1
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Kale D, Sachsenheimer T, Sickmann A, Brügger B. A New, Rapid Method for the Quantification of Dolichyl Phosphates in Cell Cultures Using TMSD Methylation Combined with LC-MS Analysis. Bio Protoc 2023; 13:e4880. [PMID: 38023789 PMCID: PMC10665631 DOI: 10.21769/bioprotoc.4880] [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: 02/28/2023] [Revised: 08/16/2023] [Accepted: 08/29/2023] [Indexed: 12/01/2023] Open
Abstract
Dolichyl phosphates (DolP) are ubiquitous lipids that are present in almost all eukaryotic membranes. They play a key role in several protein glycosylation pathways and the formation of glycosylphosphatidylinositol anchors. These lipids constitute only ~0.1% of total phospholipids, and their analysis by reverse phase (RP) liquid chromatography-high-resolution mass spectrometry (LC-HRMS) is challenging due to their high lipophilicity (log P > 20), poor ionization efficiency, and relatively low abundance. To overcome these challenges, we have introduced a new approach for DolP analysis by combining trimethylsilyldiazomethane (TMSD)-based phosphate methylation and HRMS analysis. The analytical method was validated for its reproducibility, sensitivity, and accuracy. The established workflow was successfully applied for the simultaneous characterization and quantification of DolP species with different isoprene units in lipid extracts of HeLa and Saccharomyces cerevisiae cells.
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Affiliation(s)
- Dipali Kale
- Heidelberg University Biochemistry Center (BZH), Heidelberg, Germany
- Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., Dortmund, Germany
| | | | - Albert Sickmann
- Leibniz-Institut für Analytische Wissenschaften-ISAS-e.V., Dortmund, Germany
| | - Britta Brügger
- Heidelberg University Biochemistry Center (BZH), Heidelberg, Germany
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2
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Yoldas Celik M, Yazici H, Erdem F, Yuksel Yanbolu A, Aykut A, Durmaz A, Zeybek S, Canda E, Kalkan Ucar S, Coker M. Unique clinical presentations and follow-up outcomes from experience with congenital disorders of glycosylation: PMM2-PGM1-DPAGT1-MPI-POMT2-B3GALNT2-DPM1-SRD5A3-CDG. J Pediatr Endocrinol Metab 2023:jpem-2022-0641. [PMID: 37042760 DOI: 10.1515/jpem-2022-0641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 03/26/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVES Congenital Glycosylation Disorders (CDG) are a large group of inherited metabolic diseases with multi-organ involvement. Herein, we aimed to expand the clinical characteristics of patients with CDG based on our experience with diagnoses and follow-up of CDG patients from different subtypes. METHODS The clinical and laboratory findings from the last 15 years were reviewed retrospectively in Ege University Child Metabolism and Nutrition Department. RESULTS There were 8 (57.2 %) females and 6 (42.8 %) males. Diagnoses of the patients were PMM2-CDG (n=4), PGM1-CDG (n=2), DPAGT1-CDG (n=2), SRD5A3-CDG (n=2), MPI-CDG (n=1), POMT2-CDG (n=1), B3GALNT2-CDG (n=1), DPM1-CDG (n=1). The clinical findings of the patients were dysmorphia (85.7 %), developmental delay (85.7 %), intellectual disability (85.7 %), ocular abnormalities (64.2 %), skeletal malformations (64.2 %), failure to thrive (57.1 %), microcephaly (57.1 %), hepatomegaly (35.7 %), hearing loss (35.7 %), seizures (28.5 %), gastrointestinal symptoms (21.4 %), endocrine abnormalities (21.4 %), and cardiac abnormalities (7.1 %). Laboratory findings were abnormal TIEF (92.8 %), abnormal liver enzymes (64.2 %), decreased protein C (64.2 %), decreased antithrombin III (64.2 %), decreased protein S (42.8 %), hypogammaglobulinemia (35.7 %), cerebellar hypoplasia (28.5 %), CK elevation (7.1 %), and hypoglycemia (7.1 %). CONCLUSIONS This study contributes to the literature by sharing our ultra-rare DPM1-CDG case with less than 20 cases in the literature and expanding the clinical and molecular characteristics of other CDG patients. Hyperinsulinemic hypoglycemia, short stature, hypothyroidism, growth hormone deficiency, hypogammaglobulinemia, pericardial effusion, elevated CK, congenital myasthenia, and anorectal malformation were unique findings that were observed. Cerebello-ocular findings accompanying multi-organ involvement were an essential clue for a possible CDG.
