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Koye A, Nilsson M, Epstein D, Oscarson M, Teär Fahnehjelm K. Visual functions, ocular characteristics and visual quality of life in patients with homocystinuria. Ophthalmic Genet 2024; 45:343-350. [PMID: 38629455 DOI: 10.1080/13816810.2024.2339959] [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: 10/03/2023] [Revised: 03/30/2024] [Accepted: 04/02/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Homocystinuria (HCU) is a rare metabolic disease that affects many organs, including the eyes. Aims: to assess visual functions, ocular characteristics, visual quality of life and time from the onset of ocular manifestations to HCU-diagnosis in patients with HCU. MATERIAL AND METHODS Eighteen patients underwent ophthalmological examinations and visual quality of life questionnaires. RESULTS Best corrected decimal visual acuity was median 1.0 (range amaurosis - 1.3) right eye and 1.0 (range amaurosis -1.3) left eye. Five patients presented with severe myopia as first HCU manifestation, duration to HCU diagnosis was mean 13.6 years (range 2-25). Two patients had suffered ectopia lentis as first HCU manifestation, HCU diagnosis was established mean 8.0 years (range 7-9) later. One patient had suffered both from thrombosis and ectopia lentis prior to diagnosis. Another four patients suffered thromboembolic events before diagnosis. Median VFQ-25 composite score was 93 (68-98). CONCLUSIONS The prevalence of myopia, ectopia lentis and monocular blindness was high in HCU-patients, which was reflected in their visual quality of life. Diagnosis was often delayed after the first ocular manifestation, increasing the risk of other severe non-ocular complications.
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Affiliation(s)
- Aran Koye
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Paediatric Ophthalmology, Strabismus and Electrophysiology, St. Erik Eye Hospital, Stockholm, Sweden
| | - Mattias Nilsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - David Epstein
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Retinal Diseases, St. Erik Eye Hospital, Stockholm, Sweden
| | - Mikael Oscarson
- Centre for Inherited Metabolic Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Endocrinology, Karolinska University Hospital, Stockholm, Sweden
| | - Kristina Teär Fahnehjelm
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Paediatric Ophthalmology, Strabismus and Electrophysiology, St. Erik Eye Hospital, Stockholm, Sweden
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Kožich V, Majtan T. Komrower Memorial Lecture 2023. Molecular basis of phenotype expression in homocystinuria: Where are we 30 years later? J Inherit Metab Dis 2024. [PMID: 38873792 DOI: 10.1002/jimd.12767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 05/14/2024] [Accepted: 05/22/2024] [Indexed: 06/15/2024]
Abstract
This review summarises progress in the research of homocystinuria (HCU) in the past three decades. HCU due to cystathionine β-synthase (CBS) was discovered in 1962, and Prof. Jan Peter Kraus summarised developments in the field in the first-ever Komrower lecture in 1993. In the past three decades, significant advancements have been achieved in the biology of CBS, including gene organisation, tissue expression, 3D structures, and regulatory mechanisms. Renewed interest in CBS arose in the late 1990s when this enzyme was implicated in biogenesis of H2S. Advancements in genetic and biochemical techniques enabled the identification of several hundreds of pathogenic CBS variants and the misfolding of missense mutations as a common mechanism. Several cellular, invertebrate and murine HCU models allowed us to gain insights into functional and metabolic pathophysiology of the disease. Establishing the E-HOD consortium and patient networks, HCU Network Australia and HCU Network America, offered new possibilities for acquiring clinical data in registries and data on patients´ quality of life. A recent analysis of data from the E-HOD registry showed that the clinical variability of HCU is broad, extending from severe childhood disease to milder (late) adulthood forms, which typically respond to pyridoxine. Pyridoxine responsiveness appears to be the key factor determining the clinical course of HCU. Increased awareness about HCU played a role in developing novel therapies, such as gene therapy, correction of misfolding by chaperones, removal of methionine from the gut and enzyme therapies that decrease homocysteine or methionine in the circulation.
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Affiliation(s)
- Viktor Kožich
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Tomas Majtan
- Department of Pharmacology, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
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Donis KC, Kalil MAB, Poswar F, Kok F, Kohem CL, Poloni S, Borsatto T, Vairo FPE, Pinheiro FC, Schwartz IVD. An adult with cystathionine beta-synthase deficiency, camptodactyly-arthropathy-coxa vara-pericarditis syndrome, and deafness: A case report. Genet Mol Biol 2024; 47:e20220335. [PMID: 38593426 PMCID: PMC11003653 DOI: 10.1590/1678-4685-gmb-2022-0335] [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: 11/07/2022] [Accepted: 11/11/2023] [Indexed: 04/11/2024] Open
Abstract
Massive sequencing platforms allow the identification of complex clinical phenotypes involving more than one autosomal recessive disorder. In this study, we report on an adult patient, born to a related couple (third degree cousins), referred for genetic evaluation due to ectopia lentis, deafness and previous diagnosis of juvenile idiopathic arthritis. He was biochemically diagnosed as having Classic Homocystinuria (HCU); Sanger sequencing of the CBS gene showed the genotype NM_000071.2(CBS):c.[833T>C];[833T>C], compatible with the diagnosis of pyridoxine-responsive HCU. As he also had symptoms not usually associated with HCU, exome sequencing was performed. In addition to the variants found in the Sanger sequencing, the following variants were identified: NM_001256317.1(TMPRSS3):c.[413C>A];[413C>A]; and the NM_005807.6(PRG4):c.[3756dup]:[3756dup], confirming the diagnosis of autosomal recessive nonsyndromic deafness and Camptodactyly-Arthropathy-Coxa Vara-Pericarditis Syndrome (CACP), respectively. Genomic analysis allowed the refinement of the diagnosis of a complex case and improvement of the patient's treatment.
