34:677-694, 2011) and add new research findings, relevant clinical aspects, and the perspective of affected individuals.
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Affiliation(s)
- Nikolas Boy
- Centre for Child and Adolescent Medicine, Department of General Paediatrics, Division of Neuropaediatrics and Metabolic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, D-69120, Heidelberg, Germany.
| | - Chris Mühlhausen
- University Children's Hospital, University Medical Centre Hamburg-Eppendorf, Martinistrasse 52, D-20246, Hamburg, Germany
| | - Esther M Maier
- Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, University of Munich Medical Centre, Munich, Germany
| | - Jana Heringer
- Centre for Child and Adolescent Medicine, Department of General Paediatrics, Division of Neuropaediatrics and Metabolic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, D-69120, Heidelberg, Germany
| | - Birgit Assmann
- Centre for Child and Adolescent Medicine, Department of General Paediatrics, Division of Neuropaediatrics and Metabolic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, D-69120, Heidelberg, Germany
| | - Peter Burgard
- Centre for Child and Adolescent Medicine, Department of General Paediatrics, Division of Neuropaediatrics and Metabolic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, D-69120, Heidelberg, Germany
| | - Marjorie Dixon
- Dietetics, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
| | - Sandra Fleissner
- Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, University of Munich Medical Centre, Munich, Germany
| | - Cheryl R Greenberg
- Department of Pediatrics, Children's Hospital Health Sciences Centre and University of Manitoba, Winnipeg, MB, R3A 1R9, Canada
- Department of Biochemistry and Medical Genetics, Children's Hospital Health Sciences Centre and University of Manitoba, Winnipeg, MB, R3A 1R9, Canada
| | - Inga Harting
- Centre for Child and Adolescent Medicine, Department of General Paediatrics, Division of Neuropaediatrics and Metabolic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, D-69120, Heidelberg, Germany
- Department of Neuroradiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Georg F Hoffmann
- Centre for Child and Adolescent Medicine, Department of General Paediatrics, Division of Neuropaediatrics and Metabolic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, D-69120, Heidelberg, Germany
| | - Daniela Karall
- Clinic for Paediatrics I, Inherited Metabolic Disorders, Medical, University of Innsbruck, Innsbruck, Austria
| | - David M Koeller
- Department of Molecular & Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - Michael B Krawinkel
- Justus Liebig University Giessen, Institute of Nutritional Science, Giessen, Germany
| | - Jürgen G Okun
- Centre for Child and Adolescent Medicine, Department of General Paediatrics, Division of Neuropaediatrics and Metabolic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, D-69120, Heidelberg, Germany
| | - Thomas Opladen
- Centre for Child and Adolescent Medicine, Department of General Paediatrics, Division of Neuropaediatrics and Metabolic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, D-69120, Heidelberg, Germany
| | - Roland Posset
- Centre for Child and Adolescent Medicine, Department of General Paediatrics, Division of Neuropaediatrics and Metabolic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, D-69120, Heidelberg, Germany
| | - Katja Sahm
- Centre for Child and Adolescent Medicine, Department of General Paediatrics, Division of Neuropaediatrics and Metabolic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, D-69120, Heidelberg, Germany
| | - Johannes Zschocke
- Division of Human Genetics, Medical University Innsbruck, Innsbruck, Austria
| | - Stefan Kölker
- Centre for Child and Adolescent Medicine, Department of General Paediatrics, Division of Neuropaediatrics and Metabolic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, D-69120, Heidelberg, Germany
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26
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Schillaci LAP, Greene CL, Strovel E, Rispoli-Joines J, Spector E, Woontner M, Scharer G, Enns GM, Gallagher R, Zinn AB, McCandless SE, Hoppel CL, Goodman SI, Bedoyan JK. The M405V allele of the glutaryl-CoA dehydrogenase gene is an important marker for glutaric aciduria type I (GA-I) low excretors. Mol Genet Metab 2016; 119:50-6. [PMID: 27397597 DOI: 10.1016/j.ymgme.2016.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 06/28/2016] [Indexed: 11/28/2022]
Abstract
Glutaric aciduria type I (GA-I) is an autosomal recessive organic aciduria resulting from a functional deficiency of glutaryl-CoA dehydrogenase, encoded by GCDH. Two clinically indistinguishable diagnostic subgroups of GA-I are known; low and high excretors (LEs and HEs, respectively). Early medical and dietary interventions can result in significantly better outcomes and improved quality of life for patients with GA-I. We report on nine cases of GA-I LE patients all sharing the M405V allele with two cases missed by newborn screening (NBS) using tandem mass spectrometry (MS/MS). We describe a novel case with the known pathogenic M405V variant and a novel V133L variant, and present updated and previously unreported clinical, biochemical, functional and molecular data on eight other patients all sharing the M405V allele. Three of the nine patients are of African American ancestry, with two as siblings. GCDH activity was assayed in six of the nine patients and varied from 4 to 25% of the control mean. We support the use of urine glutarylcarnitine as a biochemical marker of GA-I by demonstrating that glutarylcarnitine is efficiently cleared by the kidney (50-90%) and that plasma and urine glutarylcarnitine follow a linear relationship. We report the allele frequencies for three known GA-I LE GCDH variants (M405V, V400M and R227P) and note that both the M405V and V400M variants are significantly more common in the population of African ancestry compared to the general population. This report highlights the M405V allele as another important molecular marker in patients with the GA-I LE phenotype. Therefore, the incorporation into newborn screening of molecular screening for the M405V and V400M variants in conjunction with MS/MS could help identify asymptomatic at-risk GA-I LE patients that could potentially be missed by current NBS programs.
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Affiliation(s)
- Lori-Anne P Schillaci
- Center for Human Genetics, University Hospitals Case Medical Center, Cleveland, OH, United States
| | - Carol L Greene
- Department of Pediatrics, University of Maryland, Baltimore, MD, United States
| | - Erin Strovel
- Department of Pediatrics, University of Maryland, Baltimore, MD, United States
| | | | - Elaine Spector
- Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, United States
| | - Michael Woontner
- Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, United States
| | - Gunter Scharer
- Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, United States
| | - Gregory M Enns
- Department of Pediatrics, Division of Genetics, Stanford University School of Medicine, Stanford, CA, United States
| | - Renata Gallagher
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States
| | - Arthur B Zinn
- Center for Human Genetics, University Hospitals Case Medical Center, Cleveland, OH, United States; Center for Inherited Disorders of Energy Metabolism (CIDEM), University Hospitals Case Medical Center, Cleveland, OH, United States
| | - Shawn E McCandless
- Center for Human Genetics, University Hospitals Case Medical Center, Cleveland, OH, United States; Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, United States; Center for Inherited Disorders of Energy Metabolism (CIDEM), University Hospitals Case Medical Center, Cleveland, OH, United States
| | - Charles L Hoppel
- Department of Pharmacology, Case Western Reserve University, Cleveland, OH, United States; Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Stephen I Goodman
- Department of Pediatrics, University of Colorado School of Medicine, Denver, CO, United States
| | - Jirair K Bedoyan
- Center for Human Genetics, University Hospitals Case Medical Center, Cleveland, OH, United States; Genetics and Genome Sciences, Case Western Reserve University, Cleveland, OH, United States; Center for Inherited Disorders of Energy Metabolism (CIDEM), University Hospitals Case Medical Center, Cleveland, OH, United States.