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Affiliation(s)
- Merve Yoldas Celik
- Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Havva Yazici
- Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Fehime Erdem
- Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Ayse Yuksel Yanbolu
- Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Ayca Aykut
- Department of Genetics, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Asude Durmaz
- Department of Genetics, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Selcan Zeybek
- Department of Genetics, Tinaztepe University Faculty of Medicine, Izmir, Türkiye
| | - Ebru Canda
- Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Sema Kalkan Ucar
- Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Ege University Faculty of Medicine, Izmir, Türkiye
| | - Mahmut Coker
- Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Ege University Faculty of Medicine, Izmir, Türkiye
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3
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Holla VV, Rangarajan A, Arunachal G, Muthusamy B, Kamble N, Yadav R, Pal PK, Netravathi M. Mirror Movements and Dystonia in SRD5A3-Related Congenital Disorders of Glycosylation: Expanding the Phenotypic and Genotypic Spectrum. Mov Disord Clin Pract 2023; 10:510-513. [PMID: 36949806 PMCID: PMC10026265 DOI: 10.1002/mdc3.13627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/22/2022] [Accepted: 11/13/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Vikram V. Holla
- Department of NeurologyNational Institute of Mental Health & NeurosciencesBengaluruKarnatakaIndia
| | - Anush Rangarajan
- Department of NeurologyNational Institute of Mental Health & NeurosciencesBengaluruKarnatakaIndia
| | - Gautham Arunachal
- Department of Human GeneticsNational Institute of Mental Health & NeurosciencesBengaluruKarnatakaIndia
| | - Babylakshmi Muthusamy
- Institute of Bioinformatics, International Technology ParkBangaloreIndia
- Manipal Academy of Higher EducationManipalKarnatakaIndia
| | - Nitish Kamble
- Department of NeurologyNational Institute of Mental Health & NeurosciencesBengaluruKarnatakaIndia
| | - Ravi Yadav
- Department of NeurologyNational Institute of Mental Health & NeurosciencesBengaluruKarnatakaIndia
| | - Pramod Kumar Pal
- Department of NeurologyNational Institute of Mental Health & NeurosciencesBengaluruKarnatakaIndia
| | - Manjunath Netravathi
- Department of NeurologyNational Institute of Mental Health & NeurosciencesBengaluruKarnatakaIndia
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4
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Kale D, Kikul F, Phapale P, Beedgen L, Thiel C, Brügger B. Quantification of Dolichyl Phosphates Using Phosphate Methylation and Reverse-Phase Liquid Chromatography-High Resolution Mass Spectrometry. Anal Chem 2023; 95:3210-3217. [PMID: 36716239 PMCID: PMC9933046 DOI: 10.1021/acs.analchem.2c03623] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Dolichyl monophosphates (DolPs) are essential lipids in glycosylation pathways that are highly conserved across almost all domains of life. The availability of DolP is critical for all glycosylation processes, as these lipids serve as membrane-anchored building blocks used by various types of glycosyltransferases to generate complex post-translational modifications of proteins and lipids. The analysis of DolP species by reverse-phase liquid chromatography-mass spectrometry (RPLC-MS) remains a challenge due to their very low abundance and wide range of lipophilicities. Until now, a method for the simultaneous qualitative and quantitative assessment of DolP species from biological membranes has been lacking. Here, we describe a novel approach based on simple sample preparation, rapid and efficient trimethylsilyl diazomethane-dependent phosphate methylation, and RPLC-MS analysis for quantification of DolP species with different isoprene chain lengths. We used this workflow to selectively quantify DolP species from lipid extracts derived of Saccharomyces cerevisiae, HeLa, and human skin fibroblasts from steroid 5-α-reductase 3- congenital disorders of glycosylation (SRD5A3-CDG) patients and healthy controls. Integration of this workflow with global lipidomics analyses will be a powerful tool to expand our understanding of the role of DolPs in pathophysiological alterations of metabolic pathways downstream of HMG-CoA reductase, associated with CDGs, hypercholesterolemia, neurodegeneration, and cancer.
