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Kanjia MK, Jooste EH, Illig M, Neifeld Capps J, Eisner C, Fan SZ, Lenarczyk J, Wojdacz R. Optimizing the anesthetic care of patients with aromatic l-amino acid decarboxylase deficiency. Paediatr Anaesth 2024. [PMID: 39435566 DOI: 10.1111/pan.15025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 09/23/2024] [Accepted: 10/07/2024] [Indexed: 10/23/2024]
Abstract
Aromatic l-amino acid decarboxylase (AADC) deficiency is a rare autosomal recessive disorder that results in a lack of the monoamine neurotransmitters dopamine, serotonin, norepinephrine, and epinephrine. Patients present with a wide spectrum of symptoms, including motor and autonomic dysfunction, hypotonia, and developmental delay, often before the age of one. Until recently, treatment options were limited to symptom control, but the recent approval of the first gene therapy for AADC deficiency in Europe and the UK has provided an alternative to treating symptoms for this disease. Eladocagene exuparvovec is a one-time gene therapy, administered bilaterally to the putamen by magnetic resonance imaging-guided stereotactic neurosurgery. While administration of the gene therapy itself is minimally invasive, the anesthetic management of patients with AADC deficiency is challenging due to the absence of sympathetic regulation secondary to the lack of adrenergic neurotransmitters. Optimal anesthetic management requires an understanding of the complex and heterogeneous nature of the disease. Hemodynamic instability, temperature dysregulation, and hypoglycemia are of primary concern, but there are also challenges regarding intravenous access and airway management. A thorough preoperative assessment is essential and should be guided by the patient's history. Advanced planning is necessary regarding the timing of the procedure schedule and operative plan; meticulous preparation, simulation for the operating room, as well as communication with all perioperative staff members, are crucial. Intraoperatively, utmost care must be taken to protect the skin, maintain body temperature, and to prepare for inotropic and/or glycemic support as needed. Postoperative intensive care management is necessary for consideration of postoperative extubation and provision of supportive care. With careful planning, preparation, and vigilance, patients with AADC deficiency can safely undergo anesthesia.
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Affiliation(s)
- Megha K Kanjia
- Texas Children's Hospital, Houston, Texas, USA
- Baylor College of Medicine, Houston, Texas, USA
| | - Edmund H Jooste
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Melissa Illig
- Boston Children's Hospital, Boston, Massachusetts, USA
| | | | | | - Shou Zen Fan
- National Taiwan University Hospital, Taipei, Taiwan
| | - Jerzy Lenarczyk
- University Center for Women's and Newborn Health, Warsaw, Poland
| | - Rafał Wojdacz
- University Center for Women's and Newborn Health, Warsaw, Poland
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2
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Kessler R, Fung FW, Patel A, Gupta N, McHugh T, Gonzalez AK, Rodan L, Harini C, Kessler SK. Diagnostic Yield of CSF Testing in Infants for Disorders of Biogenic Amine Neurotransmitter Metabolism. Neurology 2024; 102:e209300. [PMID: 38630946 DOI: 10.1212/wnl.0000000000209300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Biochemical testing of CSF for neurotransmitter metabolites and their cofactors is often used in the diagnostic evaluation of infants with neurologic disorders but requires an invasive, labor-intensive procedure with many potential sources of error. Our aim was to determine the diagnostic yield of CSF testing for biogenic amines (serotonin, norepinephrine, epinephrine, and dopamine) and their cofactors in identifying inborn errors of neurotransmitter metabolism among infants. METHODS We evaluated all infants aged 1 year or younger who underwent CSF biogenic amine neurotransmitter (CSFNT) testing at Children's Hospital of Philadelphia (CHOP) and Boston Children's Hospital (BCH) between 2008 and 2017 in this cross-sectional study. The primary outcome was the proportion of individuals who received a diagnostic result from CSFNT testing. Secondary assessments included the proportion of infants who obtained a diagnostic result from other types of diagnostic testing. RESULTS The cohort included 323 individuals (191 from CHOP and 232 from BCH). The median age at presentation was 110 days (range 36-193). The most common presenting features were seizures (71%), hypotonia (47%), and developmental delay (43%). The diagnostic yield of CSFNT testing was zero. When CSF pyridoxal-5-phosphate level was assayed with CSFNT testing, 1 patient had a diagnostic result. An etiologic diagnosis was identified in 163 patients (50%) of the cohort, with genetic testing having the highest yield (120 individuals, 37%). DISCUSSION Our findings support the case for deimplementation of CSFNT testing as a standard diagnostic test of etiology in infants aged 1 year or younger presenting with neurologic disorders.
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Affiliation(s)
- Riley Kessler
- From the Children's Hospital of Philadelphia (R.K., F.W.F., S.K.K.); Departments of Neurology and Pediatrics (F.W.F., S.K.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Inova Health System (A.P.), Fairfax, VA; Department of Neurology (N.G., L.R., C.H.), Boston Children's Hospital, MA; New York Medical College (T.M.), Valhalla, NY; and Department of Biomedical and Health Informatics (A.K.G.), Children's Hospital of Philadelphia Research Institute, PA
| | - France W Fung
- From the Children's Hospital of Philadelphia (R.K., F.W.F., S.K.K.); Departments of Neurology and Pediatrics (F.W.F., S.K.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Inova Health System (A.P.), Fairfax, VA; Department of Neurology (N.G., L.R., C.H.), Boston Children's Hospital, MA; New York Medical College (T.M.), Valhalla, NY; and Department of Biomedical and Health Informatics (A.K.G.), Children's Hospital of Philadelphia Research Institute, PA
| | - Amisha Patel
- From the Children's Hospital of Philadelphia (R.K., F.W.F., S.K.K.); Departments of Neurology and Pediatrics (F.W.F., S.K.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Inova Health System (A.P.), Fairfax, VA; Department of Neurology (N.G., L.R., C.H.), Boston Children's Hospital, MA; New York Medical College (T.M.), Valhalla, NY; and Department of Biomedical and Health Informatics (A.K.G.), Children's Hospital of Philadelphia Research Institute, PA
| | - Nishtha Gupta
- From the Children's Hospital of Philadelphia (R.K., F.W.F., S.K.K.); Departments of Neurology and Pediatrics (F.W.F., S.K.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Inova Health System (A.P.), Fairfax, VA; Department of Neurology (N.G., L.R., C.H.), Boston Children's Hospital, MA; New York Medical College (T.M.), Valhalla, NY; and Department of Biomedical and Health Informatics (A.K.G.), Children's Hospital of Philadelphia Research Institute, PA
| | - Trevor McHugh
- From the Children's Hospital of Philadelphia (R.K., F.W.F., S.K.K.); Departments of Neurology and Pediatrics (F.W.F., S.K.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Inova Health System (A.P.), Fairfax, VA; Department of Neurology (N.G., L.R., C.H.), Boston Children's Hospital, MA; New York Medical College (T.M.), Valhalla, NY; and Department of Biomedical and Health Informatics (A.K.G.), Children's Hospital of Philadelphia Research Institute, PA
| | - Alexander K Gonzalez
- From the Children's Hospital of Philadelphia (R.K., F.W.F., S.K.K.); Departments of Neurology and Pediatrics (F.W.F., S.K.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Inova Health System (A.P.), Fairfax, VA; Department of Neurology (N.G., L.R., C.H.), Boston Children's Hospital, MA; New York Medical College (T.M.), Valhalla, NY; and Department of Biomedical and Health Informatics (A.K.G.), Children's Hospital of Philadelphia Research Institute, PA
| | - Lance Rodan
- From the Children's Hospital of Philadelphia (R.K., F.W.F., S.K.K.); Departments of Neurology and Pediatrics (F.W.F., S.K.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Inova Health System (A.P.), Fairfax, VA; Department of Neurology (N.G., L.R., C.H.), Boston Children's Hospital, MA; New York Medical College (T.M.), Valhalla, NY; and Department of Biomedical and Health Informatics (A.K.G.), Children's Hospital of Philadelphia Research Institute, PA
| | - Chellamani Harini
- From the Children's Hospital of Philadelphia (R.K., F.W.F., S.K.K.); Departments of Neurology and Pediatrics (F.W.F., S.K.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Inova Health System (A.P.), Fairfax, VA; Department of Neurology (N.G., L.R., C.H.), Boston Children's Hospital, MA; New York Medical College (T.M.), Valhalla, NY; and Department of Biomedical and Health Informatics (A.K.G.), Children's Hospital of Philadelphia Research Institute, PA
