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Demaret T, Bédard K, Soucy JF, Watkins D, Allard P, Levtova A, O'Brien A, Brunel-Guitton C, Rosenblatt DS, Mitchell GA. The MMACHC variant c.158T>C: Mild clinical and biochemical phenotypes and marked hydroxocobalamin response in cblC patients. Mol Genet Metab 2024; 142:108345. [PMID: 38387306 DOI: 10.1016/j.ymgme.2024.108345] [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: 12/20/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024]
Abstract
Mutations in MMACHC cause cobalamin C disease (cblC, OMIM 277400), the commonest inborn error of vitamin B12 metabolism. In cblC, deficient activation of cobalamin results in methylcobalamin and adenosylcobalamin deficiency, elevating methylmalonic acid (MMA) and total plasma homocysteine (tHcy). We retrospectively reviewed the medical files of seven cblC patients: three compound heterozygotes for the MMACHC (NM_015506.3) missense variant c.158T>C p.(Leu53Pro) in trans with the common pathogenic mutation c.271dupA (p.(Arg91Lysfs*14), "compounds"), and four c.271dupA homozygotes ("homozygotes"). Compounds receiving hydroxocobalamin intramuscular injection monotherapy had age-appropriate psychomotor performance and normal ophthalmological examinations. In contrast, c.271dupA homozygotes showed marked psychomotor retardation, retinopathy and feeding problems despite penta-therapy (hydroxocobalamin, betaine, folinic acid, l-carnitine and acetylsalicylic acid). Pretreatment levels of plasma and urine MMA and tHcy were higher in c.271dupA homozygotes than in compounds. Under treatment, levels of the compounds approached or entered the reference range but not those of c.271dupA homozygotes (tHcy: compounds 9.8-32.9 μM, homozygotes 41.6-106.8 (normal (N) < 14); plasma MMA: compounds 0.14-0.81 μM, homozygotes, 10.4-61 (N < 0.4); urine MMA: compounds 1.75-48 mmol/mol creatinine, homozygotes 143-493 (N < 10)). Patient skin fibroblasts all had low cobalamin uptake, but this was milder in compound cells. Also, the distribution pattern of cobalamin species was qualitatively different between cells from compounds and from homozygotes. Compared to the classic cblC phenotype presented by c.271dupA homozygous patients, c.[158T>C];[271dupA] compounds had mild clinical and biochemical phenotypes and responded strikingly to hydroxocobalamin monotherapy.
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Affiliation(s)
- Tanguy Demaret
- Medical Genetics Division, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada; Centre de Génétique Humaine, Institut de Pathologie et Génétique, Gosselies, Belgium
| | - Karine Bédard
- Medical Genetics Division, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada; Laboratoire de Diagnostic Moléculaire, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Département de Pathologie et Biologie Cellulaire, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Jean-François Soucy
- Medical Genetics Division, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - David Watkins
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada; Department of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Pierre Allard
- Medical Genetics Division, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada; Department of Biochemistry, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Alina Levtova
- Service de Médecine Génique, Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Alan O'Brien
- Service de Médecine Génique, Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Catherine Brunel-Guitton
- Medical Genetics Division, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada; Division of Biochemical Genetics, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - David S Rosenblatt
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada; Department of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Grant A Mitchell
- Medical Genetics Division, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada.
