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Tan YY, Fong WYN, Chan CJ, Chandran S. Do renal and cardiac malformations in the fetus signal carnitine palmitoyltransferase II deficiency? A rare lethal fatty acid oxidation defect. BMJ Case Rep 2022; 15:e251321. [PMID: 36535739 PMCID: PMC9764616 DOI: 10.1136/bcr-2022-251321] [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] [Indexed: 12/23/2022] Open
Abstract
The neonatal form of carnitine palmitoyltransferase II (CPT II) deficiency is a rare lethal inherited disorder of fatty acid oxidation. Carnitine essentially transfers long-chain fatty acids across the mitochondrial membranes for β-oxidation, where CPT II plays a key role. CPT II deficiency phenotypical forms include lethal neonatal, severe infantile and myopathic forms. We present a term small-for-gestational-age neonate with hypoglycaemia, seizures, refractory cardiac arrhythmias and intracranial haemorrhage. Plasma acylcarnitine profile and the genetic study confirmed CPT II deficiency. Additionally, likely pathogenic variants in the SLC22A5 gene point to primary carnitine deficiency. Antenatal findings of polycystic kidney disease and cardiomegaly were confirmed postnatally. All supportive measures, including extracorporeal life support, failed to improve the clinical course, and the baby succumbed. Major renal, cerebral and cardiac anomalies were reported with CPT II deficiency. In our case, fetal polycystic nephromegaly and cardiomegaly with parental consanguinity should have signalled the possibility of this disorder.
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Affiliation(s)
- Yee Yin Tan
- Department of Neonatology, KK Women's and Children's Hospital, Singapore
| | - Wen Yan Nikki Fong
- Genetic Services, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Charmaine Jiahui Chan
- Department of Paediatric Subspecialities, KK Women's and Children's Hospital, Singapore
- Paediatric Academic Clinical Programme, Lee Kong Chian School of Medicine, Singapore
- Paediatric Academic Clinical Programme, Duke NUS Medical School, Singapore
- Paediatric Academic Clinical Programme, Yong Loo Lin School of Medicine, Singapore
| | - Suresh Chandran
- Department of Neonatology, KK Women's and Children's Hospital, Singapore
- Paediatric Academic Clinical Programme, Lee Kong Chian School of Medicine, Singapore
- Paediatric Academic Clinical Programme, Duke NUS Medical School, Singapore
- Paediatric Academic Clinical Programme, Yong Loo Lin School of Medicine, Singapore
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Shelihan I, Rossignol E, Décarie J, Bonnefont J, Brivet M, Brunel‐Guitton C, Mitchell GA. Infantile onset carnitine palmitoyltransferase 2 deficiency: Cortical polymicrogyria, schizencephaly, and gray matter heterotopias in an adolescent with normal development. JIMD Rep 2022; 63:3-10. [PMID: 35028265 PMCID: PMC8743346 DOI: 10.1002/jmd2.12243] [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: 05/25/2020] [Revised: 06/21/2021] [Accepted: 07/19/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To report an adolescent with infantile-onset carnitine palmitoyltransferase 2 (CPT2) deficiency and cerebral malformations and to review the occurrence of brain malformations in CPT2 deficiency. The patient presented clinically at age 5 months with dehydration and hepatomegaly. He also has an unrelated condition, X-linked nephrogenic diabetes insipidus. He had recurrent rhabdomyolysis but normal psychomotor development. At age 17 years, he developed spontaneous focal seizures. Cerebral magnetic resonance imaging revealed extensive left temporo-parieto-occipital polymicrogyria, white matter heterotopias, and schizencephaly. Neuronal migration defects were previously reported in lethal neonatal CPT2 deficiency but not in later-onset forms. DESIGN AND METHODS We searched PubMed, Google Scholar, and the bibliographies of the articles found by these searches, for cerebral malformations in CPT2 deficiency. All antenatal, neonatal, infantile, and adult-onset cases were included. Exclusion criteria included insufficient information about age of clinical onset and lack of confirmation of CPT2 deficiency by enzymatic assay or genetic testing. For each report, we noted the presence of cerebral malformations on brain imaging or pathological examination. RESULTS Of 26 neonatal-onset CPT2-deficient patients who met the inclusion criteria, brain malformations were reported in 16 (61.5%). In 19 infantile-onset cases, brain malformations were not reported, but only 3 of the 19 reports (15.8%) include brain imaging or neuropathology data. In 276 adult-onset cases, no brain malformations were reported. CONCLUSION To the best of our knowledge, this is the first report of cerebral malformations in an infantile onset CPT2-deficient patient. Brain imaging should be considered in patients with CPTII deficiency and neurological manifestations, even in those with later clinical onset.
