1
|
Prasad A, Kumar P, Marithammanahalli Faneesha G, Kumar C. Non-ketotic hyperglycinaemia masquerading as a hypotonic-hyporesponsive episode following vaccination in an infant. BMJ Case Rep 2024; 17:e257093. [PMID: 38782422 DOI: 10.1136/bcr-2023-257093] [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: 05/25/2024] Open
Abstract
Non-ketotic hyperglycinaemia (NKH) is an inborn error of glycine metabolism with autosomal recessive inheritance. A female infant presented to our emergency department with intractable seizures, lethargy and hypotonia, 2 weeks after her routine vaccination. Detailed infective and metabolic workup revealed normal blood sugar, ketone, lactate ammonia, and a high level of glycine in serum and cerebrospinal fluid suggesting NKH. Diagnosis of NKH was further confirmed on genetic analysis for AMT gene mutation. The child showed clinical improvement with oral sodium benzoate. Here, we report the inheritance, pathophysiology, diagnostic approach, genetic confirmation, management and prognosis of a child with NKH.
Collapse
Affiliation(s)
- Arun Prasad
- Department of Pediatrics, All India Institute of Medical Sciences Patna, Patna, Bihar, India
| | - Pradeep Kumar
- Department of Pediatrics, All India Institute of Medical Sciences Patna, Patna, Bihar, India
| | | | - Chandramohan Kumar
- Department of Pediatrics, All India Institute of Medical Sciences Patna, Patna, Bihar, India
| |
Collapse
|
2
|
Huynh MT, Landais E, Agathe JMDS, Panchout A, Caroline DVDBL, Bruel H. Novel homozygous GLDC variant causing late-onset glycine encephalopathy: A case report and updated review of the literature. Mol Genet Metab Rep 2023; 34:100959. [PMID: 36817643 PMCID: PMC9932748 DOI: 10.1016/j.ymgmr.2023.100959] [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: 12/30/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023] Open
Abstract
Glycine encephalopathy (MIM #605899) is an autosomal recessive inborn error of metabolism caused by pathogenic variants in three genes GLDC, AMT, GCSH encoding glycine cleavage enzyme system. We report an 8-year-old boy with late-onset glycine encephalopathy who harbors a novel homozygous GLDC likely pathogenic variant c.707G > A p.(Arg236Gln). Polyhydramnios was noted at fetal ultrasound. He displayed global developmental delay, craniofacial dysmorphism, convulsions. Our report expands the phenotypic and genetic spectrum of late-onset nonketotic hyperglycinemia.
Collapse
Affiliation(s)
- Minh-Tuan Huynh
- Medical Genetics Department, Vinmec Times City International Hospital-Times City, HaNoi, Viet Nam
- Centre Hospitalier du Havre, Unité de Génétique Clinique, 29 Avenue Pierre Mendès-France, 76290 Montivilliers, France
- Corresponding author at: Medical Genetics Department, Vinmec Times City International Hospital-Times City, 458 Minh Khai, Hai Ba Trung District, VietNam.
