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He SJ, Li DJ, Lv WQ, Tang WH, Sun SW, Zhu YP, Liu Y, Wu J, Lu XX. Outcomes after HSCT for mucolipidosis II (I-cell disease) caused by novel compound heterozygous GNPTAB mutations. Front Pediatr 2023; 11:1199489. [PMID: 37484777 PMCID: PMC10359890 DOI: 10.3389/fped.2023.1199489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/05/2023] [Indexed: 07/25/2023] Open
Abstract
Background Mucolipidosis type II (MLII), or I-cell disease, is a rare lysosomal storage disease (LSD) caused by variants in the GNPTAB gene. MLII patients exhibit clinical phenotypes in the prenatal or neonatal stage, such as marked dysmorphic features, cardiac involvement, respiratory symptoms, dysostosis multiplex, severe growth abnormalities, and mental and motor developmental abnormalities. The median age at diagnosis for MLII is 0.7 years, the median survival is 5.0 years, and the median age at death is 1.8 years. No cure for MLII exists. Methods Sanger sequencing of the GNPTAB gene identified the compound heterozygous mutations c.673C > T in exon 7 and c.1090C > T in exon 9, which were novel double heterozygous mutations first reported in China. For the first time, we describe our experience in the use of HSCT for MLII. Our patient underwent HSCT with cells from a 9/10 human leukocyte antigen (HLA)-matched unrelated donor at 12 months of age. Myeloid neutrophil and platelet engraftment occurred on Days 10 and 11, respectively. Results The patient's limb muscle tension was significantly reduced, and his gross and fine motor skills were improved four months after transplantation. DST(Developmental Screen Test) results showed that the patient's fine motor skills and mental development were improved compared with before HSCT. Conclusion MLII is a very severe lysosomal storage disease, to date, only 3 cases have been reported on the use of HSCT to treat MLII. Our data show that HSCT is a potential way to prolong the life of patients and improve their quality of life. Due to the lack of comparable data and time, the exact benefit remains unclear in MLII patients. Longer-term follow-up and in-depth prospective studies are indispensable.
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Affiliation(s)
- Si-jia He
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Dong-jun Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Wen-qiong Lv
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Wen-hao Tang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Shu-wen Sun
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yi-ping Zhu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ying Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Pediatrics, Prenatal Diagnosis Center of West China Second University Hospital, Chengdu, China
| | - Jin Wu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Pediatrics, Prenatal Diagnosis Center of West China Second University Hospital, Chengdu, China
| | - Xiao-xi Lu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
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Ammer LS, Täuber K, Perez A, Dohrmann T, Denecke J, Santer R, Blümlein U, Ozga AK, Pohl S, Muschol NM. CNS Manifestations in Mucolipidosis Type II-A Retrospective Analysis of Longitudinal Data on Neurocognitive Development and Neuroimaging in Eleven Patients. J Clin Med 2023; 12:4114. [PMID: 37373807 DOI: 10.3390/jcm12124114] [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: 05/18/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023] Open
Abstract
Mucolipidosis type II (MLII), an ultra-rare lysosomal storage disorder, manifests as a fatal multi-systemic disease. Mental inhibition and progressive neurodegeneration are commonly reported disease manifestations. Nevertheless, longitudinal data on neurocognitive testing and neuroimaging lack in current literature. This study aimed to provide details on central nervous system manifestations in MLII. All MLII patients with at least one standardized developmental assessment performed between 2005 and 2022 were included by retrospective chart review. A multiple mixed linear regression model was applied. Eleven patients with a median age of 34.0 months (range 1.6-159.6) underwent 32 neurocognitive and 28 adaptive behaviour assessments as well as 14 brain magnetic resonance imagings. The scales used were mainly BSID-III (42%) and VABS-II (47%). Neurocognitive testing (per patient: mean 2.9, standard deviation (SD) 2.0) performed over 0-52.1 months (median 12.1) revealed profound impairment with a mean developmental quotient of 36.7% (SD 20.4) at last assessment. The patients showed sustained development; on average, they gained 0.28 age-equivalent score points per month (confidence interval 0.17-0.38). Apart from common (63%) cervical spinal stenosis, neuroimaging revealed unspecific, non-progressive abnormalities (i.e., mild brain atrophy, white matter lesions). In summary, MLII is associated with profound developmental impairment, but not with neurodegeneration and neurocognitive decline.
