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Będkowska N, Zontek A, Paprocka J. Stroke-like Episodes in Inherited Neurometabolic Disorders. Metabolites 2022; 12:metabo12100929. [PMID: 36295831 PMCID: PMC9611026 DOI: 10.3390/metabo12100929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 11/07/2022] Open
Abstract
Stroke-like episodes (SLEs) are significant clinical manifestations of metabolic disorders affecting the central nervous system. Morphological equivalents presented in neuroimaging procedures are described as stroke-like lesions (SLLs). It is crucial to distinguish SLEs from cerebral infarction or intracerebral hemorrhage, mainly due to the variety in management. Another significant issue to underline is the meaning of the main pathogenetic hypotheses in the development of SLEs. The diagnostic process is based on the patient’s medical history, physical and neurological examination, neuroimaging techniques and laboratory and genetic testing. Implementation of treatment is generally symptomatic and includes L-arginine supplementation and adequate antiepileptic management. The main aim of the current review was to summarize the basic and actual knowledge about the occurrence of SLEs in various inherited neurometabolic disorders, discuss the possible pathomechanism of their development, underline the role of neuroimaging in the detection of SLLs and identification of the electroencephalographic patterns as well as histological abnormalities in inherited disorders of metabolism.
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Affiliation(s)
- Natalia Będkowska
- Students’ Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Aneta Zontek
- Students’ Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
| | - Justyna Paprocka
- Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
- Correspondence:
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Xiong M, Chen M. Citrullinemia type I in Chinese children: Identification of two novel argininosuccinate synthetase gene mutations. Front Pediatr 2022; 10:992156. [PMID: 36263152 PMCID: PMC9574338 DOI: 10.3389/fped.2022.992156] [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: 07/12/2022] [Accepted: 09/14/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND In this study, we evaluated the clinical characteristics, prognosis, and gene mutations of five children with citrullinemia type I (CTLN1) diagnosed in our department and identified two novel ASS1 gene mutations. METHODS We examined the clinical characteristics, prognosis, and gene mutations of the five children through data collection, tandem mass spectrometry, and whole-exon sequencing. MutationTaster, regSNP-intron, and SWISS-MODEL were used for bioinformatic analysis to evaluate the two novel gene mutations. We analyzed differences in blood ammonia and citrulline levels based on clinical phenotypes. Finally, we reviewed the medical literature describing Chinese children with CTLN1. RESULTS ASS1 C773 + 6T > G and c.848 delA as well as c.952_953 del insTT and c.133G > A have not been previously reported in the Human Gene Mutation Database. Using MutationTaster and regSNP-intron, we predicted that these mutations affected protein function. The 3D structure obtained using SWISS-MODEL supported this prediction. Through comparative analysis showed that the ammonia level of the neonatal type was markedly higher than that of other types, whereas citrulline levels did not differ between groups. CONCLUSION We identified two novel mutations that cause disease. The blood ammonia level of neonatal form citrullinemia was markedly higher than that of other types. The genotype-phenotype association in Chinese patients remains unclear and should be further evaluated in genetic studies of larger sample sizes.