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Arhip L, Brox-Torrecilla N, Romero I, Motilla M, Serrano-Moreno C, Miguélez M, Cuerda C. Late-onset methylmalonic acidemia and homocysteinemia (cblC disease): systematic review. Orphanet J Rare Dis 2024; 19:20. [PMID: 38245797 PMCID: PMC10799514 DOI: 10.1186/s13023-024-03021-3] [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: 03/10/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION Combined methylmalonic acidemia and homocystinuria, cblC type is an inborn error of intracellular cobalamin metabolism and the most common one. The age of onset ranges from prenatal to adult. The disease is characterised by an elevation of methylmalonic acid (MMA) and homocysteine and a decreased production of methionine. The aim is to review existing scientific literature of all late onset cblC patients in terms of clinical symptoms, diagnosis, and outcome. METHODS A bibliographic database search was undertaken in PubMed (MEDLINE) complemented by a reference list search. We combined search terms regarding cblC disease and late onset. Two review authors performed the study selection, data extraction and quality assessment. RESULTS Of the sixty-five articles included in this systematic review, we collected a total of 199 patients. The most frequent clinical symptoms were neuropathy/myelopathy, encephalopathy, psychiatric symptoms, thrombotic microangiopathy, seizures, kidney disease, mild to severe pulmonary hypertension with heart failure and thrombotic phenomena. There were different forms of supplementation used in the different studies collected and, within these studies, some patients received several treatments sequentially and/or concomitantly. The general outcome was: 64 patients recovered, 78 patients improved, 4 patients did not improve, or the disease progressed, and 12 patients died. CONCLUSIONS Most scientific literature regarding the late onset cblC disease comes from case reports and case series. In most cases treatment initiation led to an improvement and even recovery of some patients. The lack of complete recovery underlines the necessity for increased vigilance in unclear clinical symptoms for cblC disease.
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Affiliation(s)
- Loredana Arhip
- Unidad de Nutrición Clínica y Dietética, Hospital General Universitario Gregorio Marañón, Calle del Doctor Esquerdo 46, 28007, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | | | | | - Marta Motilla
- Unidad de Nutrición Clínica y Dietética, Hospital General Universitario Gregorio Marañón, Calle del Doctor Esquerdo 46, 28007, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Clara Serrano-Moreno
- Unidad de Nutrición Clínica y Dietética, Hospital General Universitario Gregorio Marañón, Calle del Doctor Esquerdo 46, 28007, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - María Miguélez
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Cristina Cuerda
- Unidad de Nutrición Clínica y Dietética, Hospital General Universitario Gregorio Marañón, Calle del Doctor Esquerdo 46, 28007, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Universidad Complutense Madrid, Madrid, Spain
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Temova Rakuša Ž, Roškar R, Hickey N, Geremia S. Vitamin B 12 in Foods, Food Supplements, and Medicines-A Review of Its Role and Properties with a Focus on Its Stability. MOLECULES (BASEL, SWITZERLAND) 2022; 28:molecules28010240. [PMID: 36615431 PMCID: PMC9822362 DOI: 10.3390/molecules28010240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
Vitamin B12, also known as the anti-pernicious anemia factor, is an essential micronutrient totally dependent on dietary sources that is commonly integrated with food supplements. Four vitamin B12 forms-cyanocobalamin, hydroxocobalamin, 5'-deoxyadenosylcobalamin, and methylcobalamin-are currently used for supplementation and, here, we provide an overview of their biochemical role, bioavailability, and efficacy in different dosage forms. Since the effective quantity of vitamin B12 depends on the stability of the different forms, we further provide a review of their main reactivity and stability under exposure to various environmental factors (e.g., temperature, pH, light) and the presence of some typical interacting compounds (oxidants, reductants, and other water-soluble vitamins). Further, we explore how the manufacturing process and storage affect B12 stability in foods, food supplements, and medicines and provide a summary of the data published to date on the content-related quality of vitamin B12 products on the market. We also provide an overview of the approaches toward their stabilization, including minimization of the destabilizing factors, addition of proper stabilizers, or application of some (innovative) technological processes that could be implemented and contribute to the production of high-quality vitamin B12 products.