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27
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Abstract
Three cases are described of a reversible encephalopathy, all presenting with marked neurological disturbance. In all three, the diagnosis was not clear at the time of presentation but eventually it was felt all of the cases were consistent with Hashimoto's encephalopathy. The diagnosis of Hashimoto's encephalopathy should be considered in any case of unexplained encephalopathy. Common features are high anti-thyroid peroxidase antibody titres, an abnormal EEC and an elevated CSF protein concentration. The encephalopathy is independent of thyroid hormonal status. Treatment with corticosteroids leads to a prompt resolution of symptoms and long term low dose steroid therapy prevents further neurological recurrence
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Affiliation(s)
- A J Sommerfield
- Department of Diabetes and Endocrinology, Victoria Hospital, Hayfield Road, Kirkcaldy, Scotland
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Wang Q, Yang YL. [Complex heterogeneity phenotypes and genotypes of glutaric aciduria type 1]. Zhongguo Dang Dai Er Ke Za Zhi 2016; 18:460-465. [PMID: 27165598 PMCID: PMC7390359 DOI: 10.7499/j.issn.1008-8830.2016.05.016] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 03/16/2016] [Indexed: 06/05/2023]
Abstract
Glutaric aciduria type 1 is a rare autosomal recessive disorder. GCDH gene mutations cause glutaryl-CoA dehydrogenase deficiency and accumulation of glutaric acid and 3-hydroxyglutaric acid, resulting in damage of striatum and other brain nucleus and neurodegeneration. Patients with glutaric aciduria type 1 present with complex heterogeneous phenotypes and genotypes. The symptoms are extremely variable. The ages of the clinical onset of the patients range from the fetus period to adulthood. The patients with mild glutaric aciduria type 1 are almost asymptomatic before onset, however, severe glutaric aciduria type 1 may cause death or disability due to acute encephalopathy. Acute metabolic crisis in patients with underlying glutaric aciduria type 1 is often triggered by febrile illnesses, trauma, hunger, high-protein foods and vaccination during a vulnerable period of brain development in infancy or early childhood. The early-onset patients usually have a poor prognosis. Urinary organic acids analysis, blood acylcarnitines analysis and GCDH study are important for the diagnosis of this disorder. Neonatal screening is essential for the early diagnosis and the improvement of prognosis.
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Affiliation(s)
- Qiao Wang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China.
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Yamaguchi H, Nakazato M. [Endocrine and Metabolic Emergencies; Points of Initial Management. Topics: V. Hyponatremic encephalopathy]. Nihon Naika Gakkai Zasshi 2016; 105:667-675. [PMID: 27491260 DOI: 10.2169/naika.105.667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Radha Rama Devi A, Ramesh VA, Nagarajaram HA, Satish SPS, Jayanthi U, Lingappa L. Spectrum of mutations in Glutaryl-CoA dehydrogenase gene in glutaric aciduria type I--Study from South India. Brain Dev 2016; 38:54-60. [PMID: 26071121 DOI: 10.1016/j.braindev.2015.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 05/25/2015] [Accepted: 05/26/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Glutaric aciduria type I is an autosomal recessive organic acid disorder. The primary defect is the deficiency of Glutaryl-CoA dehydrogenase (EC number 1.3.99.7) enzyme that is involved in the catabolic pathways of the amino acids l-lysine, l-hydroxylysine, and l-tryptophan. It is a treatable neuro-metabolic disorder. Early diagnosis and treatment helps in preventing brain damage. METHODS The Glutaryl-CoA dehydrogenase gene (GCDH) gene was sequenced to identify disease causing mutations by direct sequencing of all the exons in twelve patients who were biochemically confirmed with GA I. RESULTS We identified eleven mutations of which nine are homozygous mutations, one heterozygous and two synonymous mutations. Among the eleven mutations, four mutations p.Q162R, p.P286S, p.W225X in two families and p.V410M are novel. A milder clinical presentation is observed in those families who are either heterozygous or with a benign synonymous SNP. Multiple sequence alignment (MSA) of GCDH with its homologues revealed that the observed novel mutations are not tolerated by protein structure and function. CONCLUSIONS The present study indicates genetic heterogeneity in GCDH gene mutations among South Indian population. Genetic analysis is useful in prenatal diagnosis and prevention. Mutation analysis is a useful tool in the absence of non-availability of enzyme assay in GA I.
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Affiliation(s)
- A Radha Rama Devi
- Genetic Metabolic Unit, Rainbow Children Hospital, India; Sandor Life Sciences, India.
| | - Vakkalagadda A Ramesh
- Laboratory of Computational Biology, CDFD, Gruhakalpa, Nampally, Hyderabad, India; Graduate Studies, Manipal University, India
| | - H A Nagarajaram
- Laboratory of Computational Biology, CDFD, Gruhakalpa, Nampally, Hyderabad, India
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Kölker S, Garcia-Cazorla A, Valayannopoulos V, Lund AM, Burlina AB, Sykut-Cegielska J, Wijburg FA, Teles EL, Zeman J, Dionisi-Vici C, Barić I, Karall D, Augoustides-Savvopoulou P, Aksglaede L, Arnoux JB, Avram P, Baumgartner MR, Blasco-Alonso J, Chabrol B, Chakrapani A, Chapman K, I Saladelafont EC, Couce ML, de Meirleir L, Dobbelaere D, Dvorakova V, Furlan F, Gleich F, Gradowska W, Grünewald S, Jalan A, Häberle J, Haege G, Lachmann R, Laemmle A, Langereis E, de Lonlay P, Martinelli D, Matsumoto S, Mühlhausen C, de Baulny HO, Ortez C, Peña-Quintana L, Ramadža DP, Rodrigues E, Scholl-Bürgi S, Sokal E, Staufner C, Summar ML, Thompson N, Vara R, Pinera IV, Walter JH, Williams M, Burgard P. The phenotypic spectrum of organic acidurias and urea cycle disorders. Part 1: the initial presentation. J Inherit Metab Dis 2015; 38:1041-57. [PMID: 25875215 DOI: 10.1007/s10545-015-9839-3] [Citation(s) in RCA: 149] [Impact Index Per Article: 16.6] [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: 08/28/2014] [Revised: 01/21/2015] [Accepted: 01/26/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND The clinical presentation of patients with organic acidurias (OAD) and urea cycle disorders (UCD) is variable; symptoms are often non-specific. AIMS/METHODS To improve the knowledge about OAD and UCD the E-IMD consortium established a web-based patient registry. RESULTS We registered 795 patients with OAD (n = 452) and UCD (n = 343), with ornithine transcarbamylase (OTC) deficiency (n = 196), glutaric aciduria type 1 (GA1; n = 150) and methylmalonic aciduria (MMA; n = 149) being the most frequent diseases. Overall, 548 patients (69 %) were symptomatic. The majority of them (n = 463) presented with acute metabolic crisis during (n = 220) or after the newborn period (n = 243) frequently demonstrating impaired consciousness, vomiting and/or muscular hypotonia. Neonatal onset of symptoms was most frequent in argininosuccinic synthetase and lyase deficiency and carbamylphosphate 1 synthetase deficiency, unexpectedly low in male OTC deficiency, and least frequently in GA1 and female OTC deficiency. For patients with MMA, propionic aciduria (PA) and OTC deficiency (male and female), hyperammonemia was more severe in metabolic crises during than after the newborn period, whereas metabolic acidosis tended to be more severe in MMA and PA patients with late onset of symptoms. Symptomatic patients without metabolic crises (n = 94) often presented with a movement disorder, mental retardation, epilepsy and psychiatric disorders (the latter in UCD only). CONCLUSIONS The initial presentation varies widely in OAD and UCD patients. This is a challenge for rapid diagnosis and early start of treatment. Patients with a sepsis-like neonatal crisis and those with late-onset of symptoms are both at risk of delayed or missed diagnosis.
