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Hung LY, Mak CM, Foo KC, Chan CHT, Tong HF, Wong TK, Leung HS, Cheung KC, Lee HCH, Ching CK. Dried Blood Spot Postmortem Metabolic Autopsy With Genotype Validation for Sudden Unexpected Deaths in Infancy and Childhood in Hong Kong. Cureus 2024; 16:e62347. [PMID: 38882225 PMCID: PMC11176880 DOI: 10.7759/cureus.62347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2024] [Indexed: 06/18/2024] Open
Abstract
Background Inborn errors of metabolism (IEM) are collectively rare but potentially preventable causes of sudden unexpected death (SUD) in infancy or childhood, and metabolic autopsy serves as the final tool for establishing the diagnosis. We conducted a retrospective review of the metabolic and molecular autopsy on SUD and characterized the biochemical and genetic findings. Methodology A retrospective review of postmortem metabolic investigations (dried blood spot acylcarnitines and amino acid analysis, urine metabolic profiling where available, and next-generation sequencing on a panel of 75 IEM genes) performed for infants and children who presented with SUD between October 2016 and December 2021 with inconclusive autopsy findings or autopsy features suspicious of underlying IEM in our locality was conducted. Clinical and autopsy findings were reviewed for each case. Results A total of 43 infants and children aged between zero days to 10 years at the time of death were referred to the authors' laboratories throughout the study period. One positive case of multiple acyl-CoA dehydrogenase deficiency was diagnosed. Postmortem reference intervals for dried blood spot amino acids and acylcarnitines profile were established based on the results from the remaining patients. Conclusions Our study confirmed the importance of metabolic autopsy and the advantages of incorporating biochemical and genetic testing in this setting.
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Affiliation(s)
- Ling Yin Hung
- Department of Pathology, Princess Margaret Hospital, Hong Kong, CHN
| | - Chloe M Mak
- Department of Pathology, Hong Kong Children's Hospital, Hong Kong, CHN
| | - Ka Chung Foo
- Forensic Pathology Service, Department of Health, Hong Kong, CHN
| | | | - Hok-Fung Tong
- Department of Pathology, Princess Margaret Hospital, Hong Kong, CHN
| | - Tsz Ki Wong
- Department of Pathology, Hong Kong Children's Hospital, Hong Kong, CHN
| | - Hoi Shan Leung
- Department of Pathology, Princess Margaret Hospital, Hong Kong, CHN
| | - Ka Chai Cheung
- Department of Pathology, Hong Kong Children's Hospital, Hong Kong, CHN
| | | | - Chor Kwan Ching
- Department of Pathology, Princess Margaret Hospital, Hong Kong, CHN
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Thunga C, Mitra S, Dayal D, Lal S. Carnitine-acylcarnitine translocase deficiency: a case report with autopsy. Autops Case Rep 2024; 14:e2024483. [PMID: 38628283 PMCID: PMC11021025 DOI: 10.4322/acr.2024.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/29/2024] [Indexed: 04/19/2024]
Abstract
Fatty acid oxidation defects are a heterogeneous group of disorders related to the mitochondrial fatty acid oxidation pathway. Carnitine acylcarnitine translocase (CACT) is an enzyme responsible for the unidirectional transport of acylcarnitine across the inner mitochondrial membrane. This enzyme plays a crucial role in the oxidation of fatty acids. The autopsy pathology of the CACT deficiency is described in only a few cases. We describe the autopsy pathology of a child with CACT deficiency dominantly in the form of microvesicular steatosis of the hepatocytes, renal proximal tubular epithelia, cardiac myocytes, and rhabdomyocytes. The diagnosis was further confirmed on whole exome sequencing with compound heterozygous variants in the exon 1 (c.82G>T, p.Gly28Cys; likely pathogenic) and exon 5 (c.535G>A, p.Asp179Asn; uncertain significance) of the SLC25A20 gene. This case elucidates the histopathology of the liver and the detailed autopsy of a case of CACT deficiency from India.