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Affiliation(s)
| | - Robert Roškar
- Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Neal Hickey
- Department of Chemical and Pharmaceutical Sciences, Centre of Excellence in Biocrystallography, University of Trieste, Via L. Giorgieri 1, 34127 Trieste, Italy
| | - Silvano Geremia
- Department of Chemical and Pharmaceutical Sciences, Centre of Excellence in Biocrystallography, University of Trieste, Via L. Giorgieri 1, 34127 Trieste, Italy
- Correspondence:
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Differences in the Formation of Reactive Oxygen Species and Their Cytotoxicity between Thiols Combined with Aqua- and Cyanocobalamins. Int J Mol Sci 2022; 23:ijms231911032. [PMID: 36232333 PMCID: PMC9569724 DOI: 10.3390/ijms231911032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/09/2022] [Accepted: 09/15/2022] [Indexed: 11/23/2022] Open
Abstract
Cobalamin is an essential nutrient required for the normal functioning of cells. Its deficiency can lead to various pathological states. Hydroxocobalamin (HOCbl) and cyanocobalamin (CNCbl) are the forms of vitamin B12 that are most commonly used for supplementation. There is substantial evidence indicating that cobalamins can both suppress and promote oxidative stress; however, the mechanisms underlying these effects are poorly understood. Here, it was shown that the oxidation of thiols catalyzed by HOCbl and CNCbl is accompanied by reactive oxygen species (ROS) production and induces, under certain conditions, oxidative stress and cell death. The form of vitamin B12 and the structure of thiol play a decisive role in these processes. It was found that the mechanisms and kinetics of thiol oxidation catalyzed by HOCbl and CNCbl differ substantially. HOCbl increased the rate of oxidation of thiols to a greater extent than CNCbl, but quenched ROS in combination with certain thiols. Oxidation catalyzed by CNCbl was generally slower. Yet, the absence of ROS quenching resulted in their higher accumulation. The aforementioned results might explain a more pronounced cytotoxicity induced by combinations of thiols with CNCbl. On the whole, the data obtained provide a new insight into the redox processes in which cobalamins are involved. Our results might also be helpful in developing new approaches to the treatment of some cobalamin-responsive disorders in which oxidative stress is an important component.
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Chen Z, Dong H, Liu Y, He R, Song J, Jin Y, Li M, Liu Y, Liu X, Yan H, Qi J, Wang F, Xiao H, Zheng H, Kang L, Li D, Zhang Y, Yang Y. Late-onset cblC deficiency around puberty: a retrospective study of the clinical characteristics, diagnosis, and treatment. Orphanet J Rare Dis 2022; 17:330. [PMID: 36056359 PMCID: PMC9438293 DOI: 10.1186/s13023-022-02471-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 08/13/2022] [Indexed: 11/12/2022] Open
Abstract
Background cblC deficiency is the most common type of methylmalonic aciduria in China. Late-onset patients present with various non-specific symptoms and are usually misdiagnosed. The purpose of this study is to investigate the clinical features of patients with late-onset cblC deficiency and explore diagnosis and management strategies around puberty. Results This study included 56 patients (35 males and 21 females) with late-onset cblC deficiency who were admitted to our clinic between 2002 and September 2021. The diagnosis was confirmed by metabolic and genetic tests. The clinical and biochemical features, disease triggers, outcome, and associated genetic variants were examined. The onset age ranged from 10 to 20 years (median age, 12 years). Fifteen patients (26.8%) presented with symptoms after infection or sports training. Further, 46 patients (82.1%) had neuropsychiatric diseases; 11 patients (19.6%), cardiovascular diseases; and 6 patients (10.7%), pulmonary hypertension. Renal damage was observed in 6 cases (10.7%). Genetic analysis revealed 21 variants of the MMACHC gene in the 56 patients. The top five common variants detected in 112 alleles were c.482G > A (36.6%), c.609G > A (16.1%), c.658_660delAAG (9.8%), c.80A > G (8.0%), and c.567dupT (6.3%). Thirty-nine patients carried the c.482G > A variant. Among 13 patients who exhibited spastic paraplegia as the main manifestation, 11 patients carried c.482G > A variants. Six patients who presented with psychotic disorders and spastic paraplegia had compound heterozygotic c.482G > A and other variants. All the patients showed improvement after metabolic treatment with cobalamin, l-carnitine, and betaine, and 30 school-aged patients returned to school. Two female patients got married and had healthy babies. Conclusions Patients with late-onset cblC deficiency present with a wide variety of neuropsychiatric symptoms and other presentations, including multiple organ damage. As a result, cb1C deficiency can easily be misdiagnosed as other conditions. Metabolic and genetic studies are important for accurate diagnosis, and metabolic treatment with cobalamin, l-carnitine, and betaine appears to be beneficial. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02471-x.