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Affiliation(s)
- Mei Xiong
- Department of Pediatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Mingwu Chen
- Department of Pediatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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Oltman SP, Rogers EE, Baer RJ, Jasper EA, Anderson JG, Steurer MA, Pantell MS, Petersen MA, Partridge JC, Karasek D, Ross KM, Feuer SK, Franck LS, Rand L, Dagle JM, Ryckman KK, Jelliffe-Pawlowski LL. Newborn metabolic vulnerability profile identifies preterm infants at risk for mortality and morbidity. Pediatr Res 2021; 89:1405-1413. [PMID: 33003189 PMCID: PMC8061535 DOI: 10.1038/s41390-020-01148-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Identifying preterm infants at risk for mortality or major morbidity traditionally relies on gestational age, birth weight, and other clinical characteristics that offer underwhelming utility. We sought to determine whether a newborn metabolic vulnerability profile at birth can be used to evaluate risk for neonatal mortality and major morbidity in preterm infants. METHODS This was a population-based retrospective cohort study of preterm infants born between 2005 and 2011 in California. We created a newborn metabolic vulnerability profile wherein maternal/infant characteristics along with routine newborn screening metabolites were evaluated for their association with neonatal mortality or major morbidity. RESULTS Nine thousand six hundred and thirty-nine (9.2%) preterm infants experienced mortality or at least one complication. Six characteristics and 19 metabolites were included in the final metabolic vulnerability model. The model demonstrated exceptional performance for the composite outcome of mortality or any major morbidity (AUC 0.923 (95% CI: 0.917-0.929). Performance was maintained across mortality and morbidity subgroups (AUCs 0.893-0.979). CONCLUSIONS Metabolites measured as part of routine newborn screening can be used to create a metabolic vulnerability profile. These findings lay the foundation for targeted clinical monitoring and further investigation of biological pathways that may increase the risk of neonatal death or major complications in infants born preterm. IMPACT We built a newborn metabolic vulnerability profile that could identify preterm infants at risk for major morbidity and mortality. Identifying high-risk infants by this method is novel to the field and outperforms models currently in use that rely primarily on infant characteristics. Utilizing the newborn metabolic vulnerability profile for precision clinical monitoring and targeted investigation of etiologic pathways could lead to reductions in the incidence and severity of major morbidities associated with preterm birth.
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Affiliation(s)
- Scott P. Oltman
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California,Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
| | - Elizabeth E. Rogers
- Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - Rebecca J. Baer
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California,Department of Pediatrics, University of California San Diego, La Jolla, CA
| | | | - James G. Anderson
- Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - Martina A. Steurer
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California,Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - Matthew S. Pantell
- Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - Mark A. Petersen
- Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - J. Colin Partridge
- Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - Deborah Karasek
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California,Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Kharah M. Ross
- Owerko Centre, Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta
| | - Sky K. Feuer
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California,Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Linda S. Franck
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California,School of Nursing, University of California San Francisco, San Francisco California
| | - Larry Rand
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California,Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - John M. Dagle
- Department of Pediatric, University of Iowa, Iowa City, IA
| | - Kelli K. Ryckman
- Department of Epidemiology, University of Iowa, Iowa City, IA,Department of Pediatric, University of Iowa, Iowa City, IA
| | - Laura L. Jelliffe-Pawlowski
- California Preterm Birth Initiative, University of California San Francisco, San Francisco, California,Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
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Delmonego L, Maia TP, Delwing-Dal Magro D, Vincenzi KL, Lima AB, Pscheidt LC, Eger L, Delwing-de Lima D. Protective effect of resveratrol on citrullinemia type I-induced brain oxidative damage in male rats. Metab Brain Dis 2021; 36:685-699. [PMID: 33555496 DOI: 10.1007/s11011-020-00655-7] [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: 07/06/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
Citrullinemia Type I is an inborn error, which leads to accumulation of citrulline and ammonia in blood and body tissues. We evaluated the in vitro effects of citrulline, ammonia and the influence of resveratrol on oxidative stress parameters in the cerebrum of 30- and 60-day-old male Wistar rats. Citrulline (0.1, 2.5, 5.0 mM), ammonia (0.01, 0.1, 1.0 mM) and resveratrol (0.01, 0.1, 0.5 mM) were added to the assays to measure thiobarbituric acid reactive substances (TBA-RS), total sulfhydryl content and the activity of antioxidant enzymes catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px). Citrulline (2.5 and 5.0 mM) increased TBA-RS in the cerebellum of 30-day-old and in the cerebral cortex and cerebellum of 60-day-old. Citrulline (5.0 mM) increased SOD and reduced GSH-Px in the hippocampus of 30-day-old, whereas in the cerebellum it increased GSH-Px. In the cerebral cortex, 2.5 and 5.0 mM citrulline reduced GSH-Px. In 60-day-old, 2.5 and 5.0 mM citrulline increased SOD in the cerebellum, increased GSH-Px in the cerebral cortex and 5.0 mM citrulline reduced CAT and increased SOD in the cerebral cortex. Ammonia (0.1 and 1.0 mM) reduced the sulfhydryl content in the cerebral cortex of 30- and 60-day-old, 1.0 mM ammonia increased SOD and reduced GSH-Px in the cerebellum of 30-day-old and increased SOD in the hippocampus and cerebellum of 60-day-old. Resveratrol was able to prevent the majority of these alterations. Thus, citrulline and ammonia induce oxidative stress in the cerebrum of rats; however, resveratrol was able to exert antioxidant effects against these substances.
