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Ortigoza-Escobar JD, Alfadhel M, Molero-Luis M, Darin N, Spiegel R, de Coo IF, Gerards M, Taylor RW, Artuch R, Nashabat M, Rodríguez-Pombo P, Tabarki B, Pérez-Dueñas B. Thiamine deficiency in childhood with attention to genetic causes: Survival and outcome predictors. Ann Neurol 2017; 82:317-330. [PMID: 28856750 DOI: 10.1002/ana.24998] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 07/09/2017] [Accepted: 07/12/2017] [Indexed: 01/09/2023]
Abstract
Primary and secondary conditions leading to thiamine deficiency have overlapping features in children, presenting with acute episodes of encephalopathy, bilateral symmetric brain lesions, and high excretion of organic acids that are specific of thiamine-dependent mitochondrial enzymes, mainly lactate, alpha-ketoglutarate, and branched chain keto-acids. Undiagnosed and untreated thiamine deficiencies are often fatal or lead to severe sequelae. Herein, we describe the clinical and genetic characterization of 79 patients with inherited thiamine defects causing encephalopathy in childhood, identifying outcome predictors in patients with pathogenic SLC19A3 variants, the most common genetic etiology. We propose diagnostic criteria that will aid clinicians to establish a faster and accurate diagnosis so that early vitamin supplementation is considered. Ann Neurol 2017;82:317-330.
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Affiliation(s)
- Juan Darío Ortigoza-Escobar
- Division of Child Neurology, Sant Joan de Déu Hospital, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Majid Alfadhel
- Division of Genetics, Department of Pediatrics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Marta Molero-Luis
- Division of Biochemistry, Sant Joan de Déu Hospital, University of Barcelona, Barcelona, Spain
| | - Niklas Darin
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ronen Spiegel
- Rappaport School of Medicine, Technion, Haifa, Israel; Department of Pediatrics B, Emek Medical Center, Afula, Israel
| | - Irenaeus F de Coo
- Department of Neurology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Mike Gerards
- MaCSBio (Maastricht Centre for Systems Biology), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Robert W Taylor
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rafael Artuch
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Division of Biochemistry, Sant Joan de Déu Hospital, University of Barcelona, Barcelona, Spain
- CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
| | - Marwan Nashabat
- Division of Genetics, Department of Pediatrics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Pilar Rodríguez-Pombo
- CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
- Departamento de Biología Molecular, Centro de Diagnóstico de Enfermedades Moleculares (CEDEM), Centro de Biología Molecular Severo Ochoa CSIC-UAM, IDIPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Brahim Tabarki
- Divisions of Pediatric Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Belén Pérez-Dueñas
- Division of Child Neurology, Sant Joan de Déu Hospital, University of Barcelona, Barcelona, Spain
- Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
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Cinici E, Ahiskali I, Cetin N, Suleyman B, Kukula O, Altuner D, Coban A, Balta H, Kuzucu M, Suleyman H. Effect of thiamine pyrophosphate on retinopathy induced by hyperglycemia in rats: A biochemical and pathological evaluation. Indian J Ophthalmol 2017; 64:434-9. [PMID: 27488151 PMCID: PMC4991169 DOI: 10.4103/0301-4738.187666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose: Information is lacking on the protective effects of thiamine pyrophosphate (TPP) against hyperglycemia-induced retinopathy in rats. This study investigated the biochemical and histopathological aspects of the effect of TPP on hyperglycemia-induced retinopathy induced by alloxan in rats. Materials and Methods: The rats were separated into a diabetic TPP-administered group (DTPG), a diabetes control group (DCG) and a healthy group (HG). While the DTPG was given TPP, the DCG and HG were administered distilled water as a solvent at the same concentrations. This procedure was repeated daily for 3 months. At the end of this period, all of the rats were euthanized under thiopental sodium anesthesia, and biochemical and histopathological analyses of the ocular retinal tissues were performed. The results of the DTPG were compared with those of the DCG and HG. Results: TPP prevented hyperglycemia by increasing the amount of malondialdehyde and decreasing endogen antioxidants, including total glutathione, glutathione reductase, glutathione S-transferase and superoxide dismutase. In addition, the amounts of the DNA oxidation product 8-hydroxyguanine were significantly lower in the retinas of the DTPG compared to the DCG. In the retinas of the DCG, there was a marked increase in vascular structures and congestion, in addition to edema. In contrast, little vascularization and edema were observed in the DTPG, and there was no congestion. The results suggest that TPP significantly reduced the degree of hyperglycemia-induced retinopathy. Conclusions: The results of this study indicate that TPP may be useful for prophylaxis against diabetic retinopathy.
