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Karachanak-Yankova S, Serbezov D, Antov G, Stancheva M, Mihaylova M, Hadjidekova S, Toncheva D, Pashov A, Belejanska D, Zhelev Y, Petrova M, Mehrabian S, Traykov L. Rare Pathogenic Variants in Pooled Whole-Exome Sequencing Data Suggest Hyperammonemia as a Possible Cause of Dementia Not Classified as Alzheimer's Disease or Frontotemporal Dementia. Genes (Basel) 2024; 15:753. [PMID: 38927689 PMCID: PMC11202446 DOI: 10.3390/genes15060753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024] Open
Abstract
The genetic bases of Alzheimer's disease (AD) and frontotemporal dementia (FTD) have been comprehensively studied, which is not the case for atypical cases not classified into these diagnoses. In the present study, we aim to contribute to the molecular understanding of the development of non-AD and non-FTD dementia due to hyperammonemia caused by mutations in urea cycle genes. The analysis was performed by pooled whole-exome sequencing (WES) of 90 patients and by searching for rare pathogenic variants in autosomal genes for enzymes or transporters of the urea cycle pathway. The survey returned two rare pathogenic coding mutations leading to citrullinemia type I: rs148918985, p.Arg265Cys, C>T; and rs121908641, p.Gly390Arg, G>A in the argininosuccinate synthase 1 (ASS1) gene. The p.Arg265Cys variant leads to enzyme deficiency, whereas p.Gly390Arg renders the enzyme inactive. These variants found in simple or compound heterozygosity can lead to the late-onset form of citrullinemia type I, associated with high ammonia levels, which can lead to cerebral dysfunction and thus to the development of dementia. The presence of urea cycle disorder-causing mutations can be used for the early initiation of antihyperammonemia therapy in order to prevent the neurotoxic effects.
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Affiliation(s)
- Sena Karachanak-Yankova
- Department of Medical Genetics, Medical Faculty, Medical University-Sofia, 1431 Sofia, Bulgaria; (D.S.); (M.M.); (S.H.); (D.T.)
- Department of Genetics, Faculty of Biology, Sofia University ‘St. Kliment Ohridski’, 1164 Sofia, Bulgaria;
| | - Dimitar Serbezov
- Department of Medical Genetics, Medical Faculty, Medical University-Sofia, 1431 Sofia, Bulgaria; (D.S.); (M.M.); (S.H.); (D.T.)
| | - Georgi Antov
- Institute of Plant Physiology and Genetics, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria;
| | - Mikaela Stancheva
- Department of Genetics, Faculty of Biology, Sofia University ‘St. Kliment Ohridski’, 1164 Sofia, Bulgaria;
| | - Marta Mihaylova
- Department of Medical Genetics, Medical Faculty, Medical University-Sofia, 1431 Sofia, Bulgaria; (D.S.); (M.M.); (S.H.); (D.T.)
| | - Savina Hadjidekova
- Department of Medical Genetics, Medical Faculty, Medical University-Sofia, 1431 Sofia, Bulgaria; (D.S.); (M.M.); (S.H.); (D.T.)
| | - Draga Toncheva
- Department of Medical Genetics, Medical Faculty, Medical University-Sofia, 1431 Sofia, Bulgaria; (D.S.); (M.M.); (S.H.); (D.T.)
- Bulgarian Academy of Sciences, 1000 Sofia, Bulgaria
| | - Anastas Pashov
- Department of Immunology, Institute of Microbiology, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria;
| | - Diyana Belejanska
- Department of Neurology, University Hospital ‘Alexandrovska’, 1431 Sofia, Bulgaria; (D.B.); (Y.Z.); (M.P.); (S.M.); (L.T.)
| | - Yavor Zhelev
- Department of Neurology, University Hospital ‘Alexandrovska’, 1431 Sofia, Bulgaria; (D.B.); (Y.Z.); (M.P.); (S.M.); (L.T.)
| | - Mariya Petrova
- Department of Neurology, University Hospital ‘Alexandrovska’, 1431 Sofia, Bulgaria; (D.B.); (Y.Z.); (M.P.); (S.M.); (L.T.)
| | - Shima Mehrabian
- Department of Neurology, University Hospital ‘Alexandrovska’, 1431 Sofia, Bulgaria; (D.B.); (Y.Z.); (M.P.); (S.M.); (L.T.)
| | - Latchezar Traykov
- Department of Neurology, University Hospital ‘Alexandrovska’, 1431 Sofia, Bulgaria; (D.B.); (Y.Z.); (M.P.); (S.M.); (L.T.)
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Yang Z, Hou Y, Zhang M, Hou P, Liu C, Dou L, Chen X, Zhao L, Su L, Jin Y. Unraveling proteome changes of Sunit lamb meat in different feeding regimes and its relationship to flavor analyzed by TMT-labeled quantitative proteomic. Food Chem 2024; 437:137657. [PMID: 37952393 DOI: 10.1016/j.foodchem.2023.137657] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 08/26/2023] [Accepted: 10/02/2023] [Indexed: 11/14/2023]
Abstract
In order to explore the molecular mechanism of the effect of feeding regimes on lamb flavor, biceps femoris muscle samples from pasture-fed groups (PF) and concentrate-fed groups (CF) were chosen, and tandem mass tag (TMT) labeling combined with mass spectrometry (MS) was performed to find associations between flavor indicators and proteome profiles. The content and composition of amino acids and volatile flavor substances were better in the PF compared to the CF, with higher levels of some beneficial flavor components such as Arg, Pro Pentanal, Heptanal, Octanal, 1-octen-3-ol and 2,3-Octanedione. About 82 differentially abundant proteins (DAPs) were identified. The Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis indicated that the pathways that may be associated with lamb flavor are focused on amino acid anabolism. These results provide a basis for further understanding of the molecular mechanisms of proteins in meat flavor regulation.
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Affiliation(s)
- Zhihao Yang
- College of Food Science and Engineering, Inner Mongolia Agricultural University, Hohhot 010018, China; Integrative Research Base of Beef and Lamb Processing Technology, Ministry of Agriculture and Rural Affairs of the People's Republic of China, Hohhot 010018, China
| | - Yanru Hou
- College of Food Science and Engineering, Ningxia University, Yinchuan 750021, China
| | - Min Zhang
- College of Food Science and Engineering, Inner Mongolia Agricultural University, Hohhot 010018, China; Integrative Research Base of Beef and Lamb Processing Technology, Ministry of Agriculture and Rural Affairs of the People's Republic of China, Hohhot 010018, China
| | - Puxin Hou
- Science and Technology Achievement Transformation Center, Bayannur 015000, China
| | - Chang Liu
- Inner Mongolia Vocational College of Chemical Engineering, Hohhot 010051, China
| | - Lu Dou
- College of Food Science and Engineering, Inner Mongolia Agricultural University, Hohhot 010018, China; Integrative Research Base of Beef and Lamb Processing Technology, Ministry of Agriculture and Rural Affairs of the People's Republic of China, Hohhot 010018, China
| | - Xiaoyu Chen
- College of Food Science and Engineering, Inner Mongolia Agricultural University, Hohhot 010018, China; Integrative Research Base of Beef and Lamb Processing Technology, Ministry of Agriculture and Rural Affairs of the People's Republic of China, Hohhot 010018, China
| | - Lihua Zhao
- College of Food Science and Engineering, Inner Mongolia Agricultural University, Hohhot 010018, China; Integrative Research Base of Beef and Lamb Processing Technology, Ministry of Agriculture and Rural Affairs of the People's Republic of China, Hohhot 010018, China
| | - Lin Su
- College of Food Science and Engineering, Inner Mongolia Agricultural University, Hohhot 010018, China; Integrative Research Base of Beef and Lamb Processing Technology, Ministry of Agriculture and Rural Affairs of the People's Republic of China, Hohhot 010018, China.
| | - Ye Jin
- College of Food Science and Engineering, Inner Mongolia Agricultural University, Hohhot 010018, China; Integrative Research Base of Beef and Lamb Processing Technology, Ministry of Agriculture and Rural Affairs of the People's Republic of China, Hohhot 010018, China.
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Burlina A, Gasperini S, la Marca G, Pession A, Siri B, Spada M, Ruoppolo M, Tummolo A. Long-Term Management of Patients with Mild Urea Cycle Disorders Identified through the Newborn Screening: An Expert Opinion for Clinical Practice. Nutrients 2023; 16:13. [PMID: 38201843 PMCID: PMC10780676 DOI: 10.3390/nu16010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/05/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024] Open
Abstract
Urea cycle disorders (UCDs) are a group of rare inborn errors of metabolism caused by a deficiency in one of the six enzymes or one of the two transporters involved in the urea cycle. Current guidelines suggest that early diagnosis and treatment of mild UCDs may improve survival and prevent decompensation and neurocognitive impairment. Nevertheless, clinical studies are very difficult to carry out in this setting due to the rarity of the diseases, and high-level evidence is scant and insufficient to draw conclusions and provide clinical guidelines. With the early introduction of newborn screening, the Italian healthcare organization fostered an advancement in expertise in metabolic disease management and screening programs, by allocating resources, and favoring the expansion of newborn screening. A group of experts operating in Italian centers decided to share their experience and provide advice for the management of mild UCDs in clinical practice. A consensus was reached by the Estimate-Talk-Estimate (ETE) method. Five items were identified, and statements for each item were agreed. Briefly, the panel advised completing the diagnosis by expanded newborn screening (ENS) with biochemical and genetic confirmation and by following up with the patient during the first year of life, with a routine laboratory and metabolic profile as well as with clinical observation. Early initiation of therapy is advised and should be followed by therapy adjustment once the diagnostic profile is completed. The therapy should be based on a low-protein diet and nitrogen scavengers. The long-term follow-up is based on growth and nutritional assessment, clinical and neurocognitive evaluation, and laboratory and instrumental parameter monitoring.