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Affiliation(s)
- Karina Carvalho Donis
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Genética e Biologia Molecular, Porto Alegre, RS, Brazil
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre, RS, Brazil
| | | | - Fabiano Poswar
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Genética e Biologia Molecular, Porto Alegre, RS, Brazil
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre, RS, Brazil
| | - Fernando Kok
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Neurologia, Unidade de Neurogenética, São Paulo, SP, Brazil
- Mendelics Análise Genômica, São Paulo, SP, Brazil
| | - Charles Lubianca Kohem
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Serviço de Reumatologia, Porto Alegre, RS, Brazil
| | - Soraia Poloni
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Experimental, Laboratório BRAIN, Porto Alegre, RS, Brazil
| | - Taciane Borsatto
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Experimental, Laboratório BRAIN, Porto Alegre, RS, Brazil
| | - Filippo Pinto e Vairo
- Mayo Clinic, Center for Individualized Medicine, Rochester, MN, USA
- Mayo Clinic, Department of Clinical Genomics, Rochester, MN, USA
| | - Franciele Cabral Pinheiro
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Genética e Biologia Molecular, Porto Alegre, RS, Brazil
| | - Ida Vanessa Doederlein Schwartz
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Genética e Biologia Molecular, Porto Alegre, RS, Brazil
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Porto Alegre, RS, Brazil
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Centro de Pesquisa Experimental, Laboratório BRAIN, Porto Alegre, RS, Brazil
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Khalil A, Khan HN, Wasim M, Ayesha H, Awan FR. Development of low-cost in-house tetra-ARMS-PCR assay for the screening of five CBS mutations found in Pakistani homocystinuria patients. NUCLEOSIDES, NUCLEOTIDES & NUCLEIC ACIDS 2023; 43:517-529. [PMID: 37971987 DOI: 10.1080/15257770.2023.2280013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Classical homocystinuria is an inborn amino acid metabolism disorder resulting from mutations in the Cystathionine-β-Synthase (CBS) gene. These mutations lead to elevated homocysteine and methionine levels and reduced cysteine levels in the blood. Typically, diagnosis occurs after patients display symptoms, and various lab methods confirm it. DNA sequencing is the best option for early detection of genetic variants in asymptomatic suspected individuals. Unfortunately, its high cost can hinder its use, especially in low-income countries like Pakistan. OBJECTIVE Aim of this study was to devise a robust low-cost diagnostic/screening assay based on Tetra-ARMS-PCR for five prevalent genetic variants found in Pakistani classical homocystinuria patients. MATERIALS AND METHODS In the current study, T-ARMS-PCR assays were developed for five mutations (c.975G > C, c.770C > T, c.752T > C, c.1039 + 1G > T, c.451 + 1GG > TA), which were characterized previously in classical homocystinuria patients. These low-cost T-ARMS-PCR assays were then used to screen the affected individuals and their family members to identify their genotypes for pathogenic variations in the asymptomatic patients and carriers in their respective families. RESULTS The outcomes were entirely consistent with those obtained from Sanger DNA sequencing, confirming the sensitivity, specificity, and reliability of the T-ARMS-PCR assay for detecting CBS mutations. CONCLUSION T-ARMS-PCR has wide applications for low-income countries for the screening and early diagnosis of asymptomatic patients and carriers in the homocystinuria affected families as well as other inherited diseases.
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Affiliation(s)
- Adila Khalil
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Pakistan
- NIBGE College, Pakistan Institute of Engineering and Applied Sciences (PIEAS), Nilore, Islamabad, Pakistan
| | - Haq Nawaz Khan
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Pakistan
- NIBGE College, Pakistan Institute of Engineering and Applied Sciences (PIEAS), Nilore, Islamabad, Pakistan
- Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - Muhammad Wasim
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Pakistan
- NIBGE College, Pakistan Institute of Engineering and Applied Sciences (PIEAS), Nilore, Islamabad, Pakistan
- Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - Hina Ayesha
- Department of Pediatrics, Punjab Medical College, Faisalabad Medical University, Faisalabad, Pakistan
| | - Fazli Rabbi Awan
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, Pakistan
- NIBGE College, Pakistan Institute of Engineering and Applied Sciences (PIEAS), Nilore, Islamabad, Pakistan
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Jiang X, Shen D, Yang X, Lu Z, Huang H, Zhang B, Ma H. CBS and SERPINC1 mutation-induced ischemic stroke and multisystem diseases in a young woman: a case description and literature analysis. Quant Imaging Med Surg 2023; 13:5423-5429. [PMID: 37581074 PMCID: PMC10423349 DOI: 10.21037/qims-23-255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/02/2023] [Indexed: 08/16/2023]