| | - Emilie Landais
- Laboratoire de Génétique, CHRU de Reims, 45 rue Cognacq-Jay, 51092 Reims, France
| | | | - Anne Panchout
- Centre Hospitalier du Havre, Service de Gynécologie, 29 Avenue Pierre Mendès-France, 76290 Montivilliers, France
| | | | - Henri Bruel
- Centre Hospitalier du Havre, Service de Néonatologie, 29 Avenue Pierre Mendès-France, 76290 Montivilliers, France
| |
Collapse
|
3
|
Weaver NE, Healy A, Wingert RA. gldc Is Essential for Renal Progenitor Patterning during Kidney Development. Biomedicines 2022; 10:biomedicines10123220. [PMID: 36551976 PMCID: PMC9776136 DOI: 10.3390/biomedicines10123220] [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: 11/05/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
The glycine cleavage system (GCS) is a complex located on the mitochondrial membrane that is responsible for regulating glycine levels and contributing one-carbon units to folate metabolism. Congenital mutations in GCS components, such as glycine decarboxylase (gldc), cause an elevation in glycine levels and the rare disease, nonketotic hyperglycinemia (NKH). NKH patients suffer from pleiotropic symptoms including seizures, lethargy, mental retardation, and early death. Therefore, it is imperative to fully elucidate the pathological effects of gldc dysfunction and glycine accumulation during development. Here, we describe a zebrafish model of gldc deficiency that recapitulates phenotypes seen in humans and mice. gldc deficient embryos displayed impaired fluid homeostasis suggesting renal abnormalities, as well as aberrant craniofacial morphology and neural development defects. Whole mount in situ hybridization (WISH) revealed that gldc transcripts were highly expressed in the embryonic kidney, as seen in mouse and human repository data, and that formation of several nephron segments was disrupted in gldc deficient embryos, including proximal and distal tubule populations. These kidney defects were caused by alterations in renal progenitor populations, revealing that the proper function of Gldc is essential for the patterning of this organ. Additionally, further analysis of the urogenital tract revealed altered collecting duct and cloaca morphology in gldc deficient embryos. Finally, to gain insight into the molecular mechanisms underlying these disruptions, we examined the effects of exogenous glycine treatment and observed analogous renal and cloacal defects. Taken together, these studies indicate for the first time that gldc function serves an essential role in regulating renal progenitor development by modulating glycine levels.
Collapse
|
4
|
Bhumika S, Basalingappa KM, Gopenath TS, Basavaraju S. Glycine encephalopathy. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022; 58:132. [PMID: 36415754 PMCID: PMC9672649 DOI: 10.1186/s41983-022-00567-6] [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: 05/31/2022] [Accepted: 10/19/2022] [Indexed: 11/18/2022] Open
Abstract
Inherited neurotransmitter diseases are a subset of rare neurometabolic disorders characterized by hereditary deficiencies in neurotransmitter metabolism or transport. Non-ketotic hyperglycinaemia (NKH), called glycine encephalopathy, is an autosomal recessive glycine metabolism disorder characterized by an abnormal accumulation of glycine in all bodily tissues, including the CNS. The SLC6A9 gene, which codes for the GLYT1 protein, a biochemical abnormality in the GCS, and dihydrolipoamide dehydrogenase enzymes, which function as a GCS component, are responsible for the neonatal form's symptoms, which include progressive encephalopathy, hypotonia, seizures, and occasionally mortality in the first few days of life. By changing the MAPK signalling pathways, glycine deprivation in the brain damages neurons by increasing NMDA receptor activation, increasing intracellular Ca levels, and leading to DNA breakage and cell death in the neuron region. In addition to the previously mentioned clinical diagnosis, NKH or GE would be determined by MLPA and 13C glycine breath tests. Pediatricians, surgeons, neurologists, and geneticists treat NKH and GE at the newborn period; there is no cure for either condition.