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Affiliation(s)
- Chennakeshava Thunga
- Post Graduate Institute of Medical Education and Research (PGIMER), Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Chandigarh, India
| | - Suvradeep Mitra
- Post Graduate Institute of Medical Education and Research (PGIMER), Department of Histopathology, Chandigarh, India
| | - Devi Dayal
- Post Graduate Institute of Medical Education and Research (PGIMER), Department of Pediatrics, Endocrinology and Diabetes Unit, Chandigarh, India
| | - Sadhna Lal
- Post Graduate Institute of Medical Education and Research (PGIMER), Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Chandigarh, India
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Yamamoto T, Emoto Y, Murase T, Umehara T, Miura A, Nishiguchi M, Ikematsu K, Nishio H. Molecular autopsy for sudden death in Japan. J Toxicol Pathol 2024; 37:1-10. [PMID: 38283375 PMCID: PMC10811381 DOI: 10.1293/tox.2023-0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/17/2023] [Indexed: 01/30/2024] Open
Abstract
Japan has various death investigation systems; however, external examinations, postmortem computed tomography, macroscopic examinations, and microscopic examinations are performed regardless of the system used. These examinations can reveal morphological abnormalities, whereas the cause of death in cases with non-morphological abnormalities can be detected through additional examinations. Molecular autopsy and postmortem genetic analyses are important additional examinations. They are capable of detecting inherited arrhythmias or inherited metabolic diseases, which are representative non-morphological disorders that cause sudden death, especially in infants and young people. In this review, we introduce molecular autopsy reports from Japan and describe our experience with representative cases. The relationships between drug-related deaths and genetic variants are also reviewed. Based on the presented information, molecular autopsy is expected to be used as routine examinations in death investigations because they can provide information to save new lives.
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Affiliation(s)
- Takuma Yamamoto
- Department of Legal Medicine, Hyogo College of Medicine, 1-1
Mukogawa-cho, Nishinomiya-shi, Hyogo 663-8501, Japan
| | - Yuko Emoto
- Department of Legal Medicine, Kansai Medical University,
2-5-1 Shinmachi, Hirakata-shi, Osaka 573-1010, Japan
| | - Takehiko Murase
- Division of Forensic Pathology and Science, Department of
Medical and Dental Sciences, Graduate School of Biomedical Sciences, School of Medicine,
Nagasaki University, 1-12-4 Sakamoto, Nagasaki-shi, Nagasaki 852-8523, Japan
| | - Takahiro Umehara
- Department of Forensic Medicine, School of Medicine,
University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku,
Kitakyushu-shi, Fukuoka 807-8555, Japan
| | - Aya Miura
- Department of Legal Medicine, Hyogo College of Medicine, 1-1
Mukogawa-cho, Nishinomiya-shi, Hyogo 663-8501, Japan
| | - Minori Nishiguchi
- Department of Legal Medicine, Hyogo College of Medicine, 1-1
Mukogawa-cho, Nishinomiya-shi, Hyogo 663-8501, Japan
| | - Kazuya Ikematsu
- Division of Forensic Pathology and Science, Department of
Medical and Dental Sciences, Graduate School of Biomedical Sciences, School of Medicine,
Nagasaki University, 1-12-4 Sakamoto, Nagasaki-shi, Nagasaki 852-8523, Japan
| | - Hajime Nishio
- Department of Legal Medicine, Hyogo College of Medicine, 1-1
Mukogawa-cho, Nishinomiya-shi, Hyogo 663-8501, Japan
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4
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Alzahrani SA, Alswaimil NF, Alammari AM, Al Saeed WH, Menezes RG. Postmortem Genetic Testing in Sudden Unexpected Death: A Narrative Review. Cureus 2023; 15:e33728. [PMID: 36643077 PMCID: PMC9837602 DOI: 10.7759/cureus.33728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 01/15/2023] Open
Abstract
Sudden unexpected death (SUD) is one of the challenging situations encountered in forensic medicine. As a rule, a comprehensive forensic assessment is performed to identify the cause of death in such cases; however, the absence of findings suggestive of a cause, i.e., a negative autopsy, warrants further investigation such as a molecular autopsy. In this review, we aim to highlight the genetic causes of SUD, tools used in a molecular autopsy, and the role of screening in surviving relatives. As per several guidelines, the most preferred samples for DNA extraction are whole blood and fresh frozen tissues. Furthermore, Sanger sequencing and next-generation sequencing are the technologies that are used for genetic analysis; the latter overcomes the former's drawbacks in terms of cost-effectiveness, time consumption, and the ability to sequence the whole exome. SUD have diverse etiologies; we can generally classify them into cardiac and non-cardiac causes. Regarding cardiac causes, many conditions having an underlying genetic basis are included, such as channelopathies and cardiomyopathies. Regarding non-cardiac causes of SUD, the main etiologies are epilepsy and metabolic disorders. Nevertheless, it has been proposed that there is a genetic overlap between channelopathies, especially long QT syndromes and epilepsy. Additionally, fatty acid oxidation disorders are major metabolic conditions that are caused by certain genetic mutations that can lead to SUD in infancy. Since many SUD causes have an underlying genetic mutation, it is important to understand the genetic variations not only to recognize the cause of death but also to undertake further preventive measures for surviving relatives. In conclusion, a molecular autopsy has a major role in the forensic examination of cases of SUD.