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Affiliation(s)
- Zhehui Chen
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Hui Dong
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Yupeng Liu
- Department of Pediatrics, Peking University People's Hospital, Beijing, 100034, China
| | - Ruxuan He
- Department of Respiratory Medicine II, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, 100045, China
| | - Jinqing Song
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Ying Jin
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Mengqiu Li
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Yi Liu
- Department of Clinical Laboratory, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Xueqin Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Hui Yan
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Jianguang Qi
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Fang Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Huijie Xiao
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Hong Zheng
- Department of Pediatrics, First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, China
| | - Lulu Kang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Dongxiao Li
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450053, China
| | - Yao Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China.
| | - Yanling Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China.
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Esser AJ, Mukherjee S, Dereven‘kov IA, Makarov SV, Jacobsen DW, Spiekerkoetter U, Hannibal L. Versatile Enzymology and Heterogeneous Phenotypes in Cobalamin Complementation Type C Disease. iScience 2022; 25:104981. [PMID: 36105582 PMCID: PMC9464900 DOI: 10.1016/j.isci.2022.104981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Nutritional deficiency and genetic errors that impair the transport, absorption, and utilization of vitamin B12 (B12) lead to hematological and neurological manifestations. The cblC disease (cobalamin complementation type C) is an autosomal recessive disorder caused by mutations and epi-mutations in the MMACHC gene and the most common inborn error of B12 metabolism. Pathogenic mutations in MMACHC disrupt enzymatic processing of B12, an indispensable step before micronutrient utilization by the two B12-dependent enzymes methionine synthase (MS) and methylmalonyl-CoA mutase (MUT). As a result, patients with cblC disease exhibit plasma elevation of homocysteine (Hcy, substrate of MS) and methylmalonic acid (MMA, degradation product of methylmalonyl-CoA, substrate of MUT). The cblC disorder manifests early in childhood or in late adulthood with heterogeneous multi-organ involvement. This review covers current knowledge on the cblC disease, structure–function relationships of the MMACHC protein, the genotypic and phenotypic spectra in humans, experimental disease models, and promising therapies.
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Iftimovici A, Chaumette B, Duchesnay E, Krebs MO. Brain anomalies in early psychosis: From secondary to primary psychosis. Neurosci Biobehav Rev 2022; 138:104716. [PMID: 35661683 DOI: 10.1016/j.neubiorev.2022.104716] [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: 09/28/2021] [Revised: 03/12/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
Abstract
Brain anomalies are frequently found in early psychoses. Although they may remain undetected for many years, their interpretation is critical for differential diagnosis. In secondary psychoses, their identification may allow specific management. They may also shed light on various pathophysiological aspects of primary psychoses. Here we reviewed cases of secondary psychoses associated with brain anomalies, reported over a 20-year period in adolescents and young adults aged 13-30 years old. We considered age at first psychotic symptoms, relevant medical history, the nature of psychiatric symptoms, clinical red flags, the nature of the brain anomaly reported, and the underlying disease. We discuss the relevance of each brain area in light of normal brain function, recent case-control studies, and postulated pathophysiology. We show that anomalies in all regions, whether diffuse, multifocal, or highly localized, may lead to psychosis, without necessarily being associated with non-psychiatric symptoms. This underlines the interest of neuroimaging in the initial workup, and supports the hypothesis of psychosis as a global network dysfunction that involves many different regions.