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Affiliation(s)
- Albero Burlina
- Division of Inherited Metabolic Diseases, Reference Centre for Expanded Newborn Screening, University Hospital of Padova, 35128 Padova, Italy
| | - Serena Gasperini
- Inherited Metabolic Unit Disorders, Pediatric Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy;
| | - Giancarlo la Marca
- Newborn Screening Lab, IRCCS Meyer Children’s Hospital, Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50139 Firenze, Italy;
| | - Andrea Pession
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Barbara Siri
- Division of Metabolic Diseases and Hepatology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Marco Spada
- Department of Pediatrics, University of Turin, 10124 Turin, Italy;
| | - Margherita Ruoppolo
- Department of Molecular Medicine and Medical Biotechnology, University of Naples, Federico II, 80138 Naples, Italy;
- CEINGE–Biotecnologie Avanzate S.C.A.R.L., 80145 Naples, Italy
| | - Albina Tummolo
- Department of Metabolic Diseases and Clinical Genetics and Diabetology, Giovanni XXIII Children Hospital, Azienda Ospedaliero-Universitaria Consorziale, 70126 Bari, Italy;
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Pontrucher A, Barth M, Ziegler A, Chao de la Barca JM, Mirebeau-Prunier D, Reynier P, Homedan C. Case report: Diagnosis of ADCY5-related dyskinesia explaining the entire phenotype in a patient with atypical citrullinemia type I. Front Neurol 2023; 14:1266686. [PMID: 38020658 PMCID: PMC10665474 DOI: 10.3389/fneur.2023.1266686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
In this case study, we report the case of a 13-year-old girl with citrullinemia type 1 (MIM #215700), an autosomal recessive inherited disorder of the urea cycle, which was confirmed by the identification of a homozygous pathogenic variant in the argininosuccinate synthetase 1 (ASS1) gene. However, the patient presented abnormal hyperkinetic movements with global developmental delay and clinical signs that were not fully consistent with those of citrullinemia type 1 or with those of her siblings with isolated citrullinemia type 1. Exome sequencing showed the presence of a de novo heterozygous pathogenic variant in the adenylate cyclase type 5 (ADCY5) gene. The variant confirmed the overlap with the so-called ADCY5-related dyskinesia with orofacial involvement, which is autosomal dominant (MIM #606703), a disorder disrupting the enzymatic conversion of adenosine triphosphate (ATP) to cyclic adenosine monophosphate (cAMP). In addition to the citrullinemia-related low-protein diet and arginine supplementation, the identification of this second disease led to the introduction of a treatment with caffeine, which considerably improved the dyskinesia neurological picture. In conclusion, this case highlights the importance of clinical-biological confrontation for the interpretation of genetic variants, as one hereditary metabolic disease may hide another with therapeutic consequences. Summary This article reports the misleading superposition of two inherited metabolic diseases, showing the importance of clinical-biological confrontation in the interpretation of genetic variants.
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Affiliation(s)
- Audrey Pontrucher
- Laboratoire de Biochimie et Biologie Moléculaire, Centre Hospitalier Universitaire, Angers, France
| | - Magalie Barth
- Service de Génétique, Centre Hospitalier Universitaire, Angers, France
| | - Alban Ziegler
- Service de Génétique, Centre Hospitalier Universitaire, Angers, France
- Service de Génétique, CRMR AnDDI-Rares, CHU Reims, Reims, France
| | | | | | - Pascal Reynier
- Laboratoire de Biochimie et Biologie Moléculaire, Centre Hospitalier Universitaire, Angers, France
| | - Chadi Homedan
- Laboratoire de Biochimie et Biologie Moléculaire, Centre Hospitalier Universitaire, Angers, France
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Hu Q, Li Y, Li D, Yuan Y, Wang K, Yao L, Cheng Z, Han T. Amino acid metabolism regulated by lncRNAs: the propellant behind cancer metabolic reprogramming. Cell Commun Signal 2023; 21:87. [PMID: 37127605 PMCID: PMC10152737 DOI: 10.1186/s12964-023-01116-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/25/2023] [Indexed: 05/03/2023] Open
Abstract
Metabolic reprogramming is one of the main characteristics of cancer cells and plays pivotal role in the proliferation and survival of cancer cells. Amino acid is one of the key nutrients for cancer cells and many studies have focused on the regulation of amino acid metabolism, including the genetic alteration, epigenetic modification, transcription, translation and post-translational modification of key enzymes in amino acid metabolism. Long non-coding RNAs (lncRNAs) are composed of a heterogeneous group of RNAs with transcripts of more than 200 nucleotides in length. LncRNAs can bind to biological molecules such as DNA, RNA and protein, regulating the transcription, translation and post-translational modification of target genes. Now, the functions of lncRNAs in cancer metabolism have aroused great research interest and significant progress has been made. This review focuses on how lncRNAs participate in the reprogramming of amino acid metabolism in cancer cells, especially glutamine, serine, arginine, aspartate, cysteine metabolism. This will help us to better understand the regulatory mechanism of cancer metabolic reprogramming and provide new ideas for the development of anti-cancer drugs. Video Abstract.
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Affiliation(s)
- Qifan Hu
- Jiangxi Institute of Respiratory Disease, The First Affiliated Hospital of Nanchang University, Nanchang City, 330006, Jiangxi, China
- Jiangxi Clinical Research Center for Respiratory Diseases, Nanchang City, 330006, Jiangxi, China
- China-Japan Friendship Jiangxi Hospital, National Regional Center for Respiratory Medicine, Nanchang City, 330200, Jiangxi, China
- School of Basic Medical Sciences, Nanchang University, Nanchang City, 330031, Jiangxi, China
| | - Yutong Li
- Nanchang Vocational University, Nanchang City, 330500, Jiangxi, China
| | - Dan Li
- Department of Critical Care Medicine, Medical Center of Anesthesiology and Pain, The First Affiliated Hospital of Nanchang University, Nanchang City, 330006, Jiangxi, China
| | - Yi Yuan
- School of Huankui Academy, Nanchang University, Nanchang City, 330031, Jiangxi, China
| | - Keru Wang
- School of Huankui Academy, Nanchang University, Nanchang City, 330031, Jiangxi, China
| | - Lu Yao
- School of Huankui Academy, Nanchang University, Nanchang City, 330031, Jiangxi, China
| | - Zhujun Cheng
- Department of Burn, The First Affiliated Hospital of Nanchang University, Nanchang City, 330006, Jiangxi, China.
| | - Tianyu Han
- Jiangxi Institute of Respiratory Disease, The First Affiliated Hospital of Nanchang University, Nanchang City, 330006, Jiangxi, China.
- Jiangxi Clinical Research Center for Respiratory Diseases, Nanchang City, 330006, Jiangxi, China.
- China-Japan Friendship Jiangxi Hospital, National Regional Center for Respiratory Medicine, Nanchang City, 330200, Jiangxi, China.
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Daou M, Souaid M, Yammine T, Khneisser I, Mansour H, Salem N, Nemr A, Awwad J, Moukarzel A, Farra C. Analysis of ASS1 gene in ten unrelated middle eastern families with citrullinemia type 1 identifies rare and novel variants. Mol Genet Genomic Med 2023; 11:e2058. [PMID: 36680390 PMCID: PMC9938749 DOI: 10.1002/mgg3.2058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Citrullinemia type 1 (CTLN1) is a rare autosomal recessive disease caused by argininosuccinate synthetase (ASS) deficiency. Manifestations vary from the acute neonatal or "classic" form to a milder, late-onset, or "unconventional" form. To date, more than 93 variants in the ASS1 gene located on chromosome 9q43.11 (OMIM #215700) are reportedly responsible for CTLN1. Their incidence and distribution vary according to geographic origins and ethnicity, and a correlation, although not clearly delineated, has been established between the genotype and the phenotype of the disease. Though, in the Middle East, national descriptions of CTLN1 are still lacking. METHODS A total of ten unrelated Middle Eastern families, five Lebanese, two Syrians, and three Iraqis with citrullinemia index cases, were included in this study. Upon informed consent, DNA was extracted from the whole blood of the index patients as well as their parents and siblings. Genetic analysis was carried out by Sanger sequencing of the ASS1 gene. RESULTS Seven different variants were identified. Two novel variants, c.286C>A (p.(Pro96Thr), RNA not analyzed) in exon 5 and deletion c.685_688+6del(p.(Lys229Glyfs*4), RNA not analyzed) in exon 10, were found in one Lebanese and one Syrian family, respectively, and were correlated with early-onset and severe clinical presentation. Five other known variants: c.535T>C (p.(Trp179Arg), RNA not analyzed) in exon 8, c.787G>A (p.(Val263Met), RNA not analyzed) in exon 12, c.847G>A (p.(Glu283Lys), RNA not analyzed) in exon 13, c.910C>T (p.(Arg304Trp), RNA not analyzed) in exon 13, and c.1168G>A (p.(Gly390Arg), RNA not analyzed) in exon 15, were found in Lebanese, Syrian, and Iraqi families, and were associated with diverse clinical presentations. CONCLUSION Two novel variants and five known variants were found in a total of ten unrelated Middle Eastern families.