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Affiliation(s)
- Ivan Shelihan
- Divisions of Medical Genetics (IS, CBG, GM) and Neurology (ER), Department of PediatricsCHU Sainte‐Justine and Université de MontréalMontrealQuebecCanada
| | - Elsa Rossignol
- Divisions of Medical Genetics (IS, CBG, GM) and Neurology (ER), Department of PediatricsCHU Sainte‐Justine and Université de MontréalMontrealQuebecCanada
- Department of NeurosciencesCHU Sainte‐Justine and Université de MontréalMontreal, QCQuebecCanada
| | - Jean‐Claude Décarie
- Department of Medical ImagingCHU Sainte‐Justine and Université de MontréalMontrealQuebecCanada
| | - Jean‐Paul Bonnefont
- Medical Genetics FederationNecker Enfants Malades Hospital and IMAGINE InstituteParisFrance
| | - Michèle Brivet
- Medical Genetics FederationNecker Enfants Malades Hospital and IMAGINE InstituteParisFrance
| | - Catherine Brunel‐Guitton
- Biochemical Diseases, Department of Pediatrics, Faculty of MedicineUniversity of British Columbia, BC Children's HospitalVancouverBritishColumbia
| | - Grant A. Mitchell
- Divisions of Medical Genetics (IS, CBG, GM) and Neurology (ER), Department of PediatricsCHU Sainte‐Justine and Université de MontréalMontrealQuebecCanada
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Boemer F, Deberg M, Schoos R, Caberg JH, Gaillez S, Dugauquier C, Delbecque K, François A, Maton P, Demonceau N, Senterre G, Ferdinandusse S, Debray FG. Diagnostic pitfall in antenatal manifestations of CPT II deficiency. Clin Genet 2015; 89:193-7. [PMID: 25827434 DOI: 10.1111/cge.12593] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 03/24/2015] [Accepted: 03/27/2015] [Indexed: 12/26/2022]
Abstract
Carnitine palmitoyltransferase II (CPT2) deficiency is a rare inborn error of mitochondrial fatty acid metabolism associated with various phenotypes. Whereas most patients present with postnatal signs of energetic failure affecting muscle and liver, a small subset of patients presents antenatal malformations including brain dysgenesis and neuronal migration defects. Here, we report recurrence of severe cerebral dysgenesis with Dandy-Walker malformation in three successive pregnancies and review previously reported antenatal cases. Interestingly, we also report that acylcarnitines profile, tested retrospectively on the amniotic fluid of last pregnancy, was not sensitive enough to allow reliable prenatal diagnosis of CPT2 deficiency. Finally, because fetuses affected by severe cerebral malformations are frequently aborted, CPT2 deficiency may be underestimated and fatty acid oxidation disorders should be considered when faced with a fetus with Dandy-Walker anomaly or another brain dysgenesis.
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Affiliation(s)
- F Boemer
- Biochemical Genetics Lab, Department of Human Genetics, CHU Sart-Tilman, University of Liège, Liege, Belgium
| | - M Deberg
- Biochemical Genetics Lab, Department of Human Genetics, CHU Sart-Tilman, University of Liège, Liege, Belgium
| | - R Schoos
- Biochemical Genetics Lab, Department of Human Genetics, CHU Sart-Tilman, University of Liège, Liege, Belgium
| | - J-H Caberg
- Molecular Genetics Lab, Department of Human Genetics, CHU Sart-Tilman, University of Liège, Liege, Belgium
| | - S Gaillez
- Clinical Genetics, Department of Human Genetics, CHU Sart-Tilman, University of Liège, Liege, Belgium
| | - C Dugauquier
- Department of Pathology, Institut de Pathologie et de Génétique, Charleroi, Belgium
| | - K Delbecque
- Department of Pathology, CHU Sart-Tilman, University of Liège, Liege, Belgium
| | - A François
- Department of Pediatrics, Clinique Saint-Vincent, CHC, Liège, Belgium
| | - P Maton
- Department of Pediatrics, Clinique Saint-Vincent, CHC, Liège, Belgium
| | - N Demonceau
- Department of Pediatrics, Clinique Saint-Vincent, CHC, Liège, Belgium
| | - G Senterre
- Department of Gynecology-Obstetrics, Clinique Saint-Vincent, CHC, Liège, Belgium
| | - S Ferdinandusse
- Laboratory Genetic Metabolic Diseases, Academic Medical Center, Amsterdam, The Netherlands
| | - F-G Debray
- Clinical Genetics, Department of Human Genetics, CHU Sart-Tilman, University of Liège, Liege, Belgium.,Department of Pediatrics, Clinique Saint-Vincent, CHC, Liège, Belgium.,Metabolic Unit, Department of Human Genetics, CHU Sart-Tilman, University of Liège, Liege, Belgium
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Jacobs LJAM, de Wert G, Geraedts JPM, de Coo IFM, Smeets HJM. The transmission of OXPHOS disease and methods to prevent this. Hum Reprod Update 2005; 12:119-36. [PMID: 16199488 DOI: 10.1093/humupd/dmi042] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Diseases owing to defects of oxidative phosphorylation (OXPHOS) affect approximately 1 in 8,000 individuals. Clinical manifestations can be extremely variable and range from single-affected tissues to multisystemic syndromes. In general, tissues with a high energy demand, like brain, heart and muscle, are affected. The OXPHOS system is under dual genetic control, and mutations in both nuclear and mitochondrial genes can cause OXPHOS diseases. The expression and segregation of mitochondrial DNA (mtDNA) mutations is different from nuclear gene defects. The mtDNA mutations can be either homoplasmic or heteroplasmic and in the latter case disease becomes manifest when the mutation exceeds a tissue-specific threshold. This mutation load can vary between tissues and often an exact correlation between mutation load and phenotypic expression is lacking. The transmission of mtDNA mutations is exclusively maternal, but the mutation load between embryos can vary tremendously because of a segregational bottleneck. Diseases by nuclear gene mutations show a normal Mendelian inheritance pattern and often have a more constant clinical manifestation. Given the prevalence and severity of OXPHOS disorders and the lack of adequate therapy, existing and new methods for the prevention of transmission of OXPHOS disorders, like prenatal diagnosis (PND), preimplantation genetic diagnosis (PGD), cytoplasmic transfer (CT) and nuclear transfer (NT), are technically and ethically evaluated.
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Affiliation(s)
- L J A M Jacobs
- Department of Genetics and Cell Biology, University of Maastricht, 6200 MD Maastricht, The Netherlands
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