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Dalili S, Sedighi Pirsaraei N, Sharifi A, Pouryousef A, Aghaee F, Bayat R, Ghavami B, Rabbani B, Mahdieh N. Intrafamilial phenotypic variability due to a missense pathogenic variant in FBP1 gene. Mol Genet Metab Rep 2024; 41:101136. [PMID: 39282051 PMCID: PMC11402249 DOI: 10.1016/j.ymgmr.2024.101136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/23/2024] [Accepted: 08/25/2024] [Indexed: 09/18/2024] Open
Abstract
Background FBPase deficiency as an autosomal recessive disorder is due pathogenic variants in the FBP1 gene. It usually presents with hyperlactic acidemia and hypoglycaemia starting from early childhood. Here, genotypes and phenotypes of all reported patients and their distributions are presented. In addition, we present an Iranian family with two affected children presenting with unusual symptoms due to pathogenic variants in the FBP1 gene.Clinical evaluations and laboratory assessments were performed for the affected members. Whole exome sequencing (WES) was applied in order to find the causal variant. In addition to segregation analysis within the family, variant pathogenicity analyses and predictions were done via bioinformatics tools and according to ACMG guidelines. The genotypes and detailed clinical features were documented for all patients. Results The study included a population of 104 patients with different variants of the FBP1 gene; 75 were homozygotes. The average age of onset was 14.97 months. The most frequent clinical features were metabolic acidosis (71 cases), hypoglycemia (70 cases), vomiting (46 cases), hyperuricemia (37 cases), and respiratory distress (25 cases). 74 families were from Asia. The most common genotypes were c.841G > A/c.841G > A and c.472C > T/c.472C > T. WES test showed a pathogenic homozygous variant, c.472C > T in two cases of a family: a six-and-a-half-year-old girl with an older brother with different symptoms. All laboratory evaluations in the patient were normal except for the blood sugar. The patient experienced her first hypoglycemic episode at age 3. Conclusions This is an unusual presentation of FBPase deficiency with intrafamilial phenotypic variability.
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Affiliation(s)
- Setila Dalili
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Ameneh Sharifi
- Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Pouryousef
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Fatemeh Aghaee
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Reza Bayat
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Babak Ghavami
- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Bahareh Rabbani
- Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nejat Mahdieh
- Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Institute, Iran University of Medical Sciences, Tehran, Iran
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Ni Q, Tang M, Chen X, Lu Y, Wu B, Wang H, Zhou W, Dong X. Fructose-1,6-bisphosphatase deficiency: estimation of prevalence in the Chinese population and analysis of genotype-phenotype association. Front Genet 2024; 15:1296797. [PMID: 39036704 PMCID: PMC11258016 DOI: 10.3389/fgene.2024.1296797] [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: 10/02/2023] [Accepted: 06/11/2024] [Indexed: 07/23/2024] Open
Abstract
Objective Fructose-1,6-bisphosphatase deficiency (FBP1D) is a rare inborn error due to mutations in the FBP1 gene. The genetic spectrum of FBP1D in China is unknown, also nonspecific manifestations confuse disease diagnosis. We systematically estimated the FBP1D prevalence in Chinese and explored genotype-phenotype association. Methods We collected 101 FBP1 variants from our cohort and public resources, and manually curated pathogenicity of these variants. Ninety-seven pathogenic or likely pathogenic variants were used in our cohort to estimate Chinese FBP1D prevalence by three methods: 1) carrier frequency, 2) permutation and combination, 3) Bayesian framework. Allele frequencies (AFs) of these variants in our cohort, China Metabolic Analytics Project (ChinaMAP) and gnomAD were compared to reveal the different hotspots in Chinese and other populations. Clinical and genetic information of 122 FBP1D patients from our cohort and published literature were collected to analyze the genotype-phenotypes association. Phenotypes of 68 hereditary fructose intolerance (HFI) patients from our previous study were used to compare the phenotypic differences between these two fructose metabolism diseases. Results The estimated Chinese FBP1D prevalence was 1/1,310,034. In the Chinese population, c.490G>A and c.355G>A had significantly higher AFs than in the non-Finland European population, and c.841G>A had significantly lower AF value than in the South Asian population (all p values < 0.05). The genotype-phenotype association analyses showed that patients carrying homozygous c.841G>A were more likely to present increased urinary glycerol, carrying two CNVs (especially homozygous exon1 deletion) were often with hepatic steatosis, carrying compound heterozygous variants were usually with lethargy, and carrying homozygous variants were usually with ketosis and hepatic steatosis (all p values < 0.05). By comparing to phenotypes of HFI patients, FBP1D patients were more likely to present hypoglycemia, metabolic acidosis, and seizures (all p-value < 0.05). Conclusion The prevalence of FBP1D in the Chinese population is extremely low. Genetic sequencing could effectively help to diagnose FBP1D.
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Affiliation(s)
- Qi Ni
- Children’s Hospital and Institutes of Biomedical Sciences, Fudan University, National Children’s Medical Center, Shanghai, China
- Center for Molecular Medicine, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Meiling Tang
- Center for Molecular Medicine, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Xiang Chen
- Division of Neonatology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Yulan Lu
- Center for Molecular Medicine, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Bingbing Wu
- Center for Molecular Medicine, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Huijun Wang
- Center for Molecular Medicine, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Wenhao Zhou
- Children’s Hospital and Institutes of Biomedical Sciences, Fudan University, National Children’s Medical Center, Shanghai, China
- Center for Molecular Medicine, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
- Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xinran Dong
- Children’s Hospital and Institutes of Biomedical Sciences, Fudan University, National Children’s Medical Center, Shanghai, China
- Center for Molecular Medicine, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
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Almousa M, Aljomaa M, Hamey S, Alasmar D. Documentation of a novel FBP1 gene mutation in the Arabian ethnicity: a case report. J Med Case Rep 2024; 18:166. [PMID: 38589931 PMCID: PMC11002998 DOI: 10.1186/s13256-024-04448-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/09/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Fructose-1,6-bisphosphatase deficiency is a rare autosomal recessive disorder characterized by impaired gluconeogenesis. Fructose-1,6-bisphosphatase 1 (FBP1) mutations demonstrate ethnic patterns. For instance, Turkish populations commonly harbor exon 2 deletions. We present a case report of whole exon 2 deletion in a Syrian Arabian child as the first recording of this mutation among Arabian ethnicity and the first report of FBP1 gene mutation in Syria. CASE PRESENTATION We present the case of a 2.5-year-old Syrian Arab child with recurrent hypoglycemic episodes, accompanied by nausea and lethargy. The patient's history, physical examination, and laboratory findings raised suspicion of fructose-1,6-bisphosphatase deficiency. Whole exome sequencing was performed, revealing a homozygous deletion of exon 2 in the FBP1 gene, confirming the diagnosis. CONCLUSION This case highlights a potential novel mutation in the Arab population; this mutation is well described in the Turkish population, which suggests potential shared mutations due to ancestral relationships between the two ethnicities. Further studies are needed to confirm this finding.