Collapse
Affiliation(s)
- S. Bhumika
- Division of Molecular Biology, School of Life Sciences, JSS Academy of Higher Education and Research, Mysuru, 570015 India
| | - Kanthesh M. Basalingappa
- Division of Molecular Biology, School of Life Sciences, JSS Academy of Higher Education and Research, Mysuru, 570015 India
| | - T. S. Gopenath
- Department of Biotechnology and Bioinformatics, School of Life Sciences, JSS AHER, Mysuru, 570015 India
| | - Suman Basavaraju
- Department of Periodontology, JSS Dental College and Hospital, S.S. Nagar, Mysuru, 570015 India
| |
Collapse
|
5
|
Ortigoza-Escobar JD. A Proposed Diagnostic Algorithm for Inborn Errors of Metabolism Presenting With Movements Disorders. Front Neurol 2020; 11:582160. [PMID: 33281718 PMCID: PMC7691570 DOI: 10.3389/fneur.2020.582160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/30/2020] [Indexed: 12/13/2022] Open
Abstract
Inherited metabolic diseases or inborn errors of metabolism frequently manifest with both hyperkinetic (dystonia, chorea, myoclonus, ataxia, tremor, etc.) and hypokinetic (rigid-akinetic syndrome) movement disorders. The diagnosis of these diseases is in many cases difficult, because the same movement disorder can be caused by several diseases. Through a literature review, two hundred and thirty one inborn errors of metabolism presenting with movement disorders have been identified. Fifty-one percent of these diseases exhibits two or more movement disorders, of which ataxia and dystonia are the most frequent. Taking into account the wide range of these disorders, a methodical evaluation system needs to be stablished. This work proposes a six-step diagnostic algorithm for the identification of inborn errors of metabolism presenting with movement disorders comprising red flags, characterization of the movement disorders phenotype (type of movement disorder, age and nature of onset, distribution and temporal pattern) and other neurological and non-neurological signs, minimal biochemical investigation to diagnose treatable diseases, radiological patterns, genetic testing and ultimately, symptomatic, and disease-specific treatment. As a strong action, it is emphasized not to miss any treatable inborn error of metabolism through the algorithm.
Collapse
Affiliation(s)
- Juan Darío Ortigoza-Escobar
- Movement Disorders Unit, Institut de Recerca Sant Joan de Déu, CIBERER-ISCIII and European Reference Network for Rare Neurological Diseases (ERN-RND), Barcelona, Spain
| |
Collapse
|
6
|
Large scale analyses of genotype-phenotype relationships of glycine decarboxylase mutations and neurological disease severity. PLoS Comput Biol 2020; 16:e1007871. [PMID: 32421718 PMCID: PMC7259800 DOI: 10.1371/journal.pcbi.1007871] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/29/2020] [Accepted: 04/13/2020] [Indexed: 12/14/2022] Open
Abstract
Monogenetic diseases provide unique opportunity for studying complex, clinical states that underlie neurological severity. Loss of glycine decarboxylase (GLDC) can severely impact neurological development as seen in non-ketotic hyperglycinemia (NKH). NKH is a neuro-metabolic disorder lacking quantitative predictors of disease states. It is characterized by elevation of glycine, seizures and failure to thrive, but glycine reduction often fails to confer neurological benefit, suggesting need for alternate tools to distinguish severe from attenuated disease. A major challenge has been that there are 255 unique disease-causing missense mutations in GLDC, of which 206 remain entirely uncharacterized. Here we report a Multiparametric Mutation Score (MMS) developed by combining in silico predictions of stability, evolutionary conservation and protein interaction models and suitable to assess 251 of 255 mutations. In addition, we created a quantitative scale of clinical disease severity comprising of four major disease domains (seizure, cognitive failure, muscular and motor control and brain-malformation) to comprehensively score patient symptoms identified in 131 clinical reports published over the last 15 years. The resulting patient Clinical Outcomes Scores (COS) were used to optimize the MMS for biological and clinical relevance and yield a patient Weighted Multiparametric Mutation Score (WMMS) that separates severe from attenuated neurological disease (p = 1.2 e-5). Our study provides understanding for developing quantitative tools to predict clinical severity of neurological disease and a clinical scale that advances monitoring disease progression needed to evaluate new treatments for NKH. Neurodegenerative disorders frequently have diverse, severe symptoms and health outcomes that can be difficult to predict. The rare disease non-ketotic hyperglycinemia (NKH) additionally has a wide range of disease-causing mutations in glycine decarboxylase (GLDC), a protein that breaks down glycine. But measuring glycine is not sufficient to foretell disease outcome. A method to predict whether a mutation will cause severe or more mild forms of NKH would be very helpful to both understanding the disease as well as developing treatments for it. We used computation-based approaches to develop a mutation score that comprehensively predicts how mutations decrease GLDC function. After training against clinical data, the score was able to predict whether a mutation will cause severe or attenuated disease. This study utilizes the power of computational and multidisciplinary analyses to advance understanding and treatment of genetically caused neurodegenerative diseases.
