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Garbowski L, Walasek M, Firszt R, Chilińska-Kopko E, Błażejewska-Gała P, Popielnicki D, Dzięcioł-Anikiej Z. A Case Study of a Rare Disease (Fructosemia) Diagnosed in a Patient with Abdominal Pain. J Clin Med 2024; 13:3394. [PMID: 38929922 PMCID: PMC11204229 DOI: 10.3390/jcm13123394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/22/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024] Open
Abstract
Hereditary fructose intolerance is a rare genetic disorder that is inherited in an autosomal recessive manner, with mutations sometimes occurring spontaneously. Consuming fructose triggers biochemical abnormalities, disrupting liver processes like glycogenolysis and gluconeogenesis. Recent studies have revealed elevated intrahepatic fat levels in affected individuals. Symptoms include aversion to fructose-containing foods, hypoglycemia, liver and kidney dysfunction, and growth delays, with severe cases leading to liver enlargement, fatty liver disease, kidney failure, and life-threatening hypoglycemia. In this case study, we present a 20-month-old child with symptoms including difficulty passing stool, abdominal rigidity, abdominal pain with bloating and hypoglycemia. Initial clinical findings revealed elevated liver enzymes, a mildly enlarged hyperechoic liver, hypercholesterolemia, and borderline alpha-fetoprotein values. Diagnostic assessments identified hereditary fructose intolerance (HFI) with pathogenic variants in the ALDOB gene, along with a diagnosis of celiac disease. Genetic testing of the parents revealed carrier status for pathological aldolase B genes. This case underscores the importance of comprehensive clinical evaluation and genetic testing in pediatric patients with complex metabolic presentations.
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Affiliation(s)
- Leszek Garbowski
- Public Independent Healthcare Services of the Ministry of Internal Affairs and Administration in Białystok, 15-471 Białystok, Poland
- Department of Human Anatomy, Medical University of Białystok, 15-089 Białystok, Poland (P.B.-G.); (D.P.)
| | - Marzena Walasek
- Public Independent Healthcare Services of the Ministry of Internal Affairs and Administration in Białystok, 15-471 Białystok, Poland
| | - Rafał Firszt
- Department of Ornamental Plants and Garden Art, Faculty of Biotechnology and Horticulture, University of Agriculture in Krakow, 31-425 Kraków, Poland;
| | - Ewelina Chilińska-Kopko
- Department of Human Anatomy, Medical University of Białystok, 15-089 Białystok, Poland (P.B.-G.); (D.P.)
| | - Paulina Błażejewska-Gała
- Department of Human Anatomy, Medical University of Białystok, 15-089 Białystok, Poland (P.B.-G.); (D.P.)
- Department of Neonatology and Newborn Intensive Care, University Clinical Hospital in Białystok, 15-276 Białystok, Poland
| | - Daniel Popielnicki
- Department of Human Anatomy, Medical University of Białystok, 15-089 Białystok, Poland (P.B.-G.); (D.P.)
| | - Zofia Dzięcioł-Anikiej
- Department of Rehabilitation, University Clinical Hospital in Białystok, 15-276 Białystok, Poland
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2
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Zuriaga E, Santander S, Lomba L, Izquierdo-García E, Luesma MJ. Descriptive Analysis of Carrier and Affected Hereditary Fructose Intolerance in Women during Pregnancy. Healthcare (Basel) 2024; 12:573. [PMID: 38470684 PMCID: PMC10930640 DOI: 10.3390/healthcare12050573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
(1) Background: Hereditary fructose intolerance (HFI) is a rare autosomal recessive metabolic disorder resulting from aldolase B deficiency, requiring a fructose, sorbitol and sucrose (FSS)-free diet. Limited information exists on the relationship between pregnancy outcomes and HFI. This study aims to analyze pregnancy-related factors in a cohort of thirty Spanish women, with twenty-three being carriers and seven being HFI-affected (45 pregnancies). (2) Methods: A descriptive, cross-sectional and retrospective study utilized an anonymous questionnaire. (3) Results: Findings encompassed physical and emotional states, nutritional habits, pathology development and baby information. Notable results include improved physical and emotional states compared to the general population, with conventional analyses mostly within normal ranges. Persistent issues after pregnancy included hepatic steatosis, liver adenomas and hemangiomas. Carrier mothers' babies exhibited higher weight than those of patient mothers, while the weights of carrier children born with HFI were similar to disease-affected children. (4) Conclusions: Pregnant women with HFI did not significantly differ in physical and emotional states, except for nausea, vomiting, and cravings. Post-pregnancy, HFI patients and carriers exhibited persistent hepatic issues. Significantly, babies born to HFI-affected mothers had lower weights. This study sheds light on pregnancy outcomes in HFI, emphasizing potential complications and the need for ongoing monitoring and care.