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Affiliation(s)
- Stefan Kölker
- Department of General Pediatrics, Division of Inherited Metabolic Diseases, University Children's Hospital Heidelberg, Im Neuenheimer Feld 430, D-69120, Heidelberg, Germany.
| | | | - Vassili Valayannopoulos
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Reference Center for Inherited Metabolic Disease, Necker-Enfants Malades University Hospital and IMAGINE Institute, Paris, France
| | - Allan M Lund
- Centre for Inherited Metabolic Diseases, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Alberto B Burlina
- U.O.C. Malattie Metaboliche Ereditarie, Azienda Ospedaliera di Padova, Padova, Italy
| | | | - Frits A Wijburg
- Department of Pediatrics, Academisch Medisch Centrum, Amsterdam, Netherlands
| | - Elisa Leão Teles
- Unidade de Doenças Metabólicas, Serviço de Pediatria, Hospital de S. João, EPE, Porto, Portugal
| | - Jiri Zeman
- First Faculty of Medicine, Charles University and General University of Prague, Prague, Czech Republic
| | - Carlo Dionisi-Vici
- U.O.C. Patologia Metabolica, Ospedale Pediatrico Bambino Gésu, Rome, Italy
| | - Ivo Barić
- School of Medicine, University Hospital Center Zagreb and University of Zagreb, Zagreb, Croatia
| | - Daniela Karall
- Clinic for Pediatrics I, Inherited Metabolic Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Lise Aksglaede
- Centre for Inherited Metabolic Diseases, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jean-Baptiste Arnoux
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Reference Center for Inherited Metabolic Disease, Necker-Enfants Malades University Hospital and IMAGINE Institute, Paris, France
| | - Paula Avram
- Institute of Mother and Child Care "Alfred Rusescu", Bucharest, Romania
| | - Matthias R Baumgartner
- Division of Metabolism and Children's Research Centre, University Children's Hospital Zurich, Steinwiesstraße 75, CH-8032, Zurich, Switzerland
| | | | - Brigitte Chabrol
- Centre de Référence des Maladies Héréditaires du Métabolisme, Service de Neurologie, Hôpital d'Enfants, CHU Timone, Marseilles, France
| | - Anupam Chakrapani
- Birmingham Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Kimberly Chapman
- Children's National Medical Center, 111 Michigan Avenue, N.W., Washington, DC, 20010, USA
| | | | - Maria L Couce
- Metabolic Unit, Department of Pediatrics, Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Dries Dobbelaere
- Centre de Référence des Maladies Héréditaires du Métabolisme de l'Enfant et de l'Adulte, Hôpital Jeanne de Flandre, Lille, France
| | - Veronika Dvorakova
- First Faculty of Medicine, Charles University and General University of Prague, Prague, Czech Republic
| | - Francesca Furlan
- U.O.C. Malattie Metaboliche Ereditarie, Azienda Ospedaliera di Padova, Padova, Italy
| | - Florian Gleich
- Department of General Pediatrics, Division of Inherited Metabolic Diseases, University Children's Hospital Heidelberg, Im Neuenheimer Feld 430, D-69120, Heidelberg, Germany
| | - Wanda Gradowska
- Department of Laboratory Diagnostics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Stephanie Grünewald
- Metabolic Unit Great Ormond Street Hospital and Institute for Child Health, University College London, London, UK
| | - Anil Jalan
- N.I.R.M.A.N., Om Rachna Society, Vashi, Navi Mumbai, Mumbai, India
| | - Johannes Häberle
- Division of Metabolism and Children's Research Centre, University Children's Hospital Zurich, Steinwiesstraße 75, CH-8032, Zurich, Switzerland
| | - Gisela Haege
- Department of General Pediatrics, Division of Inherited Metabolic Diseases, University Children's Hospital Heidelberg, Im Neuenheimer Feld 430, D-69120, Heidelberg, Germany
| | - Robin Lachmann
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - Alexander Laemmle
- Division of Metabolism and Children's Research Centre, University Children's Hospital Zurich, Steinwiesstraße 75, CH-8032, Zurich, Switzerland
| | - Eveline Langereis
- Department of Pediatrics, Academisch Medisch Centrum, Amsterdam, Netherlands
| | - Pascale de Lonlay
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Reference Center for Inherited Metabolic Disease, Necker-Enfants Malades University Hospital and IMAGINE Institute, Paris, France
| | - Diego Martinelli
- U.O.C. Patologia Metabolica, Ospedale Pediatrico Bambino Gésu, Rome, Italy
| | - Shirou Matsumoto
- Department of Pediatrics, Kumamoto University Hospital, Kumamoto City, Japan
| | - Chris Mühlhausen
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Carlos Ortez
- Servicio de Neurologia and CIBERER, ISCIII, Hospital San Joan de Deu, Barcelona, Spain
| | - Luis Peña-Quintana
- Hospital Universitario Materno-Infantil de Canarias, Unit of Pediatric Gastroenterology, Hepatology and Nutrition, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | - Esmeralda Rodrigues
- Unidade de Doenças Metabólicas, Serviço de Pediatria, Hospital de S. João, EPE, Porto, Portugal
| | - Sabine Scholl-Bürgi
- Clinic for Pediatrics I, Inherited Metabolic Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | - Etienne Sokal
- Service Gastroentérologie and Hépatologie Pédiatrique, Cliniques Universitaires St Luc, Université Catholique de Louvain, Bruxelles, Belgium
| | - Christian Staufner
- Department of General Pediatrics, Division of Inherited Metabolic Diseases, University Children's Hospital Heidelberg, Im Neuenheimer Feld 430, D-69120, Heidelberg, Germany
| | - Marshall L Summar
- Children's National Medical Center, 111 Michigan Avenue, N.W., Washington, DC, 20010, USA
| | - Nicholas Thompson
- Metabolic Unit Great Ormond Street Hospital and Institute for Child Health, University College London, London, UK
| | - Roshni Vara
- Evelina Children's Hospital, St Thomas' Hospital, London, UK
| | | | - John H Walter
- Manchester Academic Health Science Centre, Willink Biochemical Genetics Unit, Genetic Medicine, University of Manchester, Manchester, UK
| | - Monique Williams
- Erasmus MC-Sophia Kinderziekenhuis, Erasmus Universiteit Rotterdam, Rotterdam, Netherlands
| | - Peter Burgard
- Department of General Pediatrics, Division of Inherited Metabolic Diseases, University Children's Hospital Heidelberg, Im Neuenheimer Feld 430, D-69120, Heidelberg, Germany
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Kölker S, Valayannopoulos V, Burlina AB, Sykut-Cegielska J, Wijburg FA, Teles EL, Zeman J, Dionisi-Vici C, Barić I, Karall D, Arnoux JB, Avram P, Baumgartner MR, Blasco-Alonso J, Boy SPN, Rasmussen MB, Burgard P, Chabrol B, Chakrapani A, Chapman K, Cortès I Saladelafont E, Couce ML, de Meirleir L, Dobbelaere D, Furlan F, Gleich F, González MJ, Gradowska W, Grünewald S, Honzik T, Hörster F, Ioannou H, Jalan A, Häberle J, Haege G, Langereis E, de Lonlay P, Martinelli D, Matsumoto S, Mühlhausen C, Murphy E, de Baulny HO, Ortez C, Pedrón CC, Pintos-Morell G, Pena-Quintana L, Ramadža DP, Rodrigues E, Scholl-Bürgi S, Sokal E, Summar ML, Thompson N, Vara R, Pinera IV, Walter JH, Williams M, Lund AM, Garcia-Cazorla A. The phenotypic spectrum of organic acidurias and urea cycle disorders. Part 2: the evolving clinical phenotype. J Inherit Metab Dis 2015; 38:1059-74. [PMID: 25875216 DOI: 10.1007/s10545-015-9840-x] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [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: 08/28/2014] [Revised: 01/21/2015] [Accepted: 01/26/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND The disease course and long-term outcome of patients with organic acidurias (OAD) and urea cycle disorders (UCD) are incompletely understood. AIMS To evaluate the complex clinical phenotype of OAD and UCD patients at different ages. RESULTS Acquired microcephaly and movement disorders were common in OAD and UCD highlighting that the brain is the major organ involved in these diseases. Cardiomyopathy [methylmalonic (MMA) and propionic aciduria (PA)], prolonged QTc interval (PA), optic nerve atrophy [MMA, isovaleric aciduria (IVA)], pancytopenia (PA), and macrocephaly [glutaric aciduria type 1 (GA1)] were exclusively found in OAD patients, whereas hepatic involvement was more frequent in UCD patients, in particular in argininosuccinate lyase (ASL) deficiency. Chronic renal failure was often found in MMA, with highest frequency in mut(0) patients. Unexpectedly, chronic renal failure was also observed in adolescent and adult patients with GA1 and ASL deficiency. It had a similar frequency in patients with or without a movement disorder suggesting different pathophysiology. Thirteen patients (classic OAD: 3, UCD: 10) died during the study interval, ten of them during the initial metabolic crisis in the newborn period. Male patients with late-onset ornithine transcarbamylase deficiency were presumably overrepresented in the study population. CONCLUSIONS Neurologic impairment is common in OAD and UCD, whereas the involvement of other organs (heart, liver, kidneys, eyes) follows a disease-specific pattern. The identification of unexpected chronic renal failure in GA1 and ASL deficiency emphasizes the importance of a systematic follow-up in patients with rare diseases.
