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Ahmed S, Akbar F, DeBerardinis RJ, Ni M, Afroze B. Evaluation of the clinical, biochemical, and genetic presentation of neonatal and adult-onset 5,10-methylene tetrahydrofolate reductase (MTHFR) deficiency in patients from Pakistan. J Pediatr Endocrinol Metab 2023; 36:761-771. [PMID: 37440674 DOI: 10.1515/jpem-2023-0083] [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: 02/27/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES To study the biochemical, clinical and molecular characteristics of 5,10- methylenetetrahydrofolate reductase (MTHFR) deficiency in Pakistani patients from a single center. METHODS Medical charts, urine organic acid chromatograms, plasma methionine and Hcys levels, and molecular testing results of MTHFR gene of patients presenting at the Biochemical Genetics Clinic, AKUH from 2016 to 2022 were reviewed. RESULTS Neonatal MTHFR deficiency was found in five patients. The median (IQR) age of symptom onset and diagnosis were 18 (8.5-22) and 26 (16.5-31) days. The median lag between symptom onset and diagnosis was 8 (4.5-12.5) days. The median age of treatment initiation and duration of treatment were 26 (16.5-49) and 32 (25.5-54) days. The most common clinical features were lethargy, poor feeding, and seizures. The MTHFR gene sequencing revealed homozygous variants p.K510K, p.R567*, and p.R157W. Renal insufficiency manifesting as elevated serum creatinine and responding to betaine therapy was noted in one patient. This has not been previously reported in neonatal MTHFR deficiency and may reflect engagement of alternate pathways of remethylation. Adult onset MTHFR deficiency was found in six patients, with a heterogeneous neurological presentation. The median lag between symptoms onset and diagnosis was 7 (3-11) years. MTHFR gene sequencing revealed homozygous variant p.A195V in five patients from one family and p.G261V in the other. Two of the five reported variants are novel that include p.R157W and p.G261V. CONCLUSIONS Eleven patients of this rare disorder from a single center indicate the need for clinical awareness and appropriate biochemical evaluation to ensure optimal outcomes.
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Affiliation(s)
- Sibtain Ahmed
- Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Fizza Akbar
- Department of Paediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Ralph J DeBerardinis
- Children's Medical Center Research Institute at UT Southwestern, Dallas, TX, USA
- Howard Hughes Medical Institute, UT Southwestern, Dallas, TX, USA
| | - Min Ni
- Children's Medical Center Research Institute at UT Southwestern, Dallas, TX, USA
| | - Bushra Afroze
- Department of Paediatrics & Child Health, Aga Khan University Hospital, Karachi, Pakistan
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Biesalski AS, Hoffjan S, Schneider R, Nguyen HP, Dekomien G, Lücke T, Schneider-Gold C, Matusche B, Gold R, Ayzenberg I. Phoenix from the ashes: dramatic improvement in severe late-onset methylenetetrahydrofolate reductase (MTHFR) deficiency with a complete loss of vision. J Neurol 2021; 269:2206-2209. [PMID: 34657180 PMCID: PMC8940754 DOI: 10.1007/s00415-021-10841-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 12/02/2022]
Affiliation(s)
- Anne-Sophie Biesalski
- Department of Neurology, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany.
| | - Sabine Hoffjan
- Department of Human Genetics, Ruhr-University, Bochum, Germany.,Center for Rare Diseases Ruhr (CeSER), Bochum, Germany
| | - Ruth Schneider
- Department of Neurology, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Huu Phuc Nguyen
- Department of Human Genetics, Ruhr-University, Bochum, Germany.,Center for Rare Diseases Ruhr (CeSER), Bochum, Germany
| | - Gabriele Dekomien
- Department of Human Genetics, Ruhr-University, Bochum, Germany.,Center for Rare Diseases Ruhr (CeSER), Bochum, Germany
| | - Thomas Lücke
- University Children's Hospital, St. Josef Hospital, Bochum, Germany.,Center for Rare Diseases Ruhr (CeSER), Bochum, Germany
| | | | - Britta Matusche
- Institute of Neuroradiology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Ilya Ayzenberg
- Department of Neurology, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany.,Department of Neurology, Sechenov First Moscow State Medical University, Moscow, Russia
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Mezouar N, Mochel F, An-Gourfinkel I, Baulac M, Gales A. Focal epilepsy as the revealing symptom of 5,10-methylenetetrahydrofolate reductase deficiency in a young adult. Rev Neurol (Paris) 2018; 174:173-175. [DOI: 10.1016/j.neurol.2017.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 04/04/2017] [Accepted: 06/15/2017] [Indexed: 12/01/2022]