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Affiliation(s)
- Emine Cinici
- Department of Ophthalmology, Erzurum Region Education and Research Hospital, Erzurum, Turkey
| | - Ibrahim Ahiskali
- Department of Ophthalmology, Palandoken State Hospital, Erzurum, Turkey
| | - Nihal Cetin
- Department of Pharmacology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Bahadir Suleyman
- Department of Pharmacology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Osman Kukula
- Department of Pharmacology, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Durdu Altuner
- Department of Pharmacology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Abdulkadir Coban
- Department of Biochemistry, Faculty of Medicine, Erzincan University, Erzincan, Turkey
| | - Hilal Balta
- Department of Pathology, Erzurum Region Education and Research Hospital, Erzurum, Turkey
| | - Mehmet Kuzucu
- Department of Biochemistry, Faculty of Arts and Sciences, Erzincan University, Erzincan, Turkey
| | - Halis Suleyman
- Department of Pharmacology, Faculty of Medicine, Erzincan University, Erzincan, Turkey
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53
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Recent trends in determination of thiamine and its derivatives in clinical practice. J Chromatogr A 2017; 1510:1-12. [DOI: 10.1016/j.chroma.2017.06.048] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 06/14/2017] [Accepted: 06/15/2017] [Indexed: 02/06/2023]
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Turck D, Bresson J, Burlingame B, Dean T, Fairweather‐Tait S, Heinonen M, Hirsch‐Ernst KI, Mangelsdorf I, McArdle HJ, Naska A, Nowicka G, Pentieva K, Sanz Y, Siani A, Sjödin A, Stern M, Tomé D, Van Loveren H, Vinceti M, Willatts P, Lamberg‐Allardt C, Przyrembel H, Tetens I, Gudelj Rakic J, Ioannidou S, de Sesmaisons‐Lecarré A, Forss AC, Neuhäuser‐Berthold M. Dietary reference values for thiamin. EFSA J 2016. [DOI: 10.2903/j.efsa.2016.4653] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Algahtani H, Ghamdi S, Shirah B, Alharbi B, Algahtani R, Bazaid A. Biotin–thiamine–responsive basal ganglia disease: catastrophic consequences of delay in diagnosis and treatment. Neurol Res 2016; 39:117-125. [DOI: 10.1080/01616412.2016.1263176] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Hussein Algahtani
- King Abdulaziz Medical City/King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Saeed Ghamdi
- King Abdulaziz Medical City/King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Bader Shirah
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Bader Alharbi
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Raghad Algahtani
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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Cinici E, Cetin N, Suleyman B, Altuner D, Yarali O, Balta H, Calik I, Tumkaya L, Suleyman H. Gene expression and histopathological evaluation of thiamine pyrophosphate on optic neuropathy induced with ethambutol in rats. Int J Ophthalmol 2016; 9:1390-1395. [PMID: 27803853 DOI: 10.18240/ijo.2016.10.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 03/29/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the effects of thiamine pyrophosphate (TPP) and thiamine (TM) in oxidative optic neuropathy in rats induced by ethambutol. METHODS The animals were divided into four groups: a control group (CG), an ethambutol control (ETC) group, TM plus ethambutol group (TMG), and TPP plus ethambutol group (TPPG). One hour after intraperitoneal administration of TM 20 mg/kg to the TMG group and TPP 20 mg/kg to TPPG group, 30 mg/kg ethambutol was given via gavage to all the groups but the CG. This procedure was repeated once daily for 90d. After that period, all rats were exposed to high levels of anaesthesia in order to investigate the gene expression of malondialdehyde and glutathione in removed optic nerve tissue and histopathologically to examine these tissues. RESULTS Malondialdehyde gene expression significantly increased, whereas glutathione gene expression significantly decreased in the ETC group compared to the CG. TM could not prevent the increase of malondialdehyde gene expression and the decrease of glutathione, while TPP significantly could suppress. Histopathologically, significant vacuolization in the optic nerve, single-cell necrosis in the glial cells, and a decrease in oligodendrocytes were observed in the ETC group. Vacuolization in the optic nerve, a decrease in oligodendrocytes and single-cell necrosis were found in the TMG group, while no pathological finding was observed in the TPPG group except for mild vacuolization. CONCLUSION TPP protects the optic nerve against the ethambutol-induced toxicity but TM does not. TPP can be beneficial in prophilaxis of optic neuropathy in ethambutol therapy.