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Affiliation(s)
- Estefanía Zuriaga
- Facultad de Ciencias de la Salud, Universidad San Jorge, Campus Universitario, Autov A23 km 299, 50830 Villanueva de Gállego Zaragoza, Spain; (E.Z.); (L.L.)
| | - Sonia Santander
- Faculty of Health and Sports Sciences, University of Zaragoza, 22002 Huesca, Spain
| | - Laura Lomba
- Facultad de Ciencias de la Salud, Universidad San Jorge, Campus Universitario, Autov A23 km 299, 50830 Villanueva de Gállego Zaragoza, Spain; (E.Z.); (L.L.)
| | | | - María José Luesma
- Department of Human Anatomy and Histology, Faculty of Medicine, University of Zaragoza, 50009 Zaragoza, Spain;
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3
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Hong X, Edmondson AC, Strong A, Pomerantz D, Michl E, Berry G, He M. Combined PMM2-CDG and hereditary fructose intolerance in a patient with mild clinical presentation. Mol Genet Metab 2023; 140:107682. [PMID: 37597336 PMCID: PMC10840806 DOI: 10.1016/j.ymgme.2023.107682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/02/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Abstract
We report a patient with an extremely rare, combined diagnosis of PMM2-CDG and hereditary fructose intolerance (HFI). By comparing with other patients, under-galactosylation was identified as a feature of HFI. Fructose/sorbitol/sucrose restriction was initiated right afterwards. The patient is at the mild end of the PMM2-CDG spectrum, raising the question of sorbitol's role in the pathogenesis of PMM2-CDG and whether fructose/sorbitol/sucrose restriction could benefit other PMM2-CDG patients. Additionally, epalrestat, an emerging potential PMM2-CDG therapy, may benefit HFI patients.
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Affiliation(s)
- Xinying Hong
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Andrew C Edmondson
- Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alanna Strong
- Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Daniel Pomerantz
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Emma Michl
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Gerard Berry
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Miao He
- Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
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4
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Janssen LEF, Cassiman D, Brouwers MCGJ. Quality of life of adult patients with hereditary fructose intolerance. Mol Genet Metab 2023; 140:107701. [PMID: 37757598 DOI: 10.1016/j.ymgme.2023.107701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND Although patients with hereditary fructose intolerance (HFI) generally have a good prognosis on a fructose-restricted diet, relatively little is known about their quality of life. The aim of this study was to investigate the quality of life in adult patients with HFI in comparison to patients with dietary-treated, classical phenylketonuria (PKU). METHODS Patients with HFI and patients with classical PKU were recruited from the adult metabolic centers in The Netherlands and Belgium and via social media. Patients were asked to fill out the 36-item Short Form Health survey (SF-36) and a modified PKU Quality Of Life (PKU-QoL) questionnaire. RESULTS Patients with HFI (n = 19) did not report any restrictions in their health-related quality of life, except for vitality and general mental health, which were scored more unfavorable compared to patients with PKU (n = 19) (p < 0.05, adjusted for level of education and country of origin). The results from the modified PKU-QoL demonstrated a statistically significantly greater impact of the disease in the social domain in HFI. A substantial proportion of both HFI and PKU patients (21%) reported a great to severe emotional impact of their disease. Finally, patients with HFI experienced statistically significantly less food temptations, less guilt if dietary restrictions not followed, and less overall difficulty following dietary restrictions. CONCLUSIONS Although patients with HFI showed to have a generally good quality of life, they scored lower on vitality and general mental health, and reported a greater social impact of the disease. These aspects deserve further study and clinical attention.
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Affiliation(s)
- Lise E F Janssen
- Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - David Cassiman
- Department of Hepatology, KU Leuven, Leuven, Belgium; Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Martijn C G J Brouwers
- Division of Endocrinology and Metabolic Diseases, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; CARIM School for Cardiovascular Diseases, Maastricht, the Netherlands.
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Andres-Hernando A, Orlicky DJ, Kuwabara M, Cicerchi C, Pedler M, Petrash MJ, Johnson RJ, Tolan DR, Lanaspa MA. Endogenous Fructose Production and Metabolism Drive Metabolic Dysregulation and Liver Disease in Mice with Hereditary Fructose Intolerance. Nutrients 2023; 15:4376. [PMID: 37892451 PMCID: PMC10609559 DOI: 10.3390/nu15204376] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/06/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
Excessive intake of sugar, and particularly fructose, is closely associated with the development and progression of metabolic syndrome in humans and animal models. However, genetic disorders in fructose metabolism have very different consequences. While the deficiency of fructokinase, the first enzyme involved in fructose metabolism, is benign and somewhat desirable, missense mutations in the second enzyme, aldolase B, causes a very dramatic and sometimes lethal condition known as hereditary fructose intolerance (HFI). To date, there is no cure for HFI, and treatment is limited to avoiding fructose and sugar. Because of this, for subjects with HFI, glucose is their sole source of carbohydrates in the diet. However, clinical symptoms still occur, suggesting that either low amounts of fructose are still being consumed or, alternatively, fructose is being produced endogenously in the body. Here, we demonstrate that as a consequence of consuming high glycemic foods, the polyol pathway, a metabolic route in which fructose is produced from glucose, is activated, triggering a deleterious mechanism whereby glucose, sorbitol and alcohol induce severe liver disease and growth retardation in aldolase B knockout mice. We show that generically and pharmacologically blocking this pathway significantly improves metabolic dysfunction and thriving and increases the tolerance of aldolase B knockout mice to dietary triggers of endogenous fructose production.
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Affiliation(s)
- Ana Andres-Hernando
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Denver, Aurora, CO 80045, USA;
| | - David J. Orlicky
- Department of Pathology, University of Colorado School of Medicine, Aurora, CO 80045, USA;
| | - Masanari Kuwabara
- Department of Cardiology, Toranomon Hospital, Tokyo 105-8470, Japan;
- Division of Public Health, Center for Community Medicine, Jichi Medical University, Tochigi 329-0431, Japan
| | - Christina Cicerchi
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, CO 80045, USA; (C.C.); (R.J.J.)
| | - Michelle Pedler
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO 80045, USA; (M.P.); (M.J.P.)
| | - Mark J. Petrash
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO 80045, USA; (M.P.); (M.J.P.)
| | - Richard J. Johnson
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, CO 80045, USA; (C.C.); (R.J.J.)
| | - Dean R. Tolan
- Department of Biology, Boston University, Boston, MA 02215, USA;
| | - Miguel A. Lanaspa
- Division of Endocrinology, Metabolism and Diabetes, University of Colorado Denver, Aurora, CO 80045, USA;
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Panis B, Janssen LEF, Lefeber DJ, Simons N, Rubio‐Gozalbo ME, Brouwers MCGJ. Development of tools to facilitate the diagnosis of hereditary fructose intolerance. JIMD Rep 2023; 64:353-359. [PMID: 37701328 PMCID: PMC10494505 DOI: 10.1002/jmd2.12379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 09/14/2023] Open
Abstract
Although hereditary fructose intolerance (HFI) is an inborn error of fructose metabolism that classically presents at infancy, the diagnosis is often missed or delayed. In this study, we aimed to develop tools to facilitate the diagnosis of HFI. The intake of fructose-containing food products, that is, fruit, fruit juice and sugar-sweetened beverages, was assessed by a 3-day food diary in adult HFI patients (n = 15) and age, sex, and BMI-matched controls (n = 15). Furthermore, glycosylation of transferrin was examined using high-resolution mass spectrometry and abnormally glycosylated transferrin was expressed as ratio of normal glycosylated transferrin. We found that the sensitivity and specificity of the 3-day food diary for the intake of at least one fructose-containing food product were both 100%. Both mono-glyco:diglyco transferrin and a-glyco+mono-glyco:di-glyco transferrin were greater in HFI patients and had a high-discriminatory power (area under the receiver operating characteristic curve: 0.97 and 0.94, respectively). In this well-characterized cohort of adult HFI patients, the 3-day food questionnaire and the glycosylation pattern of transferrin are valuable tools to facilitate the recognition and diagnosis of HFI in adult patients.
