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Hahn P, Siefen RG, Benz K, Jackowski J, Köhler C, Lücke T. [Diagnosis and Management of Late-Onset Pompe Disease]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2024; 92:33-40. [PMID: 37494148 DOI: 10.1055/a-2095-2977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Pompe disease is a lysosomal storage disorder, with onset between the first weeks after birth and adulthood, depending on its phenotype. It can affect multiple organ systems and presents itself with a wide variety of symptoms. Thus, recognizing Pompe disease is difficult. Especially since enzyme replacement therapy for Pompe disease was introduced (in Germany in 2006), early diagnosis by means of enzyme activity determination from dried blood spot analysis and genetic verification has become important for outcome and quality of life. When facing an obscure muscular disorder, it is crucial to consider Pompe disease. This article provides an overview about Pompe disease and focuses on the diagnosis of the late onset type. The most important aspects of interdiciplinary care for patients with Pompe disease are presented. Additionally, it contains a section focusing on psychosocial challenges for children with Pompe disease and their families, which may include mental disorders and social retreat, and gives advice on how to support parents of affected children.
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Affiliation(s)
- Philipp Hahn
- Universitätsklinik für Kinder- und Jugendmedizin, Ruhr-Universität Bochum, St. Josef-Hospital, Bochum, Germany
| | - Rainer-Georg Siefen
- Universitätsklinik für Kinder- und Jugendmedizin, Ruhr-Universität Bochum, St. Josef-Hospital, Bochum, Germany
| | - Korbinian Benz
- Abteilung Zahnärztliche Chirurgie und Poliklinische Ambulanz der privaten Universität Witten/Herdecke, Universitäts-Zahnklinik, Witten/Herdecke, Germany
| | - Jochen Jackowski
- Abteilung Zahnärztliche Chirurgie und Poliklinische Ambulanz der privaten Universität Witten/Herdecke, Universitäts-Zahnklinik, Witten/Herdecke, Germany
| | - Cornelia Köhler
- Universitätsklinik für Kinder- und Jugendmedizin, Ruhr-Universität Bochum, St. Josef-Hospital, Bochum, Germany
| | - Thomas Lücke
- Universitätsklinik für Kinder- und Jugendmedizin, Ruhr-Universität Bochum, St. Josef-Hospital, Bochum, Germany
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Yue D, Jiao K, Xia X, Zhang J, Zhu B, Liu L, Du K, Gao M, Cheng N, Wang N, Luo S, Xi J, Lu J, Zhao C, Zhu W. Diagnostic delay in late-onset Pompe disease among Chinese patients: A retrospective study. JIMD Rep 2024; 65:39-46. [PMID: 38186848 PMCID: PMC10764198 DOI: 10.1002/jmd2.12404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/24/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
Surveys and retrospective studies have revealed considerable delays in diagnosing late-onset Pompe disease (LOPD) in China, where the contributing factors remain poorly represented. Our study analyzed the diagnostic journey of 34 LOPD patients seen at our neuromuscular clinic from 2005 to 2022. We defined diagnostic delay as the time from the onset of the first relevant symptoms and laboratory findings suggestive of LOPD to the eventual diagnosis, and we constructed a correlation matrix to assess relationships among these variables. The cohort consisted of 34 patients with an equal male-to-female ratio, and the mean age at diagnosis was 27.68 ± 10.03 years. We found the median diagnostic delay to be 5 years, with a range of 0.3 to 20 years, with 97.1% having been misdiagnosed previously, most commonly with "Type II Respiratory insufficiency" (36.7%). Notably, patients at earlier onset (mean age, 18.19 years vs. 31 years; p < 0.005) tended to have higher creatine kinase (CK) levels. Furthermore, 92.6% reported difficulty in sitting up from a supine position since childhood. Our research emphasizes the role of early indicators like dyspnea and difficulty performing sit-ups in adolescents for timely LOPD diagnosis and treatment initiation. The importance of early high-risk screening using dried blood spot testing cannot be overstated.