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Affiliation(s)
- Larissa Delmonego
- Programa de Pós-Graduação em Saúde e Meio Ambiente, Universidade da Região de Joinville - UNIVILLE, Rua Paulo Malschitzki, 10 - Zona Industrial Norte, Joinville, SC, CEP 89201-972, Brazil
| | - Thayná Patachini Maia
- Departamento de Medicina, Universidade da Região de Joinville - UNIVILLE, Rua Paulo Malschitzki, 10 - Zona Industrial Norte, Joinville, SC, CEP 89201-972, Brazil
| | - Débora Delwing-Dal Magro
- Departamento de Ciências Naturais, Centro de Ciências Exatas e Naturais, Universidade Regional de Blumenau - FURB, Rua Antônio da Veiga, 140, Blumenau, SC, CEP 89012-900, Brazil
| | - Karine Louize Vincenzi
- Programa de Pós-Graduação em Saúde e Meio Ambiente, Universidade da Região de Joinville - UNIVILLE, Rua Paulo Malschitzki, 10 - Zona Industrial Norte, Joinville, SC, CEP 89201-972, Brazil
| | - Aline Barbosa Lima
- Programa de Pós-Graduação em Saúde e Meio Ambiente, Universidade da Região de Joinville - UNIVILLE, Rua Paulo Malschitzki, 10 - Zona Industrial Norte, Joinville, SC, CEP 89201-972, Brazil
| | - Luana Carla Pscheidt
- Departamento de Farmácia, Universidade da Região de Joinville - UNIVILLE, Rua Paulo Malschitzki, 10 - Zona Industrial Norte, Joinville, SC, CEP 89201-972, Brazil
| | - Letícia Eger
- Departamento de Farmácia, Universidade da Região de Joinville - UNIVILLE, Rua Paulo Malschitzki, 10 - Zona Industrial Norte, Joinville, SC, CEP 89201-972, Brazil
| | - Daniela Delwing-de Lima
- Programa de Pós-Graduação em Saúde e Meio Ambiente, Universidade da Região de Joinville - UNIVILLE, Rua Paulo Malschitzki, 10 - Zona Industrial Norte, Joinville, SC, CEP 89201-972, Brazil.
- Departamento de Medicina, Universidade da Região de Joinville - UNIVILLE, Rua Paulo Malschitzki, 10 - Zona Industrial Norte, Joinville, SC, CEP 89201-972, Brazil.
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Liu Y, Luo Y, Xia L, Qiu B, Zhou T, Feng M, Wang C, Xue F, Chen X, Han L, Zhang J, Xia Q. Outcome of Liver Transplantation for Neonatal-onset Citrullinemia Type I. Transplantation 2021; 105:569-576. [PMID: 33617202 DOI: 10.1097/tp.0000000000003261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND We evaluated the outcome of liver transplantation (LT) in neonatal-onset citrullinemia type I patients, especially its impact on neurological deficits and developmental retardation. METHODS From October 2006 to October 2019, 5 of the 2003 children who received LT at Ren Ji Hospital had been diagnosed with citrullinemia type I. The primary indication for transplantation was repeated metabolic compensation and developmental retardation in 4 patients and prophylactic transplantation in the other. Among them, 3 patients received living donor LT and 2 received orthotopic LT. RESULTS All recipients had successfully recovered within the median follow-up period of 32 months (range, 6-54 mo). Transplantation restored citrulline metabolism and liver function. Plasma ammonia and citrulline concentration decreased to normal levels with no further hyperammonemic episodes being reported, even after normal diet intake began. Meanwhile, uracil-2 and orotic acid were not detected in urinary excretion. Strikingly, patients suffered developmental retardation before LT showed improved psychomotor ability and significant catch-up growth during the follow-up period. Cognitive ability, including language skills and academic performance, also greatly improved. Three patients had sustained brain injuries and exhibited severe neurological deficits before transplantation, especially repeated generalized tonic-clonic seizures. LT halted neurological deterioration and controlled seizure episodes, which further facilitated the intellectual development and improvement of life quality. CONCLUSIONS LT is an effective treatment for neonatal-onset citrullinemia type I patients, which reverses metabolism decompensation and improves quality of life. For patients who have suffered severe hyperammonemic insults, LT should be conducted at an early age to avoid further neurological or developmental deficits.