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Affiliation(s)
- Melissa Daou
- Medical Genetics UnitSaint Joseph UniversityBeirutLebanon
| | - Mirna Souaid
- Medical Genetics UnitSaint Joseph UniversityBeirutLebanon
| | - Tony Yammine
- Medical Genetics UnitSaint Joseph UniversityBeirutLebanon
| | | | - Hicham Mansour
- Department of PediatricsSaint Georges HospitalBeirutLebanon
| | - Nabiha Salem
- Medical Genetics UnitSaint Joseph UniversityBeirutLebanon
| | - Antony Nemr
- Medical Genetics UnitSaint Joseph UniversityBeirutLebanon
| | - Johnny Awwad
- Departement of Obstetrics and GynecologyAmerican University of Beirut Medical CenterBeirutLebanon
| | - Adib Moukarzel
- Department of PediatricsHotel Dieu de FranceBeirutLebanon
| | - Chantal Farra
- Medical Genetics UnitSaint Joseph UniversityBeirutLebanon,Department of Medical GeneticsHotel Dieu de FranceBeirutLebanon
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Moarefian S, Zamani M, Rahmanifar A, Behnam B, Zaman T. Clinical, laboratory data and outcomes of 17 Iranian citrullinemia type 1 patients: Identification of five novel ASS1 gene mutations. JIMD Rep 2022; 63:231-239. [PMID: 35433176 PMCID: PMC8995839 DOI: 10.1002/jmd2.12277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 02/10/2022] [Accepted: 02/21/2022] [Indexed: 11/11/2022] Open
Abstract
Citrullinemia type 1 is an autosomal recessive metabolic disease caused by ASS1 gene mutations encoding argininosuccinic acid synthetase enzyme which is within the pathway of arginine and nitric oxide biosynthesis. Disease confirmation was done by ASS1 gene mutation analysis using next-generation sequencing, DNA Sanger sequencing. The study group was 17 citrullinemia type 1 patients from 10 unrelated families referred to Iranian National Society for Study on Inborn Errors of Metabolism's clinic between 2008 and 2020. Clinical, laboratory, and molecular data were retrospectively evaluated. Eleven different ASS1 gene mutations were detected in 13 (76%) of 17 neonatal, three (18%) of 17 late infantile, and one (6%) of 17 asymptomatic patients. Severe developmental delay and intractable seizures despite metabolic control was outcome of neonatal form survivor. Two late infantile form patients live metabolically controlled with quite normal performance. DNA mutations are as follows: seven missense, one nonsense, and two insertion/deletion mutations in 12, two, and three patients, respectively. Five novel mutations were detected including a homozygous GG deletion in exon 12 (c.790_791delGG;p.Gly264Profs*3) and a homozygous mutation in exon 7 (c.440C>T; p.Met147Thr), both causing infantile (late onset) form; a homozygous mutation in exon 6 (c.1130T>C; p.Met376Thr) causing neonatal form; two compound heterozygote mutations in exon 14 (c.1167_1168insC:p.Gly390Argfs*22& c.1186T>A; p.Ser396Thr) causing asymptomatic form. Five (38%) patients with classic neonatal form had mutation in exon 14 of ASS1 (c.1168G>A; p.Gly390Arg). Classic neonatal was the most common form of disease in Iranian-studied patients and homozygote c.1168G>A was the most frequent ASS1 gene mutation. Global neonatal screening for citrullinemia type 1 in Iran is recommended and certain mutations can be used for screening severe form in this population.
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Affiliation(s)
- Shirin Moarefian
- Department of Neurogenetics, Iranian Center of Neurological Research (ICNR)Tehran University of Medical SciencesTehranIran
- Clinical and Research UnitIranian National Society for the Study of Inborn Errors of MetabolismTehranIran
| | - Mahdi Zamani
- Department of Neurogenetics, Iranian Center of Neurological Research (ICNR)Tehran University of Medical SciencesTehranIran
- Department of Medical Genetics, School of MedicineTehran University of Medical SciencesTehranIran
| | - Ali Rahmanifar
- Clinical and Research UnitIranian National Society for the Study of Inborn Errors of MetabolismTehranIran
| | - Babak Behnam
- Department of Medical Genetics and Molecular BiologyIran University of Medical SciencesTehranIran
- Present address:
Amarex Clinical Research, Department of Regulatory Affairs, GermantownMarylandUSA
| | - Talieh Zaman
- Clinical and Research UnitIranian National Society for the Study of Inborn Errors of MetabolismTehranIran
- Metabolic Unit of the Children's Medical Center, School of MedicineTehran University of Medical ScienceTehranIran
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8
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Preserved Blood Spots Aid Antenatal Diagnosis of Citrullinemia Type-1. JOURNAL OF FETAL MEDICINE 2021. [DOI: 10.1007/s40556-021-00302-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Knox S, Wissner R, Piszkiewicz S, Schepartz A. Cytosolic Delivery of Argininosuccinate Synthetase Using a Cell-Permeant Miniature Protein. ACS CENTRAL SCIENCE 2021; 7:641-649. [PMID: 34056094 PMCID: PMC8155463 DOI: 10.1021/acscentsci.0c01603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Indexed: 05/04/2023]
Abstract
Citrullinemia type I (CTLN-I) results from the absence or deficiency of argininosuccinate synthetase (AS), a 46 kDa enzyme that acts in the cytosol of hepatocytes to convert aspartic acid and citrulline into argininosuccinic acid. AS is an essential component of the urea cycle, and its absence or deficiency results in the harmful accumulation of ammonia in blood and cerebrospinal fluid. No disease-modifying treatment of CTLN-I exists. Here we report that the cell-permeant miniature protein (CPMP) ZF5.3 (ZF) can deliver AS to the cytosol of cells in culture and the livers of healthy mice. The fusion protein ZF-AS is catalytically active in vitro, stabilized in plasma, and traffics successfully to the cytosol of cultured Saos-2 and SK-HEP-1 cells, achieving cytosolic concentrations greater than 100 nM. This value is 3-10-fold higher than the concentration of endogenous AS (11 ± 1 to 44 ± 5 nM). When injected into healthy C57BL/6 mice, ZF-AS reaches the mouse liver to establish concentrations almost 200 nM above baseline. These studies demonstrate that ZF5.3 can deliver a complex enzyme to the cytosol at therapeutically relevant concentrations and support its application as an improved delivery vehicle for therapeutic proteins that function in the cytosol, including enzyme replacement therapies.
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Affiliation(s)
- Susan
L. Knox
- Department
of Chemistry, Yale University, New Haven, Connecticut 06511, United States
- Department
of Chemistry, University of California, Berkeley, California 94720, United States
| | - Rebecca Wissner
- Department
of Chemistry, Yale University, New Haven, Connecticut 06511, United States
| | - Samantha Piszkiewicz
- Department
of Chemistry, Yale University, New Haven, Connecticut 06511, United States
- Department
of Chemistry, University of California, Berkeley, California 94720, United States
| | - Alanna Schepartz
- Department
of Chemistry, University of California, Berkeley, California 94720, United States
- Department
of Molecular and Cell Biology, University
of California, Berkeley, California 94720, United States
- California
Institute for Quantitative Biosciences, University of California, Berkeley, California 94720, United States
- E-mail:
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10
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Häberle J, Burlina A, Chakrapani A, Dixon M, Karall D, Lindner M, Mandel H, Martinelli D, Pintos-Morell G, Santer R, Skouma A, Servais A, Tal G, Rubio V, Huemer M, Dionisi-Vici C. Suggested guidelines for the diagnosis and management of urea cycle disorders: First revision. J Inherit Metab Dis 2019; 42:1192-1230. [PMID: 30982989 DOI: 10.1002/jimd.12100] [Citation(s) in RCA: 249] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/04/2019] [Accepted: 04/08/2019] [Indexed: 02/06/2023]
Abstract
In 2012, we published guidelines summarizing and evaluating late 2011 evidence for diagnosis and therapy of urea cycle disorders (UCDs). With 1:35 000 estimated incidence, UCDs cause hyperammonemia of neonatal (~50%) or late onset that can lead to intellectual disability or death, even while effective therapies do exist. In the 7 years that have elapsed since the first guideline was published, abundant novel information has accumulated, experience on newborn screening for some UCDs has widened, a novel hyperammonemia-causing genetic disorder has been reported, glycerol phenylbutyrate has been introduced as a treatment, and novel promising therapeutic avenues (including gene therapy) have been opened. Several factors including the impact of the first edition of these guidelines (frequently read and quoted) may have increased awareness among health professionals and patient families. However, under-recognition and delayed diagnosis of UCDs still appear widespread. It was therefore necessary to revise the original guidelines to ensure an up-to-date frame of reference for professionals and patients as well as for awareness campaigns. This was accomplished by keeping the original spirit of providing a trans-European consensus based on robust evidence (scored with GRADE methodology), involving professionals on UCDs from nine countries in preparing this consensus. We believe this revised guideline, which has been reviewed by several societies that are involved in the management of UCDs, will have a positive impact on the outcomes of patients by establishing common standards, and spreading and harmonizing good practices. It may also promote the identification of knowledge voids to be filled by future research.
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Affiliation(s)
- Johannes Häberle
- University Children's Hospital Zurich and Children's Research Centre, Zurich, Switzerland
| | - Alberto Burlina
- Division of Inborn Metabolic Disease, Department of Pediatrics, University Hospital Padua, Padova, Italy
| | - Anupam Chakrapani
- Department of Metabolic Medicine, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Marjorie Dixon
- Dietetics, Great Ormond Street Hospital for Children, NHS Trust, London, UK
| | - Daniela Karall
- Clinic for Pediatrics, Division of Inherited Metabolic Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Lindner
- University Children's Hospital, Frankfurt am Main, Germany
| | - Hanna Mandel
- Institute of Human Genetics and metabolic disorders, Western Galilee Medical Center, Nahariya, Israel
| | - Diego Martinelli
- Division of Metabolism, Bambino Gesù Children's Hospital, Rome, Italy
| | - Guillem Pintos-Morell
- Centre for Rare Diseases, University Hospital Vall d'Hebron, Barcelona, Spain
- CIBERER_GCV08, Research Institute IGTP, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - René Santer
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anastasia Skouma
- Institute of Child Health, Agia Sofia Children's Hospital, Athens, Greece
| | - Aude Servais
- Service de Néphrologie et maladies métaboliques adulte Hôpital Necker 149, Paris, France
| | - Galit Tal
- The Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Vicente Rubio
- Instituto de Biomedicina de Valencia (IBV-CSIC), Centro de Investigación Biomédica en Red para Enfermedades Raras (CIBERER), Valencia, Spain
| | - Martina Huemer
- University Children's Hospital Zurich and Children's Research Centre, Zurich, Switzerland
- Department of Paediatrics, Landeskrankenhaus Bregenz, Bregenz, Austria
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11
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Silvera-Ruiz SM, Arranz JA, Häberle J, Angaroni CJ, Bezard M, Guelbert N, Becerra A, Peralta F, de Kremer RD, Laróvere LE. Urea cycle disorders in Argentine patients: clinical presentation, biochemical and genetic findings. Orphanet J Rare Dis 2019; 14:203. [PMID: 31426867 PMCID: PMC6700778 DOI: 10.1186/s13023-019-1177-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 08/13/2019] [Indexed: 12/30/2022] Open
Abstract
Background The incidence, prevalence, and molecular epidemiology of urea cycle disorders (UCDs) in Argentina remain underexplored. The present study is the first to thoroughly assess the clinical and molecular profiles of UCD patients examined at a single reference center in Argentina. Results Forty-nine UCD cases were collected. About half (26/49, 53%) manifested neonatally with classical presentation and had a high mortality (25/26, 96%). Ornithine transcarbamylase deficiency (OTCD) was the most common UCD (26 patients). Argininosuccinate synthetase deficiency (ASSD) was detected in 19 cases, while argininosuccinate lyase deficiency (ASLD) was diagnosed in 4 cases. Molecular genetic analysis revealed 8 private OTC mutations and two large deletion/duplication events in the OTC gene. Most mutations in the ASS1 and ASL genes were recurrent missense changes, and four alterations were novel. The clinical outcome of our UCD cohort was poor, with an overall mortality of 57% (28/49 cases), and a 28% (6/21) disability rate among the survivors. Conclusions Most patients in our case series showed severe neonatal onset, with high morbidity/mortality. We detected in total 19 mutations, most of them recurrent and of high frequency worldwide. Noteworthy, we highlight the presence of a geographic cluster with high prevalence of a point mutation in the ASS1 gene. This study suggests that these disorders may be more frequent than commonly assumed, and stresses the need for increased awareness amongst health professionals and greater availability of diagnostic tools for accurate identification, early diagnosis, and timely treatment. Electronic supplementary material The online version of this article (10.1186/s13023-019-1177-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Silene M Silvera-Ruiz
- Centro de Estudio de las Metabolopatías Congénitas, Hospital de Niños de la Santísima Trinidad, Cátedra de Clínica Pediátrica, Fac. Cs. Médicas, UNC, Ferroviarios 1250, CP 5014, Córdoba, Argentina.