Collapse
|
7
|
Stence NV, Fenton LZ, Levek C, Tong S, Coughlin CR, Hennermann JB, Wortmann SB, Van Hove JLK. Brain imaging in classic nonketotic hyperglycinemia: Quantitative analysis and relation to phenotype. J Inherit Metab Dis 2019; 42:438-450. [PMID: 30737808 DOI: 10.1002/jimd.12072] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 02/05/2019] [Indexed: 12/22/2022]
Abstract
Patients with severe nonketotic hyperglycinemia (NKH) have absent psychomotor development and intractable epilepsy, whereas attenuated patients have variable psychomotor development and absent or treatable epilepsy; differences in brain magnetic resonance imaging (MRI) between phenotypes have not been reported. In a retrospective cross-sectional study, we reviewed 38 MRI studies from 24 molecularly proven NKH patients, and 2 transient NKH patients. Quantitative analyses included corpus callosum size, apparent diffusion coefficient, automated brain volumetric analysis, and glycine/creatine ratio by spectroscopy. All patients age <3 months had restricted diffusion in the posterior limb of the internal capsule, anterior brainstem, posterior tegmental tracts, and cerebellum, not present in transient NKH. In older infants, the pattern evolved and included generalized diffusion restriction in the supratentorial white matter, which quantitatively peaked between 3 and 12 months. No patient had absent corpus callosum or gyral malformation. The corpus callosum was relatively short in severe compared to attenuated phenotypes, and thin in severe cases only. The corpus callosum growth rate differed by severity; age-matched Z-scores of thickness worsened in severe cases only. Cerebral volume was decreased in the hippocampus, globus pallidus, cerebral cortex, thalamus, and cerebellum. Severe patients had greatest glycine/creatine ratios. In this study, no brain malformations were identified. The growth failure of the corpus callosum is worse in severe NKH, whereas the diffusion restriction pattern, reflecting microspongiosis, does not discriminate by phenotypic severity. NKH is therefore a disorder of brain growth best recognized in the corpus callosum, whereas spongiosis is not prognostic.
Collapse
Affiliation(s)
- Nicholas V Stence
- Department of Radiology, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Laura Z Fenton
- Department of Radiology, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Claire Levek
- Department of Pediatrics, Research Institute Biostatistics Core, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Suhong Tong
- Department of Pediatrics, Research Institute Biostatistics Core, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Curtis R Coughlin
- Department of Pediatrics, Section of Clinical Genetics and Metabolism, University of Colorado, Aurora, Colorado
| | - Julia B Hennermann
- Department of Pediatric and Adolescent Medicine, University Medical Center Mainz, Mainz, Germany
| | - Saskia B Wortmann
- Department of Pediatrics, Salzburger Landeskliniken (SALK) und Paracelsus Medical University (PMU) Salzburg, Salzburg, Austria
| | - Johan L K Van Hove
- Department of Pediatrics, Section of Clinical Genetics and Metabolism, University of Colorado, Aurora, Colorado
| |
Collapse
|
8
|
Abstract
Although the majority of seizures in neonates are related to acute brain injury, a substantial minority are the first symptom of a neonatal-onset epilepsy often linked to a pathogenic genetic variant. Historically, studies on neonatal seizures including treatment response and long-term consequences have lumped all etiologies together. However, etiology has been consistently shown to be the most important determinant of outcome. In the past few years, an increasing number of monogenic disorders have been described and might explain up to a third of neonatal-onset epilepsy syndromes previously included under the umbrella of Ohtahara syndrome and early myoclonic encephalopathy. In this chapter, we define the concept of genetic epilepsy and review the classification. Then, we review the most relevant monogenic neonatal-onset epilepsies, detail their underlying pathophysiologic mechanisms, and present their electroclinical phenotypes. We highlight that, in some cases, such as neonates with KCNQ2 or KCNT1 gene mutations, the early recognition of the electroclinical phenotype can lead to targeted diagnostic testing and precision medicine treatment, enabling the possibility of improved outcome.