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Affiliation(s)
| | - Mohammad Aljomaa
- Department of Gastroenterology, Aleppo University Hospital, University of Aleppo, Aleppo, Syria
| | - Shekhey Hamey
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Diana Alasmar
- Department of Pediatrics, University Children Hospital, Damascus University, Damascus, Syria
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Liang X, Liu X, Li W, Zhang L, Zhang B, Lai G, Zhao Y. A novel variant in the FBP1 gene causes fructose-1,6-bisphosphatase deficiency through increased ubiquitination. Arch Biochem Biophys 2023; 742:109619. [PMID: 37142076 DOI: 10.1016/j.abb.2023.109619] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/21/2023] [Accepted: 05/01/2023] [Indexed: 05/06/2023]
Abstract
Fructose-1,6-bisphosphatase (FBPase) deficiency is an autosomal recessive disorder characterized by impaired gluconeogenesis caused by mutations in the fructose-1,6-bisphosphatase 1 (FBP1) gene. The molecular mechanisms underlying FBPase deficiency caused by FBP1 mutations require investigation. Herein, we report the case of a Chinese boy with FBPase deficiency who presented with hypoglycemia, ketonuria, metabolic acidosis, and repeated episodes of generalized seizures that progressed to epileptic encephalopathy. Whole-exome sequencing revealed compound heterozygous variants, c.761A > G (H254R) and c.962C > T (S321F), in FBP1. The variants, especially the novel H254R, reduced protein stability and enzymatic activity in patient-derived leukocytes and transfected HepG2 and U251 cells. Mutant FBP1 undergoes enhanced ubiquitination and proteasomal degradation. NEDD4-2 was identified as an E3 ligase for FBP1 ubiquitination in transfected cells and the liver and brain of Nedd4-2 knockout mice. The H254R mutant FBP1 interacted with NEDD4-2 at significantly higher levels than the wild-type control. Our study identified a novel H254R variant of FBP1 underlying FBPase deficiency and elucidated the molecular mechanism underlying the enhanced NEDD4-2-mediated ubiquitination and proteasomal degradation of mutant FBP1.
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Affiliation(s)
- Xiaoyan Liang
- Department of Clinical Genetics, Shengjing Hospital of China Medical University, Shenyang, 110004, China; Department of Central Laboratory, Binzhou People's Hospital, Shandong, 256600, China
| | - Xiaoliang Liu
- Department of Clinical Genetics, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Wenjing Li
- Department of Cardiology, Binzhou People's Hospital, Shandong, 256600, China
| | - Lu Zhang
- Department of Clinical Genetics, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Bijun Zhang
- Department of Clinical Genetics, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Guangrui Lai
- Department of Clinical Genetics, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Yanyan Zhao
- Department of Clinical Genetics, Shengjing Hospital of China Medical University, Shenyang, 110004, China.
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Emecen Sanli M, Cengiz B, Kilic A, Ozsaydi E, Inci A, Okur I, Tumer L, Lebigot E, Ezgu F. Fructose 1,6 bisphosphatase deficiency: outcomes of patients in a single center in Turkey and identification of novel splice site and indel mutations in FBP1. J Pediatr Endocrinol Metab 2022; 35:497-503. [PMID: 35179010 DOI: 10.1515/jpem-2021-0732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/16/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Fructose 1,6 bisphosphatase (FBPase) deficiency is a rare autosomal recessively inherited metabolic disease. It is encoded by FBP1, and the enzyme catalyzes the hydrolysis of fructose-1,6-bisphosphate to fructose 6-phosphate. Patients with recurrent episodes of metabolic acidosis, hypoglycemia, hypertriglyceridemia, and hyperketonemia are present. METHODS In this study, we describe the clinical, biochemical, and molecular genetic features of six unrelated Turkish patients from six different families who were genetically diagnosed with FBPase deficiency in our clinic between 2008 and 2020. Their clinical and laboratory data were collected retrospectively. Next-generation sequencing (NGS) was performed for the molecular genetic analysis. RESULTS All patients were hospitalized with recurrent hypoglycemia and metabolic acidosis episodes. Three out of six patients were presented in the neonatal period. The mean age at diagnosis was 26 months. NGS revealed a known homozygous gross deletion including exon 2 in three patients (50%), a known homozygous c.910_911dupTT pathogenic variant in one patient (16%), a novel homozygous c.651_653delCAGinsTAA likely pathogenic variant, and another novel homozygous c.705+5G>A splice site variant. Leukocyte FBPase analysis detected no enzyme activity in the patient with homozygous c.705+5G>A splice site variant. CONCLUSIONS We identified two novel mutations in this study. One of them is a splice site mutation which is five bases downstream of the exon, and the other one is an indel mutation. Both of the splice site and indel mutations are exceedingly rare in FBP1, and to the best of our knowledge, there are second splice site and indel variants reported in the literature. Exon 2 deletion is the most common mutation consistent with the previous reports in Turkish patients. FBPase is a frequent cause of hypoglycemia and metabolic acidosis, and the widespread use of molecular genetic analysis would contribute to the enlightenment of advanced genetic factors and possible genotype/phenotype correlation.
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Affiliation(s)
- Merve Emecen Sanli
- Department of Inborn Errors of Metabolism, Gazi University School of Medicine, Ankara, Turkey
| | - Basak Cengiz
- Department of Inborn Errors of Metabolism, Gazi University School of Medicine, Ankara, Turkey
| | - Ayse Kilic
- Department of Inborn Errors of Metabolism, Gazi University School of Medicine, Ankara, Turkey
| | - Ekin Ozsaydi
- Department of Inborn Errors of Metabolism, Gazi University School of Medicine, Ankara, Turkey
| | - Asli Inci
- Department of Inborn Errors of Metabolism, Gazi University School of Medicine, Ankara, Turkey
| | - Ilyas Okur
- Department of Inborn Errors of Metabolism, Gazi University School of Medicine, Ankara, Turkey
| | - Leyla Tumer
- Department of Inborn Errors of Metabolism, Gazi University School of Medicine, Ankara, Turkey
| | - Elise Lebigot
- Bicêtre Hospital, AP-HP, Biochemistry Department, 94275 Le Kremlin-Bicêtre, France
| | - Fatih Ezgu
- Department of Inborn Errors of Metabolism, Gazi University School of Medicine, Ankara, Turkey
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Gorce M, Lebigot E, Arion A, Brassier A, Cano A, De Lonlay P, Feillet F, Gay C, Labarthe F, Nassogne MC, Roche S, Roubertie A, Sacaze E, Touati G, Broué P. Fructose-1,6-bisphosphatase deficiency causes fatty liver disease and requires long-term hepatic follow-up. J Inherit Metab Dis 2022; 45:215-222. [PMID: 34687058 DOI: 10.1002/jimd.12452] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 11/06/2022]
Abstract
Liver disease, occurring during pediatric or adult age, is often of undetermined cause. Some cases are probably related to undiagnosed inherited metabolic disorders. Hepatic disorders associated with fructose-1,6-bisphosphatase deficiency, a gluconeogenesis defect, are not reported in the literature. These symptoms are mainly described during acute crises, and many reports do not mention them because hypoglycemia and hyperlactatemia are more frequently in the forefront. Herein, the liver manifestations of 18 patients affected with fructose-1,6-bisphosphatase deficiency are described and the corresponding literature is reviewed. Interestingly, all 18 patients had liver abnormalities either during follow-up (hepatomegaly [n = 8/18], elevation of transaminases [n = 6/15], bright liver [n = 7/11]) or during acute crises (hepatomegaly [n = 10/17], elevation of transaminases [n = 13/16], acute liver failure [n = 6/14], bright liver [n = 4/14]). Initial reports described cases of liver steatosis, when liver biopsy was necessary to confirm the diagnosis by an enzymatic study. There is no clear pathophysiological basis for this fatty liver disease but we postulate that endoplasmic reticulum stress and de novo lipogenesis activation could be key factors, as observed in FBP1 knockout mice. Liver steatosis may expose patients to severe long-term liver complications. As hypoglycemia becomes less frequent with age, most adult patients are no longer monitored by hepatologist. Signs of fructose-1,6-bisphosphatase deficiency may be subtle and can be missed in childhood. We suggest that fructose-1,6-bisphosphatase deficiency should be considered as an etiology of hepatic steatosis, and a liver monitoring protocol should be set up for these patients, during lifelong follow-up.