| | - José A Arranz
- Unitat Metab, Hospital Vall d'Hebron, Barcelona, Spain
| | - Johannes Häberle
- University Children's Hospital and Children's Research Center, Zurich, Switzerland
| | - Celia J Angaroni
- Centro de Estudio de las Metabolopatías Congénitas, Hospital de Niños de la Santísima Trinidad, Cátedra de Clínica Pediátrica, Fac. Cs. Médicas, UNC, Ferroviarios 1250, CP 5014, Córdoba, Argentina
| | - Miriam Bezard
- Centro de Estudio de las Metabolopatías Congénitas, Hospital de Niños de la Santísima Trinidad, Cátedra de Clínica Pediátrica, Fac. Cs. Médicas, UNC, Ferroviarios 1250, CP 5014, Córdoba, Argentina
| | - Norberto Guelbert
- Sección Enfermedades Metabólicas, Hospital de Niños de la Santísima Trinidad, Córdoba, Argentina
| | - Adriana Becerra
- Sección Enfermedades Metabólicas, Hospital de Niños de la Santísima Trinidad, Córdoba, Argentina
| | - Fernanda Peralta
- Centro de Estudio de las Metabolopatías Congénitas, Hospital de Niños de la Santísima Trinidad, Cátedra de Clínica Pediátrica, Fac. Cs. Médicas, UNC, Ferroviarios 1250, CP 5014, Córdoba, Argentina
| | - Raquel Dodelson de Kremer
- Centro de Estudio de las Metabolopatías Congénitas, Hospital de Niños de la Santísima Trinidad, Cátedra de Clínica Pediátrica, Fac. Cs. Médicas, UNC, Ferroviarios 1250, CP 5014, Córdoba, Argentina
| | - Laura E Laróvere
- Centro de Estudio de las Metabolopatías Congénitas, Hospital de Niños de la Santísima Trinidad, Cátedra de Clínica Pediátrica, Fac. Cs. Médicas, UNC, Ferroviarios 1250, CP 5014, Córdoba, Argentina
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12
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Lin Y, Gao H, Lu B, Zhou S, Zheng T, Lin W, Zhu L, Jiang M, Fu Q. Citrullinemia type I is associated with a novel splicing variant, c.773 + 4A > C, in ASS1: a case report and literature review. BMC MEDICAL GENETICS 2019; 20:110. [PMID: 31208364 PMCID: PMC6580464 DOI: 10.1186/s12881-019-0836-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/27/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Citrullinemia type I (CTLN1) is a rare autosomal recessive disorder of the urea cycle caused by a deficiency in the argininosuccinate synthetase (ASS1) enzyme due to mutations in the ASS1 gene. Only a few Chinese patients with CTLN1 have been reported, and ASS1 gene mutations have been identified sporadically in China. CASE PRESENTATION A Chinese family with one member affected with mild CTLN1 was enrolled. Targeted exome sequencing was performed on the proband, and Sanger sequencing was used to validate the detected mutation. We also reviewed the genetic and clinical characteristics of CTLN1 in Chinese patients that have been published to date. Newborn screening showed remarkably increased concentrations of citrulline with elevated ratios of citrulline/arginine and citrulline/phenylalanine, and the patient presented with a speech delay at age three. The urinary organic acid profiles were normal. A novel homozygous splicing variant c.773 + 4A > C in the ASS1 gene was identified in the proband, and it was predicted to affect splicing by in silico analysis. To date, only nine Chinese patients with CTLN1 have been reported, with a total of 15 ASS1 mutations identified and no high frequency or hot spot mutations found; the mutation spectrum of Chinese patients with CTLN1 was heterogeneous. CONCLUSIONS We described a mild Chinese CTLN1 case with a novel homozygous splicing variant c.773 + 4A > C and reviewed previous genotypes and phenotypes in Chinese patients with CTLN1. Thus, our findings contribute to understanding the molecular genetic background and clinical phenotype of CTLN1 in this population.
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Affiliation(s)
- Yiming Lin
- Neonatal Disease Screening Center, Quanzhou Maternity and Children's Hospital, 700 Fengze Street, Quanzhou, 362000, Fujian Province, China
| | - Hongzhi Gao
- Department of Central Laboratory, 2nd Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian Province, China
| | - Bin Lu
- Genuine Diagnostics Company Limited, 859 Shixiang West Road, Hangzhou, 310007, Zhejiang Province, China
| | - Shuang Zhou
- Department of Central Laboratory, 2nd Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian Province, China
| | - Tianwen Zheng
- Department of Pediatrics, Quanzhou Maternity and Children's Hospital, 700 Fengze Street, Quanzhou, 362000, Fujian Province, China
| | - Weihua Lin
- Neonatal Disease Screening Center, Quanzhou Maternity and Children's Hospital, 700 Fengze Street, Quanzhou, 362000, Fujian Province, China
| | - Lin Zhu
- Genuine Diagnostics Company Limited, 859 Shixiang West Road, Hangzhou, 310007, Zhejiang Province, China
| | - Mengyi Jiang
- Genuine Diagnostics Company Limited, 859 Shixiang West Road, Hangzhou, 310007, Zhejiang Province, China.
| | - Qingliu Fu
- Neonatal Disease Screening Center, Quanzhou Maternity and Children's Hospital, 700 Fengze Street, Quanzhou, 362000, Fujian Province, China.
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13
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Bozinov N, Han M, Lau W, Santini V. Late diagnosis of a rare urea cycle disorder mimicking Kleine-Levin syndrome. Neurol Clin Pract 2018; 8:e43-e45. [DOI: 10.1212/cpj.0000000000000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/11/2018] [Indexed: 11/15/2022]
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14
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Bijarnia-Mahay S, Häberle J, Jalan AB, Puri RD, Kohli S, Kudalkar K, Rüfenacht V, Gupta D, Maurya D, Verma J, Shigematsu Y, Yamaguchi S, Saxena R, Verma IC. Urea cycle disorders in India: clinical course, biochemical and genetic investigations, and prenatal testing. Orphanet J Rare Dis 2018; 13:174. [PMID: 30285816 PMCID: PMC6167905 DOI: 10.1186/s13023-018-0908-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 09/12/2018] [Indexed: 02/07/2023] Open
Abstract
Background Urea cycle disorders (UCDs) are inherited metabolic disorders that present with hyperammonemia, and cause significant mortality and morbidity in infants and children. These disorders are not well reported in the Indian population, due to lack of a thorough study of the clinical and molecular profile. Results We present data from two major metabolic centres in India, including 123 cases of various UCDs. The majority of them (72/123, 58%) presented in the neonatal period (before 30 days of age) with 88% on or before day 7 of life (classical presentation), and had a high mortality (64/72, 88%). Citrullinemia type 1 was the most common UCD, observed in 61/123 patients. Ornithine transcarbamylase (OTC) deficiency was the next most common, seen in 24 cases. Argininosuccinic aciduria was diagnosed in 20 cases. Deficiencies of arginase, N-acetylglutamate synthase, carbamoyl phosphate synthetase, citrin, and lysinuric protein intolerance were also observed. Molecular genetic analysis revealed two common ASS1 mutations: c.470G > A (p.Arg157His) and c.1168G > A (p.Gly390Arg) (36 of 55 tested patients). In addition, few recurrent point mutations in ASL gene, and a deletion of the whole OTC gene were also noted. A total of 24 novel mutations were observed in the various genes studied. We observed a poor clinical outcome with an overall all time mortality of 63% (70/110 cases with a known follow-up), and disability in 70% (28/40) among the survivors. Prenatal diagnosis was performed in 30 pregnancies in 25 families, including one pre-implantation genetic diagnosis. Conclusions We report the occurrence of UCDs in India and the spectrum that may be different from the rest of the world. Citrullinemia type 1 was the most common UCD observed in the cohort. Increasing awareness amongst clinicians will improve outcomes through early diagnosis and timely treatment. Genetic diagnosis in the proband will enable prenatal/pre-implantation diagnosis in subsequent pregnancies. Electronic supplementary material The online version of this article (10.1186/s13023-018-0908-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sunita Bijarnia-Mahay
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India.
