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Abou Haidar L, Pachnis P, Gotway GK, Ni M, DeBerardinis RJ, McNutt MC. Partial N-acetyl glutamate synthase deficiency presenting as postpartum hyperammonemia: Diagnosis and subsequent pregnancy management. JIMD Rep 2023; 64:403-409. [PMID: 37927481 PMCID: PMC10623101 DOI: 10.1002/jmd2.12388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 11/07/2023] Open
Abstract
N-acetyl glutamate synthase (NAGS) deficiency (OMIM #: 237310) is a rare urea cycle disorder that usually presents early in life with hyperammonemia. NAGS catalyzes the synthesis of N-acetyl glutamate (NAG) which functions as an activator of the carbamoyl phosphate synthetase-1 mediated conversion of ammonia to carbamoyl phosphate. The absence of NAG results in a proximal urea cycle disorder which can result in severe neurologic sequelae secondary to hyperammonemia and even death. Unlike the other urea cycle disorders, a specific pharmacological treatment for NAGS deficiency exists in the form of carglumic acid, an analog of NAG. Here we present a 29-year-old previously healthy female who presented with hyperammonemia and obtundation just after the birth of her first child. Exome sequencing revealed two novel variants in the NAGS gene, and plasma metabolomics revealed extremely low levels of NAG. Carglumic acid treatment led to prompt resolution of her biochemical abnormalities and symptoms. She tolerated two subsequent pregnancies, 2 years and 6 years after her initial presentation, while taking carglumic acid, and breastfed her third child, all without complications in the mother or children. This case report emphasizes the importance of considering urea cycle disorders in previously-healthy adults presenting with neurological symptoms during periods of metabolic stress, including the postpartum period. It also highlights the efficacious and safe use of carglumic acid during pregnancy and while breastfeeding.
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Affiliation(s)
- Lea Abou Haidar
- Children's Medical Center Research InstituteThe University of Texas Southwestern Medical CenterDallasTexasUSA
- Howard Hughes Medical InstituteThe University of Texas Southwestern Medical CenterDallasTexasUSA
| | - Panayotis Pachnis
- Children's Medical Center Research InstituteThe University of Texas Southwestern Medical CenterDallasTexasUSA
- Department of PediatricsThe University of Texas Southwestern Medical CenterDallasTexasUSA
| | - Garrett K. Gotway
- Department of PediatricsThe University of Texas Southwestern Medical CenterDallasTexasUSA
- Eugene McDermott Center for Human Growth and DevelopmentThe University of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Internal MedicineThe University of Texas Southwestern Medical CenterDallasTexasUSA
| | - Min Ni
- Children's Medical Center Research InstituteThe University of Texas Southwestern Medical CenterDallasTexasUSA
- Department of PediatricsThe University of Texas Southwestern Medical CenterDallasTexasUSA
| | - Ralph J. DeBerardinis
- Children's Medical Center Research InstituteThe University of Texas Southwestern Medical CenterDallasTexasUSA
- Howard Hughes Medical InstituteThe University of Texas Southwestern Medical CenterDallasTexasUSA
- Department of PediatricsThe University of Texas Southwestern Medical CenterDallasTexasUSA
- Eugene McDermott Center for Human Growth and DevelopmentThe University of Texas Southwestern Medical CenterDallasTexasUSA
| | - Markey C. McNutt
- Department of PediatricsThe University of Texas Southwestern Medical CenterDallasTexasUSA
- Eugene McDermott Center for Human Growth and DevelopmentThe University of Texas Southwestern Medical CenterDallasTexasUSA
- Department of Internal MedicineThe University of Texas Southwestern Medical CenterDallasTexasUSA
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2
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Selvanathan A, Demetriou K, Lynch M, Lipke M, Bursle C, Elliott A, Inwood A, Foyn L, McWhinney B, Coman D, McGill J. N‐acetylglutamate synthase deficiency with associated 3‐methylglutaconic aciduria: A case report. JIMD Rep 2022; 63:420-424. [PMID: 36101823 PMCID: PMC9458610 DOI: 10.1002/jmd2.12318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/01/2022] [Accepted: 07/12/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Arthavan Selvanathan
- Queensland Lifespan Metabolic Medicine Service Queensland Children's Hospital Brisbane Australia
| | - Kalliope Demetriou
- Queensland Lifespan Metabolic Medicine Service Queensland Children's Hospital Brisbane Australia