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Affiliation(s)
- Magali Gorce
- Centre de référence des maladies héréditaires du métabolisme, Unité pédiatrique de Gastro-entérologie, hépatologie, nutrition et Maladies héréditaires du métabolisme, CHU de Toulouse-Hôpital des Enfants, Toulouse, France
| | - Elise Lebigot
- APHP, CHU Bicêtre, Service de biochimie, Le Kremlin-Bicêtre, Paris, France
| | - Alina Arion
- Centre de compétence des maladies héréditaires du métabolisme, Service de pédiatrie médicale, CHU de Caen - Hôpital de la Côte de Nacre, Caen, France
| | - Anaïs Brassier
- Centre de référence des maladies héréditaires du métabolisme, Institut Imagine, Hôpital Necker, Université Paris-Descartes, Paris, France
| | - Aline Cano
- Centre de référence des maladies héréditaires du métabolisme, Service de neurologie pédiatrique, Pédiatrie spécialisée et médecine infantile, CHU de Marseille-Hôpital de la Timone, Marseille, France
| | - Pascale De Lonlay
- Centre de référence des maladies héréditaires du métabolisme, Institut Imagine, Hôpital Necker, Université Paris-Descartes, Paris, France
| | - François Feillet
- Centre de référence des maladies héréditaires du métabolisme, Service de médecine infantile, CHU Brabois Enfants, Vandœuvre-lès-Nancy, France
| | - Claire Gay
- Centre de compétence des maladies héréditaires du métabolisme, Service de Pédiatrie, CHU de Saint-Etienne-Hôpital Nord, Saint Etienne, France
| | - François Labarthe
- Centre de référence des maladies héréditaires du métabolisme, Service de Médecine pédiatrique, Pediatrics Departement, CHRU de Tours-Hôpital Clocheville, Tours, France
| | - Marie-Cécile Nassogne
- Service de neurologie pédiatrique et Centre de référence des maladies métaboliques héréditaires-Cliniques Universitaires Saint-Luc, UCLouvain, Bruxelles, Belgium
| | - Sandrine Roche
- Centre de compétence des maladies héréditaires du métabolisme, Service de pédiatrie médicale, CHU Bordeaux, hôpital Pellegrin, Bordeaux, France
| | - Agathe Roubertie
- Centre de compétence des maladies héréditaires du métabolisme, Département de neuropédiatrie, Pôle Femme Mère Enfant, CHRU de Montpellier-Hôpital Gui de Chauliac, Montpellier, France
| | - Elise Sacaze
- Centre de compétence des maladies héréditaires du métabolisme, Service de Pédiatrie, Pôle Femme-Mère-Enfant, CHRU de Brest-Hôpital Morvan, Brest, France
| | - Guy Touati
- Centre de référence des maladies héréditaires du métabolisme, Unité pédiatrique de Gastro-entérologie, hépatologie, nutrition et Maladies héréditaires du métabolisme, CHU de Toulouse-Hôpital des Enfants, Toulouse, France
| | - Pierre Broué
- Centre de référence des maladies héréditaires du métabolisme, Unité pédiatrique de Gastro-entérologie, hépatologie, nutrition et Maladies héréditaires du métabolisme, CHU de Toulouse-Hôpital des Enfants, Toulouse, France
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Salih RM, Mohammed EA, Alhashem AM, Mohamed S, Al-Aqeel AI. Fructose-1,6-bisphosphatase deficiency with confirmed molecular diagnosis. An important cause of hypoglycemia in children. Saudi Med J 2021; 41:199-202. [PMID: 32020156 PMCID: PMC7841638 DOI: 10.15537/smj.2020.2.24885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To draw attention towards fructose-1,6-bisphosphatase (FBPase) deficiency as an important cause of hypoglycemia and lactic acidosis and to implement preventive strategies. Methods: This observational, cross-sectional study was conducted on 7 Saudi patients with genetically confirmed FBPase deficiency from 2008 to 2018 at Prince Sultan Military Medical City, Riyadh, Saudi Arabia. Results: Participants ranged in age from 1-10 years, and all presented with recurrent hypoglycemia. All but one had associated severe metabolic acidosis, and 3 patients (42.9%) presented with hypoglycemia and severe acidosis since birth. The mean duration from presentation to diagnosis was 39.4 months, as other diagnoses, like glycogen storage diseases and mitochondrial diseases needed to be ruled out. Development was normal apart from speech delay in one patient with a novel variant of the FBP1 gene. All patients have homozygous variants in the FBP1 gene. Conclusion: Fructose-1,6-bisphosphatase is an important cause of hypoglycemia and acidosis; therefore, it is important to offer early molecular diagnostics in any child presenting with these symptoms. Molecular diagnostics should always be undertaken to confirm the diagnosis and for further preventive strategies.