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Affiliation(s)
- Yuan Liu
- Department of Liver Surgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Vincenzi KL, Maia TP, Delmônego L, Lima AB, Pscheidt LC, Delwing-Dal Magro D, Delwing-de Lima D. Effects of resveratrol on alterations in cerebrum energy metabolism caused by metabolites accumulated in type I citrullinemia in rats. Naunyn Schmiedebergs Arch Pharmacol 2020; 394:873-884. [PMID: 33205249 DOI: 10.1007/s00210-020-02017-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/04/2020] [Indexed: 02/06/2023]
Abstract
We investigated the in vitro effects of citrulline (0.1, 2.5 and 5.0 mM) and ammonia (0.01, 0.1 and 1.0 mM), and the influence of resveratrol (0.01 mM, 0.1 mM and 0.5 mM) on pyruvate kinase, citrate synthase, succinate dehydrogenase (SDH), complex II, and cytochrome c oxidase activities in cerebral cortex, cerebellum and hippocampus homogenates of 60-day-old male Wistar rats. Results showed that 2.5 and 5.0 mM citrulline decreased pyruvate kinase activity in cerebral cortex and, at a concentration of 5.0 mM, increased its activity in hippocampus. Additionally, 5.0 mM citrulline increased citrate synthase activity in the cerebellum of rats. Citrulline (5.0 mM) reduced complex II and cytochrome c oxidase activities in cerebral cortex and hippocampus. With regard to ammonia, at 0.1 and 1.0 mM, decreased complex II activity in cerebral cortex and at 1.0 mM decreased its activity in cerebellum and hippocampus. Ammonia (1.0 mM) also decreased cytochrome c oxidase activity in cerebral cortex and cerebellum of rats. Resveratrol was able to prevent most of the alterations caused by these metabolites in the biomarkers of energy metabolism measured in the cerebrum of rats. Data suggest that these alterations in energy metabolism, caused by citrulline and ammonia, are probably mediated by the generation of free radicals, which can in turn be scavenged by resveratrol.
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Affiliation(s)
- Karine Louize Vincenzi
- Programa de Pós Graduação em Saúde e Meio Ambiente, Universidade da Região de Joinville - UNIVILLE, Rua Paulo Malschitzki,10- Zona Industrial Norte, Joinville, SC, 89201-972, Brazil
| | - Thayna Patachini Maia
- Departamento de Medicina, Universidade da Região de Joinville - UNIVILLE, Rua Paulo Malschitzki, 10- Zona Industrial Norte, Joinville, SC, 89201-972, Brazil
| | - Larissa Delmônego
- Programa de Pós Graduação em Saúde e Meio Ambiente, Universidade da Região de Joinville - UNIVILLE, Rua Paulo Malschitzki,10- Zona Industrial Norte, Joinville, SC, 89201-972, Brazil
| | - Aline Barbosa Lima
- Programa de Pós Graduação em Saúde e Meio Ambiente, Universidade da Região de Joinville - UNIVILLE, Rua Paulo Malschitzki,10- Zona Industrial Norte, Joinville, SC, 89201-972, Brazil
| | - Luana Carla Pscheidt
- Departamento de Farmácia, Universidade da Região de Joinville - UNIVILLE, Rua Paulo Malschitzki, 10- Zona Industrial Norte, Joinville, SC, 89201-972, Brazil
| | - Débora Delwing-Dal Magro
- Departamento de Ciências Naturais, Centro de Ciências Exatas e Naturais, Universidade Regional de Blumenau, Rua Antônio daVeiga,140, Blumenau, SC, 89012-900, Brazil
| | - Daniela Delwing-de Lima
- Programa de Pós Graduação em Saúde e Meio Ambiente, Universidade da Região de Joinville - UNIVILLE, Rua Paulo Malschitzki,10- Zona Industrial Norte, Joinville, SC, 89201-972, Brazil. .,Departamento de Medicina, Universidade da Região de Joinville - UNIVILLE, Rua Paulo Malschitzki, 10- Zona Industrial Norte, Joinville, SC, 89201-972, Brazil.