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Affiliation(s)
- Dongyue Yue
- Department of NeurologyJing'an District Center Hospital of ShanghaiShanghaiChina
| | - Kexin Jiao
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Xingyu Xia
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Jialong Zhang
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Bochen Zhu
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Lingchun Liu
- The First People's Hospital of Yunnan ProvinceYunnanChina
| | - Kunzhao Du
- Jinshan Hospital Center for Neurosurgery, Jinshan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain ScienceFudan UniversityShanghaiChina
| | - Mingshi Gao
- Department of PathologyHuashan Hospital, Fudan UniversityShanghaiChina
| | - Nachuan Cheng
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Ningning Wang
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Sushan Luo
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Jianying Xi
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Jiahong Lu
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Chongbo Zhao
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Wenhua Zhu
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
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3
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Li J, Shi X, Wang B, Hsi DH, Zhu X, Ta S, Wang J, Lei C, Hu R, Huang J, Zhao X, Liu L. Pompe disease in China: clinical and molecular characteristics. Front Cardiovasc Med 2023; 10:1261172. [PMID: 38162137 PMCID: PMC10755933 DOI: 10.3389/fcvm.2023.1261172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/22/2023] [Indexed: 01/03/2024] Open
Abstract
Background Pompe disease (PD) is a rare, progressive, and autosomal recessive lysosomal storage disorder caused by mutations in the acid α-glucosidase gene. The clinical course and molecular mechanism of this disease in China have not been well defined. Methods In this single-center cohort study, we investigated a total of 15 Chinese patients with Pompe disease to better understand the clinical manifestations, echocardiographic imaging and genetic characteristics in this population. Results The median age of 15 patients at symptom onset was 5.07 months (1-24 months). The median age at diagnosis was 19.53 months (range: 3 to 109 months, n = 15). Average diagnostic delay was 13.46 months. None of the patients had received enzyme replacement therapy (ERT). Fifteen patients died at a median age of 24.80 months due to cardiorespiratory failure (range 3-120 months). Myasthenia symptoms and severe hypertrophic cardiomyopathy were universally present (15/15 = 100%). Global longitudinal strain (GLS) by echocardiography was significantly lower in these patients. After adjusting for gender, body surface area (BSA), left ventricular ejection fraction (LVEF), E/e'ratio, maximum left ventricular wall thickness (MLVWT), left ventricular posterior wall (LVPW), left ventricular outflow tract (LVOT)gradient, GLS was independently correlated with survival time (hazard ratio (HR) = 0.702, 95% confidence Interval (CI): 0.532-0.925, P = 0.012). In our cohort, we identified 4 novel GAA mutation: c.2102T > C (p.L701P), c.2006C > T (p.P669l), c.766T > A (p.Y256N), c.2405G > T (p.G802V). 12 patients were compound heterozygotes, and 4 homozygotes. Conclusions Our study provides a comprehensive examination of PD clinical course and mutations of the GAA gene for patients in China. We showed clinical utility of echocardiography in quantifying heart involvement in patients with suspected PD. GLS can provide prognostic information for mortality prediction. We reported four novel mutations in the GAA gene for the first time. Our findings may improve early recognition of PD characteristics in Chinese patients.