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Affiliation(s)
- Emine Cinici
- Department of Ophthalmology, Erzurum Region Education and Research Hospital, Erzurum 25100, Turkey
| | - Nihal Cetin
- Department of Pharmacology, Faculty of Medicine, Erzincan University, Erzincan 24030, Turkey
| | - Bahadir Suleyman
- Department of Pharmacology, Faculty of Medicine, Erzincan University, Erzincan 24030, Turkey
| | - Durdu Altuner
- Department of Pharmacology, Faculty of Medicine, Erzincan University, Erzincan 24030, Turkey
| | - Oguzhan Yarali
- Department of Medical Genetics, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul 34730, Turkey
| | - Hilal Balta
- Department of Pathology, Erzurum Region Education and Research Hospital, Erzurum 25100, Turkey
| | - Ilknur Calik
- Department of Pathology, Erzurum Region Education and Research Hospital, Erzurum 25100, Turkey
| | - Levent Tumkaya
- Department of Histology and Embryology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize 53100, Turkey
| | - Halis Suleyman
- Department of Pharmacology, Faculty of Medicine, Erzincan University, Erzincan 24030, Turkey
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Ortigoza Escobar JD, Pérez Dueñas B. Treatable Inborn Errors of Metabolism Due to Membrane Vitamin Transporters Deficiency. Semin Pediatr Neurol 2016; 23:341-350. [PMID: 28284395 DOI: 10.1016/j.spen.2016.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
B vitamins act as cofactors for strategic metabolic processes. The SLC19 gene family of solute carriers has a significant structural similarity, transporting substrates with different structure and ionic charge. Three proteins of this family are expressed ubiquitously and mediate the transport of 2 important water-soluble vitamins, folate, and thiamine. SLC19A1 transports folate and SLC19A2 and SLC19A3 transport thiamine. PCFT and FOLR1 ensure intestinal absorption and transport of folate through the blood-brain barrier and SLC19A25 transports thiamine into the mitochondria. Several damaging genetic defects in vitamin B transport and metabolism have been reported. The most relevant feature of thiamine and folate transport defects is that both of them are treatable disorders. In this article, we discuss the biology and transport of thiamine and folate, as well as the clinical phenotype of the genetic defects.
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Affiliation(s)
- Juan Darío Ortigoza Escobar
- Department of Child Neurology, Pediatric Research Institute, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain
| | - Belén Pérez Dueñas
- Department of Child Neurology, Pediatric Research Institute, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain; Centre for Biomedical Research on Rare Diseases (CIBERER), Institute of Health Carlos III, Madrid, Spain.