| | - Johannes Häberle
- University Children's Hospital Zurich and Children's Research Centre, Steinwiesstr 75, CH-8032, Zurich, Switzerland
| | - Anil B Jalan
- Navi Mumbai Institute of Research In Mental And Neurological Handicap (NIRMAN), Navi Mumbai, India
| | - Ratna Dua Puri
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Sudha Kohli
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Ketki Kudalkar
- Navi Mumbai Institute of Research In Mental And Neurological Handicap (NIRMAN), Navi Mumbai, India
| | - Véronique Rüfenacht
- University Children's Hospital Zurich and Children's Research Centre, Steinwiesstr 75, CH-8032, Zurich, Switzerland
| | - Deepti Gupta
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Deepshikha Maurya
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Jyotsna Verma
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Yosuke Shigematsu
- Department of Pediatrics, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Seiji Yamaguchi
- Department of Pediatrics, Shimane University Faculty of Medicine, 89-1 En-ya-cho Izumo, Shimane, 693-8501, Japan
| | - Renu Saxena
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Ishwar C Verma
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
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15
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Öztürk Z, Hirfanoğlu T, İnci A, Okur İ, Koç E, Tümer L, Arhan E, Aydın K, Serdaroğlu A. Citrullinemia with an Atypical Presentation: Paroxysmal Hypoventilation Attacks. J Pediatr Neurosci 2018; 13:276-278. [PMID: 30090157 PMCID: PMC6057205 DOI: 10.4103/jpn.jpn_144_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Citrullinemia type 1 (CTLN1) is a rare inherited urea cycle disorder, which resulted from the deficiency of argininosuccinate synthetase enzyme. We presented an infant who was hospitalized because of acute losses of tonus and cyanotic hypoventilation attacks lasting approximately 4–5 min. The physical and neurological examinations were normal. Ammonia level was in the normal range. Citrulline levels increased in both blood and urine. The blood sample was sent to mutation analysis, which showed one novel and one known mutation on ASS1 gene sequencing: a heterozygous novel mutation p.A94V (c.281C>T) and a heterozygous mutation p.W179R (c.535C>T). Urea cycle disorders should be considered in the differential diagnosis of unexplained brief apnea or hypoventilation attacks, even though those symptoms do not lead to hyperammonemia during infancy and childhood as seen in our patient. This is the first case in terms of atypical clinical presentation with a new mutation for CTLN1.
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Affiliation(s)
- Zeynep Öztürk
- Department of Pediatric Neurology, Ankara Pediatric and Pediatric Hematology Oncology Training and Research Hospital, Gazi University School of Medicine, Ankara, Turkey
| | - Tuğba Hirfanoğlu
- Department of Pediatric Neurology, Gazi University School of Medicine, Ankara, Turkey
| | - Aslı İnci
- Department of Metabolism, Gazi University School of Medicine, Ankara, Turkey
| | - İlyas Okur
- Department of Metabolism, Gazi University School of Medicine, Ankara, Turkey
| | - Esin Koç
- Department of Neonatology, Gazi University School of Medicine, Ankara, Turkey
| | - Leyla Tümer
- Department of Metabolism, Gazi University School of Medicine, Ankara, Turkey
| | - Ebru Arhan
- Department of Pediatric Neurology, Gazi University School of Medicine, Ankara, Turkey
| | - Kürşad Aydın
- Department of Pediatric Neurology, Gazi University School of Medicine, Ankara, Turkey
| | - Ayşe Serdaroğlu
- Department of Pediatric Neurology, Gazi University School of Medicine, Ankara, Turkey
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16
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Saini AG, Attri S, Sankhyan N, Singhi P. Hypomorphic citrullinaemia due to mutated ASS1 with episodic ataxia. BMJ Case Rep 2018; 2018:bcr-2017-220193. [PMID: 29695388 DOI: 10.1136/bcr-2017-220193] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Children with citrullinaemia commonly present in the neonatal period with life-threatening hyperammonaemia and progressive encephalopathy. Less often, 'hypomorphic' or mild late-onset childhood or adult-onset forms may be seen with intermittent neurological symptoms or acute crisis in pregnancy. We describe an 11-year-old boy with late-onset citrullinaemia manifesting as brief episodes of ataxia triggered by minor febrile illnesses, significant citrullinaemia, mild hyperammonaemia, normal neurological examination and mild cerebellar atrophy. Targeted gene sequencing showed a homozygous, missense mutation c.815G>A (p.R272H) in exon 12 of ASS1 gene resulting in the amino acid substitution of histidine for arginine at codon 272. Our case highlights the importance of recognising urea cycle defects as a cause of intermittent neurological symptoms such as ataxia. Type-1 citrullinaemia may remain hypomorphic and needs a high index of suspicion.
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Affiliation(s)
| | - Savita Attri
- Depatment of Pediatrics, Post Grad Inst Med Educ, Chandigarh, India
| | - N Sankhyan
- Depatment of Pediatrics, Post Grad Inst Med Educ, Chandigarh, India
| | - Pratibha Singhi
- Depatment of Pediatrics, Post Grad Inst Med Educ, Chandigarh, India
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17
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Diez-Fernandez C, Rüfenacht V, Häberle J. Mutations in the Human Argininosuccinate Synthetase (ASS1) Gene, Impact on Patients, Common Changes, and Structural Considerations. Hum Mutat 2017; 38:471-484. [DOI: 10.1002/humu.23184] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 01/14/2017] [Indexed: 12/30/2022]
Affiliation(s)
- Carmen Diez-Fernandez
- Division of Metabolism; University Children´s Hospital and Children's Research Center; Zurich Switzerland
| | - Véronique Rüfenacht
- Division of Metabolism; University Children´s Hospital and Children's Research Center; Zurich Switzerland
| | - Johannes Häberle
- Division of Metabolism; University Children´s Hospital and Children's Research Center; Zurich Switzerland
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18
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Kose E, Unal O, Bulbul S, Gunduz M, Häberle J, Arslan N. Identification of three novel mutations in fourteen patients with citrullinemia type 1. Clin Biochem 2017; 50:686-689. [PMID: 28132756 DOI: 10.1016/j.clinbiochem.2017.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 01/15/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Citrullinemia type 1 (CTLN1) is an autosomal recessive genetic disorder caused by mutations in the argininosuccinate synthetase 1 (ASS1) gene, which encodes for the argininosuccinate synthetase enzyme. Here, we report genetic and clinical characterizations of 14 patients with citrullinemia type 1. DESIGN & METHODS The study group consisted of 14 patients (4 females, 10 males) diagnosed with citrullinemia type 1 from three centers in Turkey. Age of onset, clinical presentation, initial citrulline and ammonia levels, family history and molecular genetic analysis were retrospectively evaluated. RESULTS The mean age of the cohort and the mean age at the time of diagnosis were 48.3±36.5months (min: 12days, max: 10years) and 11.6±26.2months (min: 3days, max: 8years), respectively. In four patients, a homozygous p.Gly390Arg pathogenic variant was detected. All patients homozygous for p.Gly390Arg were diagnosed during the newborn period with the clinical presentation of classical citrullinemia. In each two patients, homozygous p.Arg86His, c.773+49C>T and p.Gly362Val pathogenic variants were detected. Clinical presentation was compatible with the mild form of the disease in patients homozygous for c.773+49C>T and for Gly362Val. Novel compound heterozygous genotypes (p.Ala164Pro/p.Gly390Arg; p.Leu290Pro/p.Gly390Arg; p.Thr389Pro/p.Gly390Arg) were identified in five patients. Of these, three siblings with CTLN1 were diagnosed with the compound heterozygous genotype p.Ala164Pro/p.Gly390Arg at the age of 4days, 5days and 2years, respectively. The other two patients with novel compound heterozygous genotypes (p.Leu290Pro/p.Gly390Arg; p.Thr389Pro/p.Gly390Arg) were identified in the first month of life as neonatal onset form and were born to non-consanguineous parents. CONCLUSION In our study, consistent with the literature, a correlation was found between homozygous p.Gly390Arg mutation and the classic neonatal onset form. Mild citrullinemia was detected in patients with c.773+49C>T or p.Gly362Val pathogenic variants. This study adds to our understanding of the molecular genetic background of patients with CTLN1, and allows to infer on the correlation between the genotype and phenotype of the disease.
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Affiliation(s)
- Engin Kose
- Dokuz Eylul University, Division of Pediatric Metabolism and Nutrition, Izmir, Turkey
| | - Ozlem Unal
- Ankara Children's Education and Research Hospital, Division of Pediatric Metabolism and Nutrition, Ankara, Turkey
| | - Selda Bulbul
- Kırıkkale University, Division of Pediatric Metabolism and Nutrition, Kırıkkale, Turkey
| | - Mehmet Gunduz
- Ankara Children's Education and Research Hospital, Division of Pediatric Metabolism and Nutrition, Ankara, Turkey
| | - Johannes Häberle
- University Children's Hospital Zurich, Division of Metabolism and Children's Research Center, Zurich, Switzerland
| | - Nur Arslan
- Dokuz Eylul University, Division of Pediatric Metabolism and Nutrition, Izmir, Turkey; Dokuz Eylul University, Izmir Biomedicine and Genome Center, Izmir, Turkey.
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19
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Diez-Fernandez C, Wellauer O, Gemperle C, Rüfenacht V, Fingerhut R, Häberle J. Kinetic mutations in argininosuccinate synthetase deficiency: characterisation and in vitro correction by substrate supplementation. J Med Genet 2016; 53:710-9. [PMID: 27287393 DOI: 10.1136/jmedgenet-2016-103937] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/19/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Citrullinemia type 1 is an autosomal-recessive urea cycle disorder caused by mutations in the ASS1 gene and characterised by increased plasma citrulline concentrations. Of the ∼90 argininosuccinate synthetase (ASS) missense mutations reported, 21 map near the substrate (aspartate or citrulline) binding site, and thus are potential kinetic mutations whose decreased activities could be amenable to substrate supplementation. This article aims at characterising these 21 ASS mutations to prove their disease-causing role and to test substrate supplementation as a novel therapeutic approach. METHODS We used an Escherichia coli expression system to study all potentially kinetic ASS mutations. All mutant enzymes were nickel-affinity purified, their activity and kinetic parameters were measured using tandem mass spectrometry and their thermal stability using differential scanning fluorimetry. Structural rationalisation of the effects of these mutations was performed. RESULTS Of the characterised mutants, 13 were totally inactive while 8 exhibited decreased affinity for aspartate and citrulline. The activity of these eight kinetic mutations could be rescued to ∼10-99% of the wild-type using high l-aspartate concentrations. CONCLUSIONS Substrate supplementation raised in vitro the activity of eight citrullinemia type 1 mutations with reduced affinity for aspartate. As a direct translation of these results to the clinics, we propose to further evaluate the use of oxaloacetate, a nitrogen-free aspartate precursor and already available medical food (anti-ageing and brain stimulating, not considered as a drug by the US Food and Drug Administration), in patients with citrullinemia type 1 with decreased aspartate affinity. Although only patients with kinetic mutations would benefit, oxaloacetate could offer a safe novel treatment.