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Gales A, Masingue M, Millecamps S, Giraudier S, Grosliere L, Adam C, Salim C, Navarro V, Nadjar Y. Adolescence/adult onset MTHFR deficiency may manifest as isolated and treatable distinct neuro-psychiatric syndromes. Orphanet J Rare Dis 2018; 13:29. [PMID: 29391032 PMCID: PMC5796584 DOI: 10.1186/s13023-018-0767-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 01/12/2018] [Indexed: 12/02/2022] Open
Abstract
5,10-Methylene-tetrahydrofolate reductase (MTHFR) deficiency is a genetic disorder that can occur at any age and can be easily detected by increased homocysteinemia. In adolescence/adult onset forms, the clinical picture is often complex with association of various neurological features and thrombosis. Here we report the cases of two adult siblings who experienced focal epilepsy at 18 years old as a first disease manifestation, without other symptom during several years. Upon diagnosis, both patients received metabolic treatment comprising B9, B12 and betaine which has stopped the occurrence of seizures, allowing discontinuation of anti-epileptic drugs. Among 24 reviewed adolescent/adult onset patients with MTHFR deficiency in the literature, clinical manifestations included gait disorder (96%, from motor central or peripheral origin), cognitive decline (74%), epileptic syndromes (50%), encephalopathy (30%), psychotic symptoms (17%), and thrombotic events (21%). A total of 41% presented a single neurological manifestation that could stay isolated during at least 3 years, delaying achievement of the diagnosis. Brain MRI showed a mostly periventricular white matter changes in 71% of cases. All patients stabilized or improved following metabolic treatment. Despite being rare, adolescence/adult onset MTHFR deficiency can nevertheless be successfully treated. Therefore, homocysteinemia should be tested in various unexplained neuro-psychiatric syndromes like epilepsy or spastic paraparesis, even if isolated, since waiting for completion of the clinical picture is likely to increase the risk of irreversible neurological damage.
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Affiliation(s)
- Ana Gales
- AP-HP, GH Pitié-Salpêtrière-Charles Foix, Epileptology Unit, Paris, France
| | - Marion Masingue
- Neurology Department, Reference Center for Lysosomal Diseases, Neurogenetics and Metabolism Unit, AP-HP, GH Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Stephanie Millecamps
- Sorbonne Universités UMRS1127, INSERM U1127, CNRS UMR7225, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Stephane Giraudier
- AP-HP, GH Henri Mondor, Laboratoire d'Hématologie, Créteil, France.,UPEC University, Creteil, France.,INSERM U1131, Saint Louis Hospital, Paris, France
| | - Laure Grosliere
- Neurology Department, Reference Center for Lysosomal Diseases, Neurogenetics and Metabolism Unit, AP-HP, GH Pitié-Salpêtrière-Charles Foix, Paris, France
| | - Claude Adam
- AP-HP, GH Pitié-Salpêtrière-Charles Foix, Epileptology Unit, Paris, France
| | | | - Vincent Navarro
- AP-HP, GH Pitié-Salpêtrière-Charles Foix, Epileptology Unit, Paris, France.,UPMC University, Institut du Cerveau et de la Moelle épinière, Paris, France
| | - Yann Nadjar
- Neurology Department, Reference Center for Lysosomal Diseases, Neurogenetics and Metabolism Unit, AP-HP, GH Pitié-Salpêtrière-Charles Foix, Paris, France.
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5
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Fakhry A, Redonnet-Vernhet I, Sabourdy F, Elbaz M, Caussé E. [Pulmonary embolism in young adults. Think of homocysteine]. Ann Cardiol Angeiol (Paris) 2014; 63:111-113. [PMID: 24613005 DOI: 10.1016/j.ancard.2014.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 01/02/2014] [Indexed: 06/03/2023]
Abstract
Two cases of severe pulmonary embolism in young adults are presented. Biological investigation disclosed hyperhomocysteinemia. This highlights the great interest of homocysteine quantification in such clinical events.
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Affiliation(s)
- A Fakhry
- Service de cardiologie, centre hospitalier Castres-Mazamet, 81100 Castres, France
| | | | - F Sabourdy
- Service de biochimie, IFB, CHU Purpan, TSA 40031, 31059 Toulouse cedex 9, France
| | - M Elbaz
- Service de cardiologie, CHU Rangueil, TSA 50032, 31059 Toulouse cedex 9, France
| | - E Caussé
- Service de biochimie, CHU Rangueil, 1, avenue J.-Poulhes, TSA 50032, 31059 Toulouse cedex 9, France.