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Costantini A, Laureti T, Pala MI, Colangeli M, Cavalieri S, Pozzi E, Brusco A, Salvarani S, Serrati C, Fancellu R. Long-term treatment with thiamine as possible medical therapy for Friedreich ataxia. J Neurol 2016; 263:2170-2178. [PMID: 27488863 DOI: 10.1007/s00415-016-8244-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/21/2016] [Accepted: 07/22/2016] [Indexed: 01/13/2023]
Abstract
Thiamine (vitamin B1) is a cofactor of fundamental enzymes of cell energetic metabolism; its deficiency causes disorders affecting both the peripheral and central nervous system. Previous studies reported low thiamine levels in cerebrospinal fluid and pyruvate dehydrogenase dysfunction in Friedreich ataxia (FRDA). We investigated the effect of long-term treatment with thiamine in FRDA, evaluating changes in neurological symptoms, echocardiographic parameters, and plasma FXN mRNA levels. Thirty-four consecutive FRDA patients have been continuously treated with intramuscular thiamine 100 mg twice a week and have been assessed with the Scale for the Assessment and Rating of Ataxia (SARA) at baseline, after 1 month, and then every 3 months during treatment. Thiamine administration ranged from 80 to 930 days and was effective in improving total SARA scores from 26.6 ± 7.7 to 21.5 ± 6.2 (p < 0.02). Moreover, deep tendon reflexes reappeared in 57 % of patients with areflexia at baseline, and swallowing improved in 63 % of dysphagic patients. Clinical improvement was stable in all patients, who did not show worsening even after 2 years of treatment. In a subgroup of 13 patients who performed echocardiogram before and during treatment, interventricular septum thickness reduced significantly (p < 0.02). Frataxin mRNA blood levels were modestly increased in one-half of treated patients. We suppose that a focal thiamine deficiency may contribute to a selective neuronal damage in the areas involved in FRDA. Further studies are mandatory to evaluate thiamine role on FXN regulation, to exclude placebo effect, to verify our clinical results, and to confirm restorative and neuroprotective action of thiamine in FRDA.
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Affiliation(s)
- Antonio Costantini
- Department of Neurological Rehabilitation, "Villa Immacolata" Clinic, Strada Sammartinese 65A, 01100, Viterbo, Italy
| | - Tiziana Laureti
- Department of Economics and Management, University of Tuscia, Via del Paradiso 47, 01100, Viterbo, Italy
| | - Maria Immacolata Pala
- Department of Neurological Rehabilitation, "Villa Immacolata" Clinic, Strada Sammartinese 65A, 01100, Viterbo, Italy
| | - Marco Colangeli
- University Studies Abroad Consortium, University of Tuscia, Via Santa Maria in Gradi 4, 01100, Viterbo, Italy
| | - Simona Cavalieri
- Department of Medical Sciences, University of Turin, 10126, Turin, Italy
| | - Elisa Pozzi
- Department of Medical Sciences, University of Turin, 10126, Turin, Italy
| | - Alfredo Brusco
- Department of Medical Sciences, University of Turin, 10126, Turin, Italy.,Medical Genetics Unit, Città della Salute e della Scienza University Hospital, 10126, Turin, Italy
| | - Sandro Salvarani
- Unit of Neurology, ASL3 Villa Scassi Hospital, Corso O. Scassi 1, 16149, Genoa, Italy
| | - Carlo Serrati
- Unit of Neurology, IRCCS San Martino University Hospital IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Roberto Fancellu
- Unit of Neurology, ASL3 Villa Scassi Hospital, Corso O. Scassi 1, 16149, Genoa, Italy. .,Unit of Neurology, IRCCS San Martino University Hospital IST, Largo Rosanna Benzi 10, 16132, Genoa, Italy.