Collapse
|
9
|
Button K, Capraro A, Monuteaux M, Mannix R. Etiologies and Yield of Diagnostic Testing in Children Presenting to the Emergency Department with Altered Mental Status. J Pediatr 2018; 200:218-224.e2. [PMID: 29866594 DOI: 10.1016/j.jpeds.2018.04.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/19/2018] [Accepted: 04/17/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To identify etiologies of altered mental status in pediatric patients presenting to the emergency department (ED) and to characterize the yield of diagnostic testing in these patients. STUDY DESIGN Retrospective chart review of children aged 1-17 years presenting to a pediatric tertiary care ED between December 31, 2013 and December 31, 2014 with a chief complaint or International Classification of Disease, Ninth Edition code of altered mental status. The primary outcome was the etiology, defined as "immediate diagnosis" if the etiology was known in triage, "definitely established" if established by physical examination and abnormal laboratory results, imaging, or electrocardiogram findings, "probable" if the etiology was highly suspected in the ED but not confirmed with positive test results, or "unknown." The secondary outcome was testing utilization and contribution to the diagnosis. RESULTS Three hundred thirty-six eligible subjects were identified; mean age of 9 years (±6 years). The etiology of altered mental status was immediately established in 114 subjects (34%, 95% CI 29, 39). Among the remaining eligible subjects (N = 222), a definite or probable cause of altered mental status was identified in 82% (N = 182, 95% CI 76, 86) of cases and the etiology remained "unknown" in 18% (N = 40, 95% CI 14, 24). Only 10% of diagnostic tests performed were abnormal and contributed to a diagnosis. The median number of diagnostic tests per patient was 6 (IQR 3, 8). CONCLUSIONS Etiologies of altered mental status in children varied widely and often an underlying diagnosis was not found. Broad diagnostic testing was commonly performed although the overall yield was low.
Collapse
Affiliation(s)
- Katharine Button
- Division of Emergency Medicine, Children's National Medical Center, Washington DC
| | - Andrew Capraro
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Michael Monuteaux
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, MA.
| |
Collapse
|
10
|
Lin Y, Zheng Z, Sun W, Fu Q. A novel compound heterozygous variant identified in GLDC gene in a Chinese family with non-ketotic hyperglycinemia. BMC MEDICAL GENETICS 2018; 19:5. [PMID: 29304759 PMCID: PMC5755286 DOI: 10.1186/s12881-017-0517-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 12/22/2017] [Indexed: 12/23/2022]
Abstract
Background Non-ketotic hyperglycinemia (NKH) is a rare, devastating autosomal recessive disorder of glycine metabolism with a very poor prognosis. Currently, few studies have reported genetic profiling of Chinese NKH patients. This study aimed to identify the genetic mutations in a Chinese family with NKH. Methods A Chinese family of Han ethnicity, with three siblings with NKH was studied. Sanger sequencing and multiplex ligation-dependent probe amplification combined with SYBR green real-time quantitative PCR was used to identify potential mutations in the GLDC, AMT and GCSH genes. The potential pathogenicity of the identified missense mutation was analyzed using SIFT, PolyPhen-2, PROVEAN and MutationTaster software. Results All patients exhibited severe and progressive clinical symptoms, including lethargy, hypotonia and seizures, and had greatly elevated glycine levels in their plasma and CSF. Molecular genetic analysis identified compound heterozygous variants in the GLDC gene in these three siblings, including a novel missense variant c.2680A > G (p.Thr894Ala) in exon 23 and a heterozygous deletion of exon 3, which were inherited respectively from their parents. In silico analysis, using several different types of bioinformatic software, predicted that the novel variant c.2680A > G in the GLDC gene was pathogenic. Moreover, the deletion of exon 3 was identified for the first time in a Chinese population. Conclusions A novel missense variant and a previously reported deletion in GLDC gene were identified. The two variants of GLDC gene identified probably underlie the pathogenesis of non-ketotic hyperglycinemia in this family, and also enrich the mutational spectrum of GLDC gene. Electronic supplementary material The online version of this article (10.1186/s12881-017-0517-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Yiming Lin
- Neonatal Disease Screening Center of Quanzhou, Quanzhou Women's and Children's Hospital, 700 Fengze Street, Quanzhou, Fujian Province, 362000, China
| | - Zhenzhu Zheng
- Neonatal Disease Screening Center of Quanzhou, Quanzhou Women's and Children's Hospital, 700 Fengze Street, Quanzhou, Fujian Province, 362000, China
| | - Wenjia Sun
- Genuine Diagnostics Company Limited, 859 Shixiang West Road, Hangzhou, Zhejiang Province, 310007, China.