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Affiliation(s)
- Anton Iftimovici
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, GDR 3557-Institut de Psychiatrie, Paris, France; NeuroSpin, Atomic Energy Commission, Gif-sur Yvette, France; GHU Paris Psychiatrie et Neurosciences, Paris, France.
| | - Boris Chaumette
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, GDR 3557-Institut de Psychiatrie, Paris, France; GHU Paris Psychiatrie et Neurosciences, Paris, France
| | | | - Marie-Odile Krebs
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, GDR 3557-Institut de Psychiatrie, Paris, France; GHU Paris Psychiatrie et Neurosciences, Paris, France
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Kacpura A, Frigeni M, Gunther K, Farach L. Clinical and biochemical outcomes in cobalamin C deficiency with use of high-dose hydroxocobalamin in the early neonatal period. Am J Med Genet A 2022; 188:1831-1835. [PMID: 35156754 DOI: 10.1002/ajmg.a.62687] [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: 09/15/2021] [Revised: 01/05/2022] [Accepted: 01/13/2022] [Indexed: 11/06/2022]
Abstract
This case report describes a patient with early-onset cobalamin C deficiency who was started on treatment with high-dose parenteral hydroxocobalamin after diagnosis at 13 days of life. Prior to diagnosis, initial presenting symptoms included poor feeding, lethargy, apneic episodes, hypothermia, and hypotonia; these symptoms resolved after initiation of medication. Methylmalonic acid and homocysteine levels were trended and significantly improved with treatment. She was maintained on 2 mg/kg/day dosing of hydroxocobalamin. No adverse effects to treatment were observed. At the time of this report, the patient was 19 months of age; she had not manifested common findings of early-onset cobalamin C deficiency, including microcephaly, poor feeding, growth abnormalities, hypotonia, seizures, maculopathy, or neurodevelopmental delay. This report suggests that early initiation of high-dose hydroxocobalamin is safe and effective.
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Affiliation(s)
- Abigail Kacpura
- Department of Pediatrics, Division of Medical Genetics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Marta Frigeni
- Department of Pediatrics, Division of Medical Genetics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Kathryn Gunther
- Department of Pediatrics, Division of Medical Genetics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Laura Farach
- Department of Pediatrics, Division of Medical Genetics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
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Matmat K, Guéant-Rodriguez RM, Oussalah A, Wiedemann-Fodé A, Dionisi-Vici C, Coelho D, Guéant JL, Conart JB. Ocular manifestations in patients with inborn errors of intracellular cobalamin metabolism: a systematic review. Hum Genet 2021; 141:1239-1251. [PMID: 34652574 DOI: 10.1007/s00439-021-02350-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 08/19/2021] [Indexed: 01/26/2023]
Abstract
Inherited disorders of cobalamin (cbl) metabolism (cblA-J) result in accumulation of methylmalonic acid (MMA) and/or homocystinuria (HCU). Clinical presentation includes ophthalmological manifestations related to retina, optic nerve and posterior visual alterations, mainly reported in cblC and sporadically in other cbl inborn errors.We searched MEDLINE EMBASE and Cochrane Library, and analyzed articles reporting ocular manifestations in cbl inborn errors. Out of 166 studies a total of 52 studies reporting 163 cbl and 24 mut cases were included. Ocular manifestations were found in all cbl defects except for cblB and cblD-MMA; cblC was the most frequent disorder affecting 137 (84.0%) patients. The c.271dupA was the most common pathogenic variant, accounting for 70/105 (66.7%) cases. One hundred and thirty-seven out of 154 (88.9%) patients presented with early-onset disease (0-12 months). Nystagmus and strabismus were observed in all groups with the exception of MMA patients while maculopathy and peripheral retinal degeneration were almost exclusively found in MMA-HCU patients. Optic nerve damage ranging from mild temporal disc pallor to complete atrophy was prevalent in MMA-HCU.and MMA groups. Nystagmus was frequent in early-onset patients. Retinal and macular degeneration worsened despite early treatment and stabilized systemic function in these patients. The functional prognosis remains poor with final visual acuity < 20/200 in 55.6% (25/45) of cases. In conclusion, the spectrum of eye disease in Cbl patients depends on metabolic severity and age of onset. The development of visual manifestations over time despite early metabolic treatment point out the need for specific innovative therapies.