| | - Sudha K Kessler
- From the Children's Hospital of Philadelphia (R.K., F.W.F., S.K.K.); Departments of Neurology and Pediatrics (F.W.F., S.K.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Inova Health System (A.P.), Fairfax, VA; Department of Neurology (N.G., L.R., C.H.), Boston Children's Hospital, MA; New York Medical College (T.M.), Valhalla, NY; and Department of Biomedical and Health Informatics (A.K.G.), Children's Hospital of Philadelphia Research Institute, PA
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3
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Santa Paola S, Di Blasi FD, Borgione E, Lo Giudice M, Giuliano M, Pettinato R, Di Stefano V, Brighina F, Lupica A, Scuderi C. Aromatic L-Amino Acid Decarboxylase Deficiency: A Genetic Screening in Sicilian Patients with Neurological Disorders. Genes (Basel) 2024; 15:134. [PMID: 38275615 PMCID: PMC10815063 DOI: 10.3390/genes15010134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Aromatic L-amino acid decarboxylase deficiency (AADCd) is a rare autosomal recessive neurometabolic disorder caused by AADC deficiency, an enzyme encoded by the DDC gene. Since the enzyme is involved in the biosynthesis of serotonin and dopamine, its deficiency determines the lack of these neurotransmitters, but also of norepinephrine and epinephrine. Onset is early and the key signs are hypotonia, movement disorders (oculogyric crises, dystonia and hypokinesia), developmental delay and autonomic dysfunction. Taiwan is the site of a potential founder variant (IVS6+4A>T) with a predicted incidence of 1/32,000 births, while only 261 patients with this deficit have been described worldwide. Actually, the number of affected persons could be greater, given that the spectrum of clinical manifestations is broad and still little known. In our study we selected 350 unrelated patients presenting with different neurological disorders including heterogeneous neuromuscular disorders, cognitive deficit, behavioral disorders and autism spectrum disorder, for which the underlying etiology had not yet been identified. Molecular investigation of the DDC gene was carried out with the aim of identifying affected patients and/or carriers. Our study shows a high frequency of carriers (2.57%) in Sicilian subjects with neurological deficits, with a higher concentration in northern and eastern Sicily. Assuming these data as representative of the general Sicilian population, the risk may be comparable to some rare diseases included in the newborn screening programs such as spinal muscular atrophy, cystic fibrosis and phenylketonuria.
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Affiliation(s)
- Sandro Santa Paola
- Unit of Neuromuscular Diseases, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy; (E.B.); (M.L.G.); (M.G.); (C.S.)
| | | | - Eugenia Borgione
- Unit of Neuromuscular Diseases, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy; (E.B.); (M.L.G.); (M.G.); (C.S.)
| | - Mariangela Lo Giudice
- Unit of Neuromuscular Diseases, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy; (E.B.); (M.L.G.); (M.G.); (C.S.)
| | - Marika Giuliano
- Unit of Neuromuscular Diseases, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy; (E.B.); (M.L.G.); (M.G.); (C.S.)
| | - Rosa Pettinato
- Unit of Pediatrics and Medical Genetics, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy;
| | - Vincenzo Di Stefano
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Via del Vespro, 143, 90127 Palermo, Italy; (V.D.S.); (F.B.); (A.L.)
| | - Filippo Brighina
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Via del Vespro, 143, 90127 Palermo, Italy; (V.D.S.); (F.B.); (A.L.)
| | - Antonino Lupica
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Via del Vespro, 143, 90127 Palermo, Italy; (V.D.S.); (F.B.); (A.L.)
| | - Carmela Scuderi
- Unit of Neuromuscular Diseases, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy; (E.B.); (M.L.G.); (M.G.); (C.S.)
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Park JE, Lee T, Ha K, Cho EH, Ki CS. Carrier frequency and incidence of aromatic L-amino acid decarboxylase deficiency: a gnomAD-based study. Pediatr Res 2023; 94:1764-1770. [PMID: 37286773 DOI: 10.1038/s41390-023-02685-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/14/2023] [Accepted: 05/21/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Aromatic L-amino acid decarboxylase (AADC) deficiency is an autosomal recessive neurotransmitter metabolism disorder and is clinically characterized by infancy hypotonia, ophthalmic crisis, and developmental delay. With the emergence of gene therapy for AADC deficiency, accurate prediction of AADC deficiency is required. This study aimed to analyze the carrier frequency and expected incidence of AADC deficiency using exome data from the Genome Aggregation Database (gnomAD). METHODS We analyzed 125,748 exomes from gnomAD, including 9197 East Asian exomes, for the DDC gene. All identified variants were classified according to the 2015 American College of Medical Genetics and Genomics and the Association for Molecular Pathology guidelines. RESULTS The worldwide carrier frequency of AADC deficiency was 0.17%; the highest frequency was observed in East Asians at 0.78%, and the lowest was in Latinos at 0.07%. The estimated incidence of AADC deficiency was 1 in 1,374,129 worldwide and 1 in 65,266 in East Asians. CONCLUSION The results demonstrated that East Asians have a higher carrier frequency of AADC deficiency than other ethnic groups. The variant spectrum of DDC genes in East Asian populations differed greatly from those of other ethnic groups. Our data will serve as a reference for further investigation of AADC deficiency. IMPACT This study analyzed exome data from the Genome Aggregation Database (gnomAD) to estimate the carrier frequency and expected incidence of aromatic L-amino acid decarboxylase (AADC) deficiency. The article provides updated carrier frequency and incidence estimates for AADC deficiency, particularly in East Asian populations, and emphasizes the significant differences in the variant spectrum of DDC genes in this population compared to other ethnic groups. The study provides important information for accurate prediction and early diagnosis of AADC deficiency, particularly in high-risk populations, and may aid in the development of more effective targeted screening programs and gene therapies for this disorder.
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Affiliation(s)
- Jong Eun Park
- Department of Laboratory Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea.
| | | | | | - Eun Hye Cho
- Department of Laboratory Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Rizzi S, Spagnoli C, Bellini M, Cesaroni CA, Spezia E, Bergonzini P, Caramaschi E, Soliani L, Turco EC, Piccolo B, Demuth L, Cordelli DM, Biasucci G, Frattini D, Fusco C. Aromatic L-Amino-Acid Decarboxylase Deficiency Screening by Analysis of 3-O-Methyldopa in Dried Blood Spots: Results of a Multicentric Study in Neurodevelopmental Disorders. Genes (Basel) 2023; 14:1828. [PMID: 37761968 PMCID: PMC10530573 DOI: 10.3390/genes14091828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Aromatic L-amino acid decarboxylase deficiency (AADCd) is a rare recessive metabolic disorder caused by pathogenic homozygous or compound heterozygous variants in the dopa decarboxylase (DDC) gene. Adeno-associated viral vector-mediated gene transfer of the human DDC gene injected into the putamen is available. The typical presentation is characterized by early-onset hypotonia, severe developmental delay, movement disorders, and dysautonomia. Recently, mild and even atypical phenotypes have been reported, increasing the diagnostic challenge. The aim of this multicentric study is to identify the prevalence of AADCd in a population of patients with phenotypic clusters characterized by neurodevelopmental disorders (developmental delay/intellectual disability, and/or autism) by 3-O-methyldopa (3-OMD) detection in dried blood spots (DBS). It is essential to identify AADCd promptly, especially within non-typical phenotypic clusters, because better results are obtained when therapy is quickly started in mild-moderate phenotypes. Between 2021 and 2023, 390 patients with non-specific phenotypes possibly associated with AADCd were tested; none resulted in a positive result. This result highlights that the population to be investigated for AADCd should have more defined clinical characteristics: association with common signs (hypotonia) and/or pathognomonic symptoms (oculogyric crisis and dysautonomia). It is necessary to continue to screen selected clusters for reaching diagnosis and improving long-term outcomes through treatment initiation. This underscores the role of newborn screening in identifying AADCd.