| | - Matthew Lynch
- Queensland Lifespan Metabolic Medicine Service Queensland Children's Hospital Brisbane Australia
| | - Michelle Lipke
- Queensland Lifespan Metabolic Medicine Service Queensland Children's Hospital Brisbane Australia
| | - Carolyn Bursle
- Queensland Lifespan Metabolic Medicine Service Queensland Children's Hospital Brisbane Australia
| | - Aoife Elliott
- Queensland Lifespan Metabolic Medicine Service Queensland Children's Hospital Brisbane Australia
| | - Anita Inwood
- Queensland Lifespan Metabolic Medicine Service Queensland Children's Hospital Brisbane Australia
| | - Leanne Foyn
- Chemical Pathology, Central Laboratory Pathology Queensland Herston Australia
| | - Brett McWhinney
- Chemical Pathology, Central Laboratory Pathology Queensland Herston Australia
| | - David Coman
- Queensland Lifespan Metabolic Medicine Service Queensland Children's Hospital Brisbane Australia
- School of Medicine University of Queensland Brisbane Australia
| | - Jim McGill
- Chemical Pathology, Central Laboratory Pathology Queensland Herston Australia
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3
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Häberle J, Moore MB, Haskins N, Rüfenacht V, Rokicki D, Rubio-Gozalbo E, Tuchman M, Longo N, Yandell M, Andrews A, AhMew N, Caldovic L. Noncoding sequence variants define a novel regulatory element in the first intron of the N-acetylglutamate synthase gene. Hum Mutat 2021; 42:1624-1636. [PMID: 34510628 DOI: 10.1002/humu.24281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/19/2021] [Accepted: 09/08/2021] [Indexed: 11/10/2022]
Abstract
N-acetylglutamate synthase deficiency is an autosomal recessive urea cycle disorder caused either by decreased expression of the NAGS gene or defective NAGS enzyme resulting in decreased production of N-acetylglutamate (NAG), an allosteric activator of carbamylphosphate synthetase 1 (CPS1). NAGSD is the only urea cycle disorder that can be effectively treated with a single drug, N-carbamylglutamate (NCG), a stable NAG analog, which activates CPS1 to restore ureagenesis. We describe three patients with NAGSD due to four novel noncoding sequence variants in the NAGS regulatory regions. All three patients had hyperammonemia that resolved upon treatment with NCG. Sequence variants NM_153006.2:c.427-222G>A and NM_153006.2:c.427-218A>C reside in the 547 bp-long first intron of NAGS and define a novel NAGS regulatory element that binds retinoic X receptor α. Sequence variants NC_000017.10:g.42078967A>T (NM_153006.2:c.-3065A>T) and NC_000017.10:g.42078934C>T (NM_153006.2:c.-3098C>T) reside in the NAGS enhancer, within known HNF1 and predicted glucocorticoid receptor binding sites, respectively. Reporter gene assays in HepG2 and HuH-7 cells demonstrated that all four substitutions could result in reduced expression of NAGS. These findings show that analyzing noncoding regions of NAGS and other urea cycle genes can reveal molecular causes of disease and identify novel regulators of ureagenesis.
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Affiliation(s)
- Johannes Häberle
- Division of Metabolism and Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Marvin B Moore
- Department of Human Genetics, University of Utah Health Science Center, Salt Lake City, Utah, USA
| | - Nantaporn Haskins
- Center for Genetic Medicine Research, Children's National Hospital, Washington, District of Columbia, USA
| | - Véronique Rüfenacht
- Division of Metabolism and Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - Dariusz Rokicki
- Department of Pediatrics, Nutrition and Metabolic Diseases, The Children's Memorial Health Institute, Warsaw, Poland
| | - Estela Rubio-Gozalbo
- Department of Pediatrics and Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mendel Tuchman
- Center for Genetic Medicine Research, Children's National Hospital, Washington, District of Columbia, USA
| | - Nicola Longo
- Division of Medical Genetics, Department of Pediatrics, University of Utah Health Science Center, Salt Lake City, Utah, USA
| | - Mark Yandell
- Eccles Institute of Human Genetics, University of Utah Health Science Center, Salt Lake City, Utah, USA.,8USTAR Center for Genetic Discovery, University of Utah Health Science Center, Salt Lake City, Utah, USA
| | - Ashley Andrews
- Division of Medical Genetics, Pediatrics, University of Utah Health Science Center, Salt Lake City, Utah, USA
| | - Nicholas AhMew
- Center for Genetic Medicine Research, Children's National Hospital, Washington, District of Columbia, USA
| | - Ljubica Caldovic
