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Kaur G, Ahuja A, Sen A, Singhal P, Verghese R. An extremely rare case of Rogers syndrome or thiamine responsive megaloblastic anemia. INDIAN J PATHOL MICR 2023:00004270-990000000-00096. [PMID: 38391342 DOI: 10.4103/ijpm.ijpm_287_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/27/2023] [Indexed: 02/24/2024] Open
Abstract
ABSTRACT Rogers syndrome is an extremely rare autosomal recessive syndrome of which only 100 cases are known worldwide. It is characterized by thiamine-responsive megaloblastic anaemia, diabetes mellitus and sensorineural deafness. It results from the deficiency of a thiamine transporter protein. We herein report a 16-year-old Indian male referred to our centre with complaints of refractory anaemia, deafness, diabetes pulmonary arterial hypertension and tricuspid regurgitation. Based on the clinical features and haematologic picture and dramatic response of anaemia to thiamine therapy the possibility of a TRMA was considered. Sequencing analysis for TRMA revealed a homozygous c.242dup (p.Tyr81Ter) mutation of the SLC19A2 gene.
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Affiliation(s)
- Gurpreet Kaur
- Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Ankur Ahuja
- Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Arijit Sen
- Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Paresh Singhal
- Department of Pathology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Renjith Verghese
- Department of Medicine, Command Hospital Southern Command, Pune, Maharashtra, India
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2
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Gruber N, Pinhas-Hamiel O. Diabetes Out-of-the-Box: Diabetes Mellitus and Impairment in Hearing and Vision. Curr Diab Rep 2022; 22:423-432. [PMID: 35789979 DOI: 10.1007/s11892-022-01483-y] [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] [Accepted: 05/18/2022] [Indexed: 01/19/2023]
Abstract
PURPOSEOF REVIEW This review aims to provide an update on the etiologies of diabetes that are due to genetic disorders and that co-occur with impaired hearing or vision and to compare them. The potential mechanisms, including novel treatments, will be detailed. RECENT FINDINGS Wolfram syndrome, Kearns-Sayre syndrome, thiamine-responsive megaloblastic anemia, and maternally inherited diabetes and deafness are genetic disorders characterized by diabetes, impaired hearing, and vision. They differ in mode of inheritance, age at presentation, and the involvement of other organs; they are often misdiagnosed as type 1 or type 2 diabetes. Suspicion of a genetic diabetes syndrome should be raised when pancreatic autoantibodies are negative, other organs are involved, and family history includes diabetes. Correct diagnosis of the various syndromes is important for tailoring the most advanced treatment, preventing disease progression, and enabling proper genetic counseling.
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Affiliation(s)
- Noah Gruber
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Orit Pinhas-Hamiel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- The National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel.
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Ibrahim MN, Laghari TM, Riaz M, Khoso Z, Khan YN, Yasir M, Hanif MI, Flanagan SE, De Franco E, Raza J. Monogenic diabetes in Pakistani infants and children: challenges in a resource poor country. J Pediatr Endocrinol Metab 2021; 34:1095-1103. [PMID: 34187112 DOI: 10.1515/jpem-2020-0669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 05/31/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To review the data of infants and children with suspected monogenic diabetes who underwent genetic testing. METHODS Monogenic diabetes is a rare form of diabetes resulting from mutations in a single gene. It can be caused by dominant as well as recessive modes of inheritance. In a country like Pakistan where interfamily marriages are common the incidence of genetic disorders is increased. As Pakistan a resource-poor country, the diagnosis of insulin-dependent diabetes is often delayed and a genetic diagnosis of monogenic diabetes is extremely difficult. Children with clinical diagnosis of monogenic and syndromic diabates were recruited and blood samples were sent for genetic analysis. RESULTS One thousand sixty four new cases diagnosed with type 1 diabetes were registered at the National Institute of Child Health, Karachi, in the last 10 years. Of these 39 patients were selected for genetic testing who were diagnosed with diabetes/had a sibling diagnosed with diabetes before the age of nine months (n = 27) or had extra pancreatic features ( n= 12). We identified mutations in 18/27 cases diagnosed with diabetes before nine months of age. The most common genetic subtype was WolcottRallison syndrome caused by EIF2AK3 mutations (seven cases). KCNJ11 mutations were identified in two cases, ABCC8mutations were identified in four cases from three families, GCK and INS mutations were each identified in two cases, and one SLC2A2 mutation was identified in one case. A genetic diagnosis was made in 12/12 children from six families with diabetes diagnosed after the age of nine months who had extrapancreatic features. Six patients had genetically confirmed Wolfram syndrome (WFS1), three had thiamine-responsive megaloblastic anemia (SLC19A2) and three were diagnosed with histocytosis lymphadenopathy plus syndrome (SLC29A3). CONCLUSIONS Genetic testing is essential to confirm a diagnosis of monogenic diabetes which guides clinical management and future counselling. Our study highlights the importance of diagnosing monogenic diabetes in the largely consanguineously-married population of Pakistan.
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Affiliation(s)
| | | | - Miara Riaz
- National Institute of Child Health, Karachi, Pakistan
| | - Zubair Khoso
- National Institute of Child Health, Karachi, Pakistan
| | | | - Mehar Yasir
- National Institute of Child Health, Karachi, Pakistan
| | | | - Sarah E Flanagan
- Institute of Biomