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Zhou J, Li G, Zeng Y, Qiu X, Zhao P, Huang T, Wang X, Luo J, Lin N, Xu L. Screening primary carnitine deficiency in 10 million Chinese newborns: a systematic review and meta-analysis. Orphanet J Rare Dis 2024; 19:248. [PMID: 38961493 PMCID: PMC11220949 DOI: 10.1186/s13023-024-03267-x] [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: 04/17/2024] [Accepted: 06/26/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Primary carnitine deficiency (PCD) is a rare autosomal recessive fatty acid oxidation disorder caused by variants in SLC22A5, with its prevalence and SLC22A5 gene mutation spectrum varying across races and regions. This study aimed to systematically analyze the incidence of PCD in China and delineate regional differences in the prevalence of PCD and SLC22A5 gene variants. METHODS PubMed, Embase, Web of Science, and Chinese databases were searched up to November 2023. Following quality assessment and data extraction, a meta-analysis was performed on screening results for PCD among Chinese newborns. RESULTS After reviewing 1,889 articles, 22 studies involving 9,958,380 newborns and 476 PCD cases were included. Of the 476 patients with PCD, 469 underwent genetic diagnosis, revealing 890 variants of 934 alleles of SLC22A5, among which 107 different variants were detected. The meta-analysis showed that the prevalence of PCD in China was 0.05‰ [95%CI, (0.04‰, 0.06‰)] or 1/20 000 [95%CI, (1/16 667, 1/25 000)]. Subgroup analyses revealed a higher incidence in southern China [0.07‰, 95%CI, (0.05‰, 0.08‰)] than in northern China [0.02‰, 95%CI, (0.02‰, 0.03‰)] (P < 0.001). Furthermore, the result of the meta-analysis showed that the frequency of the variant with c.1400C > G, c.51C > G, c.760C > T, c.338G > A, and c.428C > T were 45% [95%CI, (34%, 59%)], 26% [95%CI, (22%, 31%)], 14% [95%CI, (10%, 20%)], 6% [95%CI, (4%, 8%)], and 5% [95%CI, (4%, 8%)], respectively. Among the subgroup analyses, the variant frequency of c.1400C > G in southern China [39%, 95%CI, (29%, 53%)] was significantly lower than that in northern China [79‰, 95%CI, (47‰, 135‰)] (P < 0.05). CONCLUSIONS This study systematically analyzed PCD prevalence and identified common SLC22A5 gene variants in the Chinese population. The findings provide valuable epidemiological insights and guidance for future PCD screening effects in newborns.
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Affiliation(s)
- Jinfu Zhou
- Medical Genetic Diagnosis and Therapy Center, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, Fujian Province, China
| | - Guilin Li
- Department of Preventive Medicine, School of Public Health, Fujian Medical University, Fuzhou, 350122, Fujian Province, China
| | - Yinglin Zeng
- Medical Genetic Diagnosis and Therapy Center, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, Fujian Province, China
| | - Xiaolong Qiu
- Medical Genetic Diagnosis and Therapy Center, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, Fujian Province, China
| | - Peiran Zhao
- Medical Genetic Diagnosis and Therapy Center, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, Fujian Province, China
| | - Ting Huang
- Medical Genetic Diagnosis and Therapy Center, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, Fujian Province, China
| | - Xi Wang
- Department of Clinical Laboratory, Changdu Maternity and Child Hospital, Tibet Autonomous Region, Changdu, 854085, China
| | - Jinying Luo
- Obstetrics and Gynecology Department, Fujian Maternity and Child Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, Fujian Province, China.
| | - Na Lin
- Medical Genetic Diagnosis and Therapy Center, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, Fujian Province, China.
| | - Liangpu Xu
- Medical Genetic Diagnosis and Therapy Center, Fujian Key Laboratory for Prenatal Diagnosis and Birth Defect, Fujian Maternity and Child Hospital College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, 350001, Fujian Province, China.
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Almomen M, Burgon PG. Why Craniofacial Surgeons/Researchers Need to be Aware of Native American Myopathy? Neuropediatrics 2024; 55:149-155. [PMID: 38378040 DOI: 10.1055/a-2271-8619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
Congenital myopathy type 13 (CMYO13), also known as Native American myopathy, is a rare muscle disease characterized by early-onset hypotonia, muscle weakness, delayed motor milestones, and susceptibility to malignant hyperthermia. The phenotypic spectrum of congenital myopathy type 13 is expanding, with milder forms reported in non-native American patients. The first description of the disease dates to 1987 when Bailey and Bloch described an infant belonging to a Native American tribe with cleft palate, micrognathia, arthrogryposis, and general-anesthesia-induced malignant hyperthermia reaction; the cause of the latter remains poorly defined in this rare disease. The pan-ethnic distribution, as well as its predisposition to malignant hyperthermia, makes the identification of CMYO13 essential to avoid life-threatening, anesthesia-related complications. In this article, we are going to review the clinical phenotype of this disease and the pathophysiology of this rare disease with a focus on two unique features of the disease, namely cleft palate and malignant hyperthermia. We also highlight the importance of recognizing this disease's expanding phenotypic spectrum-including its susceptibility to malignant hyperthermia-and providing appropriate care to affected individuals and families.
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Affiliation(s)
- Momen Almomen
- Department of Neurosciences, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia
| | - Patrick G Burgon
- Department of Chemistry and Earth Sciences, College of Arts and Sciences, Qatar University, State of Qatar
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Guerrero Cervera B, Donoso Trenado V, Fernández-Sellers C, Vila Clérigues N, Correcher Medina P, Zorio E. Cardiomyopathy associated with primary carnitine deficiency in adults: lack of complete response in patients with delayed treatment initiation. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:265-267. [PMID: 38469824 DOI: 10.1016/j.rec.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/31/2023] [Indexed: 03/13/2024]
Affiliation(s)
- Borja Guerrero Cervera
- Departamento de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain. https://twitter.com/@BorjaGueCer
| | - Víctor Donoso Trenado
- Departamento de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Carlos Fernández-Sellers
- Servicio de Patología Forense, Instituto de Medicina Legal y Ciencias Forenses de Valencia, Valencia, Spain
| | | | | | - Esther Zorio
- Departamento de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Unidad de Cardiopatías Familiares y Muerte Súbita, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
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Yang T, Liu S, Ma H, Lai H, Wang C, Ni K, Lu Y, Li W, Hu X, Zhou Z, Lou C, He D. Carnitine functions as an enhancer of NRF2 to inhibit osteoclastogenesis via regulating macrophage polarization in osteoporosis. Free Radic Biol Med 2024; 213:174-189. [PMID: 38246515 DOI: 10.1016/j.freeradbiomed.2024.01.017] [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: 12/21/2023] [Accepted: 01/12/2024] [Indexed: 01/23/2024]
Abstract
Osteoporosis, which manifests as reduced bone mass and deteriorated bone quality, is common in the elderly population. It is characterized by persistent elevation of macrophage-associated inflammation and active osteoclast bone resorption. Currently, the roles of intracellular metabolism in regulating these processes remain unclear. In this study, we initially performed bioinformatics analysis and observed a significant increase in the proportion of M1 macrophages in bone marrow with aging. Further metabolomics analysis demonstrated a notable reduction in the expression of carnitine metabolites in aged macrophages, while carnitine was not detected in osteoclasts. During the differentiation process, osteoclasts took up carnitine synthesized by macrophages to regulate their own activity. Mechanistically, carnitine enhanced the function of Nrf2 by inhibiting the Keap1-Nrf2 interaction, reducing the proteasome-dependent ubiquitination and degradation of Nrf2. In silico molecular ligand docking analysis of the interaction between carnitine and Keap1 showed that carnitine binds to Keap1 to stabilize Nrf2 and enhance its function. In this study, we found that the decrease in carnitine levels in aging macrophages causes overactivation of osteoclasts, ultimately leading to osteoporosis. A decrease in serum carnitine levels in patients with osteoporosis was found to have good diagnostic and predictive value. Moreover, supplementation with carnitine was shown to be effective in the treatment of osteoporosis.
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Affiliation(s)
- Tao Yang
- The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, Zhejiang, 323000, PR China
| | - Shijie Liu
- The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, Zhejiang, 323000, PR China
| | - Haiwei Ma
- The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, Zhejiang, 323000, PR China
| | - Hehuan Lai
- The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, Zhejiang, 323000, PR China
| | - Chengdi Wang
- The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, Zhejiang, 323000, PR China
| | - Kainan Ni
- The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, Zhejiang, 323000, PR China
| | - Yahong Lu
- The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, Zhejiang, 323000, PR China
| | - Weiqing Li
- The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, Zhejiang, 323000, PR China
| | - Xingyu Hu
- The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, Zhejiang, 323000, PR China
| | - Zhiguo Zhou
- The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, Zhejiang, 323000, PR China
| | - Chao Lou
- The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, Zhejiang, 323000, PR China.
| | - Dengwei He
- The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, 289 Kuocang Road, Lishui, Zhejiang, 323000, PR China.
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Lin Y, Lin C, Zheng Z, Huang C, Peng W. Newborn screening for primary carnitine deficiency using a second-tier genetic test. J Pediatr Endocrinol Metab 2024; 37:163-169. [PMID: 38158618 DOI: 10.1515/jpem-2023-0513] [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: 11/16/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Newborn screening (NBS) for primary carnitine deficiency (PCD) exhibits suboptimal performance. This study proposes a strategy to enhance the efficacy of second-tier genetic screening by adjusting the cutoff value for free carnitine (C0). METHODS Between January 2021 and December 2022, we screened 119,898 neonates for inborn metabolic disorders. Neonates with C0 levels below 12 μmol/L were randomly selected for second-tier genetic screening, employing a novel matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) assay. RESULTS In total, 2,515 neonates with C0 <12 μmol/L underwent further screening, including 206 neonates with C0 <8.5 μmol/L and 320 neonates with 8.5G, accounting for 25 % (7/28) of allelic frequencies. CONCLUSIONS A novel MALDI-TOF MS assay targeting 21 SLC22A5 variants in a Chinese population was successfully established. This assay exhibits a high detection and diagnostic rate, making it suitable for population-based genetic screening. Combined genetic screening is recommended to enhance the efficiency of PCD-NBS.
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Affiliation(s)
- Yiming Lin
- Department of Clinical Laboratory, Quanzhou Maternity and Children's Hospital, Quanzhou, Fujian Province, P.R. China
| | - Chunmei Lin
- Department of Clinical Laboratory, Quanzhou Maternity and Children's Hospital, Quanzhou, Fujian Province, P.R. China
| | - Zhenzhu Zheng
- Department of Clinical Laboratory, Quanzhou Maternity and Children's Hospital, Quanzhou, Fujian Province, P.R. China
| | - Chenggang Huang
- Zhejiang Biosan Biochemical Technologies Co., Ltd., Hangzhou, Zhejiang Province, P.R. China
| | - Weilin Peng
- Department of Clinical Laboratory, Quanzhou Maternity and Children's Hospital, Quanzhou, Fujian Province, P.R. China
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Lodewyckx P, Issa J, Gaschignard M, Lamireau D, De Lonlay P, Servais A, Barth M, Courapied S, Morin G, Benbrik N, Maillot F, Babuty D, Labarthe F, Lefort B. Systemic primary carnitine deficiency induces severe arrhythmia due to shortening of QT interval. Mol Genet Metab 2023; 140:107733. [PMID: 37979236 DOI: 10.1016/j.ymgme.2023.107733] [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: 06/05/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Systemic primary carnitine deficiency (PCD) is characterized by cardiomyopathy and arrhythmia. Without carnitine supplementation, progression is usually towards fatal cardiac decompensation. While the cardiomyopathy is most likely secondary to energy deficiency, the mechanism of arrhythmia is unclear, and may be related to a short QT interval. OBJECTIVE We aim to describe rhythmic manifestations at diagnosis and with carnitine supplementation. METHODS French patients diagnosed for PCD were retrospectively included. Clinical and para clinical data at diagnosis and during follow-up were collected. Electrocardiograms with QT interval measurements were blinded reviewed by two paediatric cardiologists. RESULTS Nineteen patients (median age at diagnosis 2.3 years (extremes 0.3-28.9)) followed in 8 French centres were included. At diagnosis, 21% of patients (4/19) had arrhythmia (2 ventricular fibrillations, 1 ventricular tachycardia and 1 sudden death), and 84% (16/19) had cardiomyopathy. Six electrocardiograms before treatment out of 11 available displayed a short QT (QTc < 340 ms). Median corrected QTc after carnitine supplementation was 404 ms (extremes 341-447) versus 350 ms (extremes 282-421) before treatment (p < 0.001). The whole QTc was prolonged, and no patient reached the criterion of short QT syndrome with carnitine supplementation. Three patients died, probably from rhythmic cause without carnitine supplementation (two extra-hospital sudden deaths and one non-recoverable rhythmic storm before carnitine supplementation), whereas no rhythmic complication occurred in patients with carnitine supplementation. CONCLUSION PCD is associated with shortening of the QT interval inducing severe arrhythmia. A potential explanation would be a toxic effect of accumulated fatty acid and metabolites on ionic channels embedded in the cell membrane. Carnitine supplementation normalizes the QTc and prevents arrhythmia. Newborn screening of primary carnitine deficiency would prevent avoidable deaths.
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Affiliation(s)
- Pierre Lodewyckx
- Institut des Cardiopathies Congénitales de Tours and FHU PRECICARE, CHU Tours, Tours, France
| | - Jean Issa
- Institut des Cardiopathies Congénitales de Tours and FHU PRECICARE, CHU Tours, Tours, France
| | | | | | - Pascale De Lonlay
- Maladie métabolique, Hôpital Necker Enfant Malade, APHP, Université Paris Cité, Filière G2M, MetabERN, Paris, France
| | - Aude Servais
- Maladie métabolique, Hôpital Necker Enfant Malade, APHP, Université Paris Cité, Filière G2M, MetabERN, Paris, France
| | | | - Sandy Courapied
- Maladie métabolique, CHU Lille, Filière G2M, MetabERN, Lille, France
| | | | - Nadir Benbrik
- Fédération cardiologie pédiatrique, CHU Nantes, Nantes, France
| | - François Maillot
- CRMR Maladies Héréditaires du Métabolisme ToTeM, CHU Tours, Tours, France
| | | | - François Labarthe
- CRMR Maladies Héréditaires du Métabolisme ToTeM, CHU Tours, Tours, France; INSERM UMR 1069, Université de Tours, Tours, France
| | - Bruno Lefort
- Institut des Cardiopathies Congénitales de Tours and FHU PRECICARE, CHU Tours, Tours, France; INSERM UMR 1069, Université de Tours, Tours, France.
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7
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Crefcoeur L, Ferdinandusse S, van der Crabben SN, Dekkers E, Fuchs SA, Huidekoper H, Janssen M, Langendonk J, Maase R, de Sain M, Rubio E, van Spronsen FJ, Vaz FM, Verschoof R, de Vries M, Wijburg F, Visser G, Langeveld M. Newborn screening for primary carnitine deficiency: who will benefit? - a retrospective cohort study. J Med Genet 2023; 60:1177-1185. [PMID: 37487700 DOI: 10.1136/jmg-2023-109206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/17/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Newborn screening (NBS) programmes identify a wide range of disease phenotypes, which raises the question whether early identification and treatment is beneficial for all. This study aims to answer this question for primary carnitine deficiency (PCD) taking into account that NBS for PCD identifies newborns with PCD and also until then undiagnosed mothers. METHODS We investigated clinical, genetic (variants in SLC22A5 gene) and functional (carnitine transport activity in fibroblasts) characteristics of all referred individuals through NBS (newborns and mothers) and clinically diagnosed patients with PCD (not through NBS). Disease phenotype in newborns was predicted using data from PCD mothers and cases published in literature with identical SLC22A5 variants. RESULTS PCD was confirmed in 19/131 referred newborns, 37/82 referred mothers and 5 clinically diagnosed patients. Severe symptoms were observed in all clinically diagnosed patients, 1 newborn and none of the mothers identified by NBS. PCD was classified as severe in all 5 clinically diagnosed patients, 3/19 newborns and 1/37 mothers; as benign in 8/19 newborns and 36/37 mothers and as unknown in 8/19 newborns. Carnitine transport activity completely separated severe phenotype from benign phenotype (median (range): 4.0% (3.5-5.0)] vs 26% (9.5-42.5), respectively). CONCLUSION The majority of mothers and a significant proportion of newborns with PCD identified through NBS are likely to remain asymptomatic without early treatment. Conversely, a small proportion of newborns with predicted severe PCD could greatly benefit from early treatment. Genetic variants and carnitine transport activity can be used to distinguish between these groups.
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Affiliation(s)
- Loek Crefcoeur
- Metabolic Diseases, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
- Department of Pediatrics, Division of Metabolic Disorders, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Clinical Chemistry, Laboratory Genetic Metabolic Diseases, Amsterdam UMC Locatie Meibergdreef, Amsterdam, The Netherlands
| | - Sacha Ferdinandusse
- Department of Pediatrics, Division of Metabolic Disorders, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Clinical Chemistry, Laboratory Genetic Metabolic Diseases, Amsterdam UMC Locatie Meibergdreef, Amsterdam, The Netherlands
| | - Saskia N van der Crabben
- Human Genetics, Amsterdam UMC Locatie Meibergdreef, Amsterdam, The Netherlands
- United for Metabolic Diseases, Amsterdam, The Netherlands
| | - Eugènie Dekkers
- Centre for Population Screening, RIVM, Bilthoven, The Netherlands
| | - Sabine A Fuchs
- Metabolic Diseases, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
| | - Hidde Huidekoper
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Mirian Janssen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janneke Langendonk
- Department of Internal Medicine, Center for Lysosomal and Metabolic Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rose Maase
- Department of Biologicals, Screening and Innovation, RIVM, Bilthoven, The Netherlands
| | - Monique de Sain
- Section Metabolic Diagnostics, Department of Genetics, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
| | - Estela Rubio
- Department of Pediatrics/Laboratory of Clinical Genetics, Maastricht UMC+, Maastricht, The Netherlands
| | - Francjan J van Spronsen
- Section of Metabolic Diseases, University Medical Centre Groningen, Beatrix Children's Hospital, Groningen, The Netherlands
| | - Frédéric Maxime Vaz
- Laboratory Genetic Metabolic Diseases, Amsterdam UMC, University of Amsterdam, Departments of Clinical Chemistry and Pediatrics, Core Facility Metabolomics, Emma Children's Hospital, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC Locatie Meibergdreef, Amsterdam, The Netherlands
| | - Rendelien Verschoof
- Department for Vaccine Supply and Prevention Programs, RIVM, Bilthoven, The Netherlands
| | - Maaike de Vries
- Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frits Wijburg
- Department of Pediatrics, Division of Metabolic Disorders, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Gepke Visser
- Metabolic Diseases, Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
- Department of Pediatrics, Division of Metabolic Disorders, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Mirjam Langeveld
- Department of Endocrinology and Metabolism, Amsterdam UMC Locatie Meibergdreef, Amsterdam, The Netherlands
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8
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Maier EM, Mütze U, Janzen N, Steuerwald U, Nennstiel U, Odenwald B, Schuhmann E, Lotz-Havla AS, Weiss KJ, Hammersen J, Weigel C, Thimm E, Grünert SC, Hennermann JB, Freisinger P, Krämer J, Das AM, Illsinger S, Gramer G, Fang-Hoffmann J, Garbade SF, Okun JG, Hoffmann GF, Kölker S, Röschinger W. Collaborative evaluation study on 18 candidate diseases for newborn screening in 1.77 million samples. J Inherit Metab Dis 2023; 46:1043-1062. [PMID: 37603033 DOI: 10.1002/jimd.12671] [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: 05/06/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/22/2023]
Abstract
Analytical and therapeutic innovations led to a continuous but variable extension of newborn screening (NBS) programmes worldwide. Every extension requires a careful evaluation of feasibility, diagnostic (process) quality and possible health benefits to balance benefits and limitations. The aim of this study was to evaluate the suitability of 18 candidate diseases for inclusion in NBS programmes. Utilising tandem mass spectrometry as well as establishing specific diagnostic pathways with second-tier analyses, three German NBS centres designed and conducted an evaluation study for 18 candidate diseases, all of them inherited metabolic diseases. In total, 1 777 264 NBS samples were analysed. Overall, 441 positive NBS results were reported resulting in 68 confirmed diagnoses, 373 false-positive cases and an estimated cumulative prevalence of approximately 1 in 26 000 newborns. The positive predictive value ranged from 0.07 (carnitine transporter defect) to 0.67 (HMG-CoA lyase deficiency). Three individuals were missed and 14 individuals (21%) developed symptoms before the positive NBS results were reported. The majority of tested candidate diseases were found to be suitable for inclusion in NBS programmes, while multiple acyl-CoA dehydrogenase deficiency, isolated methylmalonic acidurias, propionic acidemia and malonyl-CoA decarboxylase deficiency showed some and carnitine transporter defect significant limitations. Evaluation studies are an important tool to assess the potential benefits and limitations of expanding NBS programmes to new diseases.
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Affiliation(s)
- Esther M Maier
- Department of Inborn Errors of Metabolism, Dr. von Hauner Children's Hospital, Munich, Germany
| | - Ulrike Mütze
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Nils Janzen
- Screening-Labor Hanover, Hanover, Germany
- Department of Clinical Chemistry, Hanover Medical School, Hanover, Germany
- Division of Laboratory Medicine, Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus Auf der Bult, Hanover, Germany
| | | | - Uta Nennstiel
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | - Birgit Odenwald
- Bavarian Health and Food Safety Authority, Oberschleissheim, Germany
| | | | - Amelie S Lotz-Havla
- Department of Inborn Errors of Metabolism, Dr. von Hauner Children's Hospital, Munich, Germany
| | - Katharina J Weiss
- Department of Inborn Errors of Metabolism, Dr. von Hauner Children's Hospital, Munich, Germany
| | - Johanna Hammersen
- Department of Pediatrics, Division of Inborn Errors of Metabolism, University Hospital Erlangen, Erlangen, Germany
| | - Corina Weigel
- Department of Pediatrics, Division of Inborn Errors of Metabolism, University Hospital Erlangen, Erlangen, Germany
| | - Eva Thimm
- Department of General Pediatrics, University Children's Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sarah C Grünert
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Centre-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Julia B Hennermann
- Villa Metabolica, Center for Pediatric and Adolescent Medicine, Mainz University Medical Center, Mainz, Germany
| | - Peter Freisinger
- Children's Hospital Reutlingen, Klinikum am Steinenberg, Reutlingen, Germany
| | - Johannes Krämer
- Department of Pediatric and Adolescent Medicine, Ulm University Medical School, Ulm, Germany
| | - Anibh M Das
- Hanover Medical School, Clinic for Pediatric Kidney-Liver- and Metabolic Diseases, Hanover, Germany
| | - Sabine Illsinger
- Hanover Medical School, Clinic for Pediatric Kidney-Liver- and Metabolic Diseases, Hanover, Germany
| | - Gwendolyn Gramer
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
- University Medical Center Hamburg-Eppendorf, University Children's Hospital, Hamburg, Germany
| | - Junmin Fang-Hoffmann
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Sven F Garbade
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen G Okun
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Georg F Hoffmann
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Kölker
- Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Wulf Röschinger
- Laboratory Becker MVZ GbR, Newborn Screening Unit, Munich, Germany
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9
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Farahzadi R, Hejazi MS, Molavi O, Pishgahzadeh E, Montazersaheb S, Jafari S. Clinical Significance of Carnitine in the Treatment of Cancer: From Traffic to the Regulation. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2023; 2023:9328344. [PMID: 37600065 PMCID: PMC10435298 DOI: 10.1155/2023/9328344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/12/2022] [Accepted: 03/23/2023] [Indexed: 08/22/2023]
Abstract
Metabolic reprogramming is a common hallmark of cancer cells. Cancer cells exhibit metabolic flexibility to maintain high proliferation and survival rates. In other words, adaptation of cellular demand is essential for tumorigenesis, since a diverse supply of nutrients is required to accommodate tumor growth and progression. Diversity of carbon substrates fueling cancer cells indicate metabolic heterogeneity, even in tumors sharing the same clinical diagnosis. In addition to the alteration of glucose and amino acid metabolism in cancer cells, there is evidence that cancer cells can alter lipid metabolism. Some tumors rely on fatty acid oxidation (FAO) as the primary energy source; hence, cancer cells overexpress the enzymes involved in FAO. Carnitine is an essential cofactor in the lipid metabolic pathways. It is crucial in facilitating the transport of long-chain fatty acids into the mitochondria for β-oxidation. This role and others played by carnitine, especially its antioxidant function in cellular processes, emphasize the fine regulation of carnitine traffic within tissues and subcellular compartments. The biological activity of carnitine is orchestrated by specific membrane transporters that mediate the transfer of carnitine and its derivatives across the cell membrane. The concerted function of carnitine transporters creates a collaborative network that is relevant to metabolic reprogramming in cancer cells. Here, the molecular mechanisms relevant to the role and expression of carnitine transporters are discussed, providing insights into cancer treatment.
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Affiliation(s)
- Raheleh Farahzadi
- Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Saeid Hejazi
- Molecular Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ommoleila Molavi
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Elahe Pishgahzadeh
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Montazersaheb
- Molecular Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sevda Jafari
- Nutrition Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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10
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van den Heuvel LM, Kater-Kuipers A, van Dijk T, Crefcoeur LL, Visser G, Langeveld M, Henneman L. A qualitative study on the perspectives of mothers who had been diagnosed with primary carnitine deficiency through newborn screening of their child. Orphanet J Rare Dis 2023; 18:134. [PMID: 37268964 DOI: 10.1186/s13023-023-02735-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/14/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Primary carnitine deficiency is an inborn error of metabolism, which can lead to life-threating complications early in life. Low carnitine levels can be detected by newborn bloodspot screening (NBS). However, NBS can also identify, mostly asymptomatic, mothers with primary carnitine deficiency. To identify mothers' needs and areas for improving screening practice, this study explored the experiences with, and opinions on primary carnitine deficiency screening in NBS among women diagnosed through NBS of their newborn. METHODS Twelve Dutch women were interviewed, 3-11 years after diagnosis. Data were analysed using a thematic approach. RESULTS Four main themes were derived: 1) psychological impact of primary carnitine deficiency diagnosis, 2) becoming a patient and "patient-in-waiting", 3) information issues and care provision, and 4) primary carnitine deficiency as part of the NBS panel. Mothers shared that they did not experience major psychological distress of the diagnosis. They did experience (recall) various emotions following the initial abnormal NBS result, including fear and anxiety as well as relief, and emotions regarding their own diagnosis, including uncertainty about health risks and treatment effectiveness. Some felt a patient-in-waiting. Many participants experienced a lack of information, especially shortly after receiving the abnormal NBS result. All shared the belief that screening for primary carnitine deficiency in NBS is beneficial for the newborn, and, given the information they received, also considered the knowledge beneficial for their own health. CONCLUSIONS Psychological burden following diagnosis was experienced by women as limited, although the experienced lack of information amplified feelings of uncertainty and anxiety. Most mothers believed that benefits of knowing about primary carnitine deficiency outweighed the disadvantages. Mothers' perspectives should be incorporated in policy-making about primary carnitine deficiency in NBS.
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Affiliation(s)
- Lieke M van den Heuvel
- Department of Human Genetics, Amsterdam UMC, location Vrije Universiteit, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, the Netherlands
| | - Adriana Kater-Kuipers
- Department of Human Genetics, Amsterdam UMC, location Vrije Universiteit, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, the Netherlands
| | - Tessa van Dijk
- Department of Human Genetics, Amsterdam UMC, location Vrije Universiteit, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development research institute, Amsterdam, the Netherlands
| | - Loek L Crefcoeur
- Wilhelmina Children's Hospital, Section Metabolic Diseases, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Gepke Visser
- Wilhelmina Children's Hospital, Section Metabolic Diseases, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Mirjam Langeveld
- Department of Endocrinology and Metabolism, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Lidewij Henneman
- Department of Human Genetics, Amsterdam UMC, location Vrije Universiteit, Amsterdam, the Netherlands.
- Amsterdam Reproduction and Development research institute, Amsterdam, the Netherlands.
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11
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Urtizberea JA, Severa G, Malfatti E. Metabolic Myopathies in the Era of Next-Generation Sequencing. Genes (Basel) 2023; 14:genes14050954. [PMID: 37239314 DOI: 10.3390/genes14050954] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/07/2023] [Accepted: 04/18/2023] [Indexed: 05/28/2023] Open
Abstract
Metabolic myopathies are rare inherited disorders that deserve more attention from neurologists and pediatricians. Pompe disease and McArdle disease represent some of the most common diseases in clinical practice; however, other less common diseases are now better-known. In general the pathophysiology of metabolic myopathies needs to be better understood. Thanks to the advent of next-generation sequencing (NGS), genetic testing has replaced more invasive investigations and sophisticated enzymatic assays to reach a final diagnosis in many cases. The current diagnostic algorithms for metabolic myopathies have integrated this paradigm shift and restrict invasive investigations for complicated cases. Moreover, NGS contributes to the discovery of novel genes and proteins, providing new insights into muscle metabolism and pathophysiology. More importantly, a growing number of these conditions are amenable to therapeutic approaches such as diets of different kinds, exercise training protocols, and enzyme replacement therapy or gene therapy. Prevention and management-notably of rhabdomyolysis-are key to avoiding serious and potentially life-threatening complications and improving patients' quality of life. Although not devoid of limitations, the newborn screening programs that are currently mushrooming across the globe show that early intervention in metabolic myopathies is a key factor for better therapeutic efficacy and long-term prognosis. As a whole NGS has largely increased the diagnostic yield of metabolic myopathies, but more invasive but classical investigations are still critical when the genetic diagnosis is unclear or when it comes to optimizing the follow-up and care of these muscular disorders.
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Affiliation(s)
| | - Gianmarco Severa
- Department of Medical, Surgical and Neurological Sciences, Neurology-Neurophysiology Unit, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 5310 Siena, Italy
- Université Paris Est, U955, IMRB, INSERM, APHP, Centre de Référence de Pathologie Neuromusculaire Nord-Est-Ile-de-France, Henri Mondor Hospital, 94000 Créteil, France
| | - Edoardo Malfatti
- Université Paris Est, U955, IMRB, INSERM, APHP, Centre de Référence de Pathologie Neuromusculaire Nord-Est-Ile-de-France, Henri Mondor Hospital, 94000 Créteil, France
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12
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Pathophysiology and Management of Fatigue in Neuromuscular Diseases. Int J Mol Sci 2023; 24:ijms24055005. [PMID: 36902435 PMCID: PMC10003182 DOI: 10.3390/ijms24055005] [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: 01/18/2023] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
Fatigue is a major determinant of quality of life and motor function in patients affected by several neuromuscular diseases, each of them characterized by a peculiar physiopathology and the involvement of numerous interplaying factors. This narrative review aims to provide an overview on the pathophysiology of fatigue at a biochemical and molecular level with regard to muscular dystrophies, metabolic myopathies, and primary mitochondrial disorders with a focus on mitochondrial myopathies and spinal muscular atrophy, which, although fulfilling the definition of rare diseases, as a group represent a representative ensemble of neuromuscular disorders that the neurologist may encounter in clinical practice. The current use of clinical and instrumental tools for fatigue assessment, and their significance, is discussed. A summary of therapeutic approaches to address fatigue, encompassing pharmacological treatment and physical exercise, is also overviewed.
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13
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Lefèvre CR, Labarthe F, Dufour D, Moreau C, Faoucher M, Rollier P, Arnoux JB, Tardieu M, Damaj L, Bendavid C, Dessein AF, Acquaviva-Bourdain C, Cheillan D. Newborn Screening of Primary Carnitine Deficiency: An Overview of Worldwide Practices and Pitfalls to Define an Algorithm before Expansion of Newborn Screening in France. Int J Neonatal Screen 2023; 9:ijns9010006. [PMID: 36810318 PMCID: PMC9944086 DOI: 10.3390/ijns9010006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/24/2023] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
Primary Carnitine Deficiency (PCD) is a fatty acid oxidation disorder that will be included in the expansion of the French newborn screening (NBS) program at the beginning of 2023. This disease is of high complexity to screen, due to its pathophysiology and wide clinical spectrum. To date, few countries screen newborns for PCD and struggle with high false positive rates. Some have even removed PCD from their screening programs. To understand the risks and pitfalls of implementing PCD to the newborn screening program, we reviewed and analyzed the literature to identify hurdles and benefits from the experiences of countries already screening this inborn error of metabolism. In this study, we therefore, present the main pitfalls encountered and a worldwide overview of current practices in PCD newborn screening. In addition, we address the optimized screening algorithm that has been determined in France for the implementation of this new condition.
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Affiliation(s)
| | - François Labarthe
- Reference Center of Inherited Metabolic Disorders, Clocheville Hospital, 37000 Tours, France
| | - Diane Dufour
- Reference Center of Inherited Metabolic Disorders, Clocheville Hospital, 37000 Tours, France
| | | | | | - Paul Rollier
- Rennes University Hospital Center, 35033 Rennes, France
| | - Jean-Baptiste Arnoux
- Reference Center for Inborn Error of Metabolism, Department of Pediatrics, Necker-Enfants Malades Hospital, APHP, 75015 Paris, France
| | - Marine Tardieu
- Reference Center of Inherited Metabolic Disorders, Clocheville Hospital, 37000 Tours, France
| | - Léna Damaj
- Rennes University Hospital Center, 35033 Rennes, France
| | | | - Anne-Frédérique Dessein
- Metabolism and Rare Disease Unit, Department of Biochemistry and Molecular Biology, Center of Biology and Pathology, Lille University Hospital Center, 59000 Lille, France
| | - Cécile Acquaviva-Bourdain
- Center for Inherited Metabolic Disorders and Neonatal Screening, East Biology and Pathology Department, Groupement Hospitalier Est (GHE), Hospices Civils de Lyon, 69500 Bron, France
| | - David Cheillan
- Center for Inherited Metabolic Disorders and Neonatal Screening, East Biology and Pathology Department, Groupement Hospitalier Est (GHE), Hospices Civils de Lyon, 69500 Bron, France
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14
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Khries M, Lim A, Mitra D, Anderson M, Bengtsson J, Bowron A, Harris E, Blickwedel J, Wood K, Basu AP. Broadening the Spectrum of SLC22A5 Phenotype: Primary Carnitine Deficiency Presenting with Focal Myoclonus. Child Neurol Open 2023; 10:2329048X231184183. [PMID: 37475835 PMCID: PMC10354736 DOI: 10.1177/2329048x231184183] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/07/2023] [Indexed: 07/22/2023] Open
Abstract
Primary carnitine deficiency (PCD) is caused by pathogenic variants of the SLC22A5 gene, which encodes a transmembrane protein that functions as a high affinity carnitine transporter. Carnitine is essential for the transport of acyl-CoA, produced from fatty acids, into the mitochondria where they are oxidised to produce energy. We present the case history of an 8-year-old boy who presented with fever, lethargy, focal rhythmic (3 Hz) left wrist twitching, and severe encephalopathy. MRI brain showed basal ganglia involvement. Metabolic investigations revealed low serum carnitine; whole genome sequencing confirmed compound heterozygous SLC22A5 mutations. With carnitine replacement, intensive care support, and neurorehabilitation, he made a remarkable recovery, regaining independent breathing, speech, mobility, and hand use. Seizure presentation in PCD is rare and presentation with sustained focal myoclonus has not been previously reported. This case expands the known phenotype of PCD. Prompt carnitine replacement is imperative.
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Affiliation(s)
- Maymunah Khries
- Paediatric Neurology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Albert Lim
- Paediatric Neurology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Dipayan Mitra
- Neuroradiology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Mark Anderson
- Paediatrics, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Jan Bengtsson
- Paediatric Intensive Care Unit, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Ann Bowron
- Metabolic Biochemistry, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Elizabeth Harris
- Northern Genetics Service, Centre for Life, Newcastle upon Tyne, UK
| | - Jessica Blickwedel
- Paediatric Neurology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Karen Wood
- Paediatric Neurology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Anna P. Basu
- Paediatric Neurology, Great North Children's Hospital, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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15
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Crefcoeur LL, Melles MC, Bruning TA, Pereira RR, Langendonk JG. Primary carnitine deficiency is a life-long disease. JIMD Rep 2022; 63:524-528. [PMID: 36341172 PMCID: PMC9626665 DOI: 10.1002/jmd2.12319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/08/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022] Open
Abstract
Primary carnitine deficiency is a rare autosomal recessive disease associated with acute hypoketotic hypoglycaemia, cardiomyopathy and sudden cardiac death. Effective treatment with carnitine supplementation is available. An 18 months old boy, who presented with cardiomyopathy was diagnosed with primary carnitine deficiency, and carnitine supplementation resulted in a full recovery. At age 13 years, he discontinued his medication and at 20 years, he discontinued clinical monitoring. Nine years later, age 29, he presented with heart failure and atrial fibrillation and was admitted to an intensive care unit, where he was treated with furosemide, enoximone and intravenous carnitine supplementation, this lead to improved cardiac function within 2 weeks, and with continued oral carnitine supplements, his left ventricular ejection fraction normalised. The last 8 years were uneventful and he continued to attend his regular follow-up visits at a specialised metabolic outpatient clinic. We report recurrent reversible severe heart failure in a patient with primary carnitine deficiency; it was directly related to non-compliance to carnitine supplementation (and monitoring). This case report emphasises first, the importance of continued monitoring of metabolic disease patients, second, the potential reversibility of cardiomyopathy in an adult patient, and third, the potential risks in the period of transition from the paediatric to adult care. This is an age where young adults desire to be healthy and ignore the need for ongoing medical treatment, even as simple as oral suppletion. Before they reach this age, adequate disease insight and self-management of the disease should be promoted.
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Affiliation(s)
- Loek L. Crefcoeur
- Department of Metabolic DiseasesWilhelmina Children's Hospital, University Medical Center UtrechtUtrechtNetherlands
- Laboratory Genetic Metabolic DiseasesAmsterdam UMC location Academic Medical Center, University of Amsterdam, Amsterdam Gastroenterology and MetabolismAmsterdamNetherlands
| | | | | | | | - Janneke G. Langendonk
- Department of Internal Medicine, Center for Lysosomal and Metabolic DiseasesErasmus MC, University Medical Centre RotterdamRotterdamNetherlands
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16
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Balci MC, Karaca M, Ergul Y, Omeroglu RE, Demirkol M, Gokcay GF. Cardiologic evaluation of Turkish mitochondrial fatty acid oxidation disorders. Pediatr Int 2022; 64:e15317. [PMID: 36331231 DOI: 10.1111/ped.15317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 07/03/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mitochondrial fatty acid oxidation disorders (FAODs) cause impairment in energy metabolism and can lead to a spectrum of cardiac pathologies including cardiomyopathy and arrhythmias. The frequency of underlying cardiac pathologies and the response to recommended treatment in FAODs was investigated. METHODS Sixty-eight children (35 males, 33 females) with the diagnosis of a FAOD were included in the study. Cardiac function was evaluated with 12-lead standard electrocardiography, echocardiography, and 24 h Holter monitoring. RESULTS Forty-five patients (66%) were diagnosed after disease symptoms developed and 23 patients (34%) were diagnosed in the pre-symptomatic period. Among symptomatic patients (n: 45), cardiovascular findings were detected in 18 (40%) patients, including cardiomyopathy in 14 (31.1%) and conduction abnormalities in 4 (8.8%) patients. Cardiac symptoms were more frequently detected in primary systemic carnitine deficiency (57.1%). Patients with multiple acyl-CoA dehydrogenase, long-chain 3-hydroxyacyl-CoA dehydrogenase, and mitochondrial trifunctional protein deficiencies also had an increased frequency of cardiac symptoms. Patients with medium-chain acyl-CoA dehydrogenase, very long-chain acyl-CoA dehydrogenase, and carnitine palmitoyltransferase I deficiencies had a lower prevalence of cardiac symptoms both during admission and during clinical follow up. Cardiomyopathy resolved completely in 8/14 (57%) patients and partially in 2/14 (14.3%) patients with treatment. Two patients with cardiomyopathy died in the newborn period; cardiomyopathy persisted in 1 (7.1%) patient with very long-chain acyl-CoA dehydrogenase deficiency. CONCLUSION Early diagnosis, treatment and follow up made a significant contribution to the improvement of cardiac symptoms of patients with FAODs.
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Affiliation(s)
- Mehmet Cihan Balci
- Division of Pediatric Nutrition and Metabolism, Istanbul Medical Faculty Children's Hospital, Istanbul University, Istanbul, Turkey
| | - Meryem Karaca
- Division of Pediatric Nutrition and Metabolism, Istanbul Medical Faculty Children's Hospital, Istanbul University, Istanbul, Turkey
| | - Yakup Ergul
- Division of Pediatric Cardiology, Istanbul Medical Faculty Children's Hospital, Istanbul University, Istanbul, Turkey
| | - Rukiye Eker Omeroglu
- Division of Pediatric Cardiology, Istanbul Medical Faculty Children's Hospital, Istanbul University, Istanbul, Turkey
| | - Mubeccel Demirkol
- Division of Pediatric Nutrition and Metabolism, Istanbul Medical Faculty Children's Hospital, Istanbul University, Istanbul, Turkey
| | - Gulden Fatma Gokcay
- Division of Pediatric Nutrition and Metabolism, Istanbul Medical Faculty Children's Hospital, Istanbul University, Istanbul, Turkey.,Department of Rare Diseases, Institute of Child Health, Istanbul University, Istanbul, Turkey
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