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Affiliation(s)
- Rihab M Salih
- Department of Pediatrics, Medical Genetics and Metabolic Division, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Yasir Zahoor M, Cheema HA, Ijaz S, Fayyaz Z. Genetic Analysis of Tyrosinemia Type 1 and Fructose-1, 6 Bisphosphatase Deficiency Affected in Pakistani Cohorts. Fetal Pediatr Pathol 2020; 39:430-440. [PMID: 31584309 DOI: 10.1080/15513815.2019.1672224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background: Inborn errors of metabolism are inherited disorders that present in early childhood and are usually caused by monogenic recessive mutations in specific enzymes that metabolize dietary components. Distinct mutations are present in specific populations.Objective: To determine which genomic variants are present in Pakistani cohorts with hepatorenal tyrosinemia type 1 (HT1) and fructose 1,6-bisphosphatase deficiency (FBPD).Materials and Methods: We sequenced the fumaryl acetoacetate hydrolase encoding gene (FAH) including flanking regions in four unrelated HT1 cohorts and the fructose 1,6-bisphosphatase gene (FBP1) in eight FBPD cohorts.Results: We mapped two recessive mutations in FAH gene for HT1; c.1062 + 5G > A(IVS12 + 5G > A) in three families and c.974C > T(pT325M) in one. We identified three mutations in FBP1 gene; c.841G > A(p.E281K) in five FBPD families, c.472C > T(p.R158W) in two families and c.778G > A(p.G260R) in one.Conclusion: Knowledge of common variants for HTI and FBDP in our study population can be used in the future to build a diagnostic algorithm.
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Affiliation(s)
- Muhammad Yasir Zahoor
- Molecular Biology and Forensic Laboratory, Institute of Biochemistry & Biotechnology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Huma Arshad Cheema
- Department of Pediatric Gastroenterology and Hepatology, Children's Hospital and Institute of Child Health, Lahore, Pakistan
| | - Sadaqat Ijaz
- Molecular Biology and Forensic Laboratory, Institute of Biochemistry & Biotechnology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Zafar Fayyaz
- Department of Pediatric Gastroenterology and Hepatology, Children's Hospital and Institute of Child Health, Lahore, Pakistan
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Sharma AG, Kanwal SK, Chhapola V, Kumar V. Novel fructose bisphosphatase 1 gene mutation presenting as recurrent episodes of vomiting in an Indian child. J Postgrad Med 2019; 64:180-182. [PMID: 29992913 PMCID: PMC6066631 DOI: 10.4103/jpgm.jpgm_216_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Fructose-1, 6-bisphosphatase 1 (FBP1) deficiency is an autosomal recessive disorder of gluconeogenesis resulting in severe and recurrent life-threatening episodes of hypoglycemia and lactic acidosis in infancy. We report a 16 month-old girl who presented with recurrent episodes of vomiting, rapid breathing, lactic acidosis, hyperuricemia, and hypertriglyceridemia. Genetic analysis revealed a novel compound heterozygous mutation in FBP1 gene confirming the diagnosis of FBP1 deficiency. The patient was managed with treatment of acute episodes and preventive long-term dietary modifications. Long-term prognosis of FBP1 deficiency is excellent underlining the importance of early recognition of clinical signs, prompt diagnosis, and avoidance of fasting in this disease. FBP1 gene mutations have been described from various ethnic backgrounds, but there is limited data available from Indian population, hence the importance of this case.
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Affiliation(s)
- A G Sharma
- Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children Hospital, New Delhi, India
| | - S K Kanwal
- Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children Hospital, New Delhi, India
| | - V Chhapola
- Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children Hospital, New Delhi, India
| | - V Kumar
- Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children Hospital, New Delhi, India
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Kılıç M, Kasapkara ÇS, Yılmaz DY, Özgül RK. Exon 2 deletion represents a common mutation in Turkish patients with fructose-1,6-bisphosphatase deficiency. Metab Brain Dis 2019; 34:1487-1491. [PMID: 31278438 DOI: 10.1007/s11011-019-00455-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/27/2019] [Indexed: 10/26/2022]
Abstract
Fructose-1,6-bisphosphatase (FBPase) deficiency is an autosomal recessive inborn error of gluconeogenesis. We aimed to investigate clinical and biochemical findings and molecular genetic data in ten Turkish patients with fructose-1,6-bisphosphatase deficiency. Ten Turkish patients who were diagnosed with fructose-1,6-biphosphatase deficiency in a single center from 2013 to 2019 were included in this study. Their clinical and laboratory data were collected retrospectively. All patients were hospitalised in intensive care unit mostly after catabolic stress conditions such as infections, starvation and rarely fructose consumption. Prognosis was good after correct diagnosis and treatment. Molecular analyses of FBP1 gene revealed a homozygous exon 2 deletion in eight patients, a novel homozygous c.910_911dupTT mutation in one patient and a homozygous IVS5 + 1G > A splicing mutation in one patient. Exon 2 deletion (previously termed exon 1) was found to be the most common mutation in Turkish fructose-1,6-biphosphatase deficiency patients.
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Affiliation(s)
- Mustafa Kılıç
- Metabolism Unit, Sami Ulus Children Hospital, Babur cad. No: 44, 06080 Altındağ, Ankara, Turkey.
| | - Çiğdem Seher Kasapkara
- Metabolism Unit, Sami Ulus Children Hospital, Babur cad. No: 44, 06080 Altındağ, Ankara, Turkey
| | - Didem Yücel Yılmaz
- Institute of Child Health, Metabolism Unit, Hacettepe University, Ankara, Turkey
| | - Rıza Köksal Özgül
- Institute of Child Health, Metabolism Unit, Hacettepe University, Ankara, Turkey
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Moey LH, Abdul Azize NA, Yakob Y, Leong HY, Keng WT, Chen BC, Ngu LH. Fructose-1,6-bisphosphatase deficiency as a cause of recurrent hypoglycemia and metabolic acidosis: Clinical and molecular findings in Malaysian patients. Pediatr Neonatol 2018; 59:397-403. [PMID: 29203193 DOI: 10.1016/j.pedneo.2017.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 05/12/2017] [Accepted: 11/10/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Fructose-1,6-bisphosphatase (FBPase) deficiency is a rare autosomal recessive inborn error of gluconeogenesis. We reported the clinical findings and molecular genetic data in seven Malaysian patients with FBPase deficiency. METHODS All patients diagnosed with FBPase deficiency from 2010 to 2015 were included in this study. Their clinical and laboratory data were collected retrospectively. RESULTS All the patients presented with recurrent episodes of hypoglycemia, metabolic acidosis, hyperlactacidemia and hepatomegaly. All of them had the first metabolic decompensation prior to 2 years old. The common triggering factors were vomiting and infection. Biallelic mutations in FBP1 gene (MIM*611570) were identified in all seven patients confirming the diagnosis of FBPase deficiency. In four patients, genetic study was prompted by detection of glycerol or glycerol-3-phosphate in urine organic acids analysis. One patient also had pseudo-hypertriglyceridemia. Seven different mutations were identified in FBP1, among them four mutations were new: three point deletions (c.392delT, c.603delG and c.704delC) and one splice site mutation (c.568-2A > C). All four new mutations were predicted to be damaging by in silico analysis. One patient presented in the neonatal period and succumbed due to sepsis and multi-organ failure. Among six survivors (current age ranged from 4 to 27 years), four have normal growth and cognitive development. One patient had short stature and another had neurological deficit following status epilepticus due to profound hypoglycemia. CONCLUSION FBPase deficiency needs to be considered in any children with recurrent hypoglycemia and metabolic acidosis. Our study expands the spectrum of FBP1 gene mutations.