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Affiliation(s)
- Susanna Rizzi
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (S.R.); (C.A.C.); (D.F.); (C.F.)
| | - Carlotta Spagnoli
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (S.R.); (C.A.C.); (D.F.); (C.F.)
| | - Melissa Bellini
- Pediatrics and Neonatology Unit, Maternal and Child Health Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (M.B.); (G.B.)
| | - Carlo Alberto Cesaroni
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (S.R.); (C.A.C.); (D.F.); (C.F.)
| | - Elisabetta Spezia
- Pediatrics Unit, Department of Pediatrics, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41125 Modena, Italy; (E.S.); (P.B.); (E.C.)
| | - Patrizia Bergonzini
- Pediatrics Unit, Department of Pediatrics, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41125 Modena, Italy; (E.S.); (P.B.); (E.C.)
| | - Elisa Caramaschi
- Pediatrics Unit, Department of Pediatrics, Azienda Ospedaliero-Universitaria Policlinico di Modena, 41125 Modena, Italy; (E.S.); (P.B.); (E.C.)
| | - Luca Soliani
- U.O.C. Neuropsichiatria dell’età Pediatrica, IRCCS Istituto Delle Scienze Neurologiche di Bologna, 40138 Bologna, Italy; (L.S.); (D.M.C.)
| | - Emanuela Claudia Turco
- Child Neuropsychiatry Unit, Mother and Child Department, University-Hospital of Parma, 43126 Parma, Italy; (E.C.T.); (B.P.)
| | - Benedetta Piccolo
- Child Neuropsychiatry Unit, Mother and Child Department, University-Hospital of Parma, 43126 Parma, Italy; (E.C.T.); (B.P.)
| | - Laura Demuth
- R&D Biochemistry, Centogene GmbH, 18055 Rostock, Germany;
| | - Duccio Maria Cordelli
- U.O.C. Neuropsichiatria dell’età Pediatrica, IRCCS Istituto Delle Scienze Neurologiche di Bologna, 40138 Bologna, Italy; (L.S.); (D.M.C.)
- Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Alma Mater Studiorum, Università di Bologna, 40138 Bologna, Italy
| | - Giacomo Biasucci
- Pediatrics and Neonatology Unit, Maternal and Child Health Department, Guglielmo da Saliceto Hospital, 29121 Piacenza, Italy; (M.B.); (G.B.)
| | - Daniele Frattini
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (S.R.); (C.A.C.); (D.F.); (C.F.)
| | - Carlo Fusco
- Child Neurology and Psychiatry Unit, Department of Pediatrics, Presidio Ospedaliero Santa Maria Nuova, AUSL-IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy; (S.R.); (C.A.C.); (D.F.); (C.F.)
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6
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Himmelreich N, Bertoldi M, Alfadhel M, Alghamdi MA, Anikster Y, Bao X, Bashiri FA, Zeev BB, Bisello G, Ceylan AC, Chien YH, Choy YS, Elsea SH, Flint L, García-Cazorla À, Gijavanekar C, Gümüş EY, Hamad MH, Hişmi B, Honzik T, Kuseyri Hübschmann O, Hwu WL, Ibáñez-Micó S, Jeltsch K, Juliá-Palacios N, Kasapkara ÇS, Kurian MA, Kusmierska K, Liu N, Ngu LH, Odom JD, Ong WP, Opladen T, Oppeboen M, Pearl PL, Pérez B, Pons R, Rygiel AM, Shien TE, Spaull R, Sykut-Cegielska J, Tabarki B, Tangeraas T, Thöny B, Wassenberg T, Wen Y, Yakob Y, Yin JGC, Zeman J, Blau N. Corrigendum to: Prevalence of DDC genotypes in patients with aromatic L-amino acid decarboxylase (AADC) deficiency and in silico prediction of structural protein changes. Mol Genet Metab 2023; 139:107647. [PMID: 37453860 DOI: 10.1016/j.ymgme.2023.107647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Nastassja Himmelreich
- Dietmar-Hopp Metabolic Center and Centre for Pediatrics and Adolescent Medicine, University Children's Hospital, Heidelberg, Germany
| | - Mariarita Bertoldi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Majid Alfadhel
- Medical Genomic Research Department, King Abdullah International Medical Research Center (KAIMRC), King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; Genetics and Precision Medicine Department, King Abdullah Specialized Children's Hospital, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Malak Ali Alghamdi
- Medical Genetic Division, Pediatric Department, College of Medicine, King Saud University, Riyadh, SA, Saudi Arabia
| | - Yair Anikster
- Metabolic Disease Unit, The Edmond and Lily Safra Childrens Hospital, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Israel
| | - Xinhua Bao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Fahad A Bashiri
- Division of Neurology, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Bruria Ben Zeev
- Pediatric Neurology, Safra Pediatric Hospital, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Giovanni Bisello
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Ahmet Cevdet Ceylan
- Ankara Yıldırım Beyazıt University, Department of Medical Genetics, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Yin-Hsiu Chien
- Department of Medical Genetics & Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Sarah H Elsea
- Dept. of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | | | - Àngels García-Cazorla
- Neurometabolic Unit, Department of Neurology, Hospital Sant Joan de Déu, CIBERER, Barcelona, Spain
| | - Charul Gijavanekar
- Dept. of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Emel Yılmaz Gümüş
- Department of Pediatrics and Inherited Metabolic Diseases, Marmara University School of Medicine, Istanbul, Turkey
| | - Muddathir H Hamad
- Neurology Division, Pediatric Department, King Saud University Medical City, Riyadh, SA, Saudi Arabia
| | - Burcu Hişmi
- Department of Pediatrics and Inherited Metabolic Diseases, Marmara University School of Medicine, Istanbul, Turkey
| | - Tomas Honzik
- Dept. of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Oya Kuseyri Hübschmann
- Dietmar-Hopp Metabolic Center and Centre for Pediatrics and Adolescent Medicine, University Children's Hospital, Heidelberg, Germany; Division of Neuropediatrics and Metabolic Medicine, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Wuh-Liang Hwu
- Department of Medical Genetics & Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Kathrin Jeltsch
- Division of Neuropediatrics and Metabolic Medicine, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Natalia Juliá-Palacios
- Neurometabolic Unit, Department of Neurology, Hospital Sant Joan de Déu, CIBERER, Barcelona, Spain
| | - Çiğdem Seher Kasapkara
- Department of Pediatric Metabolism, Ankara Yıldırım Beyazıt University, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Manju A Kurian
- Developmental Neurosciences, Zayed Centre for Research, UCL GOS-Institute of Child Health & Department of Neurology, Great Ormond Street Hospital, London, United Kingdom
| | - Katarzyna Kusmierska
- Department of Screening and Metabolic Diagnostics, Institute of Mother and Child, Warsaw, Poland
| | - Ning Liu
- Dept. of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Lock Hock Ngu
- Department of Genetics, Hospital Kuala Lumpur, Ministry of Health, Malaysia
| | - John D Odom
- Dept. of Molecular & Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Winnie Peitee Ong
- Department of Genetics, Hospital Kuala Lumpur, Ministry of Health, Malaysia
| | - Thomas Opladen
- Division of Neuropediatrics and Metabolic Medicine, University Children's Hospital Heidelberg, Heidelberg, Germany
| | - Mari Oppeboen
- Children's Department, Division of Child Neurology and Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Phillip L Pearl
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Belén Pérez
- Centro de Diagnostico de Enfermedades Moleculares, CIBERER, IdiPAZ, Universidad Autonoma de Madrid, Madrid, Spain
| | - Roser Pons
- First Department of Pediatrics, Aghia Sophia Children's Hospital, University of Athens, Athens, Greece
| | - Agnieszka Magdalena Rygiel
- Department of Medical Genetics, Laboratory of Hereditary Diseases, Institute of Mother and Child, Warsaw, Poland
| | - Tan Ee Shien
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Robert Spaull
- Developmental Neurosciences, Zayed Centre for Research, UCL GOS-Institute of Child Health & Department of Neurology, Great Ormond Street Hospital, London, United Kingdom
| | - Jolanta Sykut-Cegielska
- Department of Inborn Errors of Metabolism and Paediatrics, The Institute of Mother and Child, Warsaw, Poland
| | - Brahim Tabarki
- Division of Neurology, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Trine Tangeraas
- Norwegian National Unit for Newborn Screening, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Beat Thöny
- Divisions of Metabolism, University Children's Hospital, Zürich, Switzerland
| | | | - Yongxin Wen
- Medical Genetic Division, Pediatric Department, College of Medicine, King Saud University, Riyadh, SA, Saudi Arabia
| | - Yusnita Yakob
- Molecular Diagnostics Unit, Specialised Diagnostics Centre, Institute for Medical Research, National Institute of Health, Ministry of Health, Malaysia
| | - Jasmine Goh Chew Yin
- Genetics Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Jiri Zeman
- Dept. of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Nenad Blau
- Divisions of Metabolism, University Children's Hospital, Zürich, Switzerland.