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Affiliation(s)
- Jing Li
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
| | - Xiaohe Shi
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
| | - Bo Wang
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
| | - David H. Hsi
- Heart & Vascular Institute, Stamford Hospital, CT and Columbia University College of Physicians & Surgeons, New York, NY, United States
| | - Xiaoli Zhu
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
| | - Shengjun Ta
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
| | - Jing Wang
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
| | - Changhui Lei
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
| | - Rui Hu
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
| | - Junzhe Huang
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
| | - Xueli Zhao
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
| | - Liwen Liu
- Department of Ultrasound, Xijing Hospital, Xian, Shaanxi, China
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Jiao K, Dong J, Luo S, Yu L, Ke Q, Wang Z, Luan X, Zhang X, Guo J, Chen Y, Li X, Tan S, Qian F, Jiang J, Yu X, Yue D, Liu C, Luo L, Li J, Qu Y, Chen L, Tu J, Sun C, Yan C, Song J, Xi J, Lin J, Lu J, Zhao C, Zhu W, Fang Q. High-risk screening of late-onset Pompe disease: A different early portrait in China. Front Neurol 2022; 13:965207. [PMID: 36237614 PMCID: PMC9553204 DOI: 10.3389/fneur.2022.965207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/05/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction The lack of knowledge regarding the differences between Chinese and other ethnicities in the early manifestation of late-onset Pompe disease (LOPD) prohibits the development of an effective screening strategy. We conducted a multicenter screening study to determine LOPD prevalence in high-risk populations and define the early manifestation of LOPD in China. Methods Between August 2020 and April 2021, the participants were prospectively identified through medical examination at 20 centers from inpatient departments and outpatient neuromuscular clinics in China. The inclusion criteria were as follows: (1) age ≥ 1 year and (2) either one of the following conditions: (a) persistent hyperCKemia, (b) muscle weakness of the axial and/or limb-girdle muscles, or (c) unexplained restrictive respiratory insufficiency (RI). Enzymatic activity of acid α-glucosidase (GAA) was measured in a dried blood spot (DBS) using a tandem mass spectrometry (MS/MS) assay. Next-generation sequencing (NGS) was used to evaluate all samples with decreased GAA activity, searching for GAA mutations and pseudodeficiency alleles. Results Among the 492 cases, 26 positive samples (5.3%) were detected in the DBS test. Molecular studies confirmed a diagnosis of LOPD in eight cases (1.6%). Using MS/MS assay, GAA activities in individuals with pseudodeficiency could be distinguished from those in patients with LOPD. The median interval from the onset of symptoms to diagnosis was 5 years. All patients also showed RI, with a mean forced vital capacity (FVC) of 48%, in addition to axial/proximal muscle weakness. The creatine kinase (CK) level ranged from normal to no more than 5-fold the upper normal limit (UNL). LOPD with isolated hyperCKemia was not identified. Conclusion Less frequent hyperCKemia and predominant RI depict a different early portrait of adult Chinese patients with LOPD. A modified high-risk screening strategy should be proposed for the early diagnosis of Chinese patients with LOPD.
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Affiliation(s)
- Kexin Jiao
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
| | - Jihong Dong
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Sushan Luo
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
| | - Liqiang Yu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Shanghai, China
| | - Qing Ke
- Department of Neurology, The First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, Zhejiang, China
| | - Zhiqiang Wang
- Department of Neurology, Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xinghua Luan
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiaojie Zhang
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Junhong Guo
- Department of Neurology, First Hospital, Shanxi Medical University, Taiyuan, China
| | - Yan Chen
- Department of Neurology, Tongji Hospital, Tongji University, Shanghai, China
| | - Xihua Li
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Song Tan
- Department of Neurology, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Fangyuan Qian
- Department of Neurology, School of Medicine, Affiliated ZhongDa Hospital, Research Institution of Neuropsychiatry, Southeast University, Nanjing, China
| | - Jianming Jiang
- Department of Neurology, First Affiliated Hospital to Naval Medical University, Shanghai, China
| | - Xuen Yu
- Affiliated Hospital of the Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Dongyue Yue