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Affiliation(s)
- Luise Sophie Ammer
- International Centre for Lysosomal Disorders (ICLD), Department of Paediatrics, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
- Department of Paediatric Intensive Care and Neonatology, Altona Children's Hospital, 22763 Hamburg, Germany
| | - Karolin Täuber
- International Centre for Lysosomal Disorders (ICLD), Department of Paediatrics, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Anna Perez
- International Centre for Lysosomal Disorders (ICLD), Department of Paediatrics, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Thorsten Dohrmann
- Department of Anaesthesiology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Jonas Denecke
- International Centre for Lysosomal Disorders (ICLD), Department of Paediatrics, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - René Santer
- International Centre for Lysosomal Disorders (ICLD), Department of Paediatrics, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Ulrike Blümlein
- Department of Paediatrics, Carl-Thiem-Klinikum gGmbH, 03048 Cottbus, Germany
| | - Ann-Kathrin Ozga
- Institute of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Sandra Pohl
- International Centre for Lysosomal Disorders (ICLD), Department of Paediatrics, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
- Department of Osteology and Biomechanics, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Nicole Maria Muschol
- International Centre for Lysosomal Disorders (ICLD), Department of Paediatrics, University Medical Centre Hamburg-Eppendorf, 20246 Hamburg, Germany
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Anaesthesia-Relevant Disease Manifestations and Perianaesthetic Complications in Patients with Mucolipidosis—A Retrospective Analysis of 44 Anaesthetic Cases in 12 Patients. J Clin Med 2022; 11:jcm11133650. [PMID: 35806935 PMCID: PMC9267794 DOI: 10.3390/jcm11133650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 02/04/2023] Open
Abstract
Mucolipidosis (ML) type II, intermediate, and III are lysosomal storage disorders with progressive multiorgan manifestations predisposing patients to a high risk of perioperative morbidity. The aims of the study were to systematically assess disease manifestations relevant to anaesthesia as well as anaesthesia-related complications. This retrospective study includes ML patients who underwent anaesthesia in two centres between 2008 and 2022. We reviewed patients’ demographics, medical history, disease manifestations, as well as procedure- and outcome-related data. A total of 12 patients (7 MLII, 2 ML intermediate, 3 MLIII) underwent 44 anaesthesia procedures (per patient: median 3, range 1–11). The median age was 3.3 years (range 0.1–19.1). At least one complication occurred in 27.3% of the anaesthesia procedures. The vast majority of complications (94%) occurred in children with MLII and ML intermediate. A predicted difficult airway was found in 100% and 80% of the MLII and ML intermediate patients, respectively. Accordingly, most complications (59%) occurred during the induction of anaesthesia. Altogether, respiratory complications were the most frequent (18%), followed by difficult airway management (14%). The risk for anaesthesia-related complications is alarmingly high in patients with ML, particularly in those with MLII and ML intermediate. Multidisciplinary risk–benefit analysis and thoughtful anaesthesia planning are crucial in these patients.
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Mao SJ, Zu YM, Dai YL, Zou CC. Case Report: Mucolipidosis II and III Alpha/Beta Caused by Pathogenic Variants in the GNPTAB Gene (Mucolipidosis). Front Pediatr 2022; 10:852701. [PMID: 35463894 PMCID: PMC9033252 DOI: 10.3389/fped.2022.852701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aimed to improve the cognition of mucolipidosis (ML) II and III alpha/beta by analyzing the clinical manifestations of two patients. METHODS The clinical, biochemical, and molecular data of two clinical cases associated with ML II and III alpha/beta were analyzed and compared with other case reports of ML II and III alpha/beta. RESULTS The first patient was a 14-month-old girl who was hospitalized because of abnormal postnatal coarse facial features. The child had no abnormal birth history, but developed multiple abnormalities such as psychomotor retardation, abnormal facial features, bilateral limb muscle hypotonia, and genital abnormalities. The X-ray of the spine revealed multiple bone malformations. Brain magnetic resonance imaging (MRI) showed delayed myelination. Genetic testing showed the presence of two compound heterozygous pathogenic variants (c.1364C>T and c.1284+1G>T) in the GNPTAB gene. The second patient was an 18-month-old boy who was hospitalized for recurrent respiratory tract infections. The patient was a high-risk preterm infant with postnatal psychomotor retardation, language development retardation, intellectual disability, and coarse facial features. X-ray showed multiple bone malformations. Craniocerebral ultrasound showed bilateral ventricle widening. Genetic testing showed the presence of two compound heterozygous pathogenic variants (c.1284+1G>T and c.483delT) in the same gene. CONCLUSIONS ML II and III alpha/beta are rare autosomal-recessive lysosomal storage diseases that are attributed to GNPTAB variants that cause N-acetylglucosamine-1-phosphotransferase deficiency, finally leading to multiple clinical signs and symptoms. A proper ML II and/or III alpha/beta diagnosis requires a combined analysis of a patient's clinical manifestations, imaging examination, enzymatic analysis, and genetic testing results. Ultimately, genetic counseling is essential for this disease.
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Affiliation(s)
- Shao-Jia Mao
- Department of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yu-Mei Zu
- Department of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yang-Li Dai
- Department of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Chao-Chun Zou
- Department of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
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Pathogenic variants in GNPTAB and GNPTG encoding distinct subunits of GlcNAc-1-phosphotransferase differentially impact bone resorption in patients with mucolipidosis type II and III. Genet Med 2021; 23:2369-2377. [PMID: 34341521 PMCID: PMC8629757 DOI: 10.1038/s41436-021-01285-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 11/08/2022] Open
Abstract
Purpose Pathogenic variants in GNPTAB and GNPTG, encoding different subunits of GlcNAc-1-phosphotransferase, cause mucolipidosis (ML) II, MLIII alpha/beta, and MLIII gamma. This study aimed to investigate the cellular and molecular bases underlying skeletal abnormalities in patients with MLII and MLIII. Methods We analyzed bone biopsies from patients with MLIII alpha/beta or MLIII gamma by undecalcified histology and histomorphometry. The skeletal status of Gnptgkoand Gnptab-deficient mice was determined and complemented by biochemical analysis of primary Gnptgko bone cells. The clinical relevance of the mouse data was underscored by systematic urinary collagen crosslinks quantification in patients with MLII, MLIII alpha/beta, and MLIII gamma. Results The analysis of iliac crest biopsies revealed that bone remodeling is impaired in patients with GNPTAB-associated MLIII alpha/beta but not with GNPTG-associated MLIII gamma. Opposed to Gnptab-deficient mice, skeletal remodeling is not affected in Gnptgko mice. Most importantly, patients with variants in GNPTAB but not in GNPTG exhibited increased bone resorption. Conclusion The gene-specific impact on bone remodeling in human individuals and in mice proposes distinct molecular functions of the GlcNAc-1-phosphotransferase subunits in bone cells. We therefore appeal for the necessity to classify MLIII based on genetic in addition to clinical criteria to ensure appropriate therapy.
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