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59
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Ortigoza-Escobar JD, Molero-Luis M, Arias A, Martí-Sánchez L, Rodriguez-Pombo P, Artuch R, Pérez-Dueñas B. Treatment of genetic defects of thiamine transport and metabolism. Expert Rev Neurother 2016; 16:755-63. [DOI: 10.1080/14737175.2016.1187562] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Juan Darío Ortigoza-Escobar
- Department of Child Neurology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Department of Child Neurology, Hospital General de Granollers, Barcelona, Spain
| | - Marta Molero-Luis
- Clinical Biochemistry, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Centre for the Biomedical Research on Rare Diseases (CIBERER), ISCIII, Madrid, Spain
| | - Angela Arias
- Division of Inborn Errors of Metabolism-IBC, Department of Biochemistry and Molecular Genetics, Hospital Clinic, Barcelona, Spain
- Centre for the Biomedical Research on Rare Diseases (CIBERER), ISCIII, Madrid, Spain
| | - Laura Martí-Sánchez
- Department of Child Neurology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Clinical Biochemistry, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Pilar Rodriguez-Pombo
- Departamento de Biología Molecular, Centro de Diagnóstico de Enfermedades Moleculares (CEDEM), Centro de Biología Molecular Severo Ochoa CSIC-UAM, IDIPAZ, Universidad Autónoma de Madrid, Madrid, Spain
- Centre for the Biomedical Research on Rare Diseases (CIBERER), ISCIII, Madrid, Spain
| | - Rafael Artuch
- Clinical Biochemistry, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Centre for the Biomedical Research on Rare Diseases (CIBERER), ISCIII, Madrid, Spain
| | - Belén Pérez-Dueñas
- Department of Child Neurology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Centre for the Biomedical Research on Rare Diseases (CIBERER), ISCIII, Madrid, Spain
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Gerards M, Sallevelt SCEH, Smeets HJM. Leigh syndrome: Resolving the clinical and genetic heterogeneity paves the way for treatment options. Mol Genet Metab 2016; 117:300-12. [PMID: 26725255 DOI: 10.1016/j.ymgme.2015.12.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/14/2015] [Accepted: 12/15/2015] [Indexed: 12/31/2022]
Abstract
Leigh syndrome is a progressive neurodegenerative disorder, affecting 1 in 40,000 live births. Most patients present with symptoms between the ages of three and twelve months, but adult onset Leigh syndrome has also been described. The disease course is characterized by a rapid deterioration of cognitive and motor functions, in most cases resulting in death due to respiratory failure. Despite the high genetic heterogeneity of Leigh syndrome, patients present with identical, symmetrical lesions in the basal ganglia or brainstem on MRI, while additional clinical manifestations and age of onset varies from case to case. To date, mutations in over 60 genes, both nuclear and mitochondrial DNA encoded, have been shown to cause Leigh syndrome, still explaining only half of all cases. In most patients, these mutations directly or indirectly affect the activity of the mitochondrial respiratory chain or pyruvate dehydrogenase complex. Exome sequencing has accelerated the discovery of new genes and pathways involved in Leigh syndrome, providing novel insights into the pathophysiological mechanisms. This is particularly important as no general curative treatment is available for this devastating disorder, although several recent studies imply that early treatment might be beneficial for some patients depending on the gene or process affected. Timely, gene-based personalized treatment may become an important strategy in rare, genetically heterogeneous disorders like Leigh syndrome, stressing the importance of early genetic diagnosis and identification of new genes/pathways. In this review, we provide a comprehensive overview of the most important clinical manifestations and genes/pathways involved in Leigh syndrome, and discuss the current state of therapeutic interventions in patients.