- Department of Neurology, Jing'an District Center Hospital of Shanghai, Fudan University, Shanghai, China
| | - Changxia Liu
- Department of Neurology, The Fourth Affiliated Hospital of Nantong University, Yancheng, China
| | - Lijun Luo
- Department of Neurology, Wuhan No.1 Hospital, Wuhan, China
| | - Jianping Li
- Department of Geriatrics, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yanzhou Qu
- Department of Neurology, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Lan Chen
- Department of Neurology, Nantong first people's Hospital, Nantong, Jiangsu, China
| | - Jianglong Tu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chong Sun
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
| | - Chong Yan
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Song
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianying Xi
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Lin
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiahong Lu
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
| | - Chongbo Zhao
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenhua Zhu
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Wenhua Zhu
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Shanghai, China
- Qi Fang
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Al Shehri A, Al-Asmi A, Al Salti AM, Almadani A, Hassan A, Bamaga AK, Cupler EJ, Al-Hashel J, Alabdali MM, Alanazy MH, Noori S. A Multidisciplinary Perspective Addressing the Diagnostic Challenges of Late-Onset Pompe Disease in the Arabian Peninsula Region Developed From an Expert Group Meeting. J Neuromuscul Dis 2022; 9:661-673. [PMID: 35754286 PMCID: PMC9535603 DOI: 10.3233/jnd-220819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pompe disease is a rare, metabolic, autosomal recessive disorder. Early diagnosis is critical for progressive Pompe disease as delays can significantly alter the clinical course of the disease. Diagnostic modalities, including dried blood spot testing and genetic testing, are available and are effective for diagnosing patients with late-onset Pompe disease (LOPD). However, clinicians face numerous clinical challenges related to the diagnosis of the disease. Two expert group committee meetings, involving 11 experts from the United Arab Emirates, Kuwait, the Kingdom of Saudi Arabia, and Oman, were convened in October 2019 and November 2020 respectively to develop a uniform diagnostic algorithm for the diagnosis of pediatric and adult LOPD in the Arabian Peninsula region. During the first meeting, the specialty-specific clinical presentation of LOPD was defined. During the second meeting, a diagnostic algorithm was developed after a thorough validation of clinical presentation or symptoms, which was performed with the aid of existing literature and expert judgement. A consensus was reached on the diagnostic algorithm for field specialists, such as neurologists, rheumatologists, general practitioners/internal medicine specialists, orthopedic specialists, and pulmonologists. This specialty-specific diagnostic referral algorithm for pediatric and adult LOPD will guide clinicians in the differential diagnosis of LOPD.
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Affiliation(s)
- Ali Al Shehri
- Neuromuscular Integrated Practice Unit, Neuroscience Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdullah Al-Asmi
- Neurology Unit, Medicine Department, College of Medicine and Health Sciences andSultan Qabos University Hospital, Sultan Qaboos University, Muscat, Oman
| | | | | | - Ali Hassan
- Head of Neurology Department, Tawam Hospital, AlAin, Abu Dhabi, UAE
| | - Ahmed K Bamaga
- Neurology Division, Pediatric Department, Faculty of Medicine, King Abdulaziz University Hospital, King Abdulaziz University, Pediatric Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Edward J Cupler
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Jasem Al-Hashel
- Head of Department Neurology, Ebn Sina Neurosurgery Center, Al Jahra, Kuwait
| | - Majed M Alabdali
- Department of Neurology, College of Medicine, Imam Abdulrahman bin Faisal University
| | - Mohammed H Alanazy
- Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Suzan Noori
- Head of Department Neurology, University Hospital of Sharjah (UHS), Milahah, UAE