- Center for Genetic Medicine Research, Children's National Hospital, Washington, District of Columbia, USA.,Department of Genomics and Precision Medicine, School of Medical and Health Sciences, The George Washington University, Washington, District of Columbia, USA
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4
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Zhou Y, Eid T, Hassel B, Danbolt NC. Novel aspects of glutamine synthetase in ammonia homeostasis. Neurochem Int 2020; 140:104809. [DOI: 10.1016/j.neuint.2020.104809] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023]
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5
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Kenneson A, Singh RH. Presentation and management of N-acetylglutamate synthase deficiency: a review of the literature. Orphanet J Rare Dis 2020; 15:279. [PMID: 33036647 PMCID: PMC7545900 DOI: 10.1186/s13023-020-01560-z] [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: 06/25/2020] [Accepted: 09/24/2020] [Indexed: 12/19/2022] Open
Abstract
Background N-Acetylglutamate synthase (NAGS) deficiency is an extremely rare autosomal recessive metabolic disorder affecting the urea cycle, leading to episodes of hyperammonemia which can cause significant morbidity and mortality. Since its recognition in 1981, NAGS deficiency has been treated with carbamylglutamate with or without other measures (nutritional, ammonia scavengers, dialytic, etc.). We conducted a systematic literature review of NAGS deficiency to summarize current knowledge around presentation and management. Methods Case reports and case series were identified using the Medline database, as well as references from other articles and a general internet search. Clinical data related to presentation and management were abstracted by two reviewers. Results In total, 98 cases of NAGS deficiency from 79 families, in 48 articles or abstracts were identified. Of these, 1 was diagnosed prenatally, 57 were neonatal cases, 34 were post-neonatal, and 6 did not specify age at presentation or were asymptomatic at diagnosis. Twenty-one cases had relevant family history. We summarize triggers of hyperammonemic episodes, diagnosis, clinical signs and symptoms, and management strategies. DNA testing is the preferred method of diagnosis, although therapeutic trials to assess response of ammonia levels to carbamylglutamate may also be helpful. Management usually consists of treatment with carbamylglutamate, although the reported maintenance dose varied across case reports. Protein restriction was sometimes used in conjunction with carbamylglutamate. Supplementation with citrulline, arginine, and sodium benzoate also were reported. Conclusions Presentation of NAGS deficiency varies by age and symptoms. In addition, both diagnosis and management have evolved over time and vary across clinics. Prompt recognition and appropriate treatment of NAGS deficiency with carbamylglutamate may improve outcomes of affected individuals. Further research is needed to assess the roles of protein restriction and supplements in the treatment of NAGS deficiency, especially during times of illness or lack of access to carbamylglutamate.
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Affiliation(s)
- Aileen Kenneson
- Department of Human Genetics, Emory University, Atlanta, GA, USA.
| | - Rani H Singh
- Department of Human Genetics, Emory University, Atlanta, GA, USA. .,Department of Pediatrics, Emory University, Atlanta, GA, USA.
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6
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Peoc'h K, Damaj L, Pelletier R, Lefèvre C, Dubourg C, Denis MC, Bendavid C, Odent S, Moreau C. Early care of N-acetyl glutamate synthase (NAGS) deficiency in three infants from an inbred family. Mol Genet Metab Rep 2020; 22:100558. [PMID: 32021803 PMCID: PMC6994713 DOI: 10.1016/j.ymgmr.2019.100558] [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: 10/04/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 12/30/2022] Open
Abstract
N-acetyl glutamate synthase (NAGS) deficiency is the rarest urea cycle defect presenting as neonatal onset life-threatening hyperammonemia. We report here a family history of severe NAGS deficiency: after the index-case with severe hyperammonemia, one patient benefited from antenatal diagnosis, and from primary care at birth, another one was diagnosed at 2-days and immediately treated with carbaglumic-acid. Finally, we report excellent tolerance to long-term carbaglumic-acid treatment, with no side effects, and healthy neurological and psychomotor development.