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Affiliation(s)
- Dipali Kale
- Heidelberg
University Biochemistry Center (BZH), 69120Heidelberg, Germany,Leibniz-Institut
für Analytische Wissenschaften-ISAS-e.V., 44139Dortmund, Germany,
| | - Frauke Kikul
- Heidelberg
University Biochemistry Center (BZH), 69120Heidelberg, Germany
| | - Prasad Phapale
- Leibniz-Institut
für Analytische Wissenschaften-ISAS-e.V., 44139Dortmund, Germany
| | - Lars Beedgen
- Centre
for Child and Adolescent Medicine, University
Hospital Heidelberg, 69120Heidelberg, Germany
| | - Christian Thiel
- Centre
for Child and Adolescent Medicine, University
Hospital Heidelberg, 69120Heidelberg, Germany
| | - Britta Brügger
- Heidelberg
University Biochemistry Center (BZH), 69120Heidelberg, Germany,
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5
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Nabavizadeh SH, Noeiaghdam R, Johari L, Hosseini SA, Esmaeilzadeh H, Alyasin SS. A rare case of
SRD5A3‐CDG
in a patient with ataxia and telangiectasia: A case report. Clin Case Rep 2022; 10:e6564. [PMID: 36439385 PMCID: PMC9684675 DOI: 10.1002/ccr3.6564] [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: 06/25/2022] [Revised: 09/27/2022] [Accepted: 10/19/2022] [Indexed: 11/26/2022] Open
Abstract
Steroid 5α‐reductase type 3 congenital disorder of glycosylation (SRD5A3‐CDG) is an extremely rare congenital disease. Common manifestations are developmental delay, intellectual disability, ophthalmological abnormalities, cerebellar abnormalities, ataxia, and hypotonia. Here, we discuss a seven‐year‐old boy with SRD5A3‐CDG (homozygous variant c.57G>A [p.Trp19Ter]), featuring the unprecedented finding of telangiectasia.
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Affiliation(s)
- Sayyed Hesamedin Nabavizadeh
- Allergy Research Center, Department of Pediatrics, School of Medicine Shiraz University of Medical Sciences Shiraz Iran
| | - Rafat Noeiaghdam
- Allergy Research Center, Department of Pediatrics, School of Medicine Shiraz University of Medical Sciences Shiraz Iran
| | - Leila Johari
- Allergy Research Center, Department of Pediatrics, School of Medicine Shiraz University of Medical Sciences Shiraz Iran
| | | | - Hossein Esmaeilzadeh
- Allergy Research Center, Department of Pediatrics, School of Medicine Shiraz University of Medical Sciences Shiraz Iran
| | - Soheila Sadat Alyasin
- Allergy Research Center, Department of Pediatrics, School of Medicine Shiraz University of Medical Sciences Shiraz Iran
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6
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Kamarus Jaman N, Rehsi P, Henderson RH, Löbel U, Mankad K, Grunewald S. SRD5A3-CDG: Emerging Phenotypic Features of an Ultrarare CDG Subtype. Front Genet 2021; 12:737094. [PMID: 34925443 PMCID: PMC8671882 DOI: 10.3389/fgene.2021.737094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: SRD5A3-CDG is a rare N-glycosylation defect caused by steroid 5 alpha reductase type 3 deficiency. Its key feature is an early severe visual impairment with variable ocular anomalies often leading to diagnosis. Additional symptoms are still poorly defined. In this case study, we discuss 11 genetically confirmed cases, and report on emerging features involving other systems in addition to the eye phenotype. Methods: In total, 11 SRD5A3-CDG patients in five sets of sibships were included in the study. Data on 9 of 11 patients are as of yet unpublished. Patients’ results on biochemical and genetic investigations and on in-depth phenotyping are presented. Results: Key diagnostic features of SRD5A3-CDG are ophthalmological abnormalities with early-onset retinal dystrophy and optic nerve hypoplasia. SRD5A3-CDG is also characterized by variable neurological symptoms including intellectual disability, ataxia, and hypotonia. Furthermore, ichthyosiform skin lesions, joint laxity, and scoliosis have been observed in our cohort. We also report additional findings including dystonia, anxiety disorder, gastrointestinal symptoms, and MRI findings of small basal ganglia and mal-rotated hippocampus, whereas previous publications described dysmorphic features as a common finding in SRD5A3, which could not be confirmed in our patient cohort. Conclusion: The detailed description of the phenotype of this large cohort of patients with SRD5A3-CDG highlights that the key clinical diagnostic features of SRD5A3-CDG are an early onset form of ophthalmological problems in patients with a multisystem disorder with variable symptoms evolving over time. This should aid earlier diagnosis and confirms the need for long-time follow-up of patients.