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Affiliation(s)
- Carmen Diez-Fernandez
- Division of Metabolism, University Children's Hospital and Children's Research Center, Zurich, Switzerland
| | - Olivia Wellauer
- Division of Metabolism, University Children's Hospital and Children's Research Center, Zurich, Switzerland
| | - Corinne Gemperle
- Division of Metabolism, University Children's Hospital and Children's Research Center, Zurich, Switzerland
| | - Véronique Rüfenacht
- Division of Metabolism, University Children's Hospital and Children's Research Center, Zurich, Switzerland
| | - Ralph Fingerhut
- Neonatal Screening Laboratory, University Children's Hospital and Children's Research Center, Zurich, Switzerland
| | - Johannes Häberle
- Division of Metabolism, University Children's Hospital and Children's Research Center, Zurich, Switzerland
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20
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Functional analysis of novel splicing and missense mutations identified in the ASS1 gene in classical citrullinemia patients. Clin Chim Acta 2014; 438:323-9. [PMID: 25179242 DOI: 10.1016/j.cca.2014.08.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 08/16/2014] [Accepted: 08/23/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND Classical citrullinemia (CTLN1) is an inborn error of the urea cycle caused by reduced/abolished activity of argininosuccinate synthetase due to mutations in the ASS1 gene. To determine the pathogenicity of novel variants detected in patients is often a huge challenge in molecular diagnosis. The purpose of our study was to characterize novel ASS1 gene mutations identified in CTLN1 patients. METHODS Exon trapping assay with pSPL3 was used to confirm splice aberrations while bioinformatics structural analysis predicted the possible effects of missense mutations. RESULTS Novel donor site (c.174+1G>A) and missense (p.V141G) mutations were detected in a patient exhibiting a biochemical phenotype only. The splice mutation provoked exon skipping hence the truncated product. The mutation p.V141G, is predicted to disturb a hydrophobic pocket in the ATP binding domain in the ASS. Both mutations are predicted to lower binding of ATP. The second patient presented with early onset neonatal citrullinemia marked by an elevated biochemical profile and a clinical phenotype. Analysis revealed a donor site (c.773+1G>A) mutation leading to both exon skipping and intron retention. Subsequent introduction of premature stop codons would result in severely truncated products likely to be degraded. A previously reported R265C is predicted to distort the citrulline binding site. CONCLUSIONS Three novel mutations are reported in this study. They expand the spectrum of genetic pathology underlying CTLN1. Overall this study provides new insight of CTLN1 and illustrates a comprehensive protocol investigating inborn errors of metabolism at the molecular level.
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Miller MJ, Soler-Alfonso CR, Grund JE, Fang P, Sun Q, Elsea SH, Sutton VR. Improved standards for prenatal diagnosis of citrullinemia. Mol Genet Metab 2014; 112:205-9. [PMID: 24889030 DOI: 10.1016/j.ymgme.2014.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 05/09/2014] [Accepted: 05/09/2014] [Indexed: 11/27/2022]
Abstract
Citrullinemia type I is a urea cycle disorder caused by autosomal recessive mutations in argininosuccinate synthetase 1 (ASS1). In the classical form of this disease, symptoms manifest during the neonatal period as progressive lethargy, poor feeding, and central nervous system depression secondary to hyperammonemia. In pregnancies involving two carrier parents, prenatal diagnosis is important for both reproductive decisions and advanced preparation for neonatal care. The current gold standard for prenatal diagnosis has been the citrulline incorporation assay in addition to DNA mutation analysis. Herein, we review our experience with prenatal diagnosis of citrullinemia type I over the span of 11 years in 41 at-risk pregnancies. During this time, we identified 15 affected fetuses using a combination of molecular and biochemical testing. Given the established limitations of both the citrulline incorporation assay as well DNA mutation analysis, we probed our data to assess the value of amniotic fluid amino acid levels in prenatal diagnosis. Previous publications have proposed using the amniotic fluid ratio of citrulline/(arginine+ornithine) in prenatal diagnosis; however, we noted that amniotic fluid arginine levels were normal in our cohort and hypothesized that the amniotic fluid citrulline/ornithine ratio may be superior. Indeed, our analyses revealed that the ratio of amniotic fluid citrulline/ornithine alone correctly distinguished affected from unaffected fetuses in all cases. During the establishment of a normal reference range we discovered significant elevations in amniotic fluid citrulline levels in at-risk pregnancies compared to the normal population even when the fetus was unaffected. This highlights the importance of using amniotic fluid from carrier mothers when setting up a normal reference range. Finally, we report our experience as one of the first centers to adopt Sanger sequencing for prospective prenatal diagnosis of citrullinemia. While this is clearly a useful tool in many cases, we encountered families for whom molecular analysis uncovered variants of unknown clinical significance or no mutation at all. Based upon these new findings, we recommend a combinatorial approach involving ASS1 sequencing and amniotic fluid citrulline/ornithine for the prenatal diagnosis of citrullinemia type I.
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Affiliation(s)
- Marcus J Miller
- Dept. of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Claudia R Soler-Alfonso
- Department of Pediatrics, Division of Medical Genetics, University of Texas Health Science Center at Houston, TX, USA
| | | | - Ping Fang
- Dept. of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Qin Sun
- Dept. of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Sarah H Elsea
- Dept. of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - V Reid Sutton
- Dept. of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
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22
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Molecular genetics of citrullinemia types I and II. Clin Chim Acta 2014; 431:1-8. [DOI: 10.1016/j.cca.2014.01.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 01/16/2014] [Accepted: 01/18/2014] [Indexed: 12/16/2022]
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23
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Rüegger CM, Lindner M, Ballhausen D, Baumgartner MR, Beblo S, Das A, Gautschi M, Glahn EM, Grünert SC, Hennermann J, Hochuli M, Huemer M, Karall D, Kölker S, Lachmann RH, Lotz-Havla A, Möslinger D, Nuoffer JM, Plecko B, Rutsch F, Santer R, Spiekerkoetter U, Staufner C, Stricker T, Wijburg FA, Williams M, Burgard P, Häberle J. Cross-sectional observational study of 208 patients with non-classical urea cycle disorders. J Inherit Metab Dis 2014; 37:21-30. [PMID: 23780642 PMCID: PMC3889631 DOI: 10.1007/s10545-013-9624-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 05/13/2013] [Accepted: 05/23/2013] [Indexed: 12/30/2022]
Abstract
Urea cycle disorders (UCDs) are inherited disorders of ammonia detoxification often regarded as mainly of relevance to pediatricians. Based on an increasing number of case studies it has become obvious that a significant number of UCD patients are affected by their disease in a non-classical way: presenting outside the newborn period, following a mild course, presenting with unusual clinical features, or asymptomatic patients with only biochemical signs of a UCD. These patients are surviving into adolescence and adulthood, rendering this group of diseases clinically relevant to adult physicians as well as pediatricians. In preparation for an international workshop we collected data on all patients with non-classical UCDs treated by the participants in 20 European metabolic centres. Information was collected on a cohort of 208 patients 50% of which were ≥ 16 years old. The largest subgroup (121 patients) had X-linked ornithine transcarbamylase deficiency (OTCD) of whom 83 were female and 29% of these were asymptomatic. In index patients, there was a mean delay from first symptoms to diagnosis of 1.6 years. Cognitive impairment was present in 36% of all patients including female OTCD patients (in 31%) and those 41 patients identified presymptomatically following positive newborn screening (in 12%). In conclusion, UCD patients with non-classical clinical presentations require the interest and care of adult physicians and have a high risk of neurological complications. To improve the outcome of UCDs, a greater awareness by health professionals of the importance of hyperammonemia and UCDs, and ultimately avoidance of the still long delay to correctly diagnose the patients, is crucial.