Affiliation(s)
- Xuanfei Jiang
- Department of Neurology, Huzhou Cent Hospital, the Affiliated Cent Hospital Huzhou University, Huzhou, China
| | - Dan Shen
- Longxi Street Community Health Service Center, Huzhou, China
| | - Xiangyan Yang
- Department of Neurology, Huzhou Cent Hospital, the Affiliated Cent Hospital Huzhou University, Huzhou, China
| | - Zhenchan Lu
- Department of Neurology, Huzhou Cent Hospital, the Affiliated Cent Hospital Huzhou University, Huzhou, China
| | - Huan Huang
- Department of Neurology, Huzhou Cent Hospital, the Affiliated Cent Hospital Huzhou University, Huzhou, China
| | - Bing Zhang
- Department of Neurology, Huzhou Cent Hospital, the Affiliated Cent Hospital Huzhou University, Huzhou, China
| | - Honggang Ma
- Department of Neurology, Huzhou Cent Hospital, the Affiliated Cent Hospital Huzhou University, Huzhou, China
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Majtan T, Kožich V, Kruger WD. Recent therapeutic approaches to cystathionine beta-synthase-deficient homocystinuria. Br J Pharmacol 2023; 180:264-278. [PMID: 36417581 PMCID: PMC9822868 DOI: 10.1111/bph.15991] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022] Open
Abstract
Cystathionine beta-synthase (CBS)-deficient homocystinuria (HCU) is the most common inborn error of sulfur amino acid metabolism. The pyridoxine non-responsive form of the disease manifests itself by massively increasing plasma and tissue concentrations of homocysteine, a toxic intermediate of methionine metabolism that is thought to be the major cause of clinical complications including skeletal deformities, connective tissue defects, thromboembolism and cognitive impairment. The current standard of care involves significant dietary interventions that, despite being effective, often adversely affect quality of life of HCU patients, leading to poor adherence to therapy and inadequate biochemical control with clinical complications. In recent years, the unmet need for better therapeutic options has resulted in development of novel enzyme and gene therapies and exploration of pharmacological approaches to rescue CBS folding defects caused by missense pathogenic mutations. Here, we review scientific evidence and current state of affairs in development of recent approaches to treat HCU.
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Affiliation(s)
- Tomas Majtan
- Department of Pharmacology, University of Fribourg, Faculty of Science and Medicine, Fribourg, 1700, Switzerland
| | - Viktor Kožich
- Department of Pediatrics and Inherited Metabolic Disorders, Charles University-First Faculty of Medicine, Prague, 12808, Czech Republic
- Department of Pediatrics and Inherited Metabolic Disorders, General University Hospital in Prague, Prague, 12808, Czech Republic
| | - Warren D. Kruger
- Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA, 19111, USA
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Bittmann S, Villalon G, Moschuring-Alieva E, Luchter E, Bittmann L. Current and Novel Therapeutical Approaches of Classical Homocystinuria in Childhood With Special Focus on Enzyme Replacement Therapy, Liver-Directed Therapy and Gene Therapy. J Clin Med Res 2023; 15:76-83. [PMID: 36895619 PMCID: PMC9990725 DOI: 10.14740/jocmr4843] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/09/2023] [Indexed: 03/05/2023] Open
Abstract
Classical homocystinuria is a hereditary defect of the enzyme cystathionine beta synthase, which is produced in the liver. If this enzyme fails, the synthesis pathway of cysteine from methionine is interrupted, leading to the accumulation of homocysteine in the blood plasma and homocysteine in the urine. After birth, the children are unremarkable except for the characteristic laboratory findings. Symptoms rarely appear before the second year of life. The most common symptom is a prolapse of the crystalline lens. This finding is seen in 70% of untreated 10-year-old affected individuals. As the earliest symptom, psychomotor retardation occurs in the majority of patients already during the first two years of life. Limiting factors in terms of life expectancy are thromboembolism, peripheral arterial disease, myocardial infarction, and stroke. These symptoms are due to the damage to the vessels caused by the elevated amino acid levels. About 30% suffer a thromboembolic event by the age of 20, about half by the age of 30. This review focus on present and new therapeutical approaches like the role of enzyme replacement with presentation of different novel targets in research like pegtibatinase, pegtarviliase, CDX-6512, erymethionase, chaperones, proteasome inhibitors and probiotic treatment with SYNB 1353. Furthermore, we analyze the role of liver-directed therapy with three dimensional (3D) bioprinting, liver bioengineering of liver organoids in vitro and liver transplantation. The role of different gene therapy options to treat and cure this extremely rare disease in childhood will be discussed.