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He X, Li X, Lin Y, Ba H, Peng H, Zhang L, Zhu L, Qin Y, Li S. Duchenne Muscular Dystrophy With Low Acidic α-Glucosidase Activity: Two Case Reports and Literature Review. Front Pediatr 2022; 10:855510. [PMID: 35722482 PMCID: PMC9200123 DOI: 10.3389/fped.2022.855510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pompe disease is usually considered in children with elevated creatine kinase (CK) levels and decreased acidic α-glucosidase (GAA) enzyme activity. However, there are exceptions, such as GAA pseudo deficiency alleles, which result in lower GAA enzyme activity but do not cause Pompe disease. Here, we report two cases presenting with high CK levels and low GAA activity who were ultimately diagnosed with Duchenne muscular dystrophy (DMD). CASE PRESENTATION Case 1 patient was a 2-month-old boy who presented with an extremely high serum CK level (5,480∼11,880 U/L) and low GAA activity (2.72 nmol/1 h/mg). The whole-exome sequencing did not find the pathogenic GAA gene mutation, however, there was a DMD gene hemizygous variation (c. 7657C > T, p. Arg2553Ter) inherited from his mother, which was verified by the first-generation sequencing. Further genetic analysis of GAA identified two homozygous pseudo deficiency alleles (c.1726G > A, p. Gly576Ser and c.2065G > A, p. Glu689Lys), which were believed to induce the patient's low GAA activity. Therefore, the boy was diagnosed with DMD, although he had extremely low GAA activity. Case 2 patient was also a 2-month-old boy presenting with a significant increase in CK level (12,408∼24,828 U/L). His blood GAA activity (colorimetric method) was 9.02 nmol/1 h/mg. Similarly, his whole-exome sequencing did not find the pathogenic mutation of the GAA gene, but a DMD gene hemizygous variation (c.5571del, p. Lys1857AsnfsTer8), hence he was diagnosed with DMD as well. Regarding GAA activity, the case 2 patient was not as low as the case 1 patient, mainly because his two GAA pseudo deficiency alleles were heterozygous. CONCLUSION Pompe disease is usually screened in infants with high CK levels. We should be aware that pseudo deficiency alleles can cause low GAA activities but not Pompe disease. Genetic tests would be helpful to distinguish cases with GAA pseudo deficiency alleles from patients with some muscular disorder diseases such as DMD.
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Affiliation(s)
- Xiufang He
- Department of Pediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Xuandi Li
- Department of Pediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Yuese Lin
- Department of Pediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Hongjun Ba
- Department of Pediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Huimin Peng
- Department of Pediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Lili Zhang
- Department of Pediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Ling Zhu
- Department of Pediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Youzhen Qin
- Department of Pediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
| | - Shujuan Li
- Department of Pediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Key Laboratory on Assisted Circulation, Ministry of Health, Guangzhou, China
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Wencel M, Shaibani A, Goyal NA, Dimachkie MM, Trivedi J, Johnson NE, Gutmann L, Wicklund MP, Bandyopadhay S, Genge AL, Freimer ML, Goyal N, Pestronk A, Florence J, Karam C, Ralph JW, Rasheed Z, Hays M, Hopkins S, Mozaffar T. Investigating Late-Onset Pompe Prevalence in Neuromuscular Medicine Academic Practices: The IPaNeMA Study. Neurol Genet 2021; 7:e623. [PMID: 36299500 PMCID: PMC9595038 DOI: 10.1212/nxg.0000000000000623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/25/2021] [Accepted: 08/03/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVES We investigated the prevalence of late-onset Pompe disease (LOPD) in patients presenting to 13 academic, tertiary neuromuscular practices in the United States and Canada. METHODS All successive patients presenting with proximal muscle weakness or isolated hyperCKemia and/or neck muscle weakness to these 13 centers were invited to participate in the study. Whole blood was tested for acid alpha-glucosidase (GAA) assay through the fluorometric method, and all cases with enzyme levels of ≤10 pmoL/punch/h were reflexed to molecular testing for mutations in the GAA gene. Clinical and demographic information was abstracted from their clinical visit and, along with study data, entered into a purpose-built REDCap database, and analyzed at the University of California, Irvine. RESULTS GAA enzyme assay results were available on 906 of the 921 participants who consented for the study. LOPD was confirmed in 9 participants (1% prevalence). Another 9 (1%) were determined to have pseudodeficiency of GAA, whereas 19 (1.9%) were found to be heterozygous for a pathogenic GAA mutation (carriers). Of the definite LOPD participants, 8 (89%) were Caucasian and were heterozygous for the common leaky (IVS1) splice site mutation in the GAA gene (c -32-13T>G), with a second mutation that was previously confirmed to be pathogenic. DISCUSSION The prevalence of LOPD in undiagnosed patients meeting the criteria of proximal muscle weakness, high creatine kinase, and/or neck weakness in academic, tertiary neuromuscular practices in the United States and Canada is estimated to be 1%, with an equal prevalence rate of pseudodeficiency alleles. TRIAL REGISTRATION INFORMATION Clinical trial registration number: NCT02838368.
