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Wilson C. Metabolic disease in the Pacific: Lessons for indigenous populations. J Inherit Metab Dis 2022; 45:919-925. [PMID: 35267200 DOI: 10.1002/jimd.12495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 11/09/2022]
Abstract
Twenty-five percent of the New Zealand population is either Māori or Pacific and are thus indigenous to the region. The New Zealand National Metabolic Service has considerable experience in diagnosing and managing metabolic diseases in this population. The frequencies and phenotypes of inborn errors of metabolism in indigenous people differ from that in Western European populations. Metabolic services need to be aware of these local variations and adapt their screening and treatment protocols accordingly. Likewise, the services themselves need to adopt culturally appropriate practices. This includes an understanding of the language, ideally employment of indigenous people and targeting of the service to meet the needs of the people. Knowledge of the metabolic diseases common within particular ethnic groups is important for the rapid delivery of appropriate management. Newborn screening protocols need to reflect the local populations. With the advent of expanded newborn screening relatively benign forms of fatty acid oxidation disorders have been commonly encountered. This high prevalence may reflect a selective evolutionary advantage as similar conditions have been found in other ethnic groups with traditionally high fat and low carbohydrate diets. HLA haplotypes of indigenous populations are less represented in international stem cell transplant databanks thereby making the option of human stem cell transplant more challenging. The recent discovery that short-chain enoyl-CoA hydratase deficiency is particularly common in New Zealand with nearly a dozen cases identified this year suggests there is still a lot to learn regarding Māori and Pacific and indeed an indigenous metabolic disease.
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Affiliation(s)
- Callum Wilson
- National Metabolic Service, Auckland City Hospital and Starship Children's Hospital, Auckland, New Zealand
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Abstract
Inborn errors of metabolism, also known as inherited metabolic diseases, constitute an important group of conditions presenting with neurologic signs in newborns. They are individually rare but collectively common. Many are treatable through restoration of homeostasis of a disrupted metabolic pathway. Given their frequency and potential for treatment, the clinician should be aware of this group of conditions and learn to identify the typical manifestations of the different inborn errors of metabolism. In this review, we summarize the clinical, laboratory, electrophysiologic, and neuroimaging findings of the different inborn errors of metabolism that can present with florid neurologic signs and symptoms in the neonatal period.
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MESH Headings
- Adult
- Female
- Humans
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/diagnostic imaging
- Infant, Newborn, Diseases/physiopathology
- Infant, Newborn, Diseases/therapy
- Metabolism, Inborn Errors/diagnosis
- Metabolism, Inborn Errors/diagnostic imaging
- Metabolism, Inborn Errors/physiopathology
- Metabolism, Inborn Errors/therapy
- Neuroimaging
- Pregnancy
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Affiliation(s)
- Carlos R Ferreira
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States; Rare Disease Institute, Children's National Health System, Washington, DC, United States
| | - Clara D M van Karnebeek
- Departments of Pediatrics and Clinical Genetics, Amsterdam University Medical Centers, Amsterdam, The Netherlands; Department of Pediatrics, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, BC, Canada.
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Mechanisms Governing Precise Protein Biotinylation. Trends Biochem Sci 2017; 42:383-394. [DOI: 10.1016/j.tibs.2017.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/25/2017] [Accepted: 02/03/2017] [Indexed: 12/26/2022]
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Abstract
Inborn errors of metabolism (IEM) are rare conditions that represent more than 1000 diseases, with a global prevalence of approximately 1:2000 individuals. Approximately, 40%-60% of IEM may present with epilepsy as one of the main neurologic signs. Epilepsy in IEM may appear at any age (fetal, newborn, infant, adolescent, or even adult). Different pathophysiological mechanisms may be responsible for the clinical phenotype, such as disturbances in energy metabolism (mitochondrial and fatty oxidation disorders, GLUT-1, and cerebral creatine deficiency), accumulation of complex molecules (lysosomal storage disorders), toxic mechanisms (organic acidurias and urea cycle disorders), or impairment of neurotransmission. Early diagnosis and, in some cases, an effective treatment may result in an excellent evolution of the IEM, in particularly seizure control. This review attempts to delineate a summary of IEM that may present with seizures or epilepsy and emphasizes the management in treatable conditions.