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Affiliation(s)
- Stefan Bittmann
- Ped Mind Institute, Department of Pediatrics, Medical and Finance Center Epe, D-48599 Gronau, Germany
| | - Gloria Villalon
- Ped Mind Institute, Department of Pediatrics, Medical and Finance Center Epe, D-48599 Gronau, Germany
| | - Elena Moschuring-Alieva
- Ped Mind Institute, Department of Pediatrics, Medical and Finance Center Epe, D-48599 Gronau, Germany
| | - Elisabeth Luchter
- Ped Mind Institute, Department of Pediatrics, Medical and Finance Center Epe, D-48599 Gronau, Germany
| | - Lara Bittmann
- Ped Mind Institute, Department of Pediatrics, Medical and Finance Center Epe, D-48599 Gronau, Germany
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8
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Sun S, Jin H, Rong Y, Song W, Li Q. Methylmalonic acid levels in serum, exosomes, and urine and its association with cblC type methylmalonic acidemia-induced cognitive impairment. Front Neurol 2022; 13:1090958. [PMID: 36582607 PMCID: PMC9792485 DOI: 10.3389/fneur.2022.1090958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
Background The cblC type methylmalonic acidemia is the most common methylmalonic acidemia (MMA) in China. The biochemical characteristics of this disease include elevated methylmalonic acid and homocysteine (HCY), increased propionylcarnitine (C3), decreased free carnitine (C0). In this study, we aimed to clarify the roles of these biomarkers in cblC-MMA induced cognitive impairment and evaluate the capacity of methylmalonic acid in different fluids or exosomes to distinguish cblC-MMA induced cognitive impairment. Methods 15 non-inherited hyperhomocysteinemia (HHcy) patients, 42 cblC-MMA patients and 57 age- and sex-matched healthy children were recruited in this study. The levels of HCY were detected by an automatic immune analyzer. The levels of acylcarnitines and methylmalonic acid were detected by tandem mass spectrometer. Results The main findings were all biomarkers as HCY, acylcarnitines and methylmalonic acid had capacities for distinguishing patients with cblC-MMA induced cognitive impairment from healthy children. The methylmalonic acid in different fluids or exosomes had good performances for distinguishing patients with cblC-MMA induced cognitive impairment from HHcy patients. The methylmalonic acid in serum exosomes and neuronal-derived exosomes were able to distinguishing cblC-MMA patients with cognitive impairment from patients without cognitive impairment. The methylmalonic acid in neuronal-derived exosomes might be helpful to evaluate the severity of cblC-MMA induced cognitive impairment. Discussion Methylmalonic acid levels in serum exosomes, especially in serum neuronal-derived exosomes, serve as potential biomarkers for distinguishing cblC-MMA induced cognitive impairment.
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Affiliation(s)
- Shuqi Sun
- Department of Clinical Laboratory, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Hong Jin
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yu Rong
- Department of Rehabilitation, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Wenqi Song
- Department of Clinical Laboratory, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Qiliang Li
- Department of Clinical Laboratory, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China,*Correspondence: Qiliang Li
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9
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Mauhin W, Brassier A, London J, Subran B, Zeggane A, Besset Q, Jammal C, Montardi C, Mellot C, Strauss C, Borie R, Lidove O. Manifestations pulmonaires des maladies héréditaires du métabolisme. Rev Mal Respir 2022; 39:758-777. [DOI: 10.1016/j.rmr.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/11/2022] [Indexed: 11/05/2022]
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10
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Yao B, Chen X, Liu G, Zhao X. Case report: Spontaneous bilateral intraocular lens dislocation in a patient with homocystinuria. Front Cardiovasc Med 2022; 9:974842. [PMID: 36186988 PMCID: PMC9515901 DOI: 10.3389/fcvm.2022.974842] [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: 06/21/2022] [Accepted: 08/23/2022] [Indexed: 11/24/2022] Open
Abstract
Background Spontaneous bilateral intraocular lens dislocation of the vitreous cavity is a rare ocular disorder. This article aims to comprehensively describe bilateral spontaneous intraocular lens dislocation with unilateral lamellar macular hole and retinoschisis in a Chinese woman with homocystinuria. Case presentation A 72-year-old Chinese woman with homocystinuria presented with a painless bilateral blurring of vision. The slit lamp showed the absence of lenses in both eyes. B-ultrasound and orbital computed tomography (CT) demonstrated bilateral posterior dislocation of the crystalline lenses, and spectral-domain optical coherence tomography (SD-OCT) revealed a lamellar macular hole and retinoschisis in the right eye. Biochemical examination demonstrated that the total homocysteine level was moderately elevated. Conclusion This report is the first to present an extensive and valuable description of bilateral intraocular lens dislocation with unilateral lamellar macular hole and retinoschisis secondary to homocystinuria. We have demonstrated that this case was spontaneous and chronic. CT is an effective diagnostic tool for patients with ectopia lentis. Early diagnosis and suitable management of patients with homocystinuria are essential to prevent these complications.
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Affiliation(s)
- Bangtao Yao
- Department of Ophthalmology, Nanjing Lishui People’s Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
- *Correspondence: Bangtao Yao,
| | - Xujian Chen
- Department of Ophthalmology, Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Gang Liu
- Department of Ophthalmology, Nanjing Lishui People’s Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
- Gang Liu,
| | - Xiaogui Zhao
- Department of Ophthalmology, Nanjing Lishui People’s Hospital, Zhongda Hospital Lishui Branch, Southeast University, Nanjing, China
- Xiaogui Zhao,
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11