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Abukhaled M, Al Muqbil M, Alghamdi MA, Hundallah K, Suleiman J, Ben-Omran T, Alfadhel M, Almannai M, Alsaleh R, Tabarki B. Aromatic L-amino acid decarboxylase deficiency in countries in the Middle East: a case series and literature review. Eur J Pediatr 2023; 182:2535-2545. [PMID: 36928758 PMCID: PMC10257624 DOI: 10.1007/s00431-023-04886-5] [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: 09/21/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/18/2023]
Abstract
Aromatic L-amino acid decarboxylase (AADC) deficiency is a rare inherited neurometabolic disorder that can lead to severe physical and developmental impairment. This report includes 16 patients from the Middle East and is the largest series of patients with confirmed AADC deficiency from this region reported to date. The patients displayed a range of signs and symptoms at presentation and almost all failed to reach major motor milestones. Missed and delayed diagnoses were common leading to the late introduction of targeted treatments. Eight unique variants were identified in the DDC gene, including six missense and two intronic variants. A previously undescribed variant was identified: an intronic variant between exons 13 and 14 (c.1243-10A>G). The patients were mostly treated with currently recommended medications, including dopamine agonists, vitamin B6, and monoamine oxidase inhibitors. One patient responded well, but treatment outcomes were otherwise mostly limited to mild symptomatic improvements. Five patients had died by the time of data collection, confirming that the condition is associated with premature mortality. There is an urgent need for earlier diagnosis, particularly given the potential for gene therapy as a transformative treatment for AADC deficiency when provided at an early age. Conclusions: Delays in the diagnosis of AADC deficiency are common. There is an urgent need for earlier diagnosis, particularly given the potential for gene therapy as a transformative treatment for AADC deficiency when provided at an early age. What is Known: • Aromatic L-amino acid decarboxylase deficiency is a rare neurometabolic disorder that can lead to severe physical and developmental impairment. • Currently recommended medications provide mostly mild symptomatic improvements. What is New: • The clinical presentation of sixteen patients with confirmed AADC deficiency varied considerably and almost all failed to reach major motor milestones. • There is an urgent need for earlier diagnosis, given the potential for gene therapy as a transformative treatment for AADC deficiency when provided at an early age.
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Affiliation(s)
- Musaad Abukhaled
- Department of Neurosciences, King Faisal Specialist Hospital and Research Center, (KFSH-RC), Riyadh, Saudi Arabia.
| | - Mohammed Al Muqbil
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Saudi Arabia
- Division of Pediatric Neurology, Department of Pediatrics, King Abdullah Specialized Children's Hospital, National Guard Health Affairs (NGHA), Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs (MNG-HA), Riyadh, Saudi Arabia
| | - Malak Ali Alghamdi
- Medical Genetic Division, Pediatric Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid Hundallah
- Division of Neurology, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Jehan Suleiman
- Division of Neurology, Department of Pediatrics, Tawam Hospital, Al Ain, United Arab Emirates
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- American Center for Psychiatry and Neurology, Abu Dhabi, United Arab Emirates
| | - Tawfeg Ben-Omran
- Sidra Medicine and Research Center, Doha, Qatar
- Hamad Medical Corporation, Doha, Qatar
| | - Majid Alfadhel
- Department of Genetics and Precision Medicine, Department of Pediatrics, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Medical Genomic Research Department, King Abdullah International Medical Research Centre (KAIMRC), King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard Health Affairs (MNG-HA), Riyadh, Saudi Arabia
| | - Mohammed Almannai
- Department of Genetics and Precision Medicine, Department of Pediatrics, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Medical Genomic Research Department, King Abdullah International Medical Research Centre (KAIMRC), King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Ministry of National Guard Health Affairs (MNG-HA), Riyadh, Saudi Arabia
| | | | - Brahim Tabarki
- Division of Neurology, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Mastrangelo M, Tolve M, Artiola C, Bove R, Carducci C, Carducci C, Angeloni A, Pisani F, Leuzzi V. Phenotypes and Genotypes of Inherited Disorders of Biogenic Amine Neurotransmitter Metabolism. Genes (Basel) 2023; 14:genes14020263. [PMID: 36833190 PMCID: PMC9957200 DOI: 10.3390/genes14020263] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/11/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
Inherited disorders of biogenic amine metabolism are genetically determined conditions resulting in dysfunctions or lack of enzymes involved in the synthesis, degradation, or transport of dopamine, serotonin, adrenaline/noradrenaline, and their metabolites or defects of their cofactor or chaperone biosynthesis. They represent a group of treatable diseases presenting with complex patterns of movement disorders (dystonia, oculogyric crises, severe/hypokinetic syndrome, myoclonic jerks, and tremors) associated with a delay in the emergence of postural reactions, global development delay, and autonomic dysregulation. The earlier the disease manifests, the more severe and widespread the impaired motor functions. Diagnosis mainly depends on measuring neurotransmitter metabolites in cerebrospinal fluid that may address the genetic confirmation. Correlations between the severity of phenotypes and genotypes may vary remarkably among the different diseases. Traditional pharmacological strategies are not disease-modifying in most cases. Gene therapy has provided promising results in patients with DYT-DDC and in vitro models of DYT/PARK-SLC6A3. The rarity of these diseases, combined with limited knowledge of their clinical, biochemical, and molecular genetic features, frequently leads to misdiagnosis or significant diagnostic delays. This review provides updates on these aspects with a final outlook on future perspectives.
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Affiliation(s)
- Mario Mastrangelo
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
| | - Manuela Tolve
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Cristiana Artiola
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Rossella Bove
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Claudia Carducci
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Carla Carducci
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Antonio Angeloni
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Francesco Pisani
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
- Correspondence: ; Tel.: +39-649972930; Fax: +39-64440232
| | - Vincenzo Leuzzi
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- Azienda Ospedaliero Universitaria Policlinico Umberto I, 00161 Rome, Italy
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Gantz E, Daniel Sharer J, McGrath TM. Diagnosis of Aromatic L-Amino Acid Decarboxylase (AADC) Deficiency via Epilepsy Gene Panel Screening in a Patient with Atypical Presentation. Child Neurol Open 2023. [DOI: 10.1177/2329048x231161027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
We describe an atypical presentation of a girl with aromatic L-amino acid decarboxylase (AADC) deficiency identified via a genetic testing program for children with epilepsy. At 21 months of age, she presented with poor head control, diffuse hypotonia, poor fixation, developmental delay, and dysphagia. She was lost to follow-up, then presented back at 3 years of age with staring spells and brief episodes of upward eye deviation. The diagnosis of unprovoked epilepsy allowed her to be included in a genetic testing program, which identified two heterozygous variants in the dopa decarboxylase (DCC) gene. Based on the genetic testing, plasma AADC enzyme activity and plasma 3-O-methyldopa results, a diagnosis of AADC deficiency was made when she was 4 years and 2 months of age. This case report shows that AADC deficiency can be the underlying diagnosis in patients with suspected epilepsy.