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Affiliation(s)
- Nazreen Kamarus Jaman
- Metabolic Department, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Preeya Rehsi
- Metabolic Department, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Robert H Henderson
- Ophthalmology Department, Great Ormond Street Hospital, London, United Kingdom.,Ophthalmology Department, Moorfields Eye Hospital, London, United Kingdom
| | - Ulrike Löbel
- Department of Radiology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Stephanie Grunewald
- Metabolic Department, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom.,Institute for Child Health, NIHR Biomedical Research Center (BRC), University College London, London, United Kingdom
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7
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A Prognostic Model for Brain Glioma Patients Based on 9 Signature Glycolytic Genes. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6680066. [PMID: 34222480 PMCID: PMC8225435 DOI: 10.1155/2021/6680066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/16/2021] [Accepted: 06/02/2021] [Indexed: 12/11/2022]
Abstract
Objective To screen glycolytic genes linked to the glioma prognosis and construct the prognostic model. Methods The relevant data of glioma were downloaded from TCGA and GTEx databases. GSEA of glycolysis-related pathways was carried out, and enriched differential genes were extracted. Screening out prognostic-related genes with conspicuous significance and construction of the prognostic model were conducted by multivariate Cox regression analysis and Lasso regression analysis. The model was evaluated, and cBioPortal was used to analyze the mutation of the model gene. The expression of the model gene in tumor and normal colon tissue was analyzed. The model was used to evaluate the prognosis of patients in different groups to verify the applicability of the model. Results 339 differentially glycolytic-related genes were enriched in REACTOME_GLYCOLYSIS, GLYCOLYTIC_PROCESS, HALLMARK_GLYCOLYSIS, and other pathways. We obtained 9 key prognostic genes and constructed the prognostic evaluation model. The 3-year AUC values of the ROC curve display model are greater than 0.75, which indicates that the accuracy of the model is good. The relation of age and risk score to prognosis is shown by univariate and multivariate Cox analysis. The expression of SRD5A3, MDH2, and B3GAT3 genes was significantly upregulated in the tumor tissues, while the HDAC4 and G6PC2 genes were downregulated. The mutation rate of MDH2 and HDAC4 genes was the highest. This model could effectively distinguish the risk of poor prognosis of patients in any age stage. Conclusion The prognostic assessment models based on glycolysis-related nine-gene signature could accurately predict the prognosis of patients with GBM.
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8
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Bertokova A, Bertok T, Jane E, Hires M, Ďubjaková P, Novotná O, Belan V, Fillo J, Tkac J. Detection of N,N-diacetyllactosamine (LacdiNAc) containing free prostate-specific antigen for early stage prostate cancer diagnostics and for identification of castration-resistant prostate cancer patients. Bioorg Med Chem 2021; 39:116156. [PMID: 33894508 DOI: 10.1016/j.bmc.2021.116156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/01/2021] [Indexed: 02/07/2023]
Abstract
Prostate cancer (PCa) is one of the most common cancer types among men and also acommon cause of death globally. With an increasing incidence, there is aneed for low-cost, reliable biomarkers present in samples, which could be provided non-invasively (without a need to perform prostate biopsy). Glycosylation changes of free-PSA (fPSA) are considered cancer-specific, while the level of different PSA forms can increase under other than cancerous conditions. In the present study, we investigated the role ofN,N-diacetyllactosamine (LacdiNAc) epitope of fPSA (i.e. glycoprofile of fPSA or gPSA) in combination with total-PSA (tPSA), prostate volume, and tPSA density (tPSA level divided by prostate volume i.e. PSAd) as biomarkers for monitoring of PCa development and progression in 105 men. Furthermore, we applied an genetic (evolutionary) algorithm to identify any suspicious individuals in abenign cohort having benign prostatic hyperplasia (BPH). We identified 3 suspicious men originally diagnosed with BPH using gPSA analysis. In thefollow-up we found out that two men should not be considered as BPH patients since multiparametric magnetic resonance imaging (mpMRI) identified one man with clinically significant PCa via Prostate Imaging - Reporting and Data System (PI RADS v2 = 4) and the second man was with High-gradeprostatic intraepithelial neoplasia (HG PIN), commonly described as apre-cancerous stage. Moreover, in the study we described for the first time that changed LacdiNAc on PSA can be applied to identify prostatitis patients and most importantly this is the first study suggesting that changed glycosylation on PSA can be applied to identify castration-resistant prostate cancer (CRPCa) patients.