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Affiliation(s)
- Corinne M. Rüegger
- Division of Metabolism, University Children’s Hospital, Steinwiesstr. 75, 8032 Zurich, Switzerland
- Children’s Research Center, Zurich, Switzerland
| | - Martin Lindner
- Department of General Pediatrics, Division of Inherited Metabolic Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Diana Ballhausen
- Inborn Errors of Metabolism, Molecular Pediatrics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, 1011 Lausanne, Switzerland
| | - Matthias R. Baumgartner
- Division of Metabolism, University Children’s Hospital, Steinwiesstr. 75, 8032 Zurich, Switzerland
- Children’s Research Center, Zurich, Switzerland
| | - Skadi Beblo
- University Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Anibh Das
- Department of Paediatrics, Hannover Medical School, Carl Neuberg Str. 1, D-30625 Hannover, Germany
| | - Matthias Gautschi
- University Children’s Hospital, Paediatric Endocrinology, Diabetes and Metabolism, University of Bern, Bern, Switzerland
| | - Esther M. Glahn
- Department of General Pediatrics, Division of Inherited Metabolic Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Sarah C. Grünert
- Department of Pediatrics and Adolescent Medicine, University Children’s Hospital Freiburg, Freiburg, Germany
| | - Julia Hennermann
- Department of Pediatric Endocrinology, Gastroenterology and Metabolic Diseases, Charité Universitätsmedizin, Berlin, Germany
| | - Michel Hochuli
- Department of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Zurich, CH-8091 Zurich, Switzerland
| | - Martina Huemer
- Department of Pediatrics, Landeskrankenhaus Bregenz, Carl Pedenz Str. 2, 6900 Bregenz, Austria
| | - Daniela Karall
- Clinic of Pediatrics I, Division Metabolic Inherited Disorders, Medical University Innsbruck, Innsbruck, Austria
| | - Stefan Kölker
- Department of General Pediatrics, Division of Inherited Metabolic Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Robin H. Lachmann
- National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG UK
| | - Amelie Lotz-Havla
- Department of Inborn Errors of Metabolism, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University, Munich, 80337 Germany
| | - Dorothea Möslinger
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria
| | - Jean-Marc Nuoffer
- University Children’s Hospital, Paediatric Endocrinology, Diabetes and Metabolism, University of Bern, Bern, Switzerland
- University Institute of Clinical Chemistry, University Bern, Bern, Switzerland
| | - Barbara Plecko
- Children’s Research Center, Zurich, Switzerland
- Department of Pediatrics, University Hospital Graz, Auenbruggerplatz 30, A-8036 Graz, Austria
- Division of Neuropediatrics, University Children’s Hospital, Zurich, Switzerland
| | - Frank Rutsch
- Department of General Pediatrics, Münster University Children’s Hospital, Münster, Germany
| | - René Santer
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Ute Spiekerkoetter
- Department of Pediatrics and Adolescent Medicine, University Children’s Hospital Freiburg, Freiburg, Germany
- Department of General Pediatrics and Neonatology, University Children’s Hospital Duesseldorf, Duesseldorf, Germany
| | - Christian Staufner
- Department of General Pediatrics, Division of Inherited Metabolic Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Tamar Stricker
- Division of Metabolism, University Children’s Hospital, Steinwiesstr. 75, 8032 Zurich, Switzerland
- Children’s Research Center, Zurich, Switzerland
| | - Frits A. Wijburg
- Department of Pediatrics, Academic Medical Centre, Amsterdam, The Netherlands
| | - Monique Williams
- Department of Pediatrics, Erasmus Medical Center, Sophia Children’s Hospital Rotterdam, Rotterdam, The Netherlands
| | - Peter Burgard
- Department of General Pediatrics, Division of Inherited Metabolic Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Johannes Häberle
- Division of Metabolism, University Children’s Hospital, Steinwiesstr. 75, 8032 Zurich, Switzerland
- Children’s Research Center, Zurich, Switzerland
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Balmer C, Pandey AV, Rüfenacht V, Nuoffer JM, Fang P, Wong LJ, Häberle J. Mutations and Polymorphisms in the HumanArgininosuccinate Lyase(ASL) Gene. Hum Mutat 2013; 35:27-35. [DOI: 10.1002/humu.22469] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 10/09/2013] [Indexed: 12/30/2022]
Affiliation(s)
- Cécile Balmer
- Division of Metabolism; University Children's Hospital; Zurich Switzerland
- Children's Research Center; Zurich Switzerland
| | - Amit V. Pandey
- Pediatric Endocrinology; Departments of Pediatrics and Clinical Research; University of Bern; Bern Switzerland
| | - Véronique Rüfenacht
- Division of Metabolism; University Children's Hospital; Zurich Switzerland
- Children's Research Center; Zurich Switzerland
| | - Jean-Marc Nuoffer
- University Institute of Clinical Chemistry; University Children's Hospital; University of Bern; Bern 3010 Switzerland
| | - Ping Fang
- Department of Molecular and Human Genetics; Baylor College of Medicine; Houston Texas 77030
| | - Lee-Jun Wong
- Department of Molecular and Human Genetics; Baylor College of Medicine; Houston Texas 77030
| | - Johannes Häberle
- Division of Metabolism; University Children's Hospital; Zurich Switzerland
- Children's Research Center; Zurich Switzerland
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25
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Mutation spectrum of the ASS1 gene in Korean patients with citrullinemia type I. Clin Biochem 2013; 46:209-13. [DOI: 10.1016/j.clinbiochem.2012.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 10/05/2012] [Accepted: 10/06/2012] [Indexed: 11/17/2022]
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26
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Lee BH, Kim YM, Heo SH, Kim GH, Choi IH, Lee BS, Kim EAR, Kim KS, Jhang WK, Park SJ, Yoo HW. High prevalence of neonatal presentation in Korean patients with citrullinemia type 1, and their shared mutations. Mol Genet Metab 2013; 108:18-24. [PMID: 23246278 DOI: 10.1016/j.ymgme.2012.11.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 11/15/2012] [Indexed: 12/31/2022]
Abstract
Type 1 citrullinemia (CTLN1) often presents as a hyperammonemic encephalopathy in the neonatal period, but it can also develop in the late-infantile period and in adults. In addition, some patients can be identified in the presymptomatic period by neonatal or family member screening. In this study, twenty Korean patients with CTLN1 (19 families) were examined; fourteen patients with neonatal-onset, three with late-onset, and three that were identified presymptomatically. The 13 patients with hyperammonemic encephalopathy received continuous venovenous hemofiltration (CVVH) or peritoneal dialysis (PD). Although the hyperammonemia was relieved more effectively in the six patients on CVVH than the seven on PD, most of these patients suffered from severe neurologic deficits. Recurrent hyperammonemic episodes (7 pts, 35%), recurrent and reversible acute hepatic dysfunction (5 pts, 25%), and focal cerebral infarction (2 pts, 10%) were noted. The neonates with hyperammonemic encephalopathy had extensive brain injuries at the onset of hyperammonemia, followed by encephalomalacia and brain atrophy at quite an early age. Genetic testing for the ASS1 gene revealed a different mutation spectrum from those of other ethnicities; Three common mutations, c.421-2A>G (37.8%), c.1128-6_1188dup67 (18.9%), and p.Gly324Ser (16.2%), accounted for 73% of the mutations. The poor outcome was expected in patients with the peak ammonia level at onset over 600μmol/L, whose proportion was higher in the neonatal presentation group than in the presymptomatic/late presentation group. Our findings add to the current understanding of the ethnic diversity of CTLN1 from both clinical and genetic perspectives.
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Affiliation(s)
- Beom Hee Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Lakhal-Naouar I, Jardim A, Strasser R, Luo S, Kozakai Y, Nakhasi HL, Duncan RC. Leishmania donovani argininosuccinate synthase is an active enzyme associated with parasite pathogenesis. PLoS Negl Trop Dis 2012; 6:e1849. [PMID: 23094117 PMCID: PMC3475689 DOI: 10.1371/journal.pntd.0001849] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 08/22/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Gene expression analysis in Leishmania donovani (Ld) identified an orthologue of the urea cycle enzyme, argininosuccinate synthase (LdASS), that was more abundantly expressed in amastigotes than in promastigotes. In order to characterize in detail this newly identified protein in Leishmania, we determined its enzymatic activity, subcellular localization in the parasite and affect on virulence in vivo. METHODOLOGY/PRINCIPAL FINDINGS Two parasite cell lines either over expressing wild type LdASS or a mutant form (G128S) associated with severe cases of citrullinemia in humans were developed. In addition we also produced bacterially expressed recombinant forms of the same proteins. Our results demonstrated that LdASS has argininosuccinate synthase enzymatic activity that is abolished using an ASS specific inhibitor (MDLA: methyl-D-L-Aspartic acid). However, the mutant form of the protein is inactive. We demonstrate that though LdASS has a glycosomal targeting signal that binds the targeting apparatus in vitro, only a small proportion of the total cellular ASS is localized in a vesicle, as indicated by protection from protease digestion of the crude organelle fraction. The majority of LdASS was found to be in the cytosolic fraction that may include large cytosolic complexes as indicated by the punctate distribution in IFA. Surprisingly, comparison to known glycosomal proteins by IFA revealed that LdASS was located in a structure different from the known glycosomal vesicles. Significantly, parasites expressing a mutant form of LdASS associated with a loss of in vitro activity had reduced virulence in vivo in BALB/c mice as demonstrated by a significant reduction in the parasite load in spleen and liver. CONCLUSION/SIGNIFICANCE Our study suggests that LdASS is an active enzyme, with unique localization and essential for parasite survival and growth in the mammalian host. Based on these observations LdASS could be further explored as a potential drug target.
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Affiliation(s)
- Ines Lakhal-Naouar
- Laboratory of Emerging Pathogens, Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research (CBER), Food and Drug Administration (FDA), Bethesda, Maryland, United States of America
| | - Armando Jardim
- Institute of Parasitology, McGill University and the Centre for Host-Parasite Interactions, Quebec, Canada
| | - Rona Strasser
- Institute of Parasitology, McGill University and the Centre for Host-Parasite Interactions, Quebec, Canada
| | - Shen Luo
- Laboratory of Chemistry, Division of Therapeutic Proteins, Center for Drug Evaluation and Research (CDER), Food and Drug Administration (FDA), Bethesda, Maryland, United States of America
| | - Yukiko Kozakai
- Laboratory of Emerging Pathogens, Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research (CBER), Food and Drug Administration (FDA), Bethesda, Maryland, United States of America
| | - Hira L. Nakhasi
- Laboratory of Emerging Pathogens, Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research (CBER), Food and Drug Administration (FDA), Bethesda, Maryland, United States of America
| | - Robert C. Duncan
- Laboratory of Emerging Pathogens, Division of Emerging and Transfusion Transmitted Diseases, Center for Biologics Evaluation and Research (CBER), Food and Drug Administration (FDA), Bethesda, Maryland, United States of America
- * E-mail:
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Häberle J, Boddaert N, Burlina A, Chakrapani A, Dixon M, Huemer M, Karall D, Martinelli D, Crespo PS, Santer R, Servais A, Valayannopoulos V, Lindner M, Rubio V, Dionisi-Vici C. Suggested guidelines for the diagnosis and management of urea cycle disorders. Orphanet J Rare Dis 2012; 7:32. [PMID: 22642880 PMCID: PMC3488504 DOI: 10.1186/1750-1172-7-32] [Citation(s) in RCA: 362] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 04/06/2012] [Indexed: 12/11/2022] Open
Abstract
Urea cycle disorders (UCDs) are inborn errors of ammonia detoxification/arginine synthesis due to defects affecting the catalysts of the Krebs-Henseleit cycle (five core enzymes, one activating enzyme and one mitochondrial ornithine/citrulline antiporter) with an estimated incidence of 1:8.000. Patients present with hyperammonemia either shortly after birth (~50%) or, later at any age, leading to death or to severe neurological handicap in many survivors. Despite the existence of effective therapy with alternative pathway therapy and liver transplantation, outcomes remain poor. This may be related to underrecognition and delayed diagnosis due to the nonspecific clinical presentation and insufficient awareness of health care professionals because of disease rarity. These guidelines aim at providing a trans-European consensus to: guide practitioners, set standards of care and help awareness campaigns. To achieve these goals, the guidelines were developed using a Delphi methodology, by having professionals on UCDs across seven European countries to gather all the existing evidence, score it according to the SIGN evidence level system and draw a series of statements supported by an associated level of evidence. The guidelines were revised by external specialist consultants, unrelated authorities in the field of UCDs and practicing pediatricians in training. Although the evidence degree did hardly ever exceed level C (evidence from non-analytical studies like case reports and series), it was sufficient to guide practice on both acute and chronic presentations, address diagnosis, management, monitoring, outcomes, and psychosocial and ethical issues. Also, it identified knowledge voids that must be filled by future research. We believe these guidelines will help to: harmonise practice, set common standards and spread good practices with a positive impact on the outcomes of UCD patients.