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Affiliation(s)
- Shahad A Alzahrani
- Department of General Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Nour F Alswaimil
- Department of General Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Alia M Alammari
- Department of General Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Wala H Al Saeed
- Department of General Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Ritesh G Menezes
- Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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5
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Accurate interpretation of genetic variants in sudden unexpected death in infancy by trio-targeted gene-sequencing panel analysis. Sci Rep 2021; 11:21532. [PMID: 34728707 PMCID: PMC8563990 DOI: 10.1038/s41598-021-00962-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/20/2021] [Indexed: 12/18/2022] Open
Abstract
In sudden unexpected death in infancy cases, postmortem genetic analysis with next-generation sequencing potentially can extract candidate genes associated with sudden death. However, it is difficult to accurately interpret the clinically significant genetic variants. The study aim was to conduct trio analysis of cases of sudden unexpected death in infancy and their parents to more accurately interpret the clinically significant disease-associated gene variants associated with cause of death. From the TruSight One panel targeting 4813 genes we extracted candidate genetic variants of 66 arrhythmia-, 63 inherited metabolic disease-, 81 mitochondrial disease-, and 6 salt-losing tubulopathy-related genes in 7 cases and determined if they were de novo or parental-derived variants. Thirty-four parental-derived variants and no de novo variants were found, but none appeared to be related to the cause of death. Using trio analysis and an in silico algorithm to analyze all 4813 genes, we identified OBSCN of compound heterozygous and HCCS of hemizygous variants as new candidate genetic variants related to cause of death. Genetic analysis of these deceased infants and their living parents can provide more accurate interpretation of the clinically significant genetic variants than previously possible and help confirm the cause of death.
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6
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Osawa M, Ueno Y, Ikeda N, Ikematsu K, Yamamoto T, Irie W, Kozawa S, Kotani H, Hamayasu H, Murase T, Shingu K, Sugimoto M, Nagao R, Kakimoto Y. Circumstances and factors of sleep-related sudden infancy deaths in Japan. PLoS One 2020; 15:e0233253. [PMID: 32822352 PMCID: PMC7444554 DOI: 10.1371/journal.pone.0233253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/06/2020] [Indexed: 01/15/2023] Open
Abstract
Background Sudden unexpected death in infancy (SUDI) comprises both natural and unnatural causes of death. However, few epidemiological surveys have investigated SUDI in Japan. Objective This retrospective study was conducted to investigate the latest trends of circumstances and risk factors of SUDI cases in which collapse occurred during sleep. Methods Forensic pathology sections from eight universities participated in the selection of subjects from 2013 to 2018. Data obtained from the checklist form were analyzed based on information at postmortem. Results There were 259 SUDI cases consisting of 145 male infants and 114 female infants with a mean birth weight of 2888 ± 553 and 2750 ± 370 g, respectively. Deaths most frequently occurred among infants at 1 month of age (18%). According to population data as the control, the odds ratio (95% confidence interval) of mother’s age ≤19 years was 11.1 (6.9–17.7) compared with ages 30–39. The odds ratio for the fourth- and later born infants was 5.2 (3.4–7.9) compared with the frequency of first-born infants. The most frequent time of day for discovery was between 7 and 8 o’clock, and the time difference from the last seen alive was a mean of 4.1 h. Co-sleeping was recorded for 61%, and the prone position was found for 40% of cases at discovery. Mother’s smoking habit exhibited an odds ratio of 4.5 (2.9–5.8). Conclusion This study confirmed the trends that have been observed for sudden infant death syndrome; particularly, very high odds ratios were evident for teenage mothers and later birth order in comparison with those in other developed countries. Neglect was suspected in some cases of the prolonged time to discovery of unreactive infants. To our knowledge, this is the first report of an extensive survey of SUDI during sleep in Japan.