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Fujita H, Teratani M, Hazama Y, Nakahara M, Asaka H, Nishimura S. Use of potassium adsorption filter for the removal of ammonia and potassium from red blood cell solution for neonates. Transfusion 2018; 58:2383-2387. [PMID: 30178874 DOI: 10.1111/trf.14897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/12/2018] [Accepted: 07/12/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Ammonia in the plasma usually does not pass through the blood-brain barrier (BBB). However, it can affect the brain as a neurotoxin in neonates with anemia of prematurity. Excess intake of ammonia should therefore be restricted in conditions involving BBB breakdown, such as in premature neonates. A potassium adsorption filter (PAF) can remove not only potassium, but also ammonia from red blood cell (RBC) solution. PAF for neonates (PAF-n) has been recently introduced using small satellite packs. We evaluated the effects of PAF-n on the removal of ammonia and potassium from RBC solution in small satellite packs. STUDY DESIGN AND METHODS RBC solutions were obtained from the Japanese Red Cross Society. Two units of RBC solution (280 mL) were divided into four satellite packs (70 mL/pack). The RBC solution was passed through PAF-n (Kawasumi Laboratories Inc.) that was primed with saline (100 mL) before use. The concentrations of ammonia and potassium were measured in the solution before and after filtration (four samples of 10 mL each of filtered RBC solution) by Biomedical Laboratories. RESULTS Approximately 47 to 82 and 84% to 93% of ammonia and potassium were removed from the RBC solution, respectively, without dilution with saline. CONCLUSION PAF-n can remove ammonia and potassium from RBC solution in small satellite packs. PAF-n could therefore improve the clinical prognosis of neonates with poorly developed BBB by limiting the delivery of excess ammonia found in the RBC solution.
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Affiliation(s)
- Hiroshi Fujita
- Department of Transfusion Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Miyuki Teratani
- Clinical Laboratory, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Yuki Hazama
- Clinical Laboratory, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Michiyo Nakahara
- Clinical Laboratory, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Hiroyuki Asaka
- Clinical Laboratory, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Shigeko Nishimura
- Department of Transfusion Medicine, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
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Öztürk Z, Hirfanoğlu T, İnci A, Okur İ, Koç E, Tümer L, Arhan E, Aydın K, Serdaroğlu A. Citrullinemia with an Atypical Presentation: Paroxysmal Hypoventilation Attacks. J Pediatr Neurosci 2018; 13:276-278. [PMID: 30090157 PMCID: PMC6057205 DOI: 10.4103/jpn.jpn_144_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Citrullinemia type 1 (CTLN1) is a rare inherited urea cycle disorder, which resulted from the deficiency of argininosuccinate synthetase enzyme. We presented an infant who was hospitalized because of acute losses of tonus and cyanotic hypoventilation attacks lasting approximately 4–5 min. The physical and neurological examinations were normal. Ammonia level was in the normal range. Citrulline levels increased in both blood and urine. The blood sample was sent to mutation analysis, which showed one novel and one known mutation on ASS1 gene sequencing: a heterozygous novel mutation p.A94V (c.281C>T) and a heterozygous mutation p.W179R (c.535C>T). Urea cycle disorders should be considered in the differential diagnosis of unexplained brief apnea or hypoventilation attacks, even though those symptoms do not lead to hyperammonemia during infancy and childhood as seen in our patient. This is the first case in terms of atypical clinical presentation with a new mutation for CTLN1.