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Nakladal D, Lambooy SPH, Mišúth S, Čepcová D, Joschko CP, Buiten A, Goris M, Hoogstra‐Berends F, Kloosterhuis NJ, Huijkman N, Sluis B, Diercks GF, Buikema JH, Henning RH, Deelman LE. Homozygous whole body
Cbs
knockout in adult mice features minimal pathology during ageing despite severe homocysteinemia. FASEB J 2022; 36:e22260. [DOI: 10.1096/fj.202101550r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/17/2022] [Accepted: 03/07/2022] [Indexed: 11/11/2022]
Affiliation(s)
- D. Nakladal
- Department of Clinical Pharmacy and Pharmacology University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - S. P. H. Lambooy
- Department of Clinical Pharmacy and Pharmacology University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - S. Mišúth
- Department of Clinical Pharmacy and Pharmacology University of Groningen University Medical Center Groningen Groningen The Netherlands
- Department of Pharmacology & Toxicology Faculty of Pharmacy Comenius University in Bratislava Bratislava Slovakia
| | - D. Čepcová
- Department of Clinical Pharmacy and Pharmacology University of Groningen University Medical Center Groningen Groningen The Netherlands
- Department of Pharmacology & Toxicology Faculty of Pharmacy Comenius University in Bratislava Bratislava Slovakia
| | - C. P. Joschko
- Department of Clinical Pharmacy and Pharmacology University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - A. Buiten
- Department of Clinical Pharmacy and Pharmacology University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - M. Goris
- Department of Clinical Pharmacy and Pharmacology University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - F. Hoogstra‐Berends
- Department of Clinical Pharmacy and Pharmacology University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - N. J. Kloosterhuis
- Department of Pediatrics University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - N. Huijkman
- iPSC/CRISPR Center Groningen University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - B. Sluis
- Department of Pediatrics University of Groningen University Medical Center Groningen Groningen The Netherlands
- iPSC/CRISPR Center Groningen University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - G. F. Diercks
- Department of Dermatology Center for Blistering Diseases University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - J. H. Buikema
- Department of Clinical Pharmacy and Pharmacology University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - R. H. Henning
- Department of Clinical Pharmacy and Pharmacology University of Groningen University Medical Center Groningen Groningen The Netherlands
| | - L. E. Deelman
- Department of Clinical Pharmacy and Pharmacology University of Groningen University Medical Center Groningen Groningen The Netherlands
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12
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Kruger WD. How to fix a broken protein: restoring function to mutant human cystathionine β-synthase. Hum Genet 2021; 141:1299-1308. [PMID: 34636997 DOI: 10.1007/s00439-021-02386-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 10/05/2021] [Indexed: 12/17/2022]
Abstract
Inborn errors of metabolism (IEM) comprise a large class of recessive genetic diseases involving disorders of cellular metabolism that tend to be caused by missense mutations in which a single incorrect amino acid is substituted in the polypeptide chain. Cystathionine beta-synthase (CBS) deficiency is an example of an IEM that causes large elevations of blood total homocysteine levels, resulting in phenotypes in several tissues. Current treatment strategies involve dietary restriction and vitamin therapy, but these are only partially effective and do not work in all patients. Over 85% of the described mutations in CBS-deficient patients are missense mutations in which the mutant protein fails to fold into an active conformation. The ability of CBS to achieve an active conformation is affected by a variety of intracellular protein networks including the chaperone system and the ubiquitin/proteasome system, collectively referred to as the proteostasis network. Proteostasis modulators are drugs that perturb various aspects of these networks. In this article, we will review the evidence that modulation of the intracellular protein folding environment can be used as a potential therapeutic strategy to treat CBS deficiency and discuss the pros and cons of such a strategy.
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Affiliation(s)
- Warren D Kruger
- Cancer Signaling and Epigenetics Program, Fox Chase Cancer Center, Philadelphia, PA, USA.
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Pinheiro FC, Sperb-Ludwig F, Schwartz IVD. Epidemiological aspects of hereditary fructose intolerance: A database study. Hum Mutat 2021; 42:1548-1566. [PMID: 34524712 DOI: 10.1002/humu.24282] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 09/05/2021] [Accepted: 09/11/2021] [Indexed: 12/11/2022]
Abstract
Hereditary fructose intolerance (HFI) is an inborn error of fructose metabolism of autosomal recessive inheritance caused by pathogenic variants in the ALDOB gene that lead to aldolase B deficiency in the liver, kidneys, and intestine. Patients manifest symptoms, such as ketotic hypoglycemia, vomiting, nausea, in addition to hepatomegaly and other liver and kidney dysfunctions. The treatment consists of a fructose-restricted diet, which results in a good prognosis. To analyze the distribution of ALDOB variants described in patients and to estimate the prevalence of HFI based on carrier frequency in the gnomAD database, a systematic review was conducted to assess ALDOB gene variants among patients with HFI. The prevalence of HFI was estimated from the carrier frequency of variants described in patients, as well as rare variants predicted as pathogenic by in silico tools. The p.(Ala150Pro) and p.(Ala175Asp) variants are the most frequent and are distributed worldwide. However, these variants have particular distribution patterns in Europe. The analysis of the prevalence of HFI showed that the inclusion of rare alleles predicted as pathogenic is a more informative approach for populations with few patients. The data show that HFI has a wide distribution and an estimated prevalence of ~1:10,000.