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Park KS. Two Approaches for a Genetic Analysis of Pompe Disease: A Literature Review of Patients with Pompe Disease and Analysis Based on Genomic Data from the General Population. CHILDREN-BASEL 2021; 8:children8070601. [PMID: 34356580 PMCID: PMC8305265 DOI: 10.3390/children8070601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 12/27/2022]
Abstract
In this study, two different approaches were applied in the analysis of the GAA gene. One was analyzed based on patients with Pompe disease, and the other was analyzed based on GAA genomic data from unaffected carriers in a general population genetic database. For this, GAA variants in Korean and Japanese patients reported in previous studies and in patients reported in the Pompe disease GAA variant database were analyzed as a model. In addition, GAA variants in the Korean Reference Genome Database (KRGDB), the Japanese Multi Omics Reference Panel (jMorp), and the Genome Aggregation Database (gnomAD) were analyzed. Overall, approximately 50% of the pathogenic or likely pathogenic variants (PLPVs) found in unaffected carriers were also found in real patients with Pompe disease (Koreans, 57.1%; Japanese, 46.2%). In addition, there was a moderate positive correlation (Spearman's correlation coefficient of 0.45-0.69) between the proportion of certain PLPVs in patients and the minor allele frequency of their variants in a general population database. Based on the analysis of general population databases, the total carrier frequency for Pompe disease in Koreans and Japanese was estimated to be 1.7% and 0.7%, respectively, and the predicted genetic prevalence was 1:13,657 and 1:78,013, respectively.
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Affiliation(s)
- Kyung-Sun Park
- Department of Laboratory Medicine, Kyung Hee University School of Medicine and Kyung Hee University Medical Center, Seoul 02447, Korea
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Tang H, Feuchtbaum L, Sciortino S, Matteson J, Mathur D, Bishop T, Olney RS. The First Year Experience of Newborn Screening for Pompe Disease in California. Int J Neonatal Screen 2020; 6:9. [PMID: 33073007 PMCID: PMC7422988 DOI: 10.3390/ijns6010009] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 02/05/2020] [Indexed: 12/22/2022] Open
Abstract
The California Department of Public Health started universal newborn screening for Pompe disease in August 2018 with a two-tier process including: (1) acid alpha-glucosidase (GAA) enzyme activity assay followed by, (2) GAA gene sequencing analysis. This study examines results from the first year of screening in a large and diverse screening population. With 453,152 screened newborns, the birth prevalence and GAA enzyme activity associated with various types of Pompe disease classifications are described. The frequency of GAA gene mutations and allele variants are reported. Of 88 screen positives, 18 newborns were resolved as Pompe disease, including 2 classic infantile-onset and 16 suspected late-onset form. The c.-32-13T>G variant was the most common pathogenic mutation reported. African American and Asian/Pacific Islander newborns had higher allele frequencies for both pathogenic and pseudodeficiency variants. After the first year of Pompe disease screening in California, the disease distribution in the population is now better understood. With the ongoing long-term follow-up system currently in place, our understanding of the complex genotype-phenotype relationships will become more evident in the future, and this should help us better understand the clinical significance of identified cases.