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Affiliation(s)
- Karim Matmat
- UMR_S 1256, NGERE - Nutrition, Genetics, and Environmental Risk Exposure, INSERM, University of Lorraine, 54000, Nancy, France
| | - Rosa-Maria Guéant-Rodriguez
- UMR_S 1256, NGERE - Nutrition, Genetics, and Environmental Risk Exposure, INSERM, University of Lorraine, 54000, Nancy, France.
- National Center of Inborn Errors of Metabolism, University Regional Hospital Center of Nancy, 54000, Nancy, France.
| | - Abderrahim Oussalah
- UMR_S 1256, NGERE - Nutrition, Genetics, and Environmental Risk Exposure, INSERM, University of Lorraine, 54000, Nancy, France
- National Center of Inborn Errors of Metabolism, University Regional Hospital Center of Nancy, 54000, Nancy, France
| | - Arnaud Wiedemann-Fodé
- UMR_S 1256, NGERE - Nutrition, Genetics, and Environmental Risk Exposure, INSERM, University of Lorraine, 54000, Nancy, France
| | - Carlo Dionisi-Vici
- Division of Metabolism, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - David Coelho
- UMR_S 1256, NGERE - Nutrition, Genetics, and Environmental Risk Exposure, INSERM, University of Lorraine, 54000, Nancy, France
| | - Jean-Louis Guéant
- UMR_S 1256, NGERE - Nutrition, Genetics, and Environmental Risk Exposure, INSERM, University of Lorraine, 54000, Nancy, France
- National Center of Inborn Errors of Metabolism, University Regional Hospital Center of Nancy, 54000, Nancy, France
| | - Jean-Baptiste Conart
- UMR_S 1256, NGERE - Nutrition, Genetics, and Environmental Risk Exposure, INSERM, University of Lorraine, 54000, Nancy, France.
- Department of Ophthalmology, Nancy University Hospital, 54500, Vandœuvre-lès-Nancy, France.
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Chu X, Meng L, Zhang W, Luo J, Wang Z, Yuan Y. Peripheral Nervous System Involvement in Late-Onset Cobalamin C Disease? Front Neurol 2020; 11:594905. [PMID: 33324334 PMCID: PMC7726435 DOI: 10.3389/fneur.2020.594905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Cobalamin C (cblC) has a fundamental role in both central and peripheral nervous system function at any age. Neurologic manifestations may be the earliest and often the only manifestation of hereditary or acquired cblC defect. Peripheral neuropathy remains a classical but underdiagnosed complication of cblC defect, especially in late-onset cblC disease caused by mutations in the methylmalonic aciduria type C and homocysteinemia (MMACHC) gene. So the clinical, electrophysiological, and pathological characteristics of late-onset cblC disease are not well-known. Methods: A retrospective study of patients with late-onset cblC disease was conducted at our hospital on a 3-year period. The neuropathy was confirmed by the nerve conduction study. Sural biopsies were performed in 2 patients. Results: Eight patients were identified, with a mean onset age of 16.25 ± 6.07 years. All patients had methylmalonic aciduria, homocysteinemia, compound heterozygous MMACHC gene mutations were detected in all patients, and 7/8 patients with c.482G>A mutation. One patient concomitant with homozygote c.665C>T mutation in 5,10-methylenetetrahydrofolate reductase (MTHFR) gene. All patients showed limb weakness and cognitive impairment. Five patients had possible sensorimotor axonal polyneuropathy predominantly in the distal lower limbs. Sural biopsies showed loss of myelinated and unmyelinated fibers. Electro microscopy revealed crystalline-like inclusions bodies in Schwann cells and axonal degeneration. Conclusion: Late-onset cblC disease had possible heterogeneous group of distal axonal neuropathy. c.482G>A mutation is a hot spot mutation in late-onset cblC disease.