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Affiliation(s)
- Bianca Panis
- Division of Genetic Metabolic Diseases, Department of PediatricsMaastricht University Medical CenterMaastrichtThe Netherlands
- Member of European Reference Network for Hereditary Metabolic Diseases (MetabERN)
- Member of United for Metabolic Diseases (UMD)
| | - Lise E. F. Janssen
- Division of Endocrinology and Metabolic Diseases, Department of Internal MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
| | - Dirk J. Lefeber
- Translational Metabolic Laboratory, Department of Laboratory MedicineRadboud University Medical CenterNijmegenThe Netherlands
- Department of NeurologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Nynke Simons
- Division of Endocrinology and Metabolic Diseases, Department of Internal MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
- Laboratory for Metabolism and Vascular Medicine, Division of General Internal Medicine, department of Internal MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
- CARIM, School for Cardiovascular DiseasesMaastrichtThe Netherlands
| | - M. Estela Rubio‐Gozalbo
- Division of Genetic Metabolic Diseases, Department of PediatricsMaastricht University Medical CenterMaastrichtThe Netherlands
- Member of European Reference Network for Hereditary Metabolic Diseases (MetabERN)
- Member of United for Metabolic Diseases (UMD)
- Department of Clinical GeneticsMaastricht University Medical Center, Maastricht UniversityMaastrichtThe Netherlands
- GROW‐School for Oncology and Developmental Biology, Faculty of Health, Medicine and Life SciencesMaastricht UniversityMaastrichtThe Netherlands
| | - Martijn C. G. J. Brouwers
- Member of European Reference Network for Hereditary Metabolic Diseases (MetabERN)
- Member of United for Metabolic Diseases (UMD)
- Division of Endocrinology and Metabolic Diseases, Department of Internal MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
- Laboratory for Metabolism and Vascular Medicine, Division of General Internal Medicine, department of Internal MedicineMaastricht University Medical CenterMaastrichtThe Netherlands
- CARIM, School for Cardiovascular DiseasesMaastrichtThe Netherlands
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7
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Zheng M, Huang DQ, Konkwo C, Agrawal S, Khera AV, Loomba R, Vilarinho S, Ajmera V. Genomic analysis of lean individuals with NAFLD identifies monogenic disorders in a prospective cohort study. JHEP Rep 2023; 5:100692. [PMID: 36937991 PMCID: PMC10017416 DOI: 10.1016/j.jhepr.2023.100692] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 02/05/2023] Open
Abstract
Background & Aims Lean patients with non-alcoholic fatty liver disease (NAFLD) represent 10-20% of the affected population and may have heterogeneous drivers of disease. We have recently proposed the evaluation of patients with lean NAFLD without visceral adiposity for rare monogenic drivers of disease. Here, we aimed to validate this framework in a well-characterised cohort of patients with biopsy-proven NAFLD by performing whole exome sequencing. Methods This prospective study included 124 patients with biopsy-proven NAFLD and paired liver biopsies who underwent standardised research visits including advanced magnetic resonance imaging (MRI) assessment of liver fat and stiffness. Results Six patients with lean NAFLD were identified and underwent whole exome sequencing. Two lean patients (33%) were identified to have monogenic disorders. The lean patients with monogenic disorders had similar age, and anthropometric and MRI characteristics to lean patients without a monogenic disorder. Patient 1 harbours a rare homozygous pathogenic mutation in ALDOB (aldolase B) and was diagnosed with hereditary fructose intolerance. Patient 2 harbours a rare heterozygous mutation in apolipoprotein B (APOB). The pathogenicity of this APOB variant (p.Val1856CysfsTer2) was further validated in the UK Biobank and associated with lower circulating APOB levels (beta = -0.51 g/L, 95% CI -0.65 to -0.36 g/L, p = 1.4 × 10-11) and higher liver fat on MRI (beta = +10.4%, 95% CI 4.3-16.5%, p = 8.8 × 10-4). Hence, patient 2 was diagnosed with heterozygous familial hypobetalipoproteinaemia. Conclusions In this cohort of well-characterised patients with lean NAFLD without visceral adiposity, 33% (2/6) had rare monogenic drivers of disease, highlighting the importance of genomic analysis in this NAFLD subtype. Impact and Implications Although most people with non-alcoholic fatty liver disease (NAFLD) are overweight or obese, a subset are lean and may have unique genetic mutations that cause their fatty liver disease. We show that 33% of study participants with NAFLD who were lean harboured unique mutations that cause their fatty liver, and that these mutations had effects beyond the liver. This study demonstrates the value of genetic assessment of NAFLD in lean individuals to identify distinct subtypes of disease.