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Affiliation(s)
- Jaume Campistol
- From the *Neurology Department, Hospital Sant Joan de Déu, Barcelona University, Barcelona, Spain; Center for Biomedical Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain; Institute of Pediatric Research, Sant Joan de Déu, Barcelona, Spain.
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Abstract
Holocarboxylase synthetase (HLCS) deficiency is a rare autosomal recessive disorder that presents with multiple life-threatening metabolic derangements including metabolic acidosis, ketosis, and hyperammonemia. A majority of HLCS deficiency patients respond to biotin therapy; however, some patients show only a partial or no response to biotin therapy. Here, we report a neonatal presentation of HLCS deficiency with partial response to biotin therapy. Sequencing of HLCS showed a novel heterozygous mutation in exon 5, c.996G>C (p.Gln332His), which likely abolishes the normal intron 6 splice donor site. Cytogenetic analysis revealed that the defect of the other allele is a paracentric inversion on chromosome 21 that disrupts HLCS. This case illustrates that in addition to facilitating necessary family testing, a molecular diagnosis can optimize management by providing a better explanation of the enzyme's underlying defect. It also emphasizes the potential benefit of a karyotype in cases in which molecular genetic testing fails to provide an explanation.
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Bandaralage SPS, Farnaghi S, Dulhunty JM, Kothari A. Antenatal and postnatal radiologic diagnosis of holocarboxylase synthetase deficiency: a systematic review. Pediatr Radiol 2016; 46:357-64. [PMID: 26754537 DOI: 10.1007/s00247-015-3492-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 08/07/2015] [Accepted: 10/28/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Holocarboxylase synthetase deficiency results in impaired activation of enzymes implicated in glucose, fatty acid and amino acid metabolism. Antenatal imaging and postnatal imaging are useful in making the diagnosis. Untreated holocarboxylase synthetase deficiency is fatal, while antenatal and postnatal biotin supplementation is associated with good clinical outcomes. Although biochemical assays are required for definitive diagnosis, certain radiologic features assist in the diagnosis of holocarboxylase synthetase deficiency. OBJECTIVE To review evidence regarding radiologic diagnostic features of holocarboxylase synthetase deficiency in the antenatal and postnatal period. MATERIALS AND METHODS A systematic review of all published cases of holocarboxylase synthetase deficiency identified by a search of Pubmed, Scopus and Web of Science. RESULTS A total of 75 patients with holocarboxylase synthetase deficiency were identified from the systematic review, which screened 687 manuscripts. Most patients with imaging (19/22, 86%) had abnormal findings, the most common being subependymal cysts, ventriculomegaly and intraventricular hemorrhage. CONCLUSION Although the radiologic features of subependymal cysts, ventriculomegaly, intraventricular hemorrhage and intrauterine growth restriction may be found in the setting of other pathologies, these findings should prompt consideration of holocarboxylase synthetase deficiency in at-risk children.
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Affiliation(s)
- Sahan P Semasinghe Bandaralage
- Gold Coast Hospital and Health Service, Southport, Queensland, 4215, Australia.,School of Medicine, Griffith University, Southport, Queensland, 4215, Australia
| | - Soheil Farnaghi
- Caboolture Hospital, Caboolture, Queensland, 4510, Australia
| | - Joel M Dulhunty
- Redcliffe Hospital, Redcliffe, Queensland, 4020, Australia.,School of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia
| | - Alka Kothari
- Redcliffe Hospital, Redcliffe, Queensland, 4020, Australia. .,School of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia.