| | - Qingliu Fu
- Neonatal Disease Screening Center of Quanzhou, Quanzhou Women's and Children's Hospital, 700 Fengze Street, Quanzhou, Fujian Province, 362000, China.
| |
Collapse
|
11
|
Neuroimaging of Pediatric Metabolic Disorders with Emphasis on Diffusion-Weighted Imaging and MR Spectroscopy: A Pictorial Essay. CURRENT RADIOLOGY REPORTS 2017. [DOI: 10.1007/s40134-017-0251-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
12
|
Mohammad SA, Abdelkhalek HS. Nonketotic hyperglycinemia: spectrum of imaging findings with emphasis on diffusion-weighted imaging. Neuroradiology 2017; 59:1155-1163. [PMID: 28864914 DOI: 10.1007/s00234-017-1913-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/22/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to explore brain abnormalities in nonketotic hyperglycinemia (NKH) using diffusion-weighted imaging (DWI) and when feasible, diffusion tensor imaging (DTI) and tractography. METHODS Seven patients with confirmed diagnosis of NKH (8 days-2 years) underwent brain MRI. Conventional T1 and T2WI were acquired in all patients, DWI in six and DTI and tractography in two (4 months and 2 years). Measurements of fractional anisotropy (FA), radial diffusivity (RD), axial diffusivity (AD) and Trace from eight white matter regions were compared between the two patients and age-matched controls. Tractography of corpus callosum, superior longitudinal fasciculus and corticospinal tracts was performed with extraction of their FA and diffusivity indices. RESULTS MRI showed nonspecific brain atrophy in three children. Corpus callosum atrophy was found as a part of these atrophic changes. Cerebellar vermian hypoplasia and supratentorial hydrocephalus were seen in one patient. The topographic distribution of diffusion restriction was different among patients. The affected white matter regions were not predominantly following the expected areas of myelination according to patients' age. Deep grey matter nuclei were affected in one patient. DTI revealed lower FA with higher RD in most of the measured white matter regions and tracts. These changes were more appreciated in the 2-year-old patient. However, Trace was higher in the 2-year-old patient and lower in the 4-month-old one. The extracted tracts were decreased in volume. CONCLUSION DWI, DTI and tractography with FA and diffusivity measurements can give insights into white matter microstructural alterations that can occur in NKH.
Collapse
Affiliation(s)
- Shaimaa Abdelsattar Mohammad
- Radiodiagnosis Department, Faculty of Medicine, Ain-Shams University, 9 Lotfi Elsayed St. Ain-Shams University Staff Buildings, Cairo, 11657, Egypt.
| | - Heba Salah Abdelkhalek
- Medical Genetics Unit, Pediatric Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| |
Collapse
|
13
|
Butler CJ, Likeman M, Mallick AA. Distinctive Magnetic Resonance Imaging Findings in Neonatal Nonketotic Hyperglycinemia. Pediatr Neurol 2017; 72:90-91. [PMID: 28476521 DOI: 10.1016/j.pediatrneurol.2017.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 03/23/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Christopher J Butler
- Department of Paediatric Neurology, Bristol Royal Hospital for Children, Bristol, UK.