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Lopez Sublet M, Warzocha U, Le Jeune S, Abad S, Larroche C, Roulot D, Dhote R. Un morphotype marphanoïde. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.03.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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7
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Degardin A, Dobbelaere D, Vuillaume I, Defoort-Dhellemmes S, Hurtevent JF, Sablonnière B, Destée A, Defebvre L, Devos D. Spinocerebellar Ataxia: A Rational Approach to Aetiological Diagnosis. THE CEREBELLUM 2011; 11:289-99. [DOI: 10.1007/s12311-011-0310-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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CLIA-tested genetic variants on commercial SNP arrays: potential for incidental findings in genome-wide association studies. Genet Med 2010; 12:355-63. [PMID: 20556870 DOI: 10.1097/gim.0b013e3181e1e2a9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Increases in throughput and affordability of genotyping products have led to large sample sizes in genetic studies, increasing the likelihood that incidental genetic findings may occur. We set out to survey potential notifiable variants on arrays used in genome-wide association studies and in direct-to-consumer genetic services. METHODS We used multiple bioinformatics strategies to identify, and map variants tested for genetic disorders in > or = 2 CLIA-approved laboratories (based on the GeneTests database). We subsequently surveyed 18 commercial single nucleotide polymorphism arrays and HapMap for these variants. RESULTS Of 1,362 genes tested according to GeneTests, we identified 298 specific targeted mutations measured in more than or equal to two laboratories, encompassing 56 disorders. Only 88 of 298 mutations could be identified as known single nucleotide polymorphisms in genomic databases. We found 18 of 88 single nucleotide polymorphisms present in HapMap or on commercial single nucleotide polymorphism arrays. Homozygotes for rare alleles of some variants were identified in the Framingham Heart Study, an active genome-wide association studies cohort (n = 8,410). CONCLUSIONS Variants in genes including APOE, F5, HFE, CYP21A2, MEFV, SPINK1, BTD, GALT, and G6PD were found on single nucleotide polymorphism arrays or in the HapMap. Some of these variants may warrant further review to determine their likelihood to trigger incidental findings in the course of genome-wide association studies or direct-to-consumer testing.
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Sedel F, Lyon-Caen O, Saudubray JM. [Treatable hereditary neuro-metabolic diseases]. Rev Neurol (Paris) 2008; 163:884-96. [PMID: 18033024 DOI: 10.1016/s0035-3787(07)92631-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hereditary metabolic diseases may appear during adolescence or young adulthood, revealed by an apparently unexplained neurological or psychiatric disorder. Certain metabolic diseases respond to specific treatments and should be identified early, particularly in emergency situations where rapid introduction of a treatment can avoid fatal outcome or irreversible neurological damage. The main diseases leading to an acute neurological syndrome in the adult are urea cycle disorders, homocysteine metabolisms disorders and porphyria. More rarely, Wilson's disease, aminoacid diseases, organic aciduria, or pyruvate dehydrogenase deficiency, beta-oxidation disordes or biotin metabolism may be involved. Most emergency situations can be screen correctly with simple tests (serum ammonia, homocysteine, lactate, urinary prophyrines, acylcarnitine pattern, amino acid and organic acid chromatography). For chronic situations, the main treatable diseases are Wilson's disease, homocysteine, cerebrotendinous xanthomatosis, Refsum's disease, vitamin E deficiency, Gaucher's disease, Fabry's disease, and neurotransmitter metabolism disorders. We present treatable metabolic disorders as a function of the different clinical situations observed in adults.
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Affiliation(s)
- F Sedel
- Fédération des maladies du système nerveux, Groupe Hospitalier Pitié-Salpêtrière, Paris.
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Crenn P, Maillot F. [Dietary advice for treatment of inborn errors of metabolism in adult neurology: principes and limitations]. Rev Neurol (Paris) 2008; 163:936-41. [PMID: 18033030 DOI: 10.1016/s0035-3787(07)92637-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Special diets can be an efficient treatment for certain inborn errors of metabolism. Regimens applicable in adult neurology include low protein diet (phenylketonuria, homocystinuria, urea cycle disorders, organic acidurias), low fatty acid diets (fatty acid B oxidation defects, adrenomyeloneuropathy, Refsum's disease) and ketogenic diet (pyruvate dehydrogenase deficiency, glucose transporter (GLUT1) deficiency, refractory epilepsy). Although, these regimens can be very efficient in some instances, withdrawal and nutrient deficiencies are major problems encountered.
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Affiliation(s)
- P Crenn
- Département de Médecine Aiguë Spécialisée, Hôpital Raymond Poincaré, Assistance Publique Hôpitaux de Paris, Garches, France.
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