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Affiliation(s)
- Mike Gerards
- Department of Clinical Genetics, Research School GROW, Maastricht University Medical Centre, Maastricht, The Netherlands; Maastricht Center for Systems Biology (MaCSBio), Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Suzanne C E H Sallevelt
- Department of Clinical Genetics, Research School GROW, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Hubert J M Smeets
- Department of Clinical Genetics, Research School GROW, Maastricht University Medical Centre, Maastricht, The Netherlands
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Costantini A, Trevi E, Pala MI, Fancellu R. Can long-term thiamine treatment improve the clinical outcomes of myotonic dystrophy type 1? Neural Regen Res 2016; 11:1487-1491. [PMID: 27857755 PMCID: PMC5090854 DOI: 10.4103/1673-5374.191225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Myotonic dystrophy type 1, also known as Steinert's disease, is an autosomal dominant disorder with multisystemic clinical features affecting the skeletal and cardiac muscles, the eyes, and the endocrine system. Thiamine (vitamin B1) is a cofactor of fundamental enzymes involved in the energetic cell metabolism; recent studies described its role in oxidative stress, protein processing, peroxisomal function, and gene expression. Thiamine deficiency is critical mainly in the central and peripheral nervous system, as well as in the muscular cells. Our aim was to investigate the potential therapeutical effects of long-term treatment with thiamine in myotonic dystrophy type 1 in an observational open-label pilot study. We described two patients with myotonic dystrophy type 1 treated with intramuscular thiamine 100 mg twice a week for 12 or 11 months. We evaluated the patients using the grading of muscle strength according to Medical Research Council (MRC), the Muscular Impairment Rating Scale (MIRS), and the Modified Barthel index. High-dose thiamine treatment was well tolerated and effective in improving the motor symptomatology, particularly the muscle strength evaluated with the MRC scale, and the patients' activities of daily living using the Modified Barthel Index. At the end of treatment, the MRC score was 5 in the proximal muscles and 2-4 in the distal muscles (the MRC score before the treatment was 3-4 and 1-3, respectively). The MIRS grade improved by 25% compared to baseline for both patients. In patient #1, the Modified Barthel Index improved by 44%, and in patient #2 by 29%. These findings suggest that clinical outcomes are improved by long-term thiamine treatment.
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Affiliation(s)
- Antonio Costantini
- Department of Neurological Rehabilitation, "Villa Immacolata" Clinic, Viterbo, Italy; School of Physiotherapy, Catholic University of Rome, Rome, Italy
| | - Erika Trevi
- Department of Neurological Rehabilitation, "Villa Immacolata" Clinic, Viterbo, Italy
| | - Maria Immacolata Pala
- Department of Neurological Rehabilitation, "Villa Immacolata" Clinic, Viterbo, Italy
| | - Roberto Fancellu
- Neurology Unit, IRCCS San Martino University Hospital IST, Genoa, Italy
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62
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Lonsdale D. Sudden infant death syndrome and abnormal metabolism of thiamin. Med Hypotheses 2015; 85:922-6. [DOI: 10.1016/j.mehy.2015.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/09/2015] [Indexed: 11/25/2022]
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Brunel-Guitton C, Levtova A, Sasarman F. Mitochondrial Diseases and Cardiomyopathies. Can J Cardiol 2015; 31:1360-76. [DOI: 10.1016/j.cjca.2015.08.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/21/2015] [Accepted: 08/21/2015] [Indexed: 12/31/2022] Open
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Castiglioni C, Verrigni D, Okuma C, Diaz A, Alvarez K, Rizza T, Carrozzo R, Bertini E, Miranda M. Pyruvate dehydrogenase deficiency presenting as isolated paroxysmal exercise induced dystonia successfully reversed with thiamine supplementation. Case report and mini-review. Eur J Paediatr Neurol 2015; 19:497-503. [PMID: 26008863 DOI: 10.1016/j.ejpn.2015.04.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/10/2015] [Accepted: 04/29/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Pyruvate dehydrogenase (PDH) deficiency is a disorder of energy metabolism with variable clinical presentations, ranging from severe infantile lactic acidosis to milder chronic neurological disorders. The spectrum of clinical manifestations is continuously expanding. METHODS AND RESULTS We report on a 19-year-old intelligent female with PDH deficiency caused by a Leu216Ser mutation in PDHA1. She presented with recurrent hemidystonic attacks, triggered by prolonged walking or running, as the unique clinical manifestation that manifested since childhood. Laboratory workup and neuroimages were initially normal but bilateral globus pallidum involvement appeared later on brain MRI. Dystonia completely remitted after high doses of thiamine, remaining free of symptoms after 3 years of follow up. We reviewed the literature for similar observations. CONCLUSIONS Dystonia precipitated by exercise may be the only symptom of a PDH deficiency, and the hallmark of the disease as high serum lactate or bilateral striatal necrosis at neuroimaging may be absent. A high index of suspicion and follow up is necessary for diagnosis. The clinical presentation of this patient meets the criteria for a Paroxysmal Exercise induced Dystonia, leading us to add this entity as another potential etiology for this type of paroxysmal dyskinesia, which is besides a treatable condition that responds to thiamine supplementation.