| | - Marcus Likeman
- Department of Paediatric Neuroradiology, Bristol Royal Hospital for Children, Bristol, UK
| | - Andrew A Mallick
- Department of Paediatric Neurology, Bristol Royal Hospital for Children, Bristol, UK
| |
Collapse
|
14
|
Zubarioglu T, Kiykim E, Cansever MS, Aktuglu Zeybek C, Yalcinkaya C. Neonatal nonketotic hyperglycinemia: diffusion-weighted magnetic resonance imaging and diagnostic clues. Acta Neurol Belg 2016; 116:671-673. [PMID: 26702626 DOI: 10.1007/s13760-015-0583-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 12/09/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Tanyel Zubarioglu
- Division of Nutrition and Metabolism, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa Fatih, 34098, Istanbul, Turkey.
| | - Ertugrul Kiykim
- Division of Nutrition and Metabolism, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa Fatih, 34098, Istanbul, Turkey
| | - Mehmet Serif Cansever
- Central Laboratory, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa Fatih, 34098, Istanbul, Turkey
| | - Cigdem Aktuglu Zeybek
- Division of Nutrition and Metabolism, Department of Pediatrics, Cerrahpasa Medical Faculty, Istanbul University, Kocamustafapasa Fatih, 34098, Istanbul, Turkey
| | - Cengiz Yalcinkaya
- Division of Pediatric Neurology, Department of Neurology, Cerrahpasa Medical Faculty, İstanbul University, Kocamustafapasa Fatih, 34098, Istanbul, Turkey
| |
Collapse
|
15
|
Novel compound heterozygous LIAS mutations cause glycine encephalopathy. J Hum Genet 2015; 60:631-5. [DOI: 10.1038/jhg.2015.72] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 05/18/2015] [Accepted: 05/28/2015] [Indexed: 11/09/2022]
|
16
|
Evidence that glycine induces lipid peroxidation and decreases glutathione concentrations in rat cerebellum. Mol Cell Biochem 2014; 395:125-34. [PMID: 24939360 DOI: 10.1007/s11010-014-2118-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 06/02/2014] [Indexed: 02/07/2023]
Abstract
Patients with non-ketotic hyperglycinemia (NKH) present severe neurological symptoms and brain abnormalities involving cerebellum. Although the pathomechanisms underlying the cerebellum damage have not been studied, high tissue levels of glycine (GLY), the biochemical hallmark of this disorder have been suggested to contribute to the neuropathology of this disease. We investigated the in vitro effects of GLY on important parameters of oxidative stress and energy metabolism in cerebellum of 30-day-old rats. Our results show that GLY increased 2',7'-dichlorofluorescin oxidation, suggesting that reactive species production are augmented by GLY in the cerebellum. However, hydrogen peroxide generation was not altered by GLY. GLY also increased thiobarbituric acid-reactive substances (TBA-RS) levels and reduced the glutathione (GSH) content, indicating that this amino acid provokes lipid oxidative damage and compromises the non-enzymatic antioxidant defenses, respectively, in cerebellum. The antioxidants melatonin and trolox (the hydrosoluble analog of vitamin E) prevented the GLY-induced increase of TBA-RS and decrease of GSH in cerebellum, indicating the involvement of hydroxyl and peroxyl radicals in these effects. The NMDA receptor antagonist MK-801 also attenuated GLY-induced decrease of GSH, suggesting that this effect is mediated through NMDA receptor. In contrast, GLY did not alter the protein carbonyl formation and total and protein-bound sulfhydryl group content, as well as catalase and superoxide dismutase activities. Furthermore, GLY did not alter the activities of the respiratory chain complexes and creatine kinase. Our present data indicate that oxidative stress elicited by GLY in vitro may be a potential pathomechanism involved in the cerebellar dysfunction observed in NKH.
Collapse
|