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Affiliation(s)
- Aniko Bertokova
- Institute of Chemistry, Slovak Academy of Sciences, Dubravska cesta 9, Bratislava 845 38, Slovakia; Glycanostics, Ltd., Dubravska cesta 9, Bratislava 845 38, Slovakia
| | - Tomas Bertok
- Institute of Chemistry, Slovak Academy of Sciences, Dubravska cesta 9, Bratislava 845 38, Slovakia; Glycanostics, Ltd., Dubravska cesta 9, Bratislava 845 38, Slovakia
| | - Eduard Jane
- Institute of Chemistry, Slovak Academy of Sciences, Dubravska cesta 9, Bratislava 845 38, Slovakia
| | - Michal Hires
- Institute of Chemistry, Slovak Academy of Sciences, Dubravska cesta 9, Bratislava 845 38, Slovakia
| | - Petra Ďubjaková
- University Hospital Bratislava, Mickiewiczova 13, 811 07 Bratislava, Slovakia
| | - Oľga Novotná
- University Hospital Bratislava, Mickiewiczova 13, 811 07 Bratislava, Slovakia
| | | | - Juraj Fillo
- University Hospital Bratislava, Mickiewiczova 13, 811 07 Bratislava, Slovakia
| | - Jan Tkac
- Institute of Chemistry, Slovak Academy of Sciences, Dubravska cesta 9, Bratislava 845 38, Slovakia; Glycanostics, Ltd., Dubravska cesta 9, Bratislava 845 38, Slovakia.
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9
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Lo Barco T, Osanni E, Bordugo A, Rodella G, Iascone M, Tenconi R, Barone R, Dalla Bernardina B, Cantalupo G. Epilepsy and movement disorders in CDG: Report on the oldest-known MOGS-CDG patient. Am J Med Genet A 2020; 185:219-222. [PMID: 33058492 DOI: 10.1002/ajmg.a.61916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/16/2020] [Accepted: 09/26/2020] [Indexed: 12/18/2022]
Abstract
Congenital glycosylation disorders (CDG) are inherited metabolic diseases due to defective glycoprotein and glycolipid glycan assembly and attachment. MOGS-CDG is a rare disorder with seven patients from five families reported worldwide. We report on a 19-year-old girl with MOGS-CDG. At birth she presented facial dysmorphism, marked hypotonia, and drug-resistant tonic seizures. In the following months, her motility was strongly limited by dystonia, with forced posture of the head and of both hands. She showed a peculiar hyperkinetic movement disorder with a rhythmic and repetitive pattern repeatedly documented on EEG-polygraphy recordings. Brain MRI showed progressive cortical and subcortical atrophy. Epileptic spasms appeared in first months and ceased by the age of 7 years, while tonic seizures were still present at last assessment (19 years). We report the oldest-known MOGS-CDG patient and broaden the neurological phenotype of this CDG.
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Affiliation(s)
- Tommaso Lo Barco
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.,PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Osanni
- Child Neuropsychiatry, Epilepsy and Clinical Neurophysiology Unit, IRCCS "E. Medea", Conegliano, Treviso, Italy
| | - Andrea Bordugo
- Pediatrics Unit, Department of Pediatrics, Regional Center for Newborn Screening, Diagnosis and Treatment of Inherited Metabolic Diseases and Congenital Endocrine Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giulia Rodella
- Pediatrics Unit, Department of Pediatrics, Regional Center for Newborn Screening, Diagnosis and Treatment of Inherited Metabolic Diseases and Congenital Endocrine Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Maria Iascone
- Laboratorio di Genetica Medica, ASST Papa Giovanni XXIII, Piazza OMS, Bergamo, Italy
| | - Romano Tenconi
- Genetica Clinica, Dipartimento di Pediatria, Università di Padova, Padova, Italy
| | - Rita Barone
- Child Neurology and Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Gaetano Cantalupo
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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