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Affiliation(s)
- Claudia Castiglioni
- Unit of Neurology, Dept. of Pediatrics and Dept. of Neurology, Clínica las Condes, Santiago, Chile.
| | - Daniela Verrigni
- Unit of Neuromuscular and Neurodegenerative Disorders, Laboratory of Molecular Medicine, Bambino Gesu' Children's Hospital IRCCS, Rome, Italy
| | - Cecilia Okuma
- Dept. of Radiology, Clínica las Condes, Santiago, Chile
| | - Alejandra Diaz
- National Institute of Rehabilitation, INRPAC, Santiago, Chile
| | - Karin Alvarez
- Laboratory of Molecular Genetics and Oncology, Clínica las Condes, Santiago, Chile
| | - Teresa Rizza
- Unit of Neuromuscular and Neurodegenerative Disorders, Laboratory of Molecular Medicine, Bambino Gesu' Children's Hospital IRCCS, Rome, Italy
| | - Rosalba Carrozzo
- Unit of Neuromuscular and Neurodegenerative Disorders, Laboratory of Molecular Medicine, Bambino Gesu' Children's Hospital IRCCS, Rome, Italy
| | - Enrico Bertini
- Unit of Neuromuscular and Neurodegenerative Disorders, Laboratory of Molecular Medicine, Bambino Gesu' Children's Hospital IRCCS, Rome, Italy
| | - Marcelo Miranda
- Unit of Neurology, Dept. of Pediatrics and Dept. of Neurology, Clínica las Condes, Santiago, Chile
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Sperl W, Fleuren L, Freisinger P, Haack TB, Ribes A, Feichtinger RG, Rodenburg RJ, Zimmermann FA, Koch J, Rivera I, Prokisch H, Smeitink JA, Mayr JA. The spectrum of pyruvate oxidation defects in the diagnosis of mitochondrial disorders. J Inherit Metab Dis 2015; 38:391-403. [PMID: 25526709 DOI: 10.1007/s10545-014-9787-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 10/20/2014] [Accepted: 10/23/2014] [Indexed: 10/24/2022]
Abstract
Pyruvate oxidation defects (PODs) are among the most frequent causes of deficiencies in the mitochondrial energy metabolism and represent a substantial subset of classical mitochondrial diseases. PODs are not only caused by deficiency of subunits of the pyruvate dehydrogenase complex (PDHC) but also by various disorders recently described in the whole pyruvate oxidation route including cofactors, regulation of PDHC and the mitochondrial pyruvate carrier. Our own patients from 2000 to July 2014 and patients identified by a systematic survey of the literature from 1970 to July 2014 with a pyruvate oxidation disorder and a genetically proven defect were included in the study (n=628). Of these defects 74.2% (n=466) belong to PDHC subunits, 24.5% (n=154) to cofactors, 0.5% (n=3) to PDHC regulation and 0.8% (n=5) to mitochondrial pyruvate import. PODs are underestimated in the field of mitochondrial diseases because not all diagnostic centres include biochemical investigations of PDHC in their routine analysis. Cofactor and transport defects can be missed, if pyruvate oxidation is not measured in intact mitochondria routinely. Furthermore deficiency of the X-chromosomal PDHA1 can be biochemically missed depending on the X-inactivation pattern. This is reflected by an increasing number of patients diagnosed recently by genetic high throughput screening approaches. PDHC deficiency including regulation and import affect mainly the glucose dependent central and peripheral nervous system and skeletal muscle. PODs with combined enzyme defects affect also other organs like heart, lung and liver. The spectrum of clinical presentation of PODs is still expanding. PODs are a therapeutically interesting group of mitochondrial diseases since some can be bypassed by ketogenic diet or treated by cofactor supplementation. PDHC kinase inhibition, chaperone therapy and PGC1α stimulation is still a matter of further investigations.
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Affiliation(s)
- Wolfgang Sperl
- Department of Paediatrics, Paracelsus Medical University, SALK Salzburg, Salzburg, 5020, Austria,
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