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Affiliation(s)
- Emily Gantz
- Division of Pediatric Neurology, Department of Pediatrics, University of Alabama, Birmingham, AL, USA
| | - J. Daniel Sharer
- Biochemical Genetics Laboratory, Department of Genetics, University of Alabama, Birmingham, AL, USA
| | - Tony M. McGrath
- Division of Pediatric Neurology, Department of Pediatrics, University of Alabama, Birmingham, AL, USA
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10
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Buesch K, Zhang R, Szczepańska K, Veličković V, Turner L, Despotović M, Đorđević B, Russell A. Burden and severity of disease of aromatic L-amino acid decarboxylase deficiency: a systematic literature review. Curr Med Res Opin 2022; 38:1871-1882. [PMID: 35485958 DOI: 10.1080/03007995.2022.2072090] [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] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The objective was to investigate the severity of aromatic L-amino acid decarboxylase deficiency (AADCd) as reported in the published literature and to collate evidence of the clinical manifestations of AADCd, and the impact of the disease on patients, caregivers, and healthcare systems. METHODS Published articles reporting severity of disease or disease impact were eligible for inclusion in this review. Articles were searched in MEDLINE, EMBASE, Cochrane CENTRAL, TRIP medical, and CRD databases in October 2021. The quality of the included studies was investigated using a modified version of the grading system of the Centre for Evidence-Based Medicine (CEBM). Descriptive data of the literature was extracted and a narrative synthesis of the results across studies was conducted. This review is reported according to the PRISMA reporting guidelines for systematic reviews. RESULTS The search identified 970 unique reports, of which 59 met eligibility criteria to be included in the review. Of these, 48 included reports provided details on the clinical manifestations of AADCd. Two reports explored the disease impact on patients, while four described the impact on caregivers. Five reports assessed the impact on healthcare systems. Individuals with AADCd experience very severe clinical manifestations regardless of motor milestones achieved, and present with a spectrum of other complications. Individuals with AADCd present with very limited function, which, in combination with additional complications, substantially impact the quality-of-life of individuals and their caregivers. The five studies which explore the impact on the healthcare system reported that adequate care of individuals with AADCd requires a vast array of medical services and supportive therapies. CONCLUSIONS Irrespective of the ambulatory status of individuals, AADCd is a debilitating disease that significantly impacts quality-of-life for individuals and caregivers. It impacts the healthcare system due to the need for complex coordinated activities of a multidisciplinary specialist team.
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Affiliation(s)
| | | | | | - Vladica Veličković
- Core Models Ltd, London, United Kingdom
- Institute of Public Health, Medical Decision Making and HTA, UMIT, Hall in Tirol, Austria
| | - Lucy Turner
- Core Models Ltd, London, United Kingdom
- Research in Health Consulting, Ottawa, Canada
| | | | - Branka Đorđević
- Core Models Ltd, London, United Kingdom
- Biochemistry Department, Faculty of Medicine, University of Nis, Nis, Serbia
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11
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Clinical Features in Aromatic L-Amino Acid Decarboxylase (AADC) Deficiency: A Systematic Review. Behav Neurol 2022; 2022:2210555. [PMID: 36268467 PMCID: PMC9578880 DOI: 10.1155/2022/2210555] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/01/2022] [Accepted: 09/22/2022] [Indexed: 11/18/2022] Open
Abstract
Aromatic L-amino acid decarboxylase (AADC) deficiency is a rare congenital autosomal recessive metabolic disorder caused by pathogenic homozygous or compound heterozygous variants in the dopa decarboxylase (DDC) gene. Adeno-associated viral vector-mediated gene transfer of the human AADC gene into the putamina has become available. This systematic review on PubMed, Scopus databases, and other sources is aimed at describing the AADC whole phenotypic spectrum in order to facilitate its early diagnosis. Literature reviews, original articles, retrospective and comparative studies, large case series, case reports, and short communications were considered. A database was set up using Microsoft Excel to collect clinical, molecular, biochemical, and therapeutic data. By analysing 261 patients from 41 papers with molecular and/or biochemical diagnosis of AADC deficiency for which individuality could be determined with certainty, we found symptom onset to occur in the first 6 months of life in 93% of cases. Hypotonia and developmental delay are cardinal signs, reported as present in 73.9% and 72% of cases, respectively. Oculogyric crises were seen in 67% of patients while hypokinesia in 42% and ptosis in 26%. Dysautonomic features have been revealed in 53% and gastrointestinal symptoms in 19% of cases. With 37% and 30% of patients reported being affected by sleep and behavioural disorders, it seems to be commoner than previously acknowledged. Although reporting bias cannot be excluded, there is still a need for comprehensive clinical descriptions of symptoms at onset and during follow-up. In fact, our review suggests that most of the neurological and extraneurological symptoms and signs reported, although quite frequent in this condition, are not pathognomonic, and therefore, ADCC deficiency can remain an underdiscovered disorder.
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12
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Compound Heterozygosis in AADC Deficiency and Its Complex Phenotype in Terms of AADC Protein Population. Int J Mol Sci 2022; 23:ijms231911238. [PMID: 36232540 PMCID: PMC9570296 DOI: 10.3390/ijms231911238] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Aromatic amino acid decarboxylase (AADC) deficiency is a rare monogenic disease due to mutations in the ddc gene producing AADC, a homodimeric pyridoxal 5′-phosphate-dependent enzyme. The disorder is often fatal in the first decade and is characterized by profound motor impairments and developmental delay. In the last two years, there has been a net rise in the number of patients and variants identified, maybe also pushed by the ongoing gene therapy trials. The majority of the identified genotypes are compound heterozygous (about 70%). Efforts are underway to reach early diagnosis, find possible new markers/new fast methods, and predict clinical outcome. However, no clear correlation of genotype-to-phenotype exists to date. Nevertheless, for homozygous patients, reliable results have been obtained using genetic methods combined with available computational tools on crystal structures corroborated by biochemical investigations on recombinant homodimeric AADC variants that have been obtained and characterized in solution. For these variants, the molecular basis for the defect has been suggested and validated, since it correlates quite well with mildness/severity of the homozygous phenotype. Instead, prediction for compound heterozygous patients is more difficult since complementation effects could happen. Here, by analyzing the existing literature on compound heterozygosity in AADC deficiency and other genetic disorders, we highlight that, in order to assess pathogenicity, the measurement of activity of the AADC heterodimeric variant should be integrated by bioinformatic, structural, and functional data on the whole protein constellation theoretically present in such patients. A wider discussion on symptomatic heterozygosity in AADC deficiency is also presented.
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13
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Wang H, Li J, Zhou J, Dai L, Ding C, Li M, Feng W, Fang F, Ren X, Wang X. Oculogyric crisis mimicked epilepsy in a Chinese aromatic L-amino acid decarboxylase-deficiency patient: A case report. Front Neurol 2022; 13:919583. [PMID: 36119679 PMCID: PMC9481412 DOI: 10.3389/fneur.2022.919583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAromatic amino acid decarboxylase (AADC) deficiency is a rare, autosomal recessive neurometabolic disorder with heterogeneous phenotype, including hypotonia, movement disorders, autonomic dysfunction, and developmental delay. Here, we reported a Chinese patient with AADCD who was initially misdiagnosed with epilepsy.Case presentationThe proband was a 4-month-old Chinese girl, representing hypotonia, episodes of oculogyric crises with dystonia, and delayed developmental milestones. The patient was first misdiagnosed with epilepsy because of the similarity between episodes of oculogyric crisis and epileptic seizure. The accurate diagnosis of AADCD was established through analysis of neurotransmitters in cerebrospinal fluid (CSF). The genetic test confirmed the patient carried novel compound heterozygous mutations in the DDC gene:c.419G>A and c.1375C>T.ConclusionThis study reported a patient with AADCD who was initially misdiagnosed as epilepsy. Two novel missense mutations in the DDC gene were identified from the patient and her family. Little infants with epileptic-like attacks should consider AADCD. An accurate diagnosis of AADCD is essential for drug choice and patient management.