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Key Words
- ALT, alanine aminotransferase
- APOB, apolipoprotein B
- FHBL, familial hypobetalipoproteinaemia
- LOFHC, high-confidence predicted loss-of-function
- MRE, magnetic resonance elastography
- MRI, magnetic resonance imaging
- MRI-PDFF, magnetic resonance imaging proton density fat fraction
- NAFLD
- NAFLD, non-alcoholic fatty liver disease
- Non-obese
- Rare genetic variants
- UCSD, University of California San Diego
- WES, whole exome sequencing
- Whole exome sequencing
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Affiliation(s)
- Melanie Zheng
- Departments of Internal Medicine, Section of Digestive Diseases, and of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Daniel Q. Huang
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, CA, USA
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chigoziri Konkwo
- Departments of Internal Medicine, Section of Digestive Diseases, and of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Saaket Agrawal
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Amit V. Khera
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Verve Therapeutics, Cambridge, MA, USA
| | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, CA, USA
| | - Sílvia Vilarinho
- Departments of Internal Medicine, Section of Digestive Diseases, and of Pathology, Yale School of Medicine, New Haven, CT, USA
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Veeral Ajmera
- NAFLD Research Center, Division of Gastroenterology, University of California at San Diego, La Jolla, CA, USA
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8
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Cano A, Alcalde C, Belanger-Quintana A, Cañedo-Villarroya E, Ceberio L, Chumillas-Calzada S, Correcher P, Couce ML, García-Arenas D, Gómez I, Hernández T, Izquierdo-García E, Chicano DM, Morales M, Pedrón-Giner C, Jáuregui EP, Peña-Quintana L, Sánchez-Pintos P, Serrano-Nieto J, Suarez MU, Miñana IV, de Las Heras J. Vitamin C and folate status in hereditary fructose intolerance. Eur J Clin Nutr 2022; 76:1733-1739. [PMID: 35854131 PMCID: PMC9708598 DOI: 10.1038/s41430-022-01178-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/17/2022] [Accepted: 06/23/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hereditary fructose intolerance (HFI) is a rare inborn error of fructose metabolism caused by the deficiency of aldolase B. Since treatment consists of a fructose-, sucrose- and sorbitol-restrictive diet for life, patients are at risk of presenting vitamin deficiencies. Although there is no published data on the status of these vitamins in HFI patients, supplementation with vitamin C and folic acid is common. Therefore, the aim of this study was to assess vitamin C and folate status and supplementation practices in a nationwide cohort of HFI patients. METHODS Vitamin C and folic acid dietary intake, supplementation and circulating levels were assessed in 32 HFI patients and 32 age- and sex-matched healthy controls. RESULTS Most of the HFI participants presented vitamin C (96.7%) and folate (90%) dietary intake below the recommended population reference intake. Up to 69% received vitamin C and 50% folic acid supplementation. Among HFI patients, 15.6% presented vitamin C and 3.1% folate deficiency. The amount of vitamin C supplementation and plasma levels correlated positively (R = 0.443; p = 0.011). Interestingly, a higher percentage of non-supplemented HFI patients were vitamin C deficient when compared to supplemented HFI patients (30% vs. 9.1%; p = 0.01) and to healthy controls (30% vs. 3.1%; p < 0.001). CONCLUSIONS Our results provide evidence for the first time supporting vitamin C supplementation in HFI. There is great heterogeneity in vitamin supplementation practices and, despite follow-up at specialised centres, vitamin C deficiency is common. Further research is warranted to establish optimal doses of vitamin C and the need for folic acid supplementation in HFI.