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Severe neonatal holocarboxylase synthetase deficiency in west african siblings. JIMD Rep 2015; 20:1-4. [PMID: 25690727 DOI: 10.1007/8904_2014_367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/15/2014] [Accepted: 09/18/2014] [Indexed: 03/10/2023] Open
Abstract
In multiple carboxylase deficiency (MCD), the biotin-dependent carboxylases have decreased activity due to either biotinidase deficiency or holocarboxylase synthetase (HS) deficiency. We report the case of two siblings from Ghana, the first of which presented shortly after birth with profound lactic acidosis and a urine organic acid profile consistent with MCD. In the first sibling, treatment with pulverized biotin tablets (20 mg) was begun immediately, but the patient died at 10 days of age from cardiac arrest secondary to refractory metabolic acidosis. Autopsy revealed a biotin bezoar. Sequencing of HCLS showed homozygosity for a novel missense variant (p.G241W). The second sibling had a similar presentation at birth: severe metabolic acidosis and respiratory distress. A urine organic acid profile was consistent with HS deficiency; he was treated with biotin powder (20 mg), and after 24 h, the lactate decreased significantly; by day 5 of life, the patient was tolerating 40 mg of biotin, feeding by mouth and off all other medications and support. This is the first report of the p.G241W mutation. To our knowledge, this is also the first mutation described in West African patients with HS deficiency and the cases demonstrate that it is biotin responsive. Additionally, our experience suggests that the powdered form of biotin supplementation may be more digestible than tablets for the treatment of severe neonatal HS deficiency.
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Slavin TP, Zaidi SJ, Neal C, Nishikawa B, Seaver LH. Clinical Presentation and Positive Outcome of Two Siblings with Holocarboxylase Synthetase Deficiency Caused by a Homozygous L216R Mutation. JIMD Rep 2013; 12:109-14. [PMID: 24085707 DOI: 10.1007/8904_2013_252] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/30/2013] [Accepted: 07/02/2013] [Indexed: 12/12/2022] Open
Abstract
Purpose The L216R mutation, seen in individuals of Polynesian descent, is considered one of the most severe mutations associated with holocarboxylase synthetase (HLCS) deficiency and is regarded as being unresponsive to biotin. This report describes the presentation and outcome in two surviving siblings, homozygous for this highly lethal mutation. Methods and results Both cases had perinatal head imaging findings of brain hemorrhage and subependymal cysts. Both had metabolic decompensation within 24 h after birth consisting of metabolic acidosis, lactic acidosis, and thrombocytopenia. Biochemical profiles were consistent with HLCS deficiency, and genetic analysis confirmed homozygosity for the L216R mutation. After resolution of neonatal metabolic crisis, dosing of biotin was titrated on an outpatient basis to primarily control dermatitis. The eldest is currently on 1.2 g of oral biotin daily, well above any dose previously reported to treat HLCS deficiency. To date, neither patient has required hospital readmission for acute metabolic decompensation. At the age of 7, the eldest child is, to our knowledge, the oldest patient ever described in the literature who is homozygous for the L216R mutation. She has mild intellectual disability. Conclusion This report contrasts previous reports of poor outcomes and neonatal deaths in homozygous L216R patients. We also provide data on the potential upper tolerable limit of biotin. These cases suggest that the outcome of HCLS deficiency due to a homozygous L216R mutation, when diagnosed and treated early with high-level neonatal care and biotin, may not be as severe as previously reported.
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Affiliation(s)
- T P Slavin
- Department of Pediatrics, University of Hawai'i John A. Burns School of Medicine, Honolulu, HI, USA
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Arigony ALV, de Oliveira IM, Machado M, Bordin DL, Bergter L, Prá D, Pêgas Henriques JA. The influence of micronutrients in cell culture: a reflection on viability and genomic stability. BIOMED RESEARCH INTERNATIONAL 2013; 2013:597282. [PMID: 23781504 PMCID: PMC3678455 DOI: 10.1155/2013/597282] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 04/23/2013] [Accepted: 05/03/2013] [Indexed: 12/31/2022]
Abstract
Micronutrients, including minerals and vitamins, are indispensable to DNA metabolic pathways and thus are as important for life as macronutrients. Without the proper nutrients, genomic instability compromises homeostasis, leading to chronic diseases and certain types of cancer. Cell-culture media try to mimic the in vivo environment, providing in vitro models used to infer cells' responses to different stimuli. This review summarizes and discusses studies of cell-culture supplementation with micronutrients that can increase cell viability and genomic stability, with a particular focus on previous in vitro experiments. In these studies, the cell-culture media include certain vitamins and minerals at concentrations not equal to the physiological levels. In many common culture media, the sole source of micronutrients is fetal bovine serum (FBS), which contributes to only 5-10% of the media composition. Minimal attention has been dedicated to FBS composition, micronutrients in cell cultures as a whole, or the influence of micronutrients on the viability and genetics of cultured cells. Further studies better evaluating micronutrients' roles at a molecular level and influence on the genomic stability of cells are still needed.