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Affiliation(s)
- Hongmei Wang
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jiahong Li
- Department of Gastroenterology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ji Zhou
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Lifang Dai
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Changhong Ding
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Mo Li
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Weixing Feng
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Fang Fang
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiaotun Ren
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiaohui Wang
- Department of Neurology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
- *Correspondence: Xiaohui Wang
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14
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Goldstein DS, Pekker MJ, Sullivan P, Isonaka R, Sharabi Y. Modeling the Progression of Cardiac Catecholamine Deficiency in Lewy Body Diseases. J Am Heart Assoc 2022; 11:e024411. [PMID: 35621196 PMCID: PMC9238705 DOI: 10.1161/jaha.121.024411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/15/2022] [Indexed: 11/16/2022]
Abstract
Background Lewy body diseases (LBDs) feature deficiency of the sympathetic neurotransmitter norepinephrine in the left ventricular myocardium and sympathetic intra-neuronal deposition of the protein alpha-synuclein (αS). LBDs therefore are autonomic synucleinopathies. Computational modeling has revealed multiple functional abnormalities in residual myocardial sympathetic noradrenergic nerves in LBDs, including decreased norepinephrine synthesis, vesicular storage, and recycling. We report an extended model that enables predictions about the progression of LBDs and effects of genetic predispositions and treatments on that progression. Methods and Results The model combines cardiac sympathetic activation with autotoxicity mediated by the dopamine metabolite 3,4-dihydroxyphenylacetaldehyde. We tested the model by its ability to predict longitudinal empirical data based on cardiac sympathetic neuroimaging, effects of genetic variations related to particular intra-neuronal reactions, treatment by monoamine oxidase inhibition to decrease 3,4-dihydroxyphenylacetaldehyde production, and post-mortem myocardial tissue contents of catecholamines and αS. The new model generated a triphasic decline in myocardial norepinephrine content. This pattern was confirmed by empirical data from serial cardiac 18F-dopamine positron emission tomographic scanning in patients with LBDs. The model also correctly predicted empirical data about effects of genetic variants and monoamine oxidase inhibition and about myocardial levels of catecholamines and αS. Conclusions The present computational model predicts a triphasic decline in myocardial norepinephrine content as LBDs progress. According to the model, disease-modifying interventions begun at the transition from the first to the second phase delay the onset of symptomatic disease. Computational modeling coupled with biomarkers of preclinical autonomic synucleinopathy may enable early detection and more effective treatment of LBDs.
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Affiliation(s)
- David S. Goldstein
- Autonomic Medicine SectionClinical Neurosciences ProgramDivision of Intramural ResearchNational Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesdaMD
| | - Mark J. Pekker
- Mathematical SciencesUniversity of Alabama at HuntsvilleHuntsvilleAL
| | - Patti Sullivan
- Autonomic Medicine SectionClinical Neurosciences ProgramDivision of Intramural ResearchNational Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesdaMD
| | - Risa Isonaka
- Autonomic Medicine SectionClinical Neurosciences ProgramDivision of Intramural ResearchNational Institute of Neurological Disorders and StrokeNational Institutes of HealthBethesdaMD
| | - Yehonatan Sharabi
- Tel Aviv University Sackler Faculty of Medicine and Chaim Sheba Medical CenterTel HaShomerIsrael
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15
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Williams K, Skrobanski H, Buesch K, Acaster S. Symptoms and impacts of aromatic l-amino acid decarboxylase (AADC) deficiency among individuals with different levels of motor function. Orphanet J Rare Dis 2022; 17:128. [PMID: 35313922 PMCID: PMC8935094 DOI: 10.1186/s13023-022-02274-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 02/27/2022] [Indexed: 11/20/2022] Open
Abstract
Background Aromatic l-amino acid decarboxylase (AADC) deficiency is a rare neurological disorder associated with a range of symptoms and functional impairments. The aim of this study was to describe the experience of AADC deficiency across five different motor milestone health states. Methods Qualitative interviews were conducted with caregivers of individuals with AADC deficiency in Italy, Spain, Portugal and the United States. An interview guide was developed with input from clinical experts and caregivers, and explored the symptoms and impacts of AADC deficiency. Interviews were conducted by telephone and were recorded and transcribed. Data were analysed using thematic analysis and the symptoms and impacts were compared across health states.
Results Fourteen caregivers took part, who provided care to 13 individuals with AADC deficiency aged 1–15 years. Six individuals were in the ‘no motor function’ health state, one in the ‘sitting unsupported’ health state, one in the ‘standing/stepping when fully supported’ health state and five in the ‘walking with minimal support’ health state. The results highlight a substantial impact of AADC deficiency, even among those who were able to walk with minimal support. Overall, those with better motor function also had better functional hand use, communication skills, ability to eat and perform other activities independently, and interact with their peers. The burden of caring was high across all health states, but caregivers of individuals in the walking health state were better able to participate in social and leisure activities. Conclusion Individuals with higher levels of motor function had less severe symptoms and were better able to perform their daily, leisure and social activities. Treatments which improve motor function have the potential to improve other aspects of the lives of individuals with AADC deficiency and their caregivers.
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16
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Abukhaled M, Alrakaf L, Aldhalaan H, Al Yamani S. Case report: Aromatic L-amino acid decarboxylase deficiency in three patient cases from the Kingdom of Saudi Arabia. Front Pediatr 2022; 10:1016239. [PMID: 36727005 PMCID: PMC9885213 DOI: 10.3389/fped.2022.1016239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/17/2022] [Indexed: 01/19/2023] Open
Abstract
Aromatic L-amino acid decarboxylase (AADC) deficiency is an ultra-rare and often severe neurometabolic disorder resulting from variants in the dopa decarboxylase (DDC) gene. A timely diagnosis is critical to prevent secondary complications, promote development, and optimize outcomes from future innovative treatment options, such as gene therapy. This article describes three patients with AADC deficiency managed in the Kingdom of Saudi Arabia (KSA). All three patients had homozygous variants within the DDC gene, including one novel gene variant (c.245G > A, p.Arg82Glu), and presented with symptoms from birth. In all cases, a diagnostic delay was observed owing to non-specific signs and symptoms, a lack of disease awareness among primary care physicians, and delays associated with outsourcing of genetic tests. All three patients were managed by a multidisciplinary team at a specialist tertiary center. Clinical outcomes for all three cases were poor, with one patient passing away at 3 years of age and the other two patients continuing to experience substantial disability and poor quality of life. There is an urgent need to raise awareness and improve diagnostic testing for rare diseases such as AADC deficiency in the KSA in order to improve outcomes, particularly as innovative disease-targeting therapies become available.
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Affiliation(s)
- Musaad Abukhaled
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Laila Alrakaf
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Hesham Aldhalaan
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Suad Al Yamani
- Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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17
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Babiker MOE, Kurian MA, Suleiman J. Case report: First case report of an Emirati child with a novel gene variant causing aromatic L-amino acid decarboxylase deficiency. Front Pediatr 2022; 10:964201. [PMID: 36110109 PMCID: PMC9468477 DOI: 10.3389/fped.2022.964201] [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: 06/08/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
Aromatic L-amino acid decarboxylase (AADC) deficiency is a rare, neurometabolic disorder resulting from biallelic mutations in the dopa decarboxylase (DDC) gene. This is the first reported case of AADC deficiency in the United Arab Emirates (UAE) and describes an Emirati male patient who presented in the first few months of life with a severe phenotype of global hypotonia, developmental delay and oculogyric crisis. Following whole exome sequencing, a novel homozygous mutation in the DDC gene (c.1144G>T, p.Val382Phe) was reported and the patient underwent further testing, after which a diagnosis of AADC deficiency was confirmed. This mutation has not been previously described, but the clinical phenotype and corresponding biochemical profile confirmed that it is a pathogenic variant. The patient is currently managed at a tertiary referral center in the UAE and is treated in accordance with published guidance on AADC deficiency, including the recommended medical therapy combined with multidisciplinary care from a team of specialists. Some symptomatic improvements have been reported but at 5 years of age the patient continues to exhibit profound developmental delay, oculogyric crisis and is prone to recurrent respiratory infections. In order to improve outcomes for patients with AADC deficiency in the Middle Eastern region, there is an urgent need to raise the index of clinical suspicion, particularly among primary care physicians, pediatricians, and pediatric neurologists, and to improve access to diagnostic testing. This is particularly relevant at the current time, given the ongoing development of potentially disease-modifying gene therapy for AADC deficiency.