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Affiliation(s)
- Lip Hen Moey
- Department of Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Nor Azimah Abdul Azize
- Molecular Diagnostics and Protein Unit, Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Yusnita Yakob
- Molecular Diagnostics and Protein Unit, Institute for Medical Research, Kuala Lumpur, Malaysia
| | - Huey Yin Leong
- Department of Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Wee Teik Keng
- Department of Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Bee Chin Chen
- Department of Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Lock Hock Ngu
- Department of Genetics, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
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Bhai P, Bijarnia-Mahay S, Puri RD, Saxena R, Gupta D, Kotecha U, Sachdev A, Gupta D, Vyas V, Agarwal D, Jain V, Bansal RK, Kumar TG, Verma IC. Clinical and molecular characterization of Indian patients with fructose-1, 6-bisphosphatase deficiency: Identification of a frequent variant (E281K). Ann Hum Genet 2018; 82:309-317. [PMID: 29774539 DOI: 10.1111/ahg.12256] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 03/03/2018] [Accepted: 04/12/2018] [Indexed: 12/01/2022]
Abstract
Fructose-1, 6-bisphosphatase deficiency is an autosomal recessive disorder of gluconeogenesis caused by genetic defect in the FBP1 gene. It is characterized by episodic, often life-threatening metabolic acidosis, liver dysfunction, and hyperlactatemia. Without a high index of suspicion, it may remain undiagnosed with devastating consequences. Accurate diagnosis can be achieved either by enzyme assay or gene studies. Enzyme assay requires a liver biopsy and is tedious, invasive, expensive, and not easily available. Therefore, genetic testing is the most appropriate method to confirm the diagnosis. Molecular studies were performed on 18 suspected cases presenting with episodic symptoms. Seven different pathogenic variants were identified. Two common variants were noted in two subpopulations from the Indian subcontinent; p.Glu281Lys (E281K) occurred most frequently (in 10 patients) followed by p.Arg158Trp (R158W, in 4 patients). Molecular analysis confirmed the diagnosis and helped in managing these patients by providing appropriate genetic counseling. In conclusion, genetic studies identified two common variants in the Indian subcontinent, thus simplifying the diagnostic algorithm in this treatable disorder.
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Affiliation(s)
- Pratibha Bhai
- Institute of Medical Genetics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Sunita Bijarnia-Mahay
- Institute of Medical Genetics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Ratna D Puri
- Institute of Medical Genetics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Renu Saxena
- Institute of Medical Genetics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Deepti Gupta
- Institute of Medical Genetics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Udhaya Kotecha
- Institute of Medical Genetics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Anil Sachdev
- Institute of Medical Genetics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Dhiren Gupta
- Institute of Medical Genetics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Vyomesh Vyas
- Institute of Medical Genetics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Divya Agarwal
- Institute of Medical Genetics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Vivek Jain
- Institute of Medical Genetics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Rajeev K Bansal
- Institute of Medical Genetics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Tapisha G Kumar
- Institute of Medical Genetics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
| | - Ishwar Chander Verma
- Institute of Medical Genetics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
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International practices in the dietary management of fructose 1-6 biphosphatase deficiency. Orphanet J Rare Dis 2018; 13:21. [PMID: 29370874 PMCID: PMC5785792 DOI: 10.1186/s13023-018-0760-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In fructose 1,6 bisphosphatase (FBPase) deficiency, management aims to prevent hypoglycaemia and lactic acidosis by avoiding prolonged fasting, particularly during febrile illness. Although the need for an emergency regimen to avoid metabolic decompensation is well established at times of illness, there is uncertainty about the need for other dietary management strategies such as sucrose or fructose restriction. We assessed international differences in the dietary management of FBPase deficiency. METHODS A cross-sectional questionnaire (13 questions) was emailed to all members of the Society for the Study of Inborn Errors of Metabolism (SSIEM) and a wide database of inherited metabolic disorder dietitians. RESULTS Thirty-six centres reported the dietary prescriptions of 126 patients with FBPase deficiency. Patients' age at questionnaire completion was: 1-10y, 46% (n = 58), 11-16y, 21% (n = 27), and >16y, 33% (n = 41). Diagnostic age was: <1y, 36% (n = 46); 1-10y, 59% (n = 74); 11-16y, 3% (n = 4); and >16y, 2% (n = 2). Seventy-five per cent of centres advocated dietary restrictions. This included restriction of: high sucrose foods only (n = 7 centres, 19%); fruit and sugary foods (n = 4, 11%); fruit, vegetables and sugary foods (n = 13, 36%). Twenty-five per cent of centres (n = 9), advised no dietary restrictions when patients were well. A higher percentage of patients aged >16y rather than ≤16y were prescribed dietary restrictions: patients aged 1-10y, 67% (n = 39/58), 11-16y, 63% (n = 17/27) and >16y, 85% (n = 35/41). Patients classified as having a normal fasting tolerance increased with age from 30% in 1-10y, to 36% in 11-16y, and 58% in >16y, but it was unclear if fasting tolerance was biochemically proven. Twenty centres (56%) routinely prescribed uncooked cornstarch (UCCS) to limit overnight fasting in 47 patients regardless of their actual fasting tolerance (37%). All centres advocated an emergency regimen mainly based on glucose polymer for illness management. CONCLUSIONS Although all patients were prescribed an emergency regimen for illness, use of sucrose and fructose restricted diets with UCCS supplementation varied widely. Restrictions did not relax with age. International guidelines are necessary to help direct future dietary management of FBPase deficiency.
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Ijaz S, Zahoor MY, Imran M, Ramzan K, Bhinder MA, Shakeel H, Iqbal M, Aslam A, Shehzad W, Cheema HA, Rehman H. Genetic analysis of fructose-1,6-bisphosphatase (FBPase) deficiency in nine consanguineous Pakistani families. J Pediatr Endocrinol Metab 2017; 30:1203-1210. [PMID: 29016355 DOI: 10.1515/jpem-2017-0188] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/14/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Fructose-1,6-bisphosphatase (FBPase) deficiency is a rare inherited metabolic disorder characterized by recurrent episodes of hypoglycemia, ketosis and lactic acidosis. FBPase is encoded by FBP1 gene and catalyzes the hydrolysis of fructose-1,6-bisphosphate to fructose-6-phosphate in the last step of gluconeogenesis. We report here FBP1 mutations in nine consanguineous Pakistani families affected with FBPase deficiency. METHODS Nine families having one or two individuals affected with FBPase deficiency were enrolled over a period of 3 years. All FBP1 exonic regions including splicing sites were PCR-amplified and sequenced bidirectionally. Familial cosegregation of mutations with disease was confirmed by direct sequencing and PCR-RFLP analysis. RESULTS Three different FBP1 mutations were identified. Each of two previously reported mutations (c.472C>T (p.Arg158Trp) and c.841G>A (p.Glu281Lys)) was carried by four different families. The ninth family carried a novel 4-bp deletion (c.609_612delAAAA), which is predicted to result in frameshift (p.Lys204Argfs*72) and loss of FBPase function. The novel variant was not detected in any of 120 chromosomes from normal ethnically matched individuals. CONCLUSIONS FBPase deficiency is often fatal in the infancy and early childhood. Early diagnosis and prompt treatment is therefore crucial to preventing early mortality. We recommend the use of c.472C>T and c.841G>A mutations as first choice genetic markers for molecular diagnosis of FBPase deficiency in Pakistan.