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Affiliation(s)
- Stefan Kölker
- Department of General Pediatrics, Division of Inherited Metabolic Diseases, University Children's Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.
| | - Vassili Valayannopoulos
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Reference Center for Inherited Metabolic Disease, Necker-Enfants Malades University Hospital and IMAGINE Institute, Paris, France
| | - Alberto B Burlina
- Azienda Ospedaliera di Padova, U.O.C. Malattie Metaboliche Ereditarie, Padova, Italy
| | | | - Frits A Wijburg
- Department of Pediatrics, Academisch Medisch Centrum, Amsterdam, Netherlands
| | - Elisa Leão Teles
- Unidade de Doenças Metabólicas, Serviço de Pediatria, Hospital de S. João, EPE, Porto, Portugal
| | - Jiri Zeman
- First Faculty of Medicine Charles University and General University of Prague, Prague, Czech Republic
| | - Carlo Dionisi-Vici
- Ospedale Pediatrico Bambino Gésu, U.O.C. Patologia Metabolica, Rome, Italy
| | - Ivo Barić
- School of Medicine University Hospital Center Zagreb and University of Zagreb, Zagreb, Croatia
| | - Daniela Karall
- Medical University of Innsbruck, Clinic for Pediatrics I, Inherited Metabolic Disorders, Innsbruck, Austria
| | - Jean-Baptiste Arnoux
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Reference Center for Inherited Metabolic Disease, Necker-Enfants Malades University Hospital and IMAGINE Institute, Paris, France
| | - Paula Avram
- Institute of Mother and Child Care "Alfred Rusescu", Bucharest, Romania
| | - Matthias R Baumgartner
- Division of Metabolism and Children's Research Centre, University Children's Hospital Zurich, Steinwiesstraße 75, 8032, Zurich, Switzerland
| | | | - S P Nikolas Boy
- Department of General Pediatrics, Division of Inherited Metabolic Diseases, University Children's Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Marlene Bøgehus Rasmussen
- Centre for Inherited Metabolic Diseases, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Peter Burgard
- Department of General Pediatrics, Division of Inherited Metabolic Diseases, University Children's Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Brigitte Chabrol
- Centre de Référence des Maladies Héréditaires du Métabolisme, Service de Neurologie, Hôpital d'Enfants, CHU Timone, Marseilles, France
| | - Anupam Chakrapani
- Birmingham Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK
| | - Kimberly Chapman
- Children's National Medical Center, 111 Michigan Avenue, N.W., Washington, DC, 20010, USA
| | | | - Maria L Couce
- Metabolic Unit, Department of Pediatrics, Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Dries Dobbelaere
- Centre de Référence des Maladies Héréditaires du Métabolisme de l'Enfant et de l'Adulte, Hôpital Jeanne de Flandre, Lille, France
| | - Francesca Furlan
- Azienda Ospedaliera di Padova, U.O.C. Malattie Metaboliche Ereditarie, Padova, Italy
| | - Florian Gleich
- Department of General Pediatrics, Division of Inherited Metabolic Diseases, University Children's Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | | | - Wanda Gradowska
- Department of Laboratory Diagnostics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Stephanie Grünewald
- Metabolic Unit Great Ormond Street Hospital and Institute for Child Health, University College London, London, UK
| | - Tomas Honzik
- First Faculty of Medicine Charles University and General University of Prague, Prague, Czech Republic
| | - Friederike Hörster
- Department of General Pediatrics, Division of Inherited Metabolic Diseases, University Children's Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Hariklea Ioannou
- 1st Pediatric Department, Metabolic Laboratory, General Hospital of Thessaloniki 'Hippocration', Thessaloniki, Greece
| | - Anil Jalan
- N.I.R.M.A.N., Om Rachna Society, Vashi, Navi Mumbai, Mumbai, India
| | - Johannes Häberle
- Division of Metabolism and Children's Research Centre, University Children's Hospital Zurich, Steinwiesstraße 75, 8032, Zurich, Switzerland
| | - Gisela Haege
- Department of General Pediatrics, Division of Inherited Metabolic Diseases, University Children's Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Eveline Langereis
- Department of Pediatrics, Academisch Medisch Centrum, Amsterdam, Netherlands
| | - Pascale de Lonlay
- Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Reference Center for Inherited Metabolic Disease, Necker-Enfants Malades University Hospital and IMAGINE Institute, Paris, France
| | - Diego Martinelli
- Ospedale Pediatrico Bambino Gésu, U.O.C. Patologia Metabolica, Rome, Italy
| | - Shirou Matsumoto
- Department of Pediatrics, Kumamoto University Hospital, Kumamoto City, Japan
| | - Chris Mühlhausen
- Universitätsklinikum Hamburg-Eppendorf, Klinik für Kinder- und Jugendmedizin, Hamburg, Germany
| | - Elaine Murphy
- National Hospital for Neurology and Neurosurgery, Charles Dent Metabolic Unit, London, UK
| | | | - Carlos Ortez
- Hospital San Joan de Deu, Servicio de Neurologia and CIBERER, ISCIII, Barcelona, Spain
| | - Consuelo C Pedrón
- Department of Pediatrics, Metabolic Diseases Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Guillem Pintos-Morell
- Department of Pediatrics, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | | | | | - Esmeralda Rodrigues
- Unidade de Doenças Metabólicas, Serviço de Pediatria, Hospital de S. João, EPE, Porto, Portugal
| | - Sabine Scholl-Bürgi
- Medical University of Innsbruck, Clinic for Pediatrics I, Inherited Metabolic Disorders, Innsbruck, Austria
| | - Etienne Sokal
- Cliniques Universitaires St Luc, Université Catholique de Louvain, Service Gastroentérologie and Hépatologie Pédiatrique, Bruxelles, Belgium
| | - Marshall L Summar
- Children's National Medical Center, 111 Michigan Avenue, N.W., Washington, DC, 20010, USA
| | - Nicholas Thompson
- Metabolic Unit Great Ormond Street Hospital and Institute for Child Health, University College London, London, UK
| | - Roshni Vara
- Evelina Children's Hospital, St Thomas' Hospital, London, United Kingdom
| | | | - John H Walter
- Manchester Academic Health Science Centre, University of Manchester, Willink Biochemical Genetics Unit, Genetic Medicine, Manchester, UK
| | - Monique Williams
- Erasmus MC-Sophia Kinderziekenhuis, Erasmus Universiteit Rotterdam, Rotterdam, Netherlands
| | - Allan M Lund
- Centre for Inherited Metabolic Diseases, Department of Clinical Genetics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Mohammad SA, Abdelkhalek HS, Ahmed KA, Zaki OK. Glutaric aciduria type 1: neuroimaging features with clinical correlation. Pediatr Radiol 2015; 45:1696-705. [PMID: 26111870 DOI: 10.1007/s00247-015-3395-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Revised: 04/16/2015] [Accepted: 05/20/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Glutaric aciduria type 1 is a rare neurometabolic disease with high morbidity. OBJECTIVE To describe the MR imaging abnormalities in glutaric aciduria type 1 and to identify any association between the clinical and imaging features. MATERIALS AND METHODS MRI scans of 29 children (mean age: 16.9 months) with confirmed diagnosis of glutaric aciduria type 1 were retrospectively reviewed. Gray matter and white matter scores were calculated based on a previously published pattern-recognition approach of assessing leukoencephalopathies. Hippocampal formation and opercular topography were assessed in relation to the known embryological basis. MRI scores were correlated with morbidity score. RESULTS The most consistent MRI abnormality was widened operculum with dilatation of the subarachnoid spaces surrounding underdeveloped frontotemporal lobes. Incomplete hippocampal inversion was also seen. The globus pallidus was the most frequently involved gray matter structure (86%). In addition to the central tegmental tract, white matter abnormalities preferentially involved the central and periventricular regions. The morbidity score correlated with the gray matter abnormality score (P = 0.004). Patients with dystonia had higher gray matter and morbidity scores. CONCLUSION Morbidity is significantly correlated with abnormality of gray matter, rather than white matter, whether secondary to acute encephalopathic crisis or insidious onset disease.