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Affiliation(s)
- Mohamed O E Babiker
- Neurosciences Centre, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
| | - Manju A Kurian
- Developmental Neurosciences Department, University College London (UCL) Great Ormond Street Institute of Child Health, London, United Kingdom.,Department of Neurology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Jehan Suleiman
- Division of Neurology, Department of Pediatrics, Tawam Hospital, Al Ain, United Arab Emirates.,College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Simultaneous determination of 5-hydroxytryptophan and 3-O-methyldopa in dried blood spot by UPLC-MS/MS: A useful tool for the diagnosis of L-amino acid decarboxylase deficiency. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1185:122999. [PMID: 34715572 DOI: 10.1016/j.jchromb.2021.122999] [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: 06/14/2021] [Revised: 09/14/2021] [Accepted: 10/13/2021] [Indexed: 11/22/2022]
Abstract
5-hydroxytryptophan (5HTP) and 3-O-methyldopa (3OMD) are CSF diagnostic biomarkers of the defect of aromatic L-amino acid decarboxylase (AADC), a rare inherited disorder of neurotransmitter synthesis which, if untreated, results in severely disabling neurological impairment. In the last few years, different methods to detect 3OMD in dried blood spot (DBS) were published. We developed and validated a fast and specific diagnostic tool to detect 5HTP alongside 3OMD. After extraction from DBS, 3OMD and 5HTP were separated by ultra-performance liquid chromatography (UPLC) and detected by tandem mass spectrometry (MS/MS). Instrument parameters were optimized to obtain the best sensitivity and specificity. Chromatographic separation was accomplished in 13 min. The limit of detection was 2.4 and 1.4 nmol/L of blood for 3OMD and 5HTP respectively, and response was linear over the blood range of 25-5000 nmol/L. Between-run imprecision was less than 9% for 3OMD and <13% for 5HTP. An age-specific continuous reference range was established, revealing a marked and continuous 3OMD decline with aging. The effect of age on 5HTP was less evident, showing only a slight decrease with age after the first week of life. A marked increase of both 3OMD and 5HTP was found in four patients affected by AADC deficiency (1780.6 ± 773.1 nmol/L, rv 71.0-144.9; and 94.8 ± 19.0 nmol/L, rv 15.2-42.8, respectively) while an isolated increase of 3OMD (6159.6 ± 3449.1 nmol/L, rv 73.2-192.2) was detected in three subjects affected by inherited disorders of dopamine synthesis under levodopa/carbidopa treatment (a marginal increase of 5HTP was detected in one of them). Simultaneous measurement of 5HTP and 3OMD in DBS leads to an improvement in specificity and sensitivity for the biochemical diagnosis of AADC deficiency.
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Skrobanski H, Williams K, Werner C, O'Neill S, Buesch K, Acaster S. The impact of caring for an individual with aromatic l-amino acid decarboxylase (AADC) deficiency: a qualitative study and the development of a conceptual model. Curr Med Res Opin 2021; 37:1821-1828. [PMID: 34259573 DOI: 10.1080/03007995.2021.1955668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Aromatic l-amino acid decarboxylase (AADC) deficiency is a rare neurological condition, associated with a wide range of symptoms and functional issues, such as profound motor impairment and learning disability. Most individuals with AADC deficiency are completely dependent on their caregivers. This study explored the impact of caring for an individual with AADC deficiency. METHODS Qualitative interviews were conducted with caregivers of individuals with AADC deficiency in Italy, Portugal, Spain and the United States. An interview guide was developed with input from clinical experts and caregivers and included questions on the impact of caring for an individual with AADC deficiency. Interviews were conducted by telephone/videoconference and were recorded and transcribed. Data were analysed using thematic analysis. RESULTS Fourteen caregivers took part who provided care to 13 individuals with AADC deficiency aged 1-15 years. Caregivers reported that their lives centred around the individual with AADC deficiency, due to their need for 24-hour care and regular healthcare appointments. They reported both proximal impacts (impact on time, planning, physical health and emotional wellbeing), and distal impacts (impact on social/leisure activities, relationships, work and finances). These concepts and relationships were illustrated in a conceptual model. CONCLUSIONS This is the first qualitative study to report on the experience of caring for an individual with AADC deficiency. Caregivers reported that caring had a substantial multifaceted impact on their lives. These findings highlight the importance of considering the caregiver experience when evaluating the burden of AADC deficiency.
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Affiliation(s)
- Hanna Skrobanski
- Patient-Centred Outcomes Research, Acaster Lloyd Consulting Ltd, London, United Kingdom
| | - Kate Williams
- Patient-Centred Outcomes Research, Acaster Lloyd Consulting Ltd, London, United Kingdom
| | - Christian Werner
- Global Medical Affairs, PTC Therapeutics Germany GmbH, Frankfurt am Main, Germany
| | - Sian O'Neill
- Patient Engagement EMEA, PTC Therapeutics International Limited, Ireland
| | - Katharina Buesch
- Global Health Economics and Outcomes Research, PTC Therapeutics Switzerland GmbH, Steinhausen/Zug, Switzerland
| | - Sarah Acaster
- Patient-Centred Outcomes Research, Acaster Lloyd Consulting Ltd, London, United Kingdom
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Rossignoli G, Krämer K, Lugarà E, Alrashidi H, Pope S, De La Fuente Barrigon C, Barwick K, Bisello G, Ng J, Counsell J, Lignani G, Heales SJR, Bertoldi M, Barral S, Kurian MA. Aromatic l-amino acid decarboxylase deficiency: a patient-derived neuronal model for precision therapies. Brain 2021; 144:2443-2456. [PMID: 33734312 PMCID: PMC8418346 DOI: 10.1093/brain/awab123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 01/25/2021] [Accepted: 02/08/2021] [Indexed: 11/13/2022] Open
Abstract
Aromatic l-amino acid decarboxylase (AADC) deficiency is a complex inherited neurological disorder of monoamine synthesis which results in dopamine and serotonin deficiency. The majority of affected individuals have variable, though often severe cognitive and motor delay, with a complex movement disorder and high risk of premature mortality. For most, standard pharmacological treatment provides only limited clinical benefit. Promising gene therapy approaches are emerging, though may not be either suitable or easily accessible for all patients. To characterize the underlying disease pathophysiology and guide precision therapies, we generated a patient-derived midbrain dopaminergic neuronal model of AADC deficiency from induced pluripotent stem cells. The neuronal model recapitulates key disease features, including absent AADC enzyme activity and dysregulated dopamine metabolism. We observed developmental defects affecting synaptic maturation and neuronal electrical properties, which were improved by lentiviral gene therapy. Bioinformatic and biochemical analyses on recombinant AADC predicted that the activity of one variant could be improved by l-3,4-dihydroxyphenylalanine (l-DOPA) administration; this hypothesis was corroborated in the patient-derived neuronal model, where l-DOPA treatment leads to amelioration of dopamine metabolites. Our study has shown that patient-derived disease modelling provides further insight into the neurodevelopmental sequelae of AADC deficiency, as well as a robust platform to investigate and develop personalized therapeutic approaches.