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Affiliation(s)
- Franciele C Pinheiro
- Post-Graduate Program in Genetics and Molecular Biology, Federal University of do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,BRAIN Laboratory, Center of Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Federal University of Pampa, Itaqui, Rio Grande do Sul, Brazil
| | - Fernanda Sperb-Ludwig
- Post-Graduate Program in Genetics and Molecular Biology, Federal University of do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,BRAIN Laboratory, Center of Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Ida V D Schwartz
- Post-Graduate Program in Genetics and Molecular Biology, Federal University of do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,BRAIN Laboratory, Center of Experimental Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.,Department of Genetics, Bioscience Institute, Federal University of do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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14
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Alsharhan H, Ahmed AA, Ali NM, Alahmad A, Albash B, Elshafie RM, Alkanderi S, Elkazzaz UM, Cyril PX, Abdelrahman RM, Elmonairy AA, Ibrahim SM, Elfeky YME, Sadik DI, Al-Enezi SD, Salloum AM, Girish Y, Al-Ali M, Ramadan DG, Alsafi R, Al-Rushood M, Bastaki L. Early Diagnosis of Classic Homocystinuria in Kuwait through Newborn Screening: A 6-Year Experience. Int J Neonatal Screen 2021; 7:ijns7030056. [PMID: 34449519 PMCID: PMC8395821 DOI: 10.3390/ijns7030056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/23/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022] Open
Abstract
Kuwait is a small Arabian Gulf country with a high rate of consanguinity and where a national newborn screening program was expanded in October 2014 to include a wide range of endocrine and metabolic disorders. A retrospective study conducted between January 2015 and December 2020 revealed a total of 304,086 newborns have been screened in Kuwait. Six newborns were diagnosed with classic homocystinuria with an incidence of 1:50,000, which is not as high as in Qatar but higher than the global incidence. Molecular testing for five of them has revealed three previously reported pathogenic variants in the CBS gene, c.969G>A, p.(Trp323Ter); c.982G>A, p.(Asp328Asn); and the Qatari founder variant c.1006C>T, p.(Arg336Cys). This is the first study to review the screening of newborns in Kuwait for classic homocystinuria, starting with the detection of elevated blood methionine and providing a follow-up strategy for positive results, including plasma total homocysteine and amino acid analyses. Further, we have demonstrated an increase in the specificity of the current newborn screening test for classic homocystinuria by including the methionine to phenylalanine ratio along with the elevated methionine blood levels in first-tier testing. Here, we provide evidence that the newborn screening in Kuwait has led to the early detection of classic homocystinuria cases and enabled the affected individuals to lead active and productive lives.
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Affiliation(s)
- Hind Alsharhan
- Department of Pediatrics, Faculty of Medicine, Kuwait University, P.O. Box 24923, Safat 13110, Kuwait
- Department of Pediatrics, Farwaniya Hospital, Ministry of Health, Sabah Al-Nasser 92426, Kuwait
- Kuwait Medical Genetics Center, Ministry of Health, Sulaibikhat 80901, Kuwait; (B.A.); (R.M.E.); (S.A.); (A.A.E.); (D.I.S.); (L.B.)
- Correspondence: ; Tel.: +965-60600106 or +965-25319486
| | - Amir A. Ahmed
- Newborn Screening Laboratory, Kuwait Medical Genetics Center, Ministry of Health, Sulaibikhat 80901, Kuwait; (A.A.A.); (R.M.A.); (M.A.-R.)
- Next Generation Sequencing Laboratory, Kuwait Medical Genetics Center, Ministry of Health, Sulaibikhat 80901, Kuwait; (N.M.A.); (M.A.-A.)
| | - Naser M. Ali
- Next Generation Sequencing Laboratory, Kuwait Medical Genetics Center, Ministry of Health, Sulaibikhat 80901, Kuwait; (N.M.A.); (M.A.-A.)
| | - Ahmad Alahmad
- Molecular Genetics Laboratory, Kuwait Medical Genetics Center, Ministry of Health, Sulaibikhat 80901, Kuwait; (A.A.); (S.D.A.-E.)
| | - Buthaina Albash
- Kuwait Medical Genetics Center, Ministry of Health, Sulaibikhat 80901, Kuwait; (B.A.); (R.M.E.); (S.A.); (A.A.E.); (D.I.S.); (L.B.)
| | - Reem M. Elshafie
- Kuwait Medical Genetics Center, Ministry of Health, Sulaibikhat 80901, Kuwait; (B.A.); (R.M.E.); (S.A.); (A.A.E.); (D.I.S.); (L.B.)
- Next Generation Sequencing Laboratory, Kuwait Medical Genetics Center, Ministry of Health, Sulaibikhat 80901, Kuwait; (N.M.A.); (M.A.-A.)
| | - Sumaya Alkanderi
- Kuwait Medical Genetics Center, Ministry of Health, Sulaibikhat 80901, Kuwait; (B.A.); (R.M.E.); (S.A.); (A.A.E.); (D.I.S.); (L.B.)
- Next Generation Sequencing Laboratory, Kuwait Medical Genetics Center, Ministry of Health, Sulaibikhat 80901, Kuwait; (N.M.A.); (M.A.-A.)
| | - Usama M. Elkazzaz
- Newborn Screening Office, Farwaniya Hospital, Ministry of Health, Sabah Al-Nasser 92426, Kuwait;
| | | | - Rehab M. Abdelrahman
- Newborn Screening Laboratory, Kuwait Medical Genetics Center, Ministry of Health, Sulaibikhat 80901, Kuwait; (A.A.A.); (R.M.A.); (M.A.-R.)
| | - Alaa A. Elmonairy
- Kuwait Medical Genetics Center, Ministry of Health, Sulaibikhat 80901, Kuwait; (B.A.); (R.M.E.); (S.A.); (A.A.E.); (D.I.S.); (L.B.)
| | - Samia M. Ibrahim
- Newborn Screening Office, Al-Sabah Maternity Hospital, Ministry of Health, Sulaibikhat 80901, Kuwait;
| | - Yasser M. E. Elfeky
- Newborn Screening Office, Jahra Hospital, Ministry of Health, Jahra 00020, Kuwait;
| | - Doaa I. Sadik
- Kuwait Medical Genetics Center, Ministry of Health, Sulaibikhat 80901, Kuwait; (B.A.); (R.M.E.); (S.A.); (A.A.E.); (D.I.S.); (L.B.)