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Affiliation(s)
- Ainara Cano
- Biocruces Bizkaia Health Research Institute, 48093, Barakaldo, Spain
- Food Research, AZTI, Basque Research and Technology Alliance (BRTA), Parque Tecnológico de Bizkaia, Astondo Bidea, Edificio 609, 48160, Derio, Spain
| | - Carlos Alcalde
- Paediatrics Unit, Río Hortega University Hospital, 47012, Valladolid, Spain
| | - Amaya Belanger-Quintana
- Metabolic Diseases Unit, Department of Paediatrics, Ramón y Cajal Hospital, 28034, Madrid, Spain
| | - Elvira Cañedo-Villarroya
- Department of Metabolism Diseases and Nutrition, Niño Jesús University Children´s Hospital, 28009, Madrid, Spain
| | - Leticia Ceberio
- Biocruces Bizkaia Health Research Institute, 48093, Barakaldo, Spain
- Internal Medicine Service, Cruces University Hospital, 48903, Barakaldo, Spain
| | | | - Patricia Correcher
- Nutrition and Metabolic diseases Unit, La Fe University Hospital, 46026, Valencia, Spain
| | - María Luz Couce
- Unit of Diagnosis and Treatment of Congenital Metabolic Diseases, Department of Pediatrics, IDIS-Health Research Institute of Santiago de Compostela. CIBERER. MetabERN. Santiago de Compostela University Clinical Hospital, 15704, Santiago de Compostela, Spain
| | - Dolores García-Arenas
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Sant Joan de Déu Hospital, 08950, Barcelona, Spain
| | - Igor Gómez
- Araba University Hospital, 01009, Vitoria-Gasteiz, Spain
| | - Tomás Hernández
- Paediatric Service, Albacete University Hospital, 02006, Castilla-La Mancha, Spain
| | | | - Dámaris Martínez Chicano
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Sant Joan de Déu Hospital, 08950, Barcelona, Spain
| | - Montserrat Morales
- 12 de Octubre University Hospital, CIBERER, MetabERN, 28041, Madrid, Spain
| | - Consuelo Pedrón-Giner
- Department of Metabolism Diseases and Nutrition, Niño Jesús University Children´s Hospital, 28009, Madrid, Spain
| | | | - Luis Peña-Quintana
- Paediatric Gastroenterology, Hepatology and Nutrition Unit, Mother and Child Insular University Hospital complex, Asociación Canaria para la Investigación Pediátrica (ACIP), CIBEROBN. University Institute for Research in Biomedical and Health Sciences, University of Las Palmas de Gran Canaria, 35016, Las Palmas de Gran Canaria, Spain
| | - Paula Sánchez-Pintos
- Unit of Diagnosis and Treatment of Congenital Metabolic Diseases, Department of Pediatrics, IDIS-Health Research Institute of Santiago de Compostela. CIBERER. MetabERN. Santiago de Compostela University Clinical Hospital, 15704, Santiago de Compostela, Spain
| | | | - María Unceta Suarez
- Biochemistry Laboratory, Metabolism Area, Cruces University Hospital, 48903, Barakaldo, Spain
| | - Isidro Vitoria Miñana
- Nutrition and Metabolic diseases Unit, La Fe University Hospital, 46026, Valencia, Spain
| | - Javier de Las Heras
- Biocruces Bizkaia Health Research Institute, 48093, Barakaldo, Spain.
- Division of Paediatric Metabolism, CIBERER, MetabERN, Cruces University Hospital, 48093, Barakaldo, Spain.
- Department of Paediatrics, University of the Basque Country (UPV/EHU), 48940, Leioa, Spain.