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Ramakrishna SH, Patil SJ, Jagadish AA, Sapare AK, Sagar H, Kannan S. Fructose-1,6-bisphosphatase deficiency caused by a novel homozygous Alu element insertion in the FBP1 gene and delayed diagnosis. J Pediatr Endocrinol Metab 2017; 30:703-706. [PMID: 28599390 DOI: 10.1515/jpem-2017-0078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 04/03/2017] [Indexed: 11/15/2022]
Abstract
Fructose-1,6-bisphosphatase (FBPase) enzyme deficiency is one of the treatable autosomal recessive inherited metabolic disorders. If diagnosed early, FBPase deficiency has a favorable prognosis. We report the clinical and biochemical findings of a 9.5-year-old female child with FBPase deficiency. FBPase deficiency is caused by a homozygous Arthrobacter luteus (Alu) insertion in the FBP1 gene, reported for the first time.
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Affiliation(s)
| | - Siddaramappa Jagdish Patil
- Medical Genetics, Mazumdar-Shaw Medical Center, Narayana Health City, No 258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore560099, Karnataka,India
| | | | - Anil Kumar Sapare
- Department of Pediatrics, Narayana Health City, Bangalore, Karnataka,India
| | - Hiremath Sagar
- Pediatrics Pulmonology and Intensivist, Narayana Health City, Bangalore, Karnataka,India
| | - Subramanian Kannan
- Department of Endocrinology, Narayana Health City, Bangalore, Karnataka,India
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Clinical and Molecular Characterization of Patients with Fructose 1,6-Bisphosphatase Deficiency. Int J Mol Sci 2017; 18:ijms18040857. [PMID: 28420223 PMCID: PMC5412439 DOI: 10.3390/ijms18040857] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/11/2017] [Accepted: 04/17/2017] [Indexed: 11/17/2022] Open
Abstract
Fructose-1,6-bisphosphatase (FBPase) deficiency is a rare, autosomal recessive inherited disease caused by the mutation of the FBP1 gene, the incidence is estimated to be between 1/350,000 and 1/900,000. The symptoms of affected individuals are non-specific and are easily confused with other metabolic disorders. The present study describes the clinical features of four Chinese pediatric patients who presented with hypoglycemia, hyperlactacidemia, metabolic acidosis, and hyperuricemia. Targeted-next generation sequencing using the Agilent SureSelect XT Inherited Disease Panel was used to screen for causal variants in the genome, and the clinically-relevant variants were subsequently verified using Sanger sequencing. Here, DNA sequencing identified six variations of the FBP1 gene (NM_000507.3) in the four patients. In Case 1, we found a compound heterozygous mutations of c.704delC (p.Pro235GlnfsX42) (novel) and c.960_961insG (p.Ser321Valfs) (known pathogenic). In Case 2, we found a compound heterozygous mutations of c.825 + 1G>A and c.960_961insG (both were known pathogenically). In Case 3, a homozygous missense mutation of c.355G>A (p.Asp119Asn) (reported in ClinVar database without functional study) was found. Case 4 had a compound heterozygous mutations c.720_729del (p.Tyr241GlyfsX33) (novel) and c.490G>A (p.Gly164Ser) (known pathogenically). Further in vitro studies in the COS-7cell line demonstrated that the mutation of ASP119ASN had no impact on protein expression, but decreased the enzyme activity, and with which the clinical significance of Asp119Asn can be determined to be likely pathogenic. This report not only expands upon the known spectrum of variation of the FBP1 gene, but also deepens our understanding of the clinical features of FBPase deficiency.
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Chen R, Li J, Zhou X, Liu J, Huang G. Fructose-1,6-Bisphosphatase 1 Reduces 18F FDG Uptake in Hepatocellular Carcinoma. Radiology 2017; 284:844-853. [PMID: 28387640 DOI: 10.1148/radiol.2017161607] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose To determine whether fructose 1,6-bisphosphatase 1 (FBP1) expression is associated with fluorine 18 (18F) fluorodeoxyglucose (FDG) accumulation in patients with hepatocellular carcinoma (HCC) and to investigate how FBP1 expression and 18F FDG uptake are related to tumor differentiation grade and metabolism and whether the molecular mechanism involves hypoxia-inducible factor 1-α (HIF1A) transcriptional activity. Materials and Methods This retrospective study was approved by the institutional review board with informed consent. Eighty-five patients with HCC underwent 18F FDG combined positron emission tomography and computed tomography (PET/CT). The relationship between maximum standardized uptake (SUVmax) and expression of FBP1, glucose transporter 1 (GLUT1), and hexokinase 2 (HK2) was analyzed with immunohistochemical analysis. In vitro FBP1 overexpression in HCC cells was used to examine the role of FBP1 in tumor metabolism, and its effect on HIF1A transcriptional activity was investigated with quantitative polymerase chain reaction and luciferase reporter assay. Spearman rank correlation was applied to determine the association between FBP1 expression and SUVmax. Results There was an inverse relationship between FBP1 expression and SUVmax (P = .003). SUVmax was higher in patients with poorly differentiated HCC (mean, 6.7 ± 3.6 [standard deviation]) than in those with well- (mean, 2.6 ± 0.7, P < .001) or moderately (mean, 4.1 ± 2.3, P < .001) differentiated HCC. FBP1 expression was significantly lower in patients with poorly differentiated HCC (mean, 0.6 ± 0.2) than in those with well- (mean, 1.4 ± 0.6, P = .006) or moderately (mean, 1.2 ± 0.2, P = .007) differentiated HCC. FBP1 overexpression in HCC cells led to a significant decrease in GLUT1 expression (P = .034), 18F FDG uptake (P = .023), and HIF1A transcriptional activity (P = .001). Conclusion SUVmax in patients with HCC is inversely associated with FBP1 expression, and FBP1 may inhibit 18F FDG uptake via the HIF1A pathway. SUVmax is higher in patients with poorly differentiated HCC than in those with well- or moderately differentiated HCC, which could be the result of lower FBP1 expression in the former. © RSNA, 2017.