| | - Sara D. Al-Enezi
- Molecular Genetics Laboratory, Kuwait Medical Genetics Center, Ministry of Health, Sulaibikhat 80901, Kuwait; (A.A.); (S.D.A.-E.)
| | - Ayman M. Salloum
- Biochemistry Laboratory, Al-Sabah Hospital, Ministry of Health, Shuwaikh 70051, Kuwait;
| | - Yadav Girish
- Clinical Biochemistry Laboratory, Ibn Sina Hospital, Ministry of Health, Shuwaikh, P.O. Box 25427, Safat 13115, Kuwait;
| | - Mohammad Al-Ali
- Next Generation Sequencing Laboratory, Kuwait Medical Genetics Center, Ministry of Health, Sulaibikhat 80901, Kuwait; (N.M.A.); (M.A.-A.)
| | - Dina G. Ramadan
- Department of Pediatrics, Al-Sabah Hospital, Ministry of Health, Shuweikh 70051, Kuwait;
| | - Rasha Alsafi
- Department of Pediatrics, Adan Hospital, Ministry of Health, Hadiya 52700, Kuwait;
| | - May Al-Rushood
- Newborn Screening Laboratory, Kuwait Medical Genetics Center, Ministry of Health, Sulaibikhat 80901, Kuwait; (A.A.A.); (R.M.A.); (M.A.-R.)
| | - Laila Bastaki
- Kuwait Medical Genetics Center, Ministry of Health, Sulaibikhat 80901, Kuwait; (B.A.); (R.M.E.); (S.A.); (A.A.E.); (D.I.S.); (L.B.)
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15
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Kožich V, Majtan T. Inherited disorders of sulfur amino acid metabolism: recent advances in therapy. Curr Opin Clin Nutr Metab Care 2021; 24:62-70. [PMID: 33060459 DOI: 10.1097/mco.0000000000000705] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Metabolism of sulfur amino acids (SAA) provides compounds important for many cellular functions. Inherited disorders of SAA metabolism are typically severe multisystemic diseases affecting brain, liver, connective tissue, or vasculature. The review summarizes the present therapeutic approaches and advances in identifying novel treatment targets, and provides an overview of new therapies. RECENT FINDINGS Current treatments of genetic disorders of SAA metabolism are primarily based on modulation of affected pathways by dietary measures and provision of lacking products or scavenging of toxic molecules. Recent studies identified additional therapeutic targets distant from the primary defects and explored ideas envisioning novel treatments, such as chaperone and gene therapy. Recombinant protein production and engineering resulted in development and clinical testing of enzyme therapies for cystathionine β-synthase deficiency, the most common inborn error of SAA metabolism. SUMMARY Complex regulation of pathways involved in SAA metabolism and cellular consequences of genetic defects in SAA metabolism are only partially understood. There is a pressing need to increase substantially our knowledge of the disease mechanisms to develop more effective therapies for patients suffering from these rare disorders.
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Affiliation(s)
- Viktor Kožich
- Department of Pediatrics and Inherited Metabolic Disorders, Charles University-First Faculty of Medicine and General University Hospital, Czech Republic
| | - Tomas Majtan
- Section of Genetics and Metabolism, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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16
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Kalil MAB, Donis KC, Poswar FDO, Dos Santos BB, Santos ÂBS, Schwartz IVD. Cardiovascular findings in classic homocystinuria. Mol Genet Metab Rep 2020; 25:100693. [PMID: 33335839 PMCID: PMC7734301 DOI: 10.1016/j.ymgmr.2020.100693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/26/2020] [Accepted: 11/27/2020] [Indexed: 01/21/2023] Open
Abstract
Objective describe cardiovascular findings from echocardiograms and electrocardiograms in patients with Classic Homocystinuria. Methods this retrospective exploratory study evaluated fourteen subjects with Classic Homocystinuria (median age = 27.3 years; male n = 8, B6-non-responsive n = 9 patients), recruited by convenience sampling from patients seen Hospital de Clínicas de Porto Alegre (Brazil), between January 1997 and July 2020. Data on clinical findings, echocardiogram and electrocardiogram were retrieved from medical records. Results Eight patients presented some abnormalities on echocardiogram (n = 6) or electrocardiogram (n = 5). The most frequent finding was mild tricuspid regurgitation (n = 3), followed by mitral valve prolapse, mild mitral regurgitation, enlarged left atrium and aortic valve sclerosis (n = 2 patients each). Aortic root ectasia was found in one patient. Venous thrombosis was reported in six patients: deep vein thrombosis of lower limbs (n = 3), ischaemic stroke (n = 1), cerebral venous sinus thrombosis (n = 1) and pulmonary vein thrombosis (n = 1). Conclusion mild valvulopathies seen to be common in patients with Classic Homocystinuria, but more studies regarding echocardiogram and electrocardiogram in this population are needed to draw absolute conclusions.