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Affiliation(s)
- Motoki Osawa
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
- * E-mail:
| | - Yasuhiro Ueno
- Department of Legal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Noriaki Ikeda
- Department of Forensic Pathology and Sciences, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Kazuya Ikematsu
- Department of Forensic Pathology and Science, Graduate School of Biomedical Sciences Nagasaki University, Nagasaki, Japan
| | - Takuma Yamamoto
- Department of Legal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Wataru Irie
- Department of Legal Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Shuji Kozawa
- Department of Forensic Medicine and Sciences, Mie University School of Medicine, Tsu, Mie, Japan
| | - Hirokazu Kotani
- Department of Forensic Medicine and Molecular Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hideki Hamayasu
- Department of Forensic Medicine and Molecular Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takehiko Murase
- Department of Forensic Pathology and Science, Graduate School of Biomedical Sciences Nagasaki University, Nagasaki, Japan
| | - Keita Shingu
- Department of Forensic Pathology and Science, Graduate School of Biomedical Sciences Nagasaki University, Nagasaki, Japan
| | - Marie Sugimoto
- Department of Legal Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Ryoko Nagao
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Yu Kakimoto
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Bo R, Musha I, Yamada K, Kobayashi H, Hasegawa Y, Awano H, Arao M, Kikuchi T, Taketani T, Ohtake A, Yamaguchi S, Iijima K. Need for strict clinical management of patients with carnitine palmitoyltransferase II deficiency: Experience with two cases detected by expanded newborn screening. Mol Genet Metab Rep 2020; 24:100611. [PMID: 32489884 PMCID: PMC7260588 DOI: 10.1016/j.ymgmr.2020.100611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/31/2022] Open
Abstract
In Japan, carnitine palmitoyltransferase II (CPTII) deficiency has been included as one of the primary target diseases in the expanded newborn mass screening program since 2018. However, many cases of the severe infantile hepatocardiomuscular form of CPTII deficiency showed severe neurodevelopmental delay or sudden death, which indicated that management of CPTII deficiency in the acute phase remains to be studied in detail. Herein, we discuss two cases diagnosed by newborn mass screening. Patient 1 was under strict clinical management from the neonatal period, with >20 admissions in 14 months, while Patient 2 was managed using a relatively relaxed approach, with only 2 admissions in the same period. Patient 1 showed normal development; however, Patient 2 expired at the age of 1 year 2 months. To develop strategies for preventing sudden deaths in patients with CPTII deficiency, this retrospective study focused on detailed clinical management practices and biochemical findings during the acute phase. We also investigated the correlation between conventional biomarkers (such as creatine kinase) and long-chain acylcarnitines. We propose that strict monitoring and immediate medical attention, even in case of slight fever or minor abdominal symptoms, can help prevent sudden death in patients with CPTII deficiency. Considering the higher morbidity rate of such patients, strict and acute management of CPTII deficiency cannot be overemphasized.