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Affiliation(s)
- Shaimaa Abdelsattar Mohammad
- Department of Radiodiagnosis, Faculty of Medicine, Ain-Shams University, 9 Ain-Shams university staff buildings, Lotfi Elsayed St., Cairo, Egypt, 11657.
| | - Heba Salah Abdelkhalek
- Medical Genetics Unit, Pediatric Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Khaled A Ahmed
- Department of Radiodiagnosis, Faculty of Medicine, Ain-Shams University, 9 Ain-Shams university staff buildings, Lotfi Elsayed St., Cairo, Egypt, 11657
| | - Osama K Zaki
- Medical Genetics Unit, Pediatric Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
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Harting I, Boy N, Heringer J, Seitz A, Bendszus M, Pouwels PJW, Kölker S. (1)H-MRS in glutaric aciduria type 1: impact of biochemical phenotype and age on the cerebral accumulation of neurotoxic metabolites. J Inherit Metab Dis 2015; 38:829-38. [PMID: 25860816 DOI: 10.1007/s10545-015-9826-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [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: 12/16/2014] [Revised: 02/01/2015] [Accepted: 02/10/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND In glutaric aciduria type 1 (GA1) the neurotoxic metabolites glutaric acid (GA) and 3-hydroxyglutaric acid (3-OH-GA) accumulate within the brain. Due to limited efflux across the blood-brain-barrier biochemical monitoring of intracerebrally accumulating toxic metabolites is as yet not possible. AIMS To investigate brain metabolic patterns in glutaric aciduria type 1 using (1)H magnetic resonance spectroscopy ((1)H-MRS) with focus on detecting the disease-related neurotoxic metabolites GA and 3-OH-GA. PATIENTS AND METHODS Short echo time (1)H-MRS was performed in 13 treated metabolically stable patients. Twenty-one white matter and 16 basal ganglia spectra from 12 patients (age range 7 months - 22 years) were included. Subgroups based on age, biochemical phenotype and/or associated MRI changes were compared with control spectra. RESULTS GA was elevated in white matter of patients. 3-OH-GA was elevated in white matter of older patients with associated signal changes on MRI, which was structurally characterized by decreased creatine and phosphocreatine (tCr) and elevated choline (Cho). Metabolite changes differed with biochemical phenotype and disease duration: Low excretors with up to 30% residual enzyme activity had only mildly, non-significantly elevated GA and mildly subnormal N-acetylaspartate (tNAA). High excretors with complete lack of enzyme activity had significantly increased GA, tNAA was mildly subnormal in younger and decreased in older high excretors. CONCLUSIONS GA and 3-OH-GA are detectable by in vivo (1)H-MRS, which might finally allow biochemical follow-up monitoring of intracerebrally accumulating neurotoxic metabolites in GA1. A high excreting phenotype appears to be a risk factor for cerebral GA accumulation and progressive neuroaxonal compromise despite a similar clinical course in younger high and low excreting patients. This might have consequences for long-term outcome.
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Affiliation(s)
- Inga Harting
- Department of Neuroradiology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, D-69120, Heidelberg, Germany,
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Bonnot O, Herrera P, Kuster A. [Treatable neurometabolic diseases. Association with schizophrenia spectrum disorders]. Presse Med 2015; 44:889-97. [PMID: 26248708 DOI: 10.1016/j.lpm.2015.02.023] [Citation(s) in RCA: 2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 02/10/2015] [Accepted: 02/17/2015] [Indexed: 11/18/2022] Open
Abstract
Schizophrenia spectrum disorders are presented on 1% of subjects over general population. Organic pathologies prevalence in schizophrenia spectrum patients is not well determined, and it is probably underestimated. In the present update review, we are going to highlight seven treatable neurometabolic diseases (NMD) associated to sub-clinic neurological symptoms. It is not infrequent to witness the absence of any clinical neurological signs going along with the NMD. Psychiatric symptoms may be the only clinical alarm that can guide physicians to an acute diagnosis. This is why it is a challenging pathology, defying our clinical accuracy as psychiatrist or any other practitioners confronted to this population. Hereby we are going to expose a literature review and comprehensive tables in order to present in a glance the essential clinical features of disorders of homocysteine metabolism, urea cycle disorders, Niemann-Pick disease type C, acute porphyria, cerebrotendinous-xanthomatosis. These conditions are sensible to major improvement strongly correlated to the accuracy of diagnosis. Literature analysis led us to propose a comprehensive list of atypical psychiatric symptoms including highly predominant visual hallucinations, compared to auditory ones, as well as confusion, catatonia or progressive cognitive decline. We highlight the importance of considering antipsychotic treatment resistance as a crucial sign leading to suspect an organic factor beneath the psychiatric features.