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Affiliation(s)
- Hao Tang
- Genetic Disease Screening Program, California Department of Public Health, 850 Marina Bay Parkway, MS 8200, USA; (L.F.); (S.S.); (J.M.); (D.M.); (T.B.); (R.S.O.)
| | - Lisa Feuchtbaum
- Genetic Disease Screening Program, California Department of Public Health, 850 Marina Bay Parkway, MS 8200, USA; (L.F.); (S.S.); (J.M.); (D.M.); (T.B.); (R.S.O.)
| | - Stanley Sciortino
- Genetic Disease Screening Program, California Department of Public Health, 850 Marina Bay Parkway, MS 8200, USA; (L.F.); (S.S.); (J.M.); (D.M.); (T.B.); (R.S.O.)
| | - Jamie Matteson
- Genetic Disease Screening Program, California Department of Public Health, 850 Marina Bay Parkway, MS 8200, USA; (L.F.); (S.S.); (J.M.); (D.M.); (T.B.); (R.S.O.)
| | - Deepika Mathur
- Genetic Disease Screening Program, California Department of Public Health, 850 Marina Bay Parkway, MS 8200, USA; (L.F.); (S.S.); (J.M.); (D.M.); (T.B.); (R.S.O.)
| | - Tracey Bishop
- Genetic Disease Screening Program, California Department of Public Health, 850 Marina Bay Parkway, MS 8200, USA; (L.F.); (S.S.); (J.M.); (D.M.); (T.B.); (R.S.O.)
| | - Richard S Olney
- Genetic Disease Screening Program, California Department of Public Health, 850 Marina Bay Parkway, MS 8200, USA; (L.F.); (S.S.); (J.M.); (D.M.); (T.B.); (R.S.O.)
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Jastrzębska A, Potulska‐Chromik A, Łusakowska A, Jastrzębski M, Lipowska M, Kierdaszuk B, Kamińska A, Kostera‐Pruszczyk A. Screening for late-onset Pompe disease in Poland. Acta Neurol Scand 2019; 140:239-243. [PMID: 31125121 DOI: 10.1111/ane.13133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 04/06/2019] [Accepted: 04/18/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We aimed to screen for late-onset Pompe disease using the dried blood spot (DBS) test in a cohort of patients with limb-girdle muscle weakness or persistent hyperCKemia. MATERIALS AND METHODS Patients with limb-girdle muscle weakness, persistently elevated CK, rigid spine syndrome, dyspnoea, myalgia or sibling of the patient diagnosed with LOPD were included in the study. Acid α-glucosidase (GAA) activity was measured on DBS by tandem mass spectrometry and followed by genetic testing when required. Study was conducted between June 2014 and May 2017. RESULTS A total of 337 patients aged 32.2 years (range 2-80) were included in the study. Late-onset Pompe disease was diagnosed in 10 patients (3.0% of tested cohort). All were compound heterozygotes with common c.32-13T>G mutation on one allele and missense or frameshift mutation on the other. Two of the mutations (c.1951delG and c.397T>G) were not reported previously. Seven of the patients started enzyme replacement therapy. CONCLUSIONS DBS test is a reliable method for screening for late-onset Pompe disease.
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Affiliation(s)
| | | | - Anna Łusakowska
- Department of Neurology Medical University of Warsaw Warsaw Poland
| | - Miłosz Jastrzębski
- Department of Gastroenterology and Internal Medicine Medical University of Warsaw Warsaw Poland
| | - Marta Lipowska
- Department of Neurology Medical University of Warsaw Warsaw Poland
| | | | - Anna Kamińska
- Department of Neurology Medical University of Warsaw Warsaw Poland
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Remiche G, Lukacs Z, Kasper DC, Abramowicz M, Pandolfo M. Low Prevalence Estimates of Late-Onset Glycogen Storage Disease Type II in French-Speaking Belgium are not Due to Missed Diagnoses. J Neuromuscul Dis 2018; 5:471-480. [PMID: 30175981 DOI: 10.3233/jnd-180336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Late-onset glycogen storage disease type II is associated with variable muscle phenotypes. Epidemiological data suggest that its prevalence is lower in Belgium than in bordering countries like The Netherlands. OBJECTIVE We investigated whether such low estimated prevalence is due to missed diagnoses. METHODS We screened 100 patients with muscle phenotypes of undetermined origin using a dried blood spot test for alpha-acid glucosidase (GAA) activity. Patients with low activity at screening were re-tested by the same method and, if low activity was confirmed, GAA gene analysis was performed. RESULTS The screening test revealed lower than normal GAA activity in 15 patients, but in only two of them it was low enough to be considered in the disease range. Retesting confirmed lower than normal GAA activity in five patients, but in all of them it was above the disease range. A single patient carried a heterozygous known pathogenic GAA mutation, whose significance in this case remains undetermined. CONCLUSIONS We conclude that reported low prevalence estimates in Belgium are not likely to be due to an underdiagnosis bias. Lower prevalence compared to neighbouring The Netherlands may be due to different ethnic stratification of our patients. Diagnostic strategies should keep into account the expected prevalence of a disease in specific populations.