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Affiliation(s)
- Katell Peoc'h
- APHP, HUPNVS, UF de Biochimie Clinique, Hôpital Beaujon, F-91118 Clichy, France.,Université de Paris, U1149 INSERM, F-75018 Paris, France
| | - Léna Damaj
- Service de Pédiatrie, Hôpital Sud, CHU Rennes Boulevard de Bulgarie, 35000 Rennes, France
| | - Romain Pelletier
- Laboratoire de Biochimie-Toxicologie, Hôpital Pontchaillou CHU Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France
| | - Charles Lefèvre
- Laboratoire de Biochimie-Toxicologie, Hôpital Pontchaillou CHU Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France
| | - Christèle Dubourg
- Laboratoire de Génétique moléculaire et Génomique Hôpital Pontchaillou CHU Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France.,UMR6290 IGDR, Univ Rennes, France
| | | | - Claude Bendavid
- Laboratoire de Biochimie-Toxicologie, Hôpital Pontchaillou CHU Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France.,Univ Rennes, INSERM, INRA, Institut NuMeCan, CHU, Rennes, France
| | - Sylvie Odent
- UMR6290 IGDR, Univ Rennes, France.,Service de Génétique clinique, Hôpital Sud, CHU Rennes Boulevard de Bulgarie, UMR6290 IGDR, Univ Rennes, 35000 Rennes, France
| | - Caroline Moreau
- Laboratoire de Biochimie-Toxicologie, Hôpital Pontchaillou CHU Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France.,Univ Rennes, INSERM, INRA, Institut NuMeCan, CHU, Rennes, France
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7
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N-Acetylglutamate Synthase Deficiency Due to a Recurrent Sequence Variant in the N-acetylglutamate Synthase Enhancer Region. Sci Rep 2018; 8:15436. [PMID: 30337552 PMCID: PMC6194121 DOI: 10.1038/s41598-018-33457-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 09/26/2018] [Indexed: 12/31/2022] Open
Abstract
N-acetylglutamate synthase deficiency (NAGSD, MIM #237310) is an autosomal recessive disorder of the urea cycle that results from absent or decreased production of N-acetylglutamate (NAG) due to either decreased NAGS gene expression or defective NAGS enzyme. NAG is essential for the activity of carbamylphosphate synthetase 1 (CPS1), the first and rate-limiting enzyme of the urea cycle. NAGSD is the only urea cycle disorder that can be treated with a single drug, N-carbamylglutamate (NCG), which can activate CPS1 and completely restore ureagenesis in patients with NAGSD. We describe a novel sequence variant NM_153006.2:c.-3026C > T in the NAGS enhancer that was found in three patients from two families with NAGSD; two patients had hyperammonemia that resolved upon treatment with NCG, while the third patient increased dietary protein intake after initiation of NCG therapy. Two patients were homozygous for the variant while the third patient had the c.-3026C > T variant and a partial uniparental disomy that encompassed the NAGS gene on chromosome 17. The c.-3026C > T sequence variant affects a base pair that is highly conserved in vertebrates; the variant is predicted to be deleterious by several bioinformatics tools. Functional assays in cultured HepG2 cells demonstrated that the c.-3026C > T substitution could result in reduced expression of the NAGS gene. These findings underscore the importance of analyzing NAGS gene regulatory regions when looking for molecular causes of NAGSD.
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8
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Cavicchi C, Chilleri C, Fioravanti A, Ferri L, Ripandelli F, Costa C, Calabresi P, Prontera P, Pochiero F, Pasquini E, Funghini S, la Marca G, Donati MA, Morrone A. Late-Onset N-Acetylglutamate Synthase Deficiency: Report of a Paradigmatic Adult Case Presenting with Headaches and Review of the Literature. Int J Mol Sci 2018; 19:ijms19020345. [PMID: 29364180 PMCID: PMC5855567 DOI: 10.3390/ijms19020345] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 12/30/2022] Open
Abstract
N-acetylglutamate synthase deficiency (NAGSD) is an extremely rare urea cycle disorder (UCD) with few adult cases so far described. Diagnosis of late-onset presentations is difficult and delayed treatment may increase the risk of severe hyperammonemia. We describe a 52-year-old woman with recurrent headaches who experienced an acute onset of NAGSD. As very few papers focus on headaches in UCDs, we also report a literature review of types and pathophysiologic mechanisms of UCD-related headaches. In our case, headaches had been present since puberty (3–4 days a week) and were often accompanied by nausea, vomiting, or behavioural changes. Despite three previous episodes of altered consciousness, ammonia was measured for the first time at 52 years and levels were increased. Identification of the new homozygous c.344C>T (p.Ala115Val) NAGS variant allowed the definite diagnosis of NAGSD. Bioinformatic analysis suggested that an order/disorder alteration of the mutated form could affect the arginine-binding site, resulting in poor enzyme activation and late-onset presentation. After optimized treatment for NAGSD, ammonia and amino acid levels were constantly normal and prevented other headache bouts. The manuscript underlies that headache may be the presenting symptom of UCDs and provides clues for the rapid diagnosis and treatment of late-onset NAGSD.