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Affiliation(s)
- Zeynep Öztürk
- Department of Pediatric Neurology, Ankara Pediatric and Pediatric Hematology Oncology Training and Research Hospital, Gazi University School of Medicine, Ankara, Turkey
| | - Tuğba Hirfanoğlu
- Department of Pediatric Neurology, Gazi University School of Medicine, Ankara, Turkey
| | - Aslı İnci
- Department of Metabolism, Gazi University School of Medicine, Ankara, Turkey
| | - İlyas Okur
- Department of Metabolism, Gazi University School of Medicine, Ankara, Turkey
| | - Esin Koç
- Department of Neonatology, Gazi University School of Medicine, Ankara, Turkey
| | - Leyla Tümer
- Department of Metabolism, Gazi University School of Medicine, Ankara, Turkey
| | - Ebru Arhan
- Department of Pediatric Neurology, Gazi University School of Medicine, Ankara, Turkey
| | - Kürşad Aydın
- Department of Pediatric Neurology, Gazi University School of Medicine, Ankara, Turkey
| | - Ayşe Serdaroğlu
- Department of Pediatric Neurology, Gazi University School of Medicine, Ankara, Turkey
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Effects of potassium adsorption filters on the removal of ammonia from blood products. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 16:173-177. [PMID: 28287384 DOI: 10.2450/2017.0231-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/09/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although ammonia in plasma does not usually pass through the blood-brain barrier (BBB), in cases of traumatic brain injury it may do so, acting as a neurotoxin on the brain. Excess intake of ammonia should be restricted in conditions involving BBB breakdown, such as traumatic brain injury. Washing is a method to remove ammonia from blood products, but fresh-frozen plasma and albumin products cannot be washed. A potassium adsorption filter (PAF) can remove not only potassium, but also ammonia from red blood cell solutions. We, therefore, examined the effects of a PAF on the removal of ammonia from a range of blood products. MATERIALS AND METHODS Ammonia concentrations were measured in expired red blood cell solutions, fresh-frozen plasma, and platelet concentrates and purchased albumin products before and after filtration through a PAF. The PAF was primed with saline, which was removed before the filter was used. RESULTS The percentages of ammonia removal from the red blood cell solutions, fresh-frozen plasma, plasma concentrates, 20% albumin and 5% albumin were approximately 76-87%, 21-31%, 53%, 77-92% and 49-63%, respectively. DISCUSSION A PAF appears capable of removing ammonia from a range of blood products, although the reason for the lesser effect on the ammonia concentration in fresh-frozen plasma compared to other blood products remains unknown. We hypothesise that, by lowering ammonia levels in blood products, the PAF could improve the clinical prognosis of neonates with an underdeveloped BBB or patients with BBB breakdown following traumatic brain injury.
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In Vivo NMR Studies of the Brain with Hereditary or Acquired Metabolic Disorders. Neurochem Res 2015; 40:2647-85. [PMID: 26610379 DOI: 10.1007/s11064-015-1772-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 11/10/2015] [Accepted: 11/12/2015] [Indexed: 01/09/2023]
Abstract
Metabolic disorders, whether hereditary or acquired, affect the brain, and abnormalities of the brain are related to cellular integrity; particularly in regard to neurons and astrocytes as well as interactions between them. Metabolic disturbances lead to alterations in cellular function as well as microscopic and macroscopic structural changes in the brain with diabetes, the most typical example of metabolic disorders, and a number of hereditary metabolic disorders. Alternatively, cellular dysfunction and degeneration of the brain lead to metabolic disturbances in hereditary neurological disorders with neurodegeneration. Nuclear magnetic resonance (NMR) techniques allow us to assess a range of pathophysiological changes of the brain in vivo. For example, magnetic resonance spectroscopy detects alterations in brain metabolism and energetics. Physiological magnetic resonance imaging (MRI) detects accompanying changes in cerebral blood flow related to neurovascular coupling. Diffusion and T1/T2-weighted MRI detect microscopic and macroscopic changes of the brain structure. This review summarizes current NMR findings of functional, physiological and biochemical alterations within a number of hereditary and acquired metabolic disorders in both animal models and humans. The global view of the impact of these metabolic disorders on the brain may be useful in identifying the unique and/or general patterns of abnormalities in the living brain related to the pathophysiology of the diseases, and identifying future fields of inquiry.
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