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Affiliation(s)
- Gauthier Remiche
- Department of Neurology, Centre de Référence Neuromusculaire, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium
| | - Zoltan Lukacs
- Newborn Screening and Metabolic Diagnostics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - David C Kasper
- ARCHIMED Life Science GmbH, Vienna, Austria. ARCHIMEDlife Laboratories, Leberstraße 20/2 1110 Vienna, Austria
| | - Marc Abramowicz
- Department of Medical Genetics, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium
| | - Massimo Pandolfo
- Department of Neurology, Centre de Référence Neuromusculaire, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium
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Mashima R, Okuyama T. Enzyme activities of α-glucosidase in Japanese neonates with pseudodeficiency alleles. Mol Genet Metab Rep 2017; 12:110-114. [PMID: 28725570 PMCID: PMC5503834 DOI: 10.1016/j.ymgmr.2017.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 11/25/2022] Open
Abstract
Lysosomal storage disorders (LSDs) are caused by defective enzyme activities in lysosomes, characterized by the accumulation of sphingolipids, glycolipids, oligosaccharides, mucopolysaccharides, the oxidation products of cholesterol, and other biological substances. A growing number of clinical studies have suggested the enhanced efficacy of existing therapies, including enzyme replacement therapy, which is effective when it is initiated during the presymptomatic period. Thus, the identification of disease-affected individuals by newborn screening has been considered an effective platform. Previous studies have suggested that the discrimination of infantile-onset Pompe disease (IOPD) requires multi-step examination of GAA enzyme activity using the fluorometric technique. In sharp contrast, the MS/MS-based technique can identify the population of IOPD and the pseudodeficiency alleles of the GAA enzyme [Liao HC et al. Clin Chem (2017) in press; doi: http://dx.doi.org/10.1373/clinchem.2016.269027]. To determine whether MS/MS-based assay can identify these two populations in Japanese neonates, we first performed a validation study of this assay using flow-injection analysis (FIA)-MS/MS and liquid chromatography (LC)-MS/MS followed by examination of GAA enzyme activity in our population. By minimizing the effect of substrate-derived in-source decomposition products, the activities of 6 LSD enzymes were quantified in FIA-MS/MS and LC-MS/MS. The mean value of GAA activity with IOPD, pseudodeficiency alleles, and healthy controls by FIA-MS/MS were 1.0 ± 0.3 μmol/h/L (max, 1.3; min, 0.7; median, 1.2; n = 3), 2.7 ± 0.7 μmol/h/L (max, 4.5; min, 1.5; median, 2.5; n = 19), and 12.9 ± 5.4 μmol/h/L (max, 29.6; min, 2.5; median, 11.0; n = 83), respectively. These results suggest that the population of GAA with pseudodeficiency alleles has approximately 20% of GAA enzyme activity compared to controls, providing the preliminary evidence to estimate the cut-off values in the Japanese population using this technique.
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Affiliation(s)
- Ryuichi Mashima
- Department of Clinical Laboratory Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Torayuki Okuyama
- Department of Clinical Laboratory Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
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