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Affiliation(s)
- Johannes Häberle
- University Children’s Hospital Zurich and Children’s Research Centre, Zurich, 8032, Switzerland
| | - Nathalie Boddaert
- Radiologie Hopital Necker, Service Radiologie Pediatrique, 149 Rue De Sevres, Paris 15, 75015, France
| | - Alberto Burlina
- Department of Pediatrics, Division of Inborn Metabolic Disease, University Hospital Padua, Via Giustiniani 3, Padova, 35128, Italy
| | - Anupam Chakrapani
- Birmingham Children’s Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom
| | - Marjorie Dixon
- Dietetic Department, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, WC1N 3JH, United Kingdom
| | - Martina Huemer
- Kinderabteilung, LKH Bregenz, Carl-Pedenz-Strasse 2, Bregenz, A-6900, Austria
| | - Daniela Karall
- University Children’s Hospital, Medical University Innsbruck, Anichstrasse 35, Innsbruck, 6020, Austria
| | - Diego Martinelli
- Division of Metabolism, Bambino Gesù Children’s Hospital, IRCCS, Piazza S. Onofrio 4, Rome, I-00165, Italy
| | | | - René Santer
- Universitätsklinikum Hamburg Eppendorf, Klinik für Kinder- und Jugendmedizin, Martinistr. 52, Hamburg, 20246, Germany
| | - Aude Servais
- Service de Néphrologie et maladies métaboliques adulte Hôpital Necker 149, rue de Sèvres, Paris, 75015, France
| | - Vassili Valayannopoulos
- Reference Center for Inherited Metabolic Disorders (MaMEA), Hopital Necker-Enfants Malades, 149 Rue de Sevres, Paris, 75015, France
| | - Martin Lindner
- University Children’s Hospital, Im Neuenheimer Feld 430, Heidelberg, 69120, Germany
| | - Vicente Rubio
- Instituto de Biomedicina de Valencia del Consejo Superior de Investigaciones Científicas (IBV-CSIC) and Centro de Investigación Biomédica en Red para Enfermedades Raras (CIBERER), C/ Jaume Roig 11, Valencia, 46010, Spain
| | - Carlo Dionisi-Vici
- Division of Metabolism, Bambino Gesù Children’s Hospital, IRCCS, Piazza S. Onofrio 4, Rome, I-00165, Italy
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Ben-Rebeh I, Hertecant JL, Al-Jasmi FA, Aburawi HE, Al-Yahyaee SA, Al-Gazali L, Ali BR. Identification of mutations underlying 20 inborn errors of metabolism in the United Arab Emirates population. Genet Test Mol Biomarkers 2011; 16:366-71. [PMID: 22106832 DOI: 10.1089/gtmb.2011.0175] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Inborn errors of metabolism (IEM) are frequently encountered by physicians in the United Arab Emirates (UAE). However, the mutations underlying a large number of these disorders have not yet been determined. Therefore, the objective of this study was to identify the mutations underlying a number of IEM disorders among UAE residents from both national and expatriate families. A case series of patients from 34 families attending the metabolic clinic at Tawam Hospital were clinically evaluated, and molecular testing was carried out to determine their causative mutations. The mutation analysis was carried out at molecular genetics diagnostic laboratories. Thirty-eight mutations have been identified as responsible for twenty IEM disorders, including in the metabolism of amino acids, lipids, steroids, metal transport and mitochondrial energy metabolism, and lysosomal storage disorders. Nine of the identified mutations are novel, including two missense mutations, three premature stop codons and four splice site mutations. Mutation analysis of IEM disorders in the UAE population has an important impact on molecular diagnosis and genetic counseling for families affected by these disorders.
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Affiliation(s)
- Imen Ben-Rebeh
- Department of Pathology, Faculty of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
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30
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Häberle J. Varianten von Harnstoffzyklusstörungen. Monatsschr Kinderheilkd 2011. [DOI: 10.1007/s00112-011-2444-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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De Bie I, Lemyre E, Lambert M. Favorable long-term outcome following severe neonatal hyperammonemic coma in a patient with argininosuccinate synthetase deficiency. JIMD Rep 2011; 1:83-8. [PMID: 23430833 DOI: 10.1007/8904_2011_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Revised: 01/24/2011] [Accepted: 01/25/2011] [Indexed: 03/24/2023] Open
Abstract
This chapter reports on the sequelae-free 8-year follow-up with normal growth, intellectual development, and schooling of a boy with argininosuccinate synthetase deficiency (citrullinemia type I) who was rescued from severe neonatal hyperammonemic coma at 8 days of life (peak ammonia level of 1,058 μmol/L). Important clinical management aspects were: rapidity of response to emergency therapeutic measures that included specific drug regimen, protein restriction, optimal caloric intake and hemodialysis, short coma duration (14 h), possible neuroprotective effect of mild systemic hypothermia during the acute episode, long-term metabolic control with strict compliance to standard of care therapeutic and dietary regimens, active prevention of subsequent hyperammonemic episodes, and early neurodevelopmental evaluations and interventions. We conclude that good long-term neurological outcome following rescue from neonatal hyperammonemic coma is rarely reported but attainable. Prospective registries and interventional studies regrouping clinical data from urea cycle disorders patients will assist clinicians in instituting the appropriate therapeutic measures to provide the best prospect of positive long-term outcome for these children.
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Affiliation(s)
- Isabelle De Bie
- Medical Genetics Division, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, 3175 Côte Sainte-Catherine, Montréal, QC, Canada, H3T-1C5,
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32
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Wilcken B. Expanded newborn screening: reducing harm, assessing benefit. J Inherit Metab Dis 2010; 33:S205-10. [PMID: 20440650 DOI: 10.1007/s10545-010-9106-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 03/28/2010] [Accepted: 04/01/2010] [Indexed: 12/30/2022]
Abstract
Achieving the goals of newborn screening is, as for any screening, a balancing act: getting the maximum benefit from screening while producing the minimum harm. The advent of "expanded" newborn screening, with a large number of disorders detectable using a single test, has also posed problems, not new, but now more obvious. One is the finding of many more cases by screening, the extra cases being largely patients who have attenuated phenotypes and may remain asymptomatic for many years, even throughout life. These may or may not require active management in the short term, but do need lifelong awareness. Additionally, disorders have been included that are now thought benign or largely so. Babies risk being unnecessarily medicalized. Assessing outcome has also proved difficult because of the rarity of some disorders and the impracticality of randomized controlled trials. The requirements for valid studies include the need for case definitions, comparable comparison groups and probably assessment on a whole-population basis. An Australia-wide study of tandem mass spectrometry newborn screening involving 2 million screened and unscreened babies has demonstrated benefits overall to screened patients at age 6 years. The study was too small to provide conclusions for individual disorders other than for medium-chain acyl-CoA dehydrogenase deficiency.
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Affiliation(s)
- Bridget Wilcken
- Biochemical Genetics and Newborn Screening, The Children's Hospital at Westmead, Hawkesbury Road, Westmead, NSW, Australia.
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33
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Perez CJ, Jaubert J, Guénet JL, Barnhart KF, Ross-Inta CM, Quintanilla VC, Aubin I, Brandon JL, Otto NW, DiGiovanni J, Gimenez-Conti I, Giulivi C, Kusewitt DF, Conti CJ, Benavides F. Two hypomorphic alleles of mouse Ass1 as a new animal model of citrullinemia type I and other hyperammonemic syndromes. THE AMERICAN JOURNAL OF PATHOLOGY 2010; 177:1958-68. [PMID: 20724589 DOI: 10.2353/ajpath.2010.100118] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Citrullinemia type I (CTLN1, OMIM# 215700) is an inherited urea cycle disorder that is caused by an argininosuccinate synthetase (ASS) enzyme deficiency. In this report, we describe two spontaneous hypomorphic alleles of the mouse Ass1 gene that serve as an animal model of CTLN1. These two independent mouse mutant alleles, also described in patients affected with CTLN1, interact to produce a range of phenotypes. While some mutant mice died within the first week after birth, others survived but showed severe retardation during postnatal development as well as alopecia, lethargy, and ataxia. Notable pathological findings were similar to findings in human CTLN1 patients and included citrullinemia and hyperammonemia along with delayed cerebellar development, epidermal hyperkeratosis, and follicular dystrophy. Standard treatments for CTLN1 were effective in rescuing the phenotype of these mutant mice. Based on our studies, we propose that defective cerebellar granule cell migration secondary to disorganization of Bergmann glial cell fibers cause cerebellar developmental delay in the hyperammonemic and citrullinemic brain, pointing to a possible role for nitric oxide in these processes. These mouse mutations constitute a suitable model for both mechanistic and preclinical studies of CTLN1 and other hyperammonemic encephalopathies and, at the same time, underscore the importance of complementing knockout mutations with hypomorphic mutations for the generation of animal models of human genetic diseases.
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Affiliation(s)
- Carlos J Perez
- Department of Carcinogenesis, The University of Texas MD Anderson Cancer Center, Smithville, Texas 78957, USA
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34
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The Diagnosis and Management of a Female With Mild Citrullinemia and Undetectable Argininosuccinate Synthetase Activity in Fibroblasts. TOP CLIN NUTR 2009. [DOI: 10.1097/tin.0b013e3181c621e6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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35
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Laróvere LE, Angaroni CJ, Antonozzi SL, Bezard MB, Shimohama M, Dodelson de Kremer R. Citrullinemia Type I, Classical Variant. Identification of ASS∼p.G390R (c.1168G>A) mutation in families of a limited geographic area of Argentina: A possible population cluster. Clin Biochem 2009; 42:1166-8. [DOI: 10.1016/j.clinbiochem.2009.03.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2008] [Revised: 03/24/2009] [Accepted: 03/25/2009] [Indexed: 11/25/2022]
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