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Affiliation(s)
- Ruohua Chen
- From the Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Rd, Shanghai 200127, China (R.C., J. Li, X.Z., J. Liu, G.H.); Department of Cancer Metabolism, Institute of Health Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai, China (G.H.); and Department of Cancer Metabolism, Shanghai University of Medicine and Health Sciences, Shanghai, China (G.H.)
| | - Jiajin Li
- From the Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Rd, Shanghai 200127, China (R.C., J. Li, X.Z., J. Liu, G.H.); Department of Cancer Metabolism, Institute of Health Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai, China (G.H.); and Department of Cancer Metabolism, Shanghai University of Medicine and Health Sciences, Shanghai, China (G.H.)
| | - Xiang Zhou
- From the Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Rd, Shanghai 200127, China (R.C., J. Li, X.Z., J. Liu, G.H.); Department of Cancer Metabolism, Institute of Health Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai, China (G.H.); and Department of Cancer Metabolism, Shanghai University of Medicine and Health Sciences, Shanghai, China (G.H.)
| | - Jianjun Liu
- From the Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Rd, Shanghai 200127, China (R.C., J. Li, X.Z., J. Liu, G.H.); Department of Cancer Metabolism, Institute of Health Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai, China (G.H.); and Department of Cancer Metabolism, Shanghai University of Medicine and Health Sciences, Shanghai, China (G.H.)
| | - Gang Huang
- From the Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 1630 Dongfang Rd, Shanghai 200127, China (R.C., J. Li, X.Z., J. Liu, G.H.); Department of Cancer Metabolism, Institute of Health Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School of Medicine, Shanghai, China (G.H.); and Department of Cancer Metabolism, Shanghai University of Medicine and Health Sciences, Shanghai, China (G.H.)
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Santer R, du Moulin M, Shahinyan T, Vater I, Maier E, Muntau AC, Steinmann B. A summary of molecular genetic findings in fructose-1,6-bisphosphatase deficiency with a focus on a common long-range deletion and the role of MLPA analysis. Orphanet J Rare Dis 2016; 11:44. [PMID: 27101822 PMCID: PMC4839065 DOI: 10.1186/s13023-016-0415-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/16/2016] [Indexed: 11/18/2022] Open
Abstract
Background Fructose-1,6-bisphosphatase deficiency is a rare inborn error of metabolism affecting gluconeogenesis with only sporadic reports on its molecular genetic basis. Results We report our experience with mutation analysis in 14 patients (13 families) with fructose-1,6-bisphosphatase deficiency using conventional Sanger sequencing and multiplex ligation-dependent probe amplification analysis, and we provide a mutation update for the fructose bisphosphatase-1 gene (FBP1). Mutations were found on both chromosomes in all of our 14 patients including 5 novel mutations. Among the novel mutations is a 5412-bp deletion (c.-24-26_170 + 5192del) including the entire coding sequence of exon 2 of FBP1 that was repeatedly found in patients from Turkey and Armenia which may explain earlier poorly defined findings in patients from this area. This deletion can be detected with specific primers by generation of a junction fragment and by MLPA and SNP array assays. MLPA analysis was able to detect copy number variations in two further patients, one heterozygous for a deletion within exon 8, another heterozygous for a novel deletion of the entire FBP1 gene. Conclusions Based on our update for the FBP1 gene, currently listing 35 mutations worldwide, and knowledge of PCR conditions that allow simple detection of a common FBP1 deletion in the Armenian and Turkish population, molecular genetic diagnosis has become easier in FBP1 deficiency. Furthermore, MLPA analysis may plays a useful role in patients with this disorder. Electronic supplementary material The online version of this article (doi:10.1186/s13023-016-0415-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- René Santer
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D - 20246, Hamburg, Germany.
| | - Marcel du Moulin
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D - 20246, Hamburg, Germany
| | | | - Inga Vater
- Institute of Human Genetics, University of Kiel, Kiel, Germany
| | - Esther Maier
- Department of Pediatrics, University Children's Hospital, Munich, Germany
| | - Ania C Muntau
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D - 20246, Hamburg, Germany
| | - Beat Steinmann
- Department of Pediatrics, University of Zurich, Zurich, Switzerland
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Chaturvedi S, Singh AK, Keshari AK, Maity S, Sarkar S, Saha S. Human Metabolic Enzymes Deficiency: A Genetic Mutation Based Approach. SCIENTIFICA 2016; 2016:9828672. [PMID: 27051561 PMCID: PMC4804091 DOI: 10.1155/2016/9828672] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 01/21/2016] [Accepted: 01/31/2016] [Indexed: 05/30/2023]
Abstract
One of the extreme challenges in biology is to ameliorate the understanding of the mechanisms which emphasize metabolic enzyme deficiency (MED) and how these pretend to have influence on human health. However, it has been manifested that MED could be either inherited as inborn error of metabolism (IEM) or acquired, which carries a high risk of interrupted biochemical reactions. Enzyme deficiency results in accumulation of toxic compounds that may disrupt normal organ functions and cause failure in producing crucial biological compounds and other intermediates. The MED related disorders cover widespread clinical presentations and can involve almost any organ system. To sum up the causal factors of almost all the MED-associated disorders, we decided to embark on a less traveled but nonetheless relevant direction, by focusing our attention on associated gene family products, regulation of their expression, genetic mutation, and mutation types. In addition, the review also outlines the clinical presentations as well as diagnostic and therapeutic approaches.
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Affiliation(s)
- Swati Chaturvedi
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Raebareli Road, Vidyavihar, Lucknow 226025, India
| | - Ashok K. Singh
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Raebareli Road, Vidyavihar, Lucknow 226025, India
| | - Amit K. Keshari
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Raebareli Road, Vidyavihar, Lucknow 226025, India
| | - Siddhartha Maity
- Department of Pharmaceutical Technology, Jadavpur University, Kolkata 700032, India
| | - Srimanta Sarkar
- Dr. Reddy's Laboratories Limited, Bachupally, Hyderabad, Telangana 502325, India
| | - Sudipta Saha
- Department of Pharmaceutical Sciences, Babasaheb Bhimrao Ambedkar University, Raebareli Road, Vidyavihar, Lucknow 226025, India
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Eren E, Edgunlu T, Abuhandan M, Yetkin I. Novel fructose-1,6-bisphosphatase gene mutation in two siblings. DNA Cell Biol 2013; 32:635-9. [PMID: 24007283 DOI: 10.1089/dna.2013.2119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Fructose-1,6-bisphosphatase (FBPase) deficiency is an autosomal, recessively inherited disease that progresses with severe hypoglycemia, and metabolic attacks result in a defect in gluconeogenesis. If not appropriately treated, and if fructose is not excluded from the diet, the outcome could be fatal. Two Turkish children with FBPase deficiency were diagnosed based on mutation of the FBP1 gene. The first, a 2-year-old girl, was referred to our clinic because of lactic acidosis, uncorrectable hypoglycemia, and increased transaminases. FBPase deficiency was suspected in the patient, who recovered dramatically after a high-dose glucose infusion and adequate bicarbonate replacement. The second patient, a five-and-a-half-year-old male sibling of the patient, was also hospitalized, twice, because of hypoglycemic attacks and metabolic acidosis. Different from previous analyses, a homozygous c.658delT mutation was detected at exon 5 of the FBP1 gene in the two siblings. As a result of this mutation, there was a TGA (stop codon) at exon 6. There was first-degree consanguinity between the parents. These two cases were the first FBP1 gene mutations reported in our country.