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Affiliation(s)
| | - Karina Carvalho Donis
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, RS, Brazil.,Post graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, RS, Brazil
| | | | - Bruna Bento Dos Santos
- Post graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, RS, Brazil
| | - Ângela Barreto Santiago Santos
- Post graduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, RS, Brazil.,Cardiology Service, Hospital de Clínicas de Porto Alegre, RS, Brazil
| | - Ida Vanessa Doederlein Schwartz
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, RS, Brazil.,Post graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, RS, Brazil
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17
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Al Mutairi F. Hyperhomocysteinemia: Clinical Insights. J Cent Nerv Syst Dis 2020; 12:1179573520962230. [PMID: 33100834 PMCID: PMC7549175 DOI: 10.1177/1179573520962230] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/06/2020] [Indexed: 12/12/2022] Open
Abstract
Homocysteine (Hcy) is a sulfhydryl-containing amino acid, and intermediate metabolite formed in metabolising methionine (Met) to cysteine (Cys); defective Met metabolism can increase Hcy. The effect of hyperhomocysteinemia (HHcy) on human health, is well described and associated with multiple clinical conditions. HHcy is considered to be an independent risk factor for common cardiovascular and central nervous disorders, where its role in folate metabolism and choline catabolism is fundamental in many metabolic pathways. HHcy induces inflammatory responses via increasing the pro-inflammatory cytokines and downregulation of anti-inflammatory cytokines which lead to Hcy-induced cell apoptosis. Conflicting evidence indicates that the development of the homocysteine-associated cerebrovascular disease may be prevented by the maintenance of normal Hcy levels. In this review, we discuss common conditions associated with HHcy and biochemical diagnostic workup that may help in reaching diagnosis at early stages. Furthermore, future systematic studies need to prove the exact pathophysiological mechanism of HHcy at the cellular level and the effect of Hcy lowering agents on disease courses.
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Affiliation(s)
- Fuad Al Mutairi
- Medical Genetics Division, Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
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18
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Gus PI, Donis KC, Marinho D, Martins TF, de Souza CFM, Carloto RB, Leivas G, Schwartz IVD. Ocular manifestations in classic homocystinuria. Ophthalmic Genet 2020; 42:71-74. [PMID: 32940091 DOI: 10.1080/13816810.2020.1821384] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Classic homocystinuria (HCU), or cystathionine beta-synthase (CBS) deficiency, is a rare inborn error of methionine metabolism. Main clinical features may include skeletal and vascular manifestations, developmental delay, intellectual disability and eye disorders. MATERIAL AND METHODS This is an observational and retrospective study aiming at describing eye abnormalities presented by a cohort of late-diagnosed HCU patients. Data regarding ophthalmological evaluation included visual acuity, refraction, biomicroscopy, Perkins tonometry, fundus examination, retinography, biometry, ocular ultrasound, optical coherence tomography, anterior segment photography and topography. RESULTS Ten patients with HCU (20 eyes) were included. The most frequent findings were ectopia lentis(n = 20) and myopia (n = 9). Biometry, ultrasound, OCT and topography findings were available for four patients. One patient had keratoconus; one had abnormal retinal pigmentation; and two had lens surgery scars with irregular astigmatism. CONCLUSIONS Eye abnormalities are very frequent in late-diagnosed HCU patients. The presence of ectopia lentis should always raise the diagnostic hypothesis of HCU.
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Affiliation(s)
- Patrícia Ioschpe Gus
- Ophthalmology Division, Hospital de Clínicas de Porto Alegre (HCPA) , Porto Alegre, Brazil
| | - Karina Carvalho Donis
- Medical Genetics Division, Hospital de Clínicas de Porto Alegre (HCPA) , Porto Alegre, Brazil
| | - Diane Marinho
- Ophthalmology Division, Hospital de Clínicas de Porto Alegre (HCPA) , Porto Alegre, Brazil
| | | | | | - Rafael Barboza Carloto
- Medical Student, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS) , Porto Alegre, Brazil
| | - Gabriel Leivas
- Medical Student, Universidade Federal do Rio Grande do Sul (UFRGS) , Porto Alegre, Brazil
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19
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Weber Hoss GR, Sperb-Ludwig F, Schwartz IVD, Blom HJ. Classical homocystinuria: A common inborn error of metabolism? An epidemiological study based on genetic databases. Mol Genet Genomic Med 2020; 8:e1214. [PMID: 32232970 PMCID: PMC7284035 DOI: 10.1002/mgg3.1214] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/25/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Biallelic pathogenic variants in CBS gene cause the most common form of homocystinuria, the classical homocystinuria (HCU). The worldwide prevalence of HCU is estimated to be 0.82:100,000 [95% CI, 0.39-1.73:100,000] according to clinical records and 1.09:100,000 [95% CI, 0.34-3.55:100,000] by neonatal screening. In this study, we aimed to estimate the minimal worldwide incidence of HCU. METHODS The 25 most common pathogenic alleles of HCU were identified through a literature review. The incidence of HCU was estimated based on the frequency of these common pathogenic alleles in a large genomic database (gnomAD). RESULTS The minimum worldwide incidence of HCU was estimated to be ~0.38:100,000, and the incidence was higher in Europeans non-Finnish (~0.72:100,000) and Latin Americans (~0.45:100,000) and lower in Africans (~0.20:100,000) and Asians (~0.02:100,000). CONCLUSION Our data are in accordance with the only published metanalysis on this topic. To our surprise, the observed incidence of HCU in Europeans was much lower than those described in articles exploring small populations from northern Europe but was similar to the incidence described on the basis of neonatal screening programs. In our opinion, this large dataset analyzed and its population coverage gave us greater precision in the estimation of incidence.
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Affiliation(s)
- Giovana R Weber Hoss
- BRAIN Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Post Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Fernanda Sperb-Ludwig
- BRAIN Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Post Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Ida V D Schwartz
- BRAIN Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Post Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Henk J Blom
- Department of Clinical Genetics, Center for Lysosomal and Metabolic Diseases, ErasmusMC, Rotterdam, The Netherlands
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