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Affiliation(s)
- Ana Lúcia Vargas Arigony
- Laboratório de Reparação de DNA em Eucariotos, Departamento de Biofísica/Centro de Biotecnologia, UFRGS, Avenida Bento Gonçalves 9500, Prédio 43422, Setor IV, Campus do Vale, 91501-970 Porto Alegre, RS, Brazil
| | - Iuri Marques de Oliveira
- Laboratório de Reparação de DNA em Eucariotos, Departamento de Biofísica/Centro de Biotecnologia, UFRGS, Avenida Bento Gonçalves 9500, Prédio 43422, Setor IV, Campus do Vale, 91501-970 Porto Alegre, RS, Brazil
| | - Miriana Machado
- Laboratório de Reparação de DNA em Eucariotos, Departamento de Biofísica/Centro de Biotecnologia, UFRGS, Avenida Bento Gonçalves 9500, Prédio 43422, Setor IV, Campus do Vale, 91501-970 Porto Alegre, RS, Brazil
- Instituto de Educação para Pesquisa, Desenvolvimento e Inovação Tecnológica—ROYAL, Unidade GENOTOX—ROYAL, Centro de Biotecnologia, UFRGS, Avenida Bento Gonçalves 9500, Prédio 43421, Setor IV, Campus do Vale, 91501-970 Porto Alegre, RS, Brazil
| | - Diana Lilian Bordin
- Laboratório de Reparação de DNA em Eucariotos, Departamento de Biofísica/Centro de Biotecnologia, UFRGS, Avenida Bento Gonçalves 9500, Prédio 43422, Setor IV, Campus do Vale, 91501-970 Porto Alegre, RS, Brazil
| | - Lothar Bergter
- Instituto de Educação para Pesquisa, Desenvolvimento e Inovação Tecnológica—ROYAL, Unidade GENOTOX—ROYAL, Centro de Biotecnologia, UFRGS, Avenida Bento Gonçalves 9500, Prédio 43421, Setor IV, Campus do Vale, 91501-970 Porto Alegre, RS, Brazil
| | - Daniel Prá
- Laboratório de Reparação de DNA em Eucariotos, Departamento de Biofísica/Centro de Biotecnologia, UFRGS, Avenida Bento Gonçalves 9500, Prédio 43422, Setor IV, Campus do Vale, 91501-970 Porto Alegre, RS, Brazil
- PPG em Promoção da Saúde, Universidade de Santa Cruz do Sul (UNISC), Avenida Independência 2293, 96815-900 Santa Cruz do Sul, RS, Brazil
| | - João Antonio Pêgas Henriques
- Laboratório de Reparação de DNA em Eucariotos, Departamento de Biofísica/Centro de Biotecnologia, UFRGS, Avenida Bento Gonçalves 9500, Prédio 43422, Setor IV, Campus do Vale, 91501-970 Porto Alegre, RS, Brazil
- Instituto de Educação para Pesquisa, Desenvolvimento e Inovação Tecnológica—ROYAL, Unidade GENOTOX—ROYAL, Centro de Biotecnologia, UFRGS, Avenida Bento Gonçalves 9500, Prédio 43421, Setor IV, Campus do Vale, 91501-970 Porto Alegre, RS, Brazil
- Instituto de Biotecnologia, Departamento de Ciências Biomédicas, Universidade de Caxias do Sul (UCS), Rua Francisco Getúlio Vargas 1130, 95070-560 Caxias do Sul, RS, Brazil
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A novel molecular mechanism to explain biotin-unresponsive holocarboxylase synthetase deficiency. J Mol Med (Berl) 2011; 90:81-8. [DOI: 10.1007/s00109-011-0811-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 07/26/2011] [Accepted: 08/18/2011] [Indexed: 10/17/2022]
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Pendini NR, Bailey LM, Booker GW, Wilce MC, Wallace JC, Polyak SW. Microbial biotin protein ligases aid in understanding holocarboxylase synthetase deficiency. BIOCHIMICA ET BIOPHYSICA ACTA-PROTEINS AND PROTEOMICS 2008; 1784:973-82. [DOI: 10.1016/j.bbapap.2008.03.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 03/16/2008] [Accepted: 03/26/2008] [Indexed: 11/16/2022]
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