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Affiliation(s)
- Olivier Bonnot
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, CHU de Nantes, université de Nantes, 44093 Nantes, France.
| | - Paula Herrera
- Service universitaire de psychiatrie de l'enfant et de l'adolescent, CHU de Nantes, université de Nantes, 44093 Nantes, France; Service de pédiatrie, centre hospitalier universitaire de Nantes, Nantes, France
| | - Alice Kuster
- Service de pédiatrie, centre hospitalier universitaire de Nantes, Nantes, France
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Shah UA, Henderson MC, Abourjaily P, Thaler D, Rencic J. Exercises in clinical reasoning: a confusing interaction. J Gen Intern Med 2015; 30:860-3. [PMID: 25623299 PMCID: PMC4441680 DOI: 10.1007/s11606-014-3173-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 12/18/2014] [Accepted: 12/30/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Urvi A. Shah
- />Department of Internal Medicine, Tufts Medical Center, 800 Washington Street, Boston, 02111 USA
| | - Mark C. Henderson
- />Department of Internal Medicine, University of California Davis Medical Center, Sacramento, 95817 USA
| | - Paul Abourjaily
- />Department of Internal Medicine, Tufts Medical Center, 800 Washington Street, Boston, 02111 USA
| | - David Thaler
- />Department of Neurology, Tufts Medical Center, 800 Washington Street, Boston, 02111 USA
| | - Joseph Rencic
- />Department of Internal Medicine, Tufts Medical Center, 800 Washington Street, Boston, 02111 USA
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Kurtcan S, Aksu B, Alkan A, Guler S, Iscan A. MRS features during encephalopathic crisis period in 11 years old case with GA-1. Brain Dev 2015; 37:546-51. [PMID: 25277297 DOI: 10.1016/j.braindev.2014.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 11/18/2022]
Abstract
Glutaric aciduria type-1 (GA-1) is a disorder of amino acid metabolism. The usual clinical-onset is an acute encephalopathic crisis in early childhood. There are only a few cases diagnosed in older age groups. MRI features of the disease are well defined. However, there are limited number of studies concerning advanced neuroimaging findings. We present DWI and MRS findings of an 11 year-old GA-1 patient admitted with an encephalopathic crisis. Diffusion restrictions in bilateral basal ganglia, corpus callosum and periventricular deep white matter were observed. In left occipital periventricular white matter and left basal ganglia, mild increased Cho/Cr and MI/Cr ratios and decreased NAA/Cr ratio were detected. Also inverted double lactate peak (TE: 135 ms) was present at 1.33 ppm in the left basal ganglia. In addition to these findings, a peak at 1.56 ppm above the baseline was seen on both short and long echo-time MRS in left occipital lobe deep white matter which may show accumulation of degradation products of amino acids in the GCDH enzyme deficiency.
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Affiliation(s)
- Serpil Kurtcan
- Department of Radiology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey.
| | - Banu Aksu
- Department of Radiology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey
| | - Alpay Alkan
- Department of Radiology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey
| | - Serhat Guler
- Department of Pediatric Neurology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey
| | - Akin Iscan
- Department of Pediatric Neurology, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey
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Badve MS, Bhuta S, Mcgill J. Rare presentation of a treatable disorder: glutaric aciduria type 1. N Z Med J 2015; 128:61-64. [PMID: 25721963] [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: 06/04/2023]
Abstract
A 32-year-old female patient presented with migraine and a bipolar disorder with frontal lobe dysfunction and bilateral pyramidal tract signs on examination. MRI brain revealed confluent bilateral symmetric white matter signal abnormality on T2 and FLAIR images with mild cerebral atrophy. Classic widening of Sylvian fissures and CSF space anterior to temporal lobes was seen. In view of the clinical and radiologic findings suggestive of a leukodystrophy, she was investigated for the same. Her investigations revealed an high level of urinary glutaric acid 857 mmol/mol creatinine (normal <4mmol/mol creatinine) and 3-hydroxyglutaric acid 44 mmol/mol creatinine (normal <1 mmol/mol creatinine) and plasma glutaryl carnitine 1.2 micromol/L; (normal <0.34 micromol/L). This was diagnostic of glutaric aciduria type 1. She was started on L-carnitine with which she showed clinical improvement. Testing for urinary organic acids is important when looking for treatable metabolic disorders (such as glutaric aciduria type I) in patients with leukodystrophy.
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Affiliation(s)
- Monica S Badve
- Gold Coast University Hospital, Level 5, A-Block, 1 Hospital Boulevard, Southport, QLD 4215, Australia.
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Newborn screening programme expanded. Community Pract 2015; 88:5. [PMID: 25720200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Abstract
ABSTRACT:Background:Triphasic waves (TWs) and generalized nonconvulsive status epilepticus (GNCSE) share morphological features that may create diagnostic ambiguity.Objective::To describe electroencephalographic differences between TWs and GNCSE.Methods:We retrospectively compared the electroencephalograms (EEGs) of two groups of patients presenting with decreased level of consciousness; those with TWs associated with metabolic encephalopathy and those with GNCSE. We studied the following: demographics, etiology and EEG morphological features. All EEGs were classified blindly (TWs or GNCSE) by two expert EEGers. Agreement between experts and concordance with clinical diagnosis were measured.Results:We analysed 87 EEGs (71 patients) with TWs and 27 EEGs (13 patients) with GNCSE. Agreement between experts and concordance with clinical diagnosis were excellent. When compared to TWs, epileptiform discharges associated with GNCSE had a higher frequency (mean=2.4Hz vs 1.8Hz) (p<0.001), a shorter duration of phase one (p=0.001), extra-spikes components (69% vs 0%) (p<0.001) and less generalized background slowing (15.1% vs 91.1%) (p<0.001). Amplitude predominance of phase two was common with TWs (40.8% vs 0%) (p=0.01). Lag of phase two was absent in all cases of GNCSE but present in 40.8% of patients with TWs. Noxious or auditory stimulation frequently increased the TWs (51%) while it had no effect on the epileptiform pattern (p=0.008).Conclusion:Certain EEG morphological criteria and the response to stimulation are very helpful in distinguishing TWs from GNCSE.
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Affiliation(s)
- Jean-Martin Boulanger
- Department of Neurology, Centre Hospitalier Universitaire de Sherbrooke, Quebec, Canada
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Estrella J, Wilcken B, Carpenter K, Bhattacharya K, Tchan M, Wiley V. Expanded newborn screening in New South Wales: missed cases. J Inherit Metab Dis 2014; 37:881-7. [PMID: 24970580 DOI: 10.1007/s10545-014-9727-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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: 03/26/2014] [Revised: 04/10/2014] [Accepted: 05/19/2014] [Indexed: 10/25/2022]
Abstract
There have been few reports of cases missed by expanded newborn screening. Tandem mass spectrometry was introduced in New South Wales, Australia in 1998 to screen for selected disorders of amino acid, organic acid and fatty acid metabolism. Of 1,500,000 babies screened by 2012, 1:2700 were diagnosed with a target disorder. Fifteen affected babies were missed by testing, and presented clinically or in family studies. In three cases (cobalamin C defect, very-long-chain acyl-CoA dehydrogenase deficiency and glutaric aciduria type 1), this led to modification of analyte cut-off values or protocols during the first 3 years. Two patients with intermittent MSUD, two with β-ketothiolase deficiency, two with citrin deficiency, two siblings with arginosuccinic aciduria, two siblings with homocystinuria, and one with cobalamin C defect had analyte values and ratios below the action limits which could not have been detected without unacceptable false-positive rates. A laboratory interpretation error led to missing one case of cobalamin C defect. Reference ranges, regularly reviewed, were not altered. For citrin deficiency, while relevant metabolites are detectable by tandem mass spectrometry, our cut-off values do not specifically screen for that disorder. Most of the missed cases are doing well and with no acute presentations although eight of 15 are likely to have been somewhat adversely affected by a late diagnosis. Analyte ratio and cut-off value optimisations are important, but for some disorders occasional missed cases may have to be tolerated to maintain an acceptable specificity, and avoid harm from screening.