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9
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Tang M, Chen X, Ni Q, Lu Y, Wu B, Wang H, Yin Z, Zhou W, Dong X. Estimation of hereditary fructose intolerance prevalence in the Chinese population. Orphanet J Rare Dis 2022; 17:326. [PMID: 36028839 PMCID: PMC9419342 DOI: 10.1186/s13023-022-02487-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/15/2022] [Indexed: 11/15/2022] Open
Abstract
Background Hereditary fructose intolerance (HFI) caused by aldolase B reduction or deficiency that results in fructose metabolism disorder. The disease prevalence in the Chinese population is unknown, which impedes the formulation of HFI screening and diagnosis strategies. Materials and methods By searching a local cohort (Chinese Children’s Rare Disease Genetic Testing Clinical Collaboration System, CCGT) and public databases (ClinVar and Human Gene Mutation Database) and reviewing HFI-related literature, we manually curated ALDOB pathogenic or likely pathogenic (P/LP) variants according to ACMG guidelines. Allele frequency (AF) information from the local database CCGT and the public databases HuaBiao and gnomAD for ALDOB P/LP variants was used to estimate and the HFI prevalence in the Chinese population and other populations by the Bayesian framework. We collected the genotype and clinical characteristics of HFI patients from the CCGT database and published literature to study genotype–phenotype relationships. Result In total, 81 variants of ALDOB were curated as P/LP. The estimated Chinese HFI prevalence was approximately 1/504,678, which was much lower than that for non-Finland European (1/23,147), Finnish in Finland (1/55,539), admixed American (1/132,801) and Ashkenazi Jewish (1/263,150) populations. By analyzing the genetic characteristics of ALDOB in the Chinese population, two variants (A338V, A338G) had significantly higher AFs in the Chinese population than in the non-Finland European population from gnomAD (all P values < 0.05). Five variants (A150P, A175D, N335K, R60*, R304Q) had significantly lower AFs (all P values < 0.1). The genotype–phenotype association analyses were based on 68 reported HFI patients from a literature review and the CCGT database. The results showed that patients carrying homozygous variant sites (especially A150P) were more likely to present nausea, and patients carrying two missense variant sites were more likely to present aversion to sweets and fruit (all P values < 0.05). Our research reveals that some gastrointestinal symptoms seem to be associated with certain genotypes. Conclusion The prevalence of HFI in the Chinese population is extremely low, and there is no need to add HFI testing to the current newborn screening programs if medical costs are considered. A genetic testing strategy is suggested for early diagnosis of HFI. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02487-3.
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Affiliation(s)
- Meiling Tang
- Center for Molecular Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Xiang Chen
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, 201102, China
| | - Qi Ni
- Center for Molecular Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Yulan Lu
- Center for Molecular Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Bingbing Wu
- Center for Molecular Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Huijun Wang
- Center for Molecular Medicine, Children's Hospital of Fudan University, Shanghai, China
| | - Zhaoqing Yin
- Department of Pediatrics, Dehong Hospital of Kunming Medical University, Dehong, 678400, China
| | - Wenhao Zhou
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, 201102, China.
| | - Xinran Dong
- Center for Molecular Medicine, Children's Hospital of Fudan University, Shanghai, China.
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Singh SK, Sarma MS. Hereditary fructose intolerance: A comprehensive review. World J Clin Pediatr 2022; 11:321-329. [PMID: 36052111 PMCID: PMC9331401 DOI: 10.5409/wjcp.v11.i4.321] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 05/08/2022] [Accepted: 06/20/2022] [Indexed: 02/06/2023] Open
Abstract
Hereditary fructose intolerance (HFI) is a rare autosomal recessive inherited disorder that occurs due to the mutation of enzyme aldolase B located on chromosome 9q22.3. A fructose load leads to the rapid accumulation of fructose 1-phosphate and manifests with its downstream effects. Most commonly children are affected with gastrointestinal symptoms, feeding issues, aversion to sweets and hypoglycemia. Liver manifestations include an asymptomatic increase of transaminases, steatohepatitis and rarely liver failure. Renal involvement usually occurs in the form of proximal renal tubular acidosis and may lead to chronic renal insufficiency. For confirmation, a genetic test is favored over the measurement of aldolase B activity in the liver biopsy specimen. The crux of HFI management lies in the absolute avoidance of foods containing fructose, sucrose, and sorbitol (FSS). There are many dilemmas regarding tolerance, dietary restriction and occurrence of steatohepatitis. Patients with HFI who adhere strictly to FSS free diet have an excellent prognosis with a normal lifespan. This review attempts to increase awareness and provide a comprehensive review of this rare but treatable disorder.
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Affiliation(s)
- Sumit Kumar Singh
- Department of Pediatrics, Sri Aurobindo Medical College and PGI, Indore 453555, Madhya Pradesh, India
| | - Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India
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