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Affiliation(s)
- Xujun Chu
- Department of Neurology, First Hospital, Peking University, Beijing, China
| | - Lingchao Meng
- Department of Neurology, First Hospital, Peking University, Beijing, China
| | - Wei Zhang
- Department of Neurology, First Hospital, Peking University, Beijing, China
| | - Jinjun Luo
- Department of Neurology, Temple University, Philadelphia, PA, United States
| | - Zhaoxia Wang
- Department of Neurology, First Hospital, Peking University, Beijing, China
| | - Yun Yuan
- Department of Neurology, First Hospital, Peking University, Beijing, China
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11
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Liu J, Tang X, Zhou C, Xu H, Yang H, He R, Li H, Zhao S. Cobalamin C deficiency presenting with diffuse alveolar hemorrhage and pulmonary microangiopathy. Pediatr Pulmonol 2020; 55:1481-1486. [PMID: 32293809 DOI: 10.1002/ppul.24781] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/24/2020] [Accepted: 04/08/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Combined methylmalonic acidemia and homocysteinemia is a genetically heterogeneous disorder of cobalamin (cbl; vitamin B12) metabolism, which consists of five subtypes including cblC, cblD, cblF, cblJ, and cblX deficiencies. The purpose of this study is to summarize new clinical features mainly diffuse alveolar hemorrhage (DAH) in cblC deficiency. METHODS We made a retrospective analysis of four pediatric patients diagnosed with DAH and pulmonary microangiopathy due to cblC deficiency between January 2017 and December 2018 in Beijing Children's Hospital. RESULTS This study describes four patients with their ages ranging from 4 years 2 months to 7 years 6 months with cblC deficiency who developed late-onset diffuse lung disease (DLD). Of these, the first three patients presented predominantly with DAH, and the last patient with pulmonary microangiopathy confirmed by thoracoscopic lung biopsy. All patients were accompanied by pulmonary arterial hypertension (PAH), two accompanied by respiratory failure, and two accompanied by moderate megaloblastic anemia. Diffuse ground-glass opacification and poorly defined ground-glass centrilobular nodules were seen on high-resolution computed tomography in one patient and three patients, respectively. All patients were suspected of having idiopathic pulmonary hemosiderosis or interstitial lung disease at other hospitals. All of them received treatment with corticosteroid before admission, but the symptoms did not improve. Moreover, all patients carried compound heterozygous mutations (c.80A>G, c.609G>A) in MMACHC and improved significantly after being treated for cblC deficiency and PAH. CONCLUSIONS CblC deficiency should be considered in the differential diagnosis of DAH especially with PAH, and pulmonary microangiopathy be the main reason of DLD in these patients.
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Affiliation(s)
- Jinrong Liu
- Department of Respiratory Medicine II, Beijing Children's Hospital affiliated to Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Xiaolei Tang
- Department of Respiratory Medicine II, Beijing Children's Hospital affiliated to Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Chunju Zhou
- Department of Pathology, Beijing Children's Hospital affiliated to Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Hui Xu
- Department of Respiratory Medicine II, Beijing Children's Hospital affiliated to Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Haiming Yang
- Department of Respiratory Medicine II, Beijing Children's Hospital affiliated to Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Ruxuan He
- Department of Respiratory Medicine II, Beijing Children's Hospital affiliated to Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Huimin Li
- Department of Respiratory Medicine II, Beijing Children's Hospital affiliated to Capital Medical University, National Center for Children's Health, Beijing, P.R. China
| | - Shunying Zhao
- Department of Respiratory Medicine II, Beijing Children's Hospital affiliated to Capital Medical University, National Center for Children's Health, Beijing, P.R. China
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12