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Affiliation(s)
- Jane Estrella
- Department of Medical Genetics Westmead Hospital, Sydney, Australia
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Garbade SF, Greenberg CR, Demirkol M, Gökçay G, Ribes A, Campistol J, Burlina AB, Burgard P, Kölker S. Unravelling the complex MRI pattern in glutaric aciduria type I using statistical models-a cohort study in 180 patients. J Inherit Metab Dis 2014; 37:763-73. [PMID: 24810368 DOI: 10.1007/s10545-014-9676-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 07/16/2013] [Revised: 01/02/2014] [Accepted: 01/13/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Glutaric aciduria type I (GA-I) is a cerebral organic aciduria caused by inherited deficiency of glutaryl-CoA dehydrogenase and is characterized biochemically by an accumulation of putatively neurotoxic dicarboxylic metabolites. The majority of untreated patients develops a complex movement disorder with predominant dystonia during age 3-36 months. Magnetic resonance imaging (MRI) studies have demonstrated striatal and extrastriatal abnormalities. AIMS/METHODS The major aim of this study was to elucidate the complex neuroradiological pattern of patients with GA-I and to associate the MRI findings with the severity of predominant neurological symptoms. In 180 patients, detailed information about the neurological presentation and brain region-specific MRI abnormalities were obtained via a standardized questionnaire. RESULTS Patients with a movement disorder had more often MRI abnormalities in putamen, caudate, cortex, ventricles and external CSF spaces than patients without or with minor neurological symptoms. Putaminal MRI changes and strongly dilated ventricles were identified as the most reliable predictors of a movement disorder. In contrast, abnormalities in globus pallidus were not clearly associated with a movement disorder. Caudate and putamen as well as cortex, ventricles and external CSF spaces clearly collocalized on a two-dimensional map demonstrating statistical similarity and suggesting the same underlying pathomechanism. CONCLUSIONS This study demonstrates that complex statistical methods are useful to decipher the age-dependent and region-specific MRI patterns of rare neurometabolic diseases and that these methods are helpful to elucidate the clinical relevance of specific MRI findings.
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Affiliation(s)
- Sven F Garbade
- SFG: Faculty of Applied Psychology, SRH University of Applied Sciences, Heidelberg, Germany
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Akella RRD, Aoyama Y, Mori C, Lingappa L, Cariappa R, Fukao T. Metabolic encephalopathy in beta-ketothiolase deficiency: the first report from India. Brain Dev 2014; 36:537-40. [PMID: 23958592 DOI: 10.1016/j.braindev.2013.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 07/22/2013] [Accepted: 07/22/2013] [Indexed: 01/11/2023]
Abstract
Beta-ketothiolase deficiency, or mitochondrial acetoacetyl-CoA thiolase (T2) deficiency, is a rare autosomal recessive disorder affecting isoleucine catabolism and ketone body metabolism. A patient from South India presented with acute ketoacidosis at 11 months of age. During the acute crisis the C5OH (2-methyl-3-hydroxybutyryl) carnitine and C5:1 (tiglyl) carnitine were elevated and large amounts of 2-methyl-3-hydroxybutyrate, tiglylglycine, and 2-methylacetoacetate were excreted. Brain CT showed bilateral basal ganglia lesions. Potassium ion-activated acetoacetyl-CoA thiolase activity was deficient in the patient's fibroblasts. The patient is a homozygote for a novel c.578T>G (M193R) mutation. This is the first report of T2 deficiency confirmed by enzyme and molecular analysis from India.
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Affiliation(s)
- Radha Rama Devi Akella
- Department of Pediatric Neurology and Metabolic Medicine, Rainbow Hospital for Women and Children, Hyderabad, India
| | - Yuka Aoyama
- Medical Information Sciences Division, United Graduate School of Drug Discovery and Medical Information Sciences, Gifu University, Gifu, Japan
| | - Chihiro Mori
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Lokesh Lingappa
- Department of Pediatric Neurology and Metabolic Medicine, Rainbow Hospital for Women and Children, Hyderabad, India
| | | | - Toshiyuki Fukao
- Medical Information Sciences Division, United Graduate School of Drug Discovery and Medical Information Sciences, Gifu University, Gifu, Japan; Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan.
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Wang Q, Ding Y, Liu Y, Li X, Wu T, Song J, Wang Y, Yang Y. [Clinical and laboratory studies on 28 patients with glutaric aciduria type 1]. Zhonghua Er Ke Za Zhi 2014; 52:415-419. [PMID: 25190159] [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: 06/03/2023]
Abstract
OBJECTIVE To investigate the clinical, biochemical and genetic profiles of 28 Chinese patients with glutaric aciduria type 1. METHOD Twenty-eight patients with glutaric aciduria type 1 seen in the Department of Pediatrics, Peking University First Hospital from July 2003 to October 2013 were studied. The data of clinical course, laboratory examinations, cranial MRI and GCDH gene mutations of the patients were analyzed. RESULT (1) Three cases were detected by newborn screening, and the other patients were diagnosed at the age of 2 months to 17 years. (2) 22 patients (79%) were infant onset cases with psychomotor retardation, dystonia, seizures, athetosis, recurrent vomiting, drowsiness or feeding difficulty. Only two of the 22 patients with infant onset got normal intelligence and movement after treatment. Twenty of them were improved slowly with delayed development, dystonia and other neurological problems. Three patients (11%) had late onset. They had motor regression, headache and seizure at the age of 8, 9 and 17 years, respectively. Rapid improvement was observed after treatment. (3) Cranial MRI has been checked in 23 patients; 22 of them showed characteristic widening of the Sylvian fissure, abnormalities of the basal ganglia, leukoencephalopathy and brain atrophy. Thirty-five mutations in GCDH gene of the patients were identified; c.148T>C (p.W50R) was the most common mutation with the frequency of 7.7%; 6 mutations (c.628A>G, c.700C>T, c.731G>T, c.963G>C, c.1031C>T and c.1109T>C) were novel. CONCLUSION Glutaric aciduria type 1 usually induced neurological deterioration resulting in severe psychomotor retardation and dystonia. Most of our patients were clinically diagnosed. Patients with early onset usually remained having neurological damage. Phenotype and genotype correlation has not been found in the patients. Neonatal screening for organic acidurias should be expanded in China.
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Affiliation(s)
- Qiao Wang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Yuan Ding
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Yupeng Liu
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Xiyuan Li
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Tongfei Wu
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Jinqing Song
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Yujie Wang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
| | - Yanling Yang
- Department of Pediatrics, Peking University First Hospital, Beijing 100034, China.
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Szymańska K, Szczałuba K, Ługowska A, Obersztyn E, Radkowski M, Nowakowska BA, Kuśmierska K, Tryfon J, Demkow U. The analysis of genetic aberrations in children with inherited neurometabolic and neurodevelopmental disorders. Biomed Res Int 2014; 2014:424796. [PMID: 24949445 PMCID: PMC4052700 DOI: 10.1155/2014/424796] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/11/2014] [Accepted: 04/16/2014] [Indexed: 02/05/2023]
Abstract
Inherited encephalopathies include a broad spectrum of heterogeneous disorders. To provide a correct diagnosis, an integrated approach including genetic testing is warranted. We report seven patients with difficult to diagnose inborn paediatric encephalopathies. The diagnosis could not be attained only by means of clinical and laboratory investigations and MRI. Additional genetic testing was required. Cytogenetics, PCR based tests, and array-based comparative genome hybridization were performed. In 4 patients with impaired language abilities we found the presence of microduplication in the region 16q23.1 affecting two dose-sensitive genes: WWOX (OMIM 605131) and MAF (OMIM 177075) (1 case), an interstitial deletion of the 17p11.2 region (2 patients further diagnosed as Smith-Magenis syndrome), and deletion encompassing first three exons of Myocyte Enhancer Factor gene 2MEF2C (1 case). The two other cases represented progressing dystonia. Characteristic GAG deletion in DYT1 consistently with the diagnosis of torsion dystonia was confirmed in 1 case. Last enrolled patient presented with clinical picture consistent with Krabbe disease confirmed by finding of two pathogenic variants of GALC gene and the absence of mutations in PSAP. The integrated diagnostic approach including genetic testing in selected examples of complicated hereditary diseases of the brain is largely discussed in this paper.