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Affiliation(s)
- Catia Cavicchi
- Molecular and Cell Biology Laboratory of Neurometabolic Diseases, Neuroscience Department, Meyer Children's Hospital, 50139 Florence, Italy.
| | - Chiara Chilleri
- Molecular and Cell Biology Laboratory of Neurometabolic Diseases, Neuroscience Department, Meyer Children's Hospital, 50139 Florence, Italy.
| | - Antonella Fioravanti
- Structural Biology Researcher Center, VIB, Vrije Universiteit Brussel, 1050 Brussels, Belgium.
| | - Lorenzo Ferri
- Molecular and Cell Biology Laboratory of Neurometabolic Diseases, Neuroscience Department, Meyer Children's Hospital, 50139 Florence, Italy.
| | | | - Cinzia Costa
- Neurology Unit, Santa Maria della Misericordia Hospital, 06123 Perugia, Italy.
| | - Paolo Calabresi
- Neurology Unit, Santa Maria della Misericordia Hospital, 06123 Perugia, Italy.
| | - Paolo Prontera
- Medical Genetics Unit, Santa Maria della Misericordia Hospital, 06123 Perugia, Italy.
| | - Francesca Pochiero
- Metabolic and Muscular Unit, Neuroscience Department, Meyer Children's Hospital, 50139 Florence, Italy.
| | - Elisabetta Pasquini
- Metabolic and Muscular Unit, Neuroscience Department, Meyer Children's Hospital, 50139 Florence, Italy.
| | - Silvia Funghini
- Newborn Screening, Biochemistry and Pharmacology Laboratory, Neuroscience Department, Meyer Children's Hospital, 50139 Florence, Italy.
| | - Giancarlo la Marca
- Newborn Screening, Biochemistry and Pharmacology Laboratory, Neuroscience Department, Meyer Children's Hospital, 50139 Florence, Italy.
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50139 Florence, Italy.
| | - Maria Alice Donati
- Metabolic and Muscular Unit, Neuroscience Department, Meyer Children's Hospital, 50139 Florence, Italy.
| | - Amelia Morrone
- Molecular and Cell Biology Laboratory of Neurometabolic Diseases, Neuroscience Department, Meyer Children's Hospital, 50139 Florence, Italy.
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, 50139 Florence, Italy.
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9
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Chen X, Yuan L, Sun M, Liu Q, Wu Y. Two novel CPS1 mutations in a case of carbamoyl phosphate synthetase 1 deficiency causing hyperammonemia and leukodystrophy. J Clin Lab Anal 2018; 32:e22375. [PMID: 29314318 DOI: 10.1002/jcla.22375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 12/02/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Carbamoyl phosphate synthetase 1 deficiency (CPS1D) is a rare autosomal recessive disorder of the urea cycle, mostly characterized by hyperammonemia and the concomitant leukodystrophy. The onset of CPS1D can be at any age, and the clinical manifestations are variable and atypical. Genetic tests are indispensable for accurate diagnosis of CPS1D on the basis of biochemical tests. METHODS Blood tandem mass spectrometric analysis and urea organic acidemia screening were performed on a Chinese neonatal patient with low activity, recurrent seizures, and hyperammonemia. Next-generation sequencing and Sanger sequencing were followed up for making a definite diagnosis. Bioinformatics tools were used for the conservation analysis and pathogenicity predictions of the identified mutations. RESULTS Increased lactate in urea and decreased citrulline in blood were detected in the patient. Two novel mutations (c.173G>T, p.G58V in exon 2 and c.796G>A, p.G266R in exon 8) in CPS1 identified in the neonatal patient were found through coseparation verification. Both of the two mutations were predicted to be deleterious, and the two relevant amino acids exerted highly evolutionarily conserved. The final diagnosis of the patient was compound heterozygous CPS1D. CONCLUSION This study described the specific clinical characteristics and the variations of physiological and biochemical indices in a Chinese neonatal patient with CPS1D, which facilitated the diagnosis and mechanism research of the disease. Two novel causative missense mutations were identified, which enriched the mutation spectrum of CPS1D in China and worldwide. Advice of prenatal diagnosis was given to the family for a new pregnancy.