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Higashimoto T, Kim AY, Ogawa JT, Sloan JL, Almuqbil MA, Carlson JM, Manoli I, Venditti CP, Gunay-Aygun M, Wang T. High-dose hydroxocobalamin achieves biochemical correction and improvement of neuropsychiatric deficits in adults with late onset cobalamin C deficiency. JIMD Rep 2019; 51:17-24. [PMID: 32071835 PMCID: PMC7012733 DOI: 10.1002/jmd2.12087] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 10/24/2019] [Accepted: 11/14/2019] [Indexed: 12/18/2022] Open
Abstract
Cobalamin C (cblC) deficiency is the most common inborn error of intracellular cobalamin metabolism caused by pathogenic variant(s) in MMACHC and manifests with methylmalonic acidemia, hyperhomocysteinemia, and hypomethioninemia with a variable age of presentation. Individuals with late‐onset cblC may be asymptomatic until manifesting neuropsychiatric symptoms, thromboembolic events, and renal disease. Although hydroxocobalamin provides a foundation for therapy, optimal dose regimen for adult patients has not been systematically evaluated. We report three adult siblings with late‐onset cblC disease, and their biochemical and clinical responses to high‐dose hydroxocobalamin. The 28‐year‐old proband presented with severe psychosis, progressive neurological deterioration, and deep venous thrombosis complicated by a pulmonary embolism. MRI studies identified lesions in the spinal cord, periventricular white matter, and basal ganglia. Serum homocysteine and methylmalonic acid levels were markedly elevated. Hydroxocobalamin at standard dose (1 mg/day) initially resulted in partial metabolic correction. A regimen of high‐dose hydroxocobalamin (25 mg/day) together with betaine and folic acid resulted in rapid and sustainable biochemical correction, resolution of psychosis, improvement of neurological functions, and amelioration of brain and spinal cord lesions. Two siblings who did not manifest neuropsychiatric symptoms or thromboembolism achieved a satisfactory metabolic control with the same high‐dose regimen. Hydroxocobalamin injection was then spaced out to 25 mg weekly with good and sustainable metabolic control. All three patients are compound heterozygotes for c.271dupA p.Arg91LysfsX14 and c.389A > G p.Tyr130Cys. This study highlights the importance of evaluating intracellular cobalamin metabolism in adults with neuropsychiatric manifestations and/or thromboembolic events, and demonstrates that high‐dose hydroxocobalamin achieves rapid and sustainable metabolic control and improvement in neuropsychiatric outcomes in adults with late‐onset cblC disease.
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Affiliation(s)
- Tomoyasu Higashimoto
- Department of Genetic Medicine and Pediatrics Johns Hopkins University Baltimore Maryland
| | - Alexander Y Kim
- Department of Genetic Medicine and Pediatrics Johns Hopkins University Baltimore Maryland
| | - Jessica T Ogawa
- Department of Genetic Medicine and Pediatrics Johns Hopkins University Baltimore Maryland
| | - Jennifer L Sloan
- Medical Genomics and Metabolic Genetics Branch National Institute of Human Genome Research, National Institutes of Health Bethesda Maryland
| | - Mohammed A Almuqbil
- Department of Genetic Medicine and Pediatrics Johns Hopkins University Baltimore Maryland.,Division of Pediatric Neurology King Saud bin Abdulaziz University for Health Sciences Riyadh Saudi Arabia.,King Abdullah International Medical Research Center King Abdullah Specialist Children's Hospital - Ministry of National Guard Riyadh Saudi Arabia
| | - Julia M Carlson
- Department of Neurology Johns Hopkins University Baltimore Maryland
| | - Irini Manoli
- Medical Genomics and Metabolic Genetics Branch National Institute of Human Genome Research, National Institutes of Health Bethesda Maryland
| | - Charles P Venditti
- Medical Genomics and Metabolic Genetics Branch National Institute of Human Genome Research, National Institutes of Health Bethesda Maryland
| | - Meral Gunay-Aygun
- Department of Genetic Medicine and Pediatrics Johns Hopkins University Baltimore Maryland
| | - Tao Wang
- Department of Genetic Medicine and Pediatrics Johns Hopkins University Baltimore Maryland
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