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Affiliation(s)
- Giada Rossignoli
- Developmental Neurosciences, GOS Institute of Child Health, University College London, London WC1N 1EH, UK
- Biological Chemistry, NBM Department, University of Verona, 37134 Verona, Italy
| | - Karolin Krämer
- Developmental Neurosciences, GOS Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Eleonora Lugarà
- Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Haya Alrashidi
- Genetics and Genomic Medicine, GOS Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Simon Pope
- Neurometabolic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
| | | | - Katy Barwick
- Developmental Neurosciences, GOS Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Giovanni Bisello
- Biological Chemistry, NBM Department, University of Verona, 37134 Verona, Italy
| | - Joanne Ng
- Developmental Neurosciences, GOS Institute of Child Health, University College London, London WC1N 1EH, UK
- Gene Transfer Technology Group, EGA-Institute for Women's Health, University College London, London WC1E 6HU, UK
| | - John Counsell
- Developmental Neurosciences, GOS Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Gabriele Lignani
- Clinical and Experimental Epilepsy, Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK
| | - Simon J R Heales
- Neurometabolic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK
- Centre for Inborn Errors of Metabolism, GOS Institute of Child Health, UniversCity College London, London WC1N 1EH, UK
| | - Mariarita Bertoldi
- Biological Chemistry, NBM Department, University of Verona, 37134 Verona, Italy
- Correspondence may also be addressed to: Prof Mariarita Bertoldi Department of Neuroscience, Biomedicine and Movement Sciences Biological Chemistry Section, Room 1.24 Strada le Grazie 8, 37134 Verona, Italy E-mail:
| | - Serena Barral
- Developmental Neurosciences, GOS Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Manju A Kurian
- Developmental Neurosciences, GOS Institute of Child Health, University College London, London WC1N 1EH, UK
- Department of Neurology, Great Ormond Street Hospital, London WC1N 3JH, UK
- Correspondence to: Prof Manju Kurian Zayed Centre for Research UCL Great Ormond Street Institute of Child Health 20 Guilford St, London WC1N 1DZ, UK E-mail:
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Williams K, Skrobanski H, Werner C, O'Neill S, Buesch K, Acaster S. Symptoms and impact of aromatic l-amino acid decarboxylase (AADC) deficiency: a qualitative study and the development of a patient-centred conceptual model. Curr Med Res Opin 2021; 37:1353-1361. [PMID: 34042550 DOI: 10.1080/03007995.2021.1932449] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Aromatic l-amino acid decarboxylase (AADC) deficiency is a rare neurological condition, with an estimated global prevalence of 1:32,000 to 1:90,000 live births. AADC deficiency is associated with a range of symptoms and functional impairments, but these have not previously been explored qualitatively. This study aimed to understand the symptoms of AADC deficiency and its impact on individuals' health-related quality of life. METHODS Qualitative interviews were conducted with caregivers of individuals with AADC deficiency in Italy, Spain, Portugal and the United States. An interview guide was developed with input from clinical experts and caregivers, and explored the symptoms and impacts of AADC deficiency. Interviews were conducted by telephone and were recorded and transcribed. Data were analysed using thematic analysis and saturation was recorded. RESULTS Fourteen caregivers took part, who provided care to 13 individuals with AADC deficiency aged 1-15 years. All individuals had impaired motor function, which was attributed to low muscle tone and muscle weakness. The level of motor function varied considerably, ranging from no motor function (no head control) to being able to take a few steps without support. Other impairments included cognitive impairment, communication difficulties, movement disorders (e.g. oculogyric crises), gastrointestinal symptoms, eating difficulties, fatigue and sleep disruption. Most individuals were completely dependent on their caregivers for all aspects of their lives. This limited function had a negative impact on their ability to socialise with their peers and on their emotional wellbeing. These concepts and relationships are illustrated in a conceptual model, and moderating factors (e.g. physiotherapy and medication) are discussed. CONCLUSION This is the first qualitative study to report on the experience of living with AADC deficiency. Caregivers report individuals with AADC deficiency experience a wide range of symptoms and functional impairments, which have a substantial impact on their health-related quality of life.
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Affiliation(s)
- Kate Williams
- Patient-Centred Outcomes Research, Acaster Lloyd Consulting Ltd, London, UK
| | - Hanna Skrobanski
- Patient-Centred Outcomes Research, Acaster Lloyd Consulting Ltd, London, UK
| | - Christian Werner
- Global Medical Affairs, PTC Therapeutics Germany GmbH, Frankfurt am Main, Germany
| | - Sian O'Neill
- Patient Engagement EMEA, PTC Therapeutics International Limited, Dublin, Ireland
| | - Katharina Buesch
- Global Health Economics and Outcomes Research, PTC Therapeutics Switzerland GmbH, Steinhausen/Zug, Switzerland
| | - Sarah Acaster
- Patient-Centred Outcomes Research, Acaster Lloyd Consulting Ltd, London, UK
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Smith AB, Hanbury A, Beitia Ortiz de Zarate I, Hammes F, de Pouvourville G, Buesch K. Eliciting Health State Utilities for Aromatic L-Amino Acid Decarboxylase (AADC) Deficiency: A Vignette Study in France. Patient Relat Outcome Meas 2021; 12:237-246. [PMID: 34285619 PMCID: PMC8285298 DOI: 10.2147/prom.s306228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/23/2021] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Health-related quality of life (HRQoL) is difficult to measure in rare diseases, especially in paediatric populations, yet capturing HRQoL is critical to evaluating treatment, including the cost-effectiveness of treatments. Given the ultra-rare nature of AADC deficiency indirect elicitation of HRQoL data through proxy caregiver/parent ratings is not feasible. In these circumstances, HRQoL data may be derived through vignette studies using the general population. The aim of the study was to generate health utility values specific for France for AADC deficiency using vignettes. METHODS The study was completed online by panel participants from a French representative sample. Five health state vignettes, reflecting key milestones in the eladocagene exuparvovec clinical trials and economic model, were presented to the participants: "bedridden", "head control", "sitting unsupported", "standing with assistance" and "walking with assistance". The vignettes had been previously developed with input from parents of patients with AADC deficiency, patients and expert opinion. Participants also completed the Health Utilities Index-3 for the "bedridden" health state. RESULTS A total of 1001 participants (51% females; mean age 46 years) completed the vignettes. Utilities increased linearly as the health state improved for both the time trade-off (TTO): 0.47 (standard deviation, SD 0.36) to 0.54 (SD 0.36) and standard gamble (SG): 0.61 (SD 0.29) to 0.67 (SD 0.27). A significant minority had incongruent responses (high utilities for the bedridden compared to walking health states) for the vignette (27%). When these were removed, the TTO health utilities (N=729) ranged from 0.39 (SD 0.36) to 0.56 (SD 0.38) and 0.61 (SD 0.30) to 0.69 (SD 0.27) for the SG. CONCLUSION Health utilities were derived for AADC deficiency which will be used for a cost-effectiveness model of an AADC deficiency treatment.
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Affiliation(s)
- Adam B Smith
- York Health Economics Consortium, University of York, York, UK
| | - Andria Hanbury
- York Health Economics Consortium, University of York, York, UK
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Opladen T, Brennenstuhl H, Kuseyri Hübschmann O, Call D, Green K, Schara U, Rascher W, Hövel A, Assmann B, Kölker S, Westhoff JH, Walter M, Ziegler A, Hoffmann GF, Kiening K. Die intrazerebrale Gentherapie des Aromatischen-L-Aminosäure-Decarboxylase-Mangels mit Eladocagene exuparvovec. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01232-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Fusco C, Leuzzi V, Striano P, Battini R, Burlina A, Spagnoli C. Aromatic L-amino Acid Decarboxylase (AADC) deficiency: results from an Italian modified Delphi consensus. Ital J Pediatr 2021; 47:13. [PMID: 33478565 PMCID: PMC7819234 DOI: 10.1186/s13052-021-00954-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 01/04/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Aromatic L-amino acid decarboxylase (AADC) deficiency is a rare and underdiagnosed neurometabolic disorder resulting in a complex neurological and non-neurological phenotype, posing diagnostic challenges resulting in diagnostic delay. Due to the low number of patients, gathering high-quality scientific evidence on diagnosis and treatment is difficult. Additionally, based on the estimated prevalence, the number of undiagnosed patients is likely to be high. METHODS Italian experts in AADC deficiency formed a steering committee to engage clinicians in a modified Delphi consensus to promote discussion, and support research, dissemination and awareness on this disorder. Five experts in the field elaborated six main topics, each subdivided into 4 statements and invited 13 clinicians to give their anonymous feedback. RESULTS 100% of the statements were answered and a consensus was reached at the first round. This enabled the steering committee to acknowledge high rates of agreement between experts on clinical presentation, phenotypes, diagnostic work-up and treatment strategies. A research gap was identified in the lack of standardized cognitive and motor outcome data. The need for setting up an Italian working group and a patients' association, together with the dissemination of knowledge inside and outside scientific societies in multiple medical disciplines were recognized as critical lines of intervention. CONCLUSIONS The panel expressed consensus with high rates of agreement on a series of statements paving the way to disseminate clear messages concerning disease presentation, diagnosis and treatment and strategic interventions to disseminate knowledge at different levels. Future lines of research were also identified.
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Affiliation(s)
- Carlo Fusco
- Child Neurology and Psychiatric Unit-Presidio Ospedaliero Santa Maria Nuova -AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
| | - Vincenzo Leuzzi
- Department of Paediatric Neuropsychiatry, Università La Sapienza, Rome, Italy
| | - Pasquale Striano
- Paediatric Neurology and Muscular Diseases Unit, IRCCS Istituto G. Gaslini, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genoa, Italy
| | - Roberta Battini
- Department of Developmental Neuroscience, Scientific Institute for Child and Adolescent Neuropsychiatry - IRCCS Stella Maris Foundation, Pisa, Italy.,Department of Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alberto Burlina
- Division of Inborn Metabolic Disease, Department of Pediatrics, University Hospital Padua, Padova, Italy
| | | | - Carlotta Spagnoli
- Child Neurology and Psychiatric Unit-Presidio Ospedaliero Santa Maria Nuova -AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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