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Affiliation(s)
- Ryosuke Bo
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.,Department of Pediatrics, Shimane University Faculty of Medicine, 89-1 En-ya-cho, Izumo 693-8501, Japan
| | - Ikuma Musha
- Department of Pediatrics, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-cho, Saitama 350-0495, Japan
| | - Kenji Yamada
- Department of Pediatrics, Shimane University Faculty of Medicine, 89-1 En-ya-cho, Izumo 693-8501, Japan
| | - Hironori Kobayashi
- Department of Pediatrics, Shimane University Faculty of Medicine, 89-1 En-ya-cho, Izumo 693-8501, Japan
| | - Yuki Hasegawa
- Department of Pediatrics, Shimane University Faculty of Medicine, 89-1 En-ya-cho, Izumo 693-8501, Japan
| | - Hiroyuki Awano
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
| | - Masato Arao
- Department of Pediatrics, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-cho, Saitama 350-0495, Japan
| | - Toru Kikuchi
- Department of Pediatrics, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-cho, Saitama 350-0495, Japan
| | - Takeshi Taketani
- Department of Pediatrics, Shimane University Faculty of Medicine, 89-1 En-ya-cho, Izumo 693-8501, Japan
| | - Akira Ohtake
- Department of Pediatrics, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-cho, Saitama 350-0495, Japan
| | - Seiji Yamaguchi
- Department of Pediatrics, Shimane University Faculty of Medicine, 89-1 En-ya-cho, Izumo 693-8501, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan
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8
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Sadat R, Hall PL, Wittenauer AL, Vengoechea ED, Park K, Hagar AF, Singh R, Moore RH, Gambello MJ. Increased parental anxiety and a benign clinical course: Infants identified with short-chain acyl-CoA dehydrogenase deficiency and isobutyryl-CoA dehydrogenase deficiency through newborn screening in Georgia. Mol Genet Metab 2020; 129:20-25. [PMID: 31813752 DOI: 10.1016/j.ymgme.2019.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 12/29/2022]
Abstract
The long-term consequences and need for therapy in children with short-chain acyl-CoA dehydrogenase deficiency (SCADD) or isobutyryl-CoA dehydrogenase deficiency (IBDD) identified via newborn screening (NBS) remains controversial. Initial clinical descriptions were severe; however, while most cases identified through NBS have remained asymptomatic, clinical concerns have been raised in these populations. It is not clear whether these children are asymptomatic because of the success of NBS, or because the normal clinical course of these disorders is relatively benign. To evaluate these possibilities in our program, we evaluated the clinical outcomes of children with SCADD or IBDD identified by the Georgia NBS compared to the health status of a healthy age-matched control group. We also assessed parental anxiety during a phone interview both subjectively and objectively using the Pediatric Inventory for Parents (PIP), a validated measure of illness-related parental stress. The general health of 52 SCADD and nine IBDD cases from 2007 to 2016 were compared to the general health of unaffected control children obtained through the Centers for Disease Control and Prevention (CDC) parent listserv. We also collected statements from parents who participated in a phone survey regarding events they experienced during and after their diagnostic process. Overall, the children with SCADD and IBDD had no major health problems. There was no significant difference in cognitive development (p = .207). We identified a slightly higher incidence of reported neonatal hypoglycemia in the SCADD group; two of these occurred in the context of maternal diabetes. All interviewed parents reported extreme anxiety during the diagnostic period and current feelings of uncertainty about their child's future. PIP scores for all six caregivers who responded to that portion of the survey were consistent with some degree of parental stress. The greatest reported stressor was the unknown long-term impact of the illness. All children with SCADD and IBDD had no significant long-term sequelae. The phone interviews revealed substantial parental anxiety about the identification and follow-up of SCADD and IBDD. Based on our findings, the anxiety parents experience may be unwarranted given that we see no disease-associated morbidity or mortality in these children. Consideration should be given to the removal of these conditions from NBS panels, or if that is not possible, clinicians could educate parents on the benign nature of these diagnoses and release them from follow-up without treatment.
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Affiliation(s)
- Roa Sadat
- Genetic Counseling Program, Emory University Emory University School of Medicine, Atlanta, GA, USA
| | - Patricia L Hall
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Angela L Wittenauer
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Kevin Park
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Rani Singh
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Reneé H Moore
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michael J Gambello
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA.