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Affiliation(s)
- Xihui Chen
- Department of Biochemistry and Molecular Biology, Fourth Military Medical University, Xi'an, China.,Center for DNA Typing, Fourth Military Medical University, Xi'an, China
| | - Lijuan Yuan
- Department of Biochemistry and Molecular Biology, Fourth Military Medical University, Xi'an, China.,Center for DNA Typing, Fourth Military Medical University, Xi'an, China.,Department of General Surgery, Tangdu Hospital, Fourth Military Medical Universiy, Xi'an, China
| | - Mao Sun
- Department of Biochemistry and Molecular Biology, Fourth Military Medical University, Xi'an, China.,Center for DNA Typing, Fourth Military Medical University, Xi'an, China
| | - Qingbo Liu
- Department of Biochemistry and Molecular Biology, Fourth Military Medical University, Xi'an, China.,Center for DNA Typing, Fourth Military Medical University, Xi'an, China
| | - Yuanming Wu
- Department of Biochemistry and Molecular Biology, Fourth Military Medical University, Xi'an, China.,Center for DNA Typing, Fourth Military Medical University, Xi'an, China
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10
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Wasim M, Awan FR, Khan HN, Tawab A, Iqbal M, Ayesha H. Aminoacidopathies: Prevalence, Etiology, Screening, and Treatment Options. Biochem Genet 2017; 56:7-21. [PMID: 29094226 DOI: 10.1007/s10528-017-9825-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 09/18/2017] [Indexed: 12/26/2022]
Abstract
Inborn errors of metabolism (IEMs) are a group of inherited metabolic disorders which are caused by mutations in the specific genes that lead to impaired proteins or enzymes production. Different metabolic pathways are perturbed due to the deficiency or lack of enzymes. To date, more than 500 IEMs have been reported with most of them being untreatable. However, fortunately 91 such disorders are potentially treatable, if diagnosed at an earlier stage of life. IEMs have been classified into different categories and one class of IEMs, characterized by the physiological disturbances of amino acids is called as aminoacidopathies. Out of 91 treatable IEM, thirteen disorders are amino acid related. Aminoacidopathies can be detected by chromatography and mass spectrometry based analytical techniques (e.g., HPLC, GC-MS, LC-MS/MS) for amino acid level changes, and through genetic assays (e.g., PCR, TaqMan Genotyping, DNA sequencing) at the mutation level in the corresponding genes. Hence, this review is focused to describe thirteen common aminoacidopathies namely: Phenylketonuria (PKU), Maple Syrup Urine Disease (MSUD), Homocystinuria/Methylene Tetrahydrofolate Reductase (MTHFR) deficiency, Tyrosinemia type II, Citrullinemia type I and type II, Argininosuccinic aciduria, Carbamoyl Phosphate Synthetase I (CPS) deficiency, Argininemia (arginase deficiency), Hyperornithinemia-Hyperammonemia-Homocitrullinuria (HHH) syndrome, N-Acetylglutamate Synthase (NAGS) deficiency, Ornithine Transcarbamylase (OTC) deficiency, and Pyruvate Dehydrogenase (PDH) complex deficiency. Furthermore, the etiology, prevalence and commonly used analytical techniques for screening of aminoacidopathies are briefly described. This information would be helpful to researchers and clinicians especially from developing countries to initiate newborn screening programs for aminoacidopathies.
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Affiliation(s)
- Muhammad Wasim
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE) / [Pakistan Institute of Engineering and Applied Sciences (PIEAS), Islamabad], Jhang Road, P.O. Box. 577, Faisalabad, 38000, Pakistan
| | - Fazli Rabbi Awan
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE) / [Pakistan Institute of Engineering and Applied Sciences (PIEAS), Islamabad], Jhang Road, P.O. Box. 577, Faisalabad, 38000, Pakistan.
| | - Haq Nawaz Khan
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE) / [Pakistan Institute of Engineering and Applied Sciences (PIEAS), Islamabad], Jhang Road, P.O. Box. 577, Faisalabad, 38000, Pakistan
| | - Abdul Tawab
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE) / [Pakistan Institute of Engineering and Applied Sciences (PIEAS), Islamabad], Jhang Road, P.O. Box. 577, Faisalabad, 38000, Pakistan
| | - Mazhar Iqbal
- Health Biotechnology Division, National Institute for Biotechnology and Genetic Engineering (NIBGE) / [Pakistan Institute of Engineering and Applied Sciences (PIEAS), Islamabad], Jhang Road, P.O. Box. 577, Faisalabad, 38000, Pakistan
| | - Hina Ayesha
- DHQ Hospital, Faisalabad Medical University, Faisalabad, Pakistan
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11
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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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