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Affiliation(s)
- Erdal Eren
- 1 Department of Pediatrics, Harran University , School of Medicine, Sanliurfa, Turkey
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Afroze B, Yunus Z, Steinmann B, Santer R. Transient pseudo-hypertriglyceridemia: a useful biochemical marker of fructose-1,6-bisphosphatase deficiency. Eur J Pediatr 2013; 172:1249-53. [PMID: 23881342 DOI: 10.1007/s00431-013-2084-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 06/20/2013] [Indexed: 11/28/2022]
Abstract
UNLABELLED Fructose-1,6-bisphosphatase (FBP) deficiency is an autosomal-recessive disorder of gluconeogenesis resulting from mutations within the FBP1 gene. During periods of trivial illness, individuals with FBP deficiency may develop ketotic hypoglycemia, metabolic acidosis, lactic acidemia, and an increased anion gap. Although detection of urinary excretion of glycerol by urine organic acid analysis has been previously described, the presence of transient pseudo-hypertriglyceridemia in serum during metabolic decompensation has not been reported before. This study describes four consanguineous Pakistani families, in which four patients were diagnosed with FBP deficiency. All showed transient pseudo-hypertriglyceridemia during the acute phase of metabolic decompensation, which resolved in a metabolically stable phase. Mutations in the FBP1 gene have been described from various ethnicities, but there is very limited literature available for the Pakistani population. This study also describes one novel mutation in the FBP1 gene which seems to be prevalent in Pakistani-Indian patients. CONCLUSION As a result of this study, transient pseudo-hypertriglyceridemia should be added to glyceroluria, ketotic hypoglycemia, metabolic acidosis, and lactic acidosis as a useful biochemical marker of FBP deficiency.
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Affiliation(s)
- Bushra Afroze
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Stadium Road, P.O. Box 3500, Karachi 74800, Pakistan.
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Al-Owain M, Al-Zaidan H, Al-Hassnan Z. Map of autosomal recessive genetic disorders in Saudi Arabia: Concepts and future directions. Am J Med Genet A 2012; 158A:2629-40. [DOI: 10.1002/ajmg.a.35551] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 06/06/2012] [Indexed: 12/23/2022]
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Visinoni S, Khalid NFI, Joannides CN, Shulkes A, Yim M, Whitehead J, Tiganis T, Lamont BJ, Favaloro JM, Proietto J, Andrikopoulos S, Fam BC. The role of liver fructose-1,6-bisphosphatase in regulating appetite and adiposity. Diabetes 2012; 61:1122-32. [PMID: 22517657 PMCID: PMC3331739 DOI: 10.2337/db11-1511] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Liver fructose-1,6-bisphosphatase (FBPase) is a regulatory enzyme in gluconeogenesis that is elevated by obesity and dietary fat intake. Whether FBPase functions only to regulate glucose or has other metabolic consequences is not clear; therefore, the aim of this study was to determine the importance of liver FBPase in body weight regulation. To this end we performed comprehensive physiologic and biochemical assessments of energy balance in liver-specific transgenic FBPase mice and negative control littermates of both sexes. In addition, hepatic branch vagotomies and pharmacologic inhibition studies were performed to confirm the role of FBPase. Compared with negative littermates, liver-specific FBPase transgenic mice had 50% less adiposity and ate 15% less food but did not have altered energy expenditure. The reduced food consumption was associated with increased circulating leptin and cholecystokinin, elevated fatty acid oxidation, and 3-β-hydroxybutyrate ketone levels, and reduced appetite-stimulating neuropeptides, neuropeptide Y and Agouti-related peptide. Hepatic branch vagotomy and direct pharmacologic inhibition of FBPase in transgenic mice both returned food intake and body weight to the negative littermates. This is the first study to identify liver FBPase as a previously unknown regulator of appetite and adiposity and describes a novel process by which the liver participates in body weight regulation.
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Affiliation(s)
- Sherley Visinoni
- Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia
| | | | | | - Arthur Shulkes
- Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Mildred Yim
- Department of Surgery, Austin Health, University of Melbourne, Heidelberg, Victoria, Australia
| | - Jon Whitehead
- Mater Medical Research Institute, Brisbane, Queensland, Australia
| | - Tony Tiganis
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia
| | - Benjamin J. Lamont
- Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia
| | - Jenny M. Favaloro
- Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia
| | - Joseph Proietto
- Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia
| | | | - Barbara C. Fam
- Department of Medicine, University of Melbourne, Heidelberg, Victoria, Australia
- Corresponding author: Barbara C. Fam,
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Åsberg C, Hjalmarson O, Alm J, Martinsson T, Waldenström J, Hellerud C. Fructose 1,6-bisphosphatase deficiency: enzyme and mutation analysis performed on calcitriol-stimulated monocytes with a note on long-term prognosis. J Inherit Metab Dis 2010; 33 Suppl 3:S113-21. [PMID: 20151204 DOI: 10.1007/s10545-009-9034-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2009] [Revised: 10/24/2009] [Accepted: 12/11/2009] [Indexed: 10/19/2022]
Abstract
Fructose 1,6-bisphosphatase (FBPase) deficiency is an inborn error of metabolism in the gluconeogenetic pathway. During periods of low food intake or infections, a defect in FBPase can result in hypoglycemia, ketonuria and metabolic acidosis. We established a diagnostic system for FBPase deficiency consisting of enzyme activity measurement and mutation detection in calcitriol-stimulated monocytes. In healthy individuals, we showed that FBPase activity is present in monocytes but not in other leukocytes. We describe the clinical course of four individuals from two Swedish families with FBPase deficiency. Family 1: patient 1 died at the age of 6 months after a severe episode with hypoglycemia and acidosis; patients 2 and 3 were followed for >30 years and were found to have a very favorable long-term prognosis. Their FBPase activity from jejunum (residual activity 15-25% of healthy controls), mixed leukocytes (low or normal levels), and calcitriol-stimulated monocytes (no detectable activity) was compared. Mutation analysis showed they were heterozygous for two genetic alterations (c.778G>A; c.881G>A), predicting amino acid exchanges at position p.G260R and p.G294E, originating from their parents. Family 2: patient 4 had no detectable levels of FBPase in stimulated monocytes. A mutation (c.648C>G) predicting a premature stop codon at position p.Y216X was found in one allele and a large deletion of about 300 kb, where the genes FBP2, FBP1 and a part of ONPEP are located, in the other. In conclusion, we present a reliable diagnostic system to verify an FBPase deficiency and find the genetic aberration.
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Affiliation(s)
- Cristine Åsberg
- Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
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