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Estimating carrier frequencies of newborn screening disorders using a whole-genome reference panel of 3552 Japanese individuals. Hum Genet 2019; 138:389-409. [PMID: 30887117 DOI: 10.1007/s00439-019-01998-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/06/2019] [Indexed: 12/19/2022]
Abstract
Incidence rates of Mendelian diseases vary among ethnic groups, and frequencies of variant types of causative genes also vary among human populations. In this study, we examined to what extent we can predict population frequencies of recessive disorders from genomic data, and explored better strategies for variant interpretation and classification. We used a whole-genome reference panel from 3552 general Japanese individuals constructed by the Tohoku Medical Megabank Organization (ToMMo). Focusing on 32 genes for 17 congenital metabolic disorders included in newborn screening (NBS) in Japan, we identified reported and predicted pathogenic variants through variant annotation, interpretation, and multiple ways of classifications. The estimated carrier frequencies were compared with those from the Japanese NBS data based on 1,949,987 newborns from a previous study. The estimated carrier frequency based on genomic data with a recent guideline of variant interpretation for the PAH gene, in which defects cause hyperphenylalaninemia (HPA) and phenylketonuria (PKU), provided a closer estimate to that by the observed incidence than the other methods. In contrast, the estimated carrier frequencies for SLC25A13, which causes citrin deficiency, were much higher compared with the incidence rate. The results varied greatly among the 11 NBS diseases with single responsible genes; the possible reasons for departures from the carrier frequencies by reported incidence rates were discussed. Of note, (1) the number of pathogenic variants increases by including additional lines of evidence, (2) common variants with mild effects also contribute to the actual frequency of patients, and (3) penetrance of each variant remains unclear.
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10
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Peri-mortem evaluation of infants who die without a diagnosis: focus on advances in genomic technology. J Perinatol 2018; 38:1125-1134. [PMID: 30076402 PMCID: PMC6419510 DOI: 10.1038/s41372-018-0187-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/01/2018] [Accepted: 07/09/2018] [Indexed: 12/16/2022]
Abstract
Infants who die within the first weeks to months of life may have genetic disorders, though many die without a confirmed diagnosis. Non-genetic conditions may also be responsible for unexplained infant deaths, and the diagnosis may be reliant upon studies performed in the peri-mortem period. Neonatologists, obstetricians, or pediatricians caring for these children and their families may be unsure of which investigations can and should be performed in the setting of a newborn or infant who is dying or has died. Recent advances in genomic sequencing technology may provide additional diagnostic options, though the interpretation of genetic variants discovered by this technique may be contingent upon clinical phenotype information that is obtained peri-mortem or upon autopsy. We have reviewed the current literature concerning the evaluation of an unexplained neonatal or infantile demise and synthesized a diagnostic approach, with a focus on the contribution of new and emerging genomic technologies.
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11
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Yamamoto T, Matsusue A, Umehara T, Kubo SI, Ikematsu K. No association between cardiac ion channel variants and sudden infant death. Pediatr Int 2018; 60:483-484. [PMID: 29700890 DOI: 10.1111/ped.13532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/20/2017] [Accepted: 02/14/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Takuma Yamamoto
- Division of Forensic Pathology and Science, Unit of Social Medicine, Course of Medical and Dental Sciences, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Aya Matsusue
- Department of Forensic Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Takahiro Umehara
- Division of Forensic Pathology and Science, Unit of Social Medicine, Course of Medical and Dental Sciences, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Shin-Ichi Kubo
- Department of Forensic Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kazuya Ikematsu
- Division of Forensic Pathology and Science, Unit of Social Medicine, Course of Medical and Dental Sciences, Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, Nagasaki, Japan
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12
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Postmortem genetic analysis of sudden unexpected death in infancy: neonatal genetic screening may enable the prevention of sudden infant death. J Hum Genet 2017; 62:989-995. [DOI: 10.1038/jhg.2017.79] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/27/2017] [Accepted: 06/27/2017] [Indexed: 11/08/2022]
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