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Affiliation(s)
- Krystyna Szymańska
- Department of Clinical and Experimental Neuropathology, Mossakowski Medical Research Centre, Polish Academy of Sciences, 02-106 Warsaw, Poland
- Department of Child Psychiatry, Medical University of Warsaw, 00-576 Warsaw, Poland
| | - Krzysztof Szczałuba
- GenCentrum (Regional Center for Clinical Genetics and Modern Technologies), 25-375 Kielce, Poland
| | - Agnieszka Ługowska
- Department of Genetics, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland
| | - Ewa Obersztyn
- Department of Medical Genetics, Institute of Mother and Child, 01-211 Warsaw, Poland
| | - Marek Radkowski
- Department of Immunopathology of Infectious Diseases, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Beata A. Nowakowska
- Department of Medical Genetics, Institute of Mother and Child, 01-211 Warsaw, Poland
| | - Katarzyna Kuśmierska
- Clinic of Child and Adolescent Neurology, Institute of Mother and Child, 01-211 Warsaw, Poland
| | - Jolanta Tryfon
- Department of Laboratory Diagnostics and Clinical Immunology, Medical University of Warsaw, 00-576 Warsaw, Poland
| | - Urszula Demkow
- Clinic of Child and Adolescent Neurology, Institute of Mother and Child, 01-211 Warsaw, Poland
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Afroze B, Yunus ZM. Glutaric aciduria type 1--importance of early diagnosis and treatment. J PAK MED ASSOC 2014; 64:593-595. [PMID: 25272554] [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: 06/03/2023]
Abstract
Glutaric aciduria type 1 is a rare inherited organic academia. Untreated patients characteristically develop dystonia secondary to striatal injury during early childhood, which results in high morbidity and mortality. In patients diagnosed during neonatal period, striatal injury can be prevented by metabolic treatment including low lysine diet, carnitine supplementation and aggressive emergency treatment during acute episode of inter current illnesses. However, after the onset of neurological damage initiation of treatment is generally not effective. Therefore; glutaric aciduria type 1 is included in newborn screening panel for inherited metabolic diseases in many countries. We describe two children in a family with glutaric aciduria type 1 and their different long term outcomes. The first child was diagnosed late leading to severe neurological damage. The second child was diagnosed in the neonatal period as a result of selective high-risk screening and was treated appropriately giving a normal growth.
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Abstract
Magnetic resonance spectroscopy (MRS) can be useful as an adjuvant diagnostic tool to traditional MR imaging of the brain. MRS can provide both quantitative and qualitative information about white matter pathologic abnormality. It is important to interpret MRS in conjunction with other clinical factors including but not limited to additional diagnostic neuroimaging, history and physical examination findings, and genetics.
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Affiliation(s)
- Macey D Bray
- Department of Radiology, University of New Mexico, MSC10 5530, 1 University of New Mexico, Albuquerque, NM 87131, USA.
| | - Mark E Mullins
- Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Road Northeast, Room D125A, Atlanta, GA 30345, USA
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Krishnan V, Leung LY, Caplan LR. A neurologist's approach to delirium: diagnosis and management of toxic metabolic encephalopathies. Eur J Intern Med 2014; 25:112-6. [PMID: 24332366 DOI: 10.1016/j.ejim.2013.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 11/22/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
Abstract
Toxic metabolic encephalopathies (TMEs) present as an acute derangement in consciousness, cognition and behavior, and can be brought about by various triggers, including endocrine and metabolic disturbances, exogenous toxins, pain and infection. Also referred to as "delirium" or "acute confusional states," TMEs are characterized by (1) an altered level of consciousness and activity, (2) global changes in cognition with inattention, (3) a fluctuating course with disturbances in the sleep-wake cycle, and (4) asterixis and myoclonus. The pathophysiology of this syndrome is poorly understood. Imbalanced neurotransmitter signaling and pathologically heightened brain inflammatory cytokine signaling have been proposed as candidate mechanisms. Focal brain lesions can also occasionally mimic TMEs. A neurological examination is required to identify the presence of focal findings, which when present, identify a new focal lesion or the recrudescence of prior ischemic, inflammatory or neoplastic insults. Diagnostic testing must include a search for metabolic and infectious derangements. Offending medications should be withdrawn. Magnetic resonance imaging, cerebrospinal fluid analysis and electroencephalography should be considered in select clinical situations. In addition to being an unpleasant experience for the patient and family, this condition is associated with extended hospital stays, increased mortality and high costs. In individuals with diminished cognitive reserve, episodes of TME lead to an accelerated decline in cognitive functioning. Starting with an illustrative case, this paper provides a neurologist's approach to the diagnosis, differential diagnosis and management of toxic metabolic encephalopathies.
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Affiliation(s)
- Vaishnav Krishnan
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States.
| | - Lester Y Leung
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Louis R Caplan
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States
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Pfeil J, Listl S, Hoffmann GF, Kölker S, Lindner M, Burgard P. Newborn screening by tandem mass spectrometry for glutaric aciduria type 1: a cost-effectiveness analysis. Orphanet J Rare Dis 2013; 8:167. [PMID: 24135440 PMCID: PMC4015693 DOI: 10.1186/1750-1172-8-167] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 10/05/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Glutaric aciduria type I (GA-I) is a rare metabolic disorder caused by inherited deficiency of glutaryl-CoA dehydrogenase. Despite high prognostic relevance of early diagnosis and start of metabolic treatment as well as an additional cost saving potential later in life, only a limited number of countries recommend newborn screening for GA-I. So far only limited data is available enabling health care decision makers to evaluate whether investing into GA-I screening represents value for money. The aim of our study was therefore to assess the cost-effectiveness of newborn screening for GA-I by tandem mass spectrometry (MS/MS) compared to a scenario where GA-I is not included in the MS/MS screening panel. METHODS We assessed the cost-effectiveness of newborn screening for GA-I against the alternative of not including GA-I in MS/MS screening. A Markov model was developed simulating the clinical course of screened and unscreened newborns within different time horizons of 20 and 70 years. Monte Carlo simulation based probabilistic sensitivity analysis was used to determine the probability of GA-I screening representing a cost-effective therapeutic strategy. RESULTS Within a 20 year time horizon, GA-I screening averts approximately 3.7 DALYs (95% CI 2.9 - 4.5) and about one life year is gained (95% CI 0.7 - 1.4) per 100,000 neonates screened initially . Moreover, the screening programme saves a total of around 30,682 Euro (95% CI 14,343 to 49,176 Euro) per 100,000 screened neonates over a 20 year time horizon. CONCLUSION Within the limitations of the present study, extending pre-existing MS/MS newborn screening programmes by GA-I represents a highly cost-effective diagnostic strategy when assessed under conditions comparable to the German health care system.
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Affiliation(s)
- Johannes Pfeil
- Department of General Paediatrics, Division of Inherited Metabolic Diseases, Centre for Paediatric and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, Heidelberg 69120, Germany
| | - Stefan Listl
- Department of Conservative Dentistry, University of Heidelberg, Heidelberg, Germany
- Munich Center for the Economics of Aging, Max Planck Institute for Social Law and Social Policy, Munich, Germany
| | - Georg F Hoffmann
- Department of General Paediatrics, Division of Inherited Metabolic Diseases, Centre for Paediatric and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, Heidelberg 69120, Germany
| | - Stefan Kölker
- Department of General Paediatrics, Division of Inherited Metabolic Diseases, Centre for Paediatric and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, Heidelberg 69120, Germany
| | - Martin Lindner
- Department of General Paediatrics, Division of Inherited Metabolic Diseases, Centre for Paediatric and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, Heidelberg 69120, Germany
| | - Peter Burgard
- Department of General Paediatrics, Division of Inherited Metabolic Diseases, Centre for Paediatric and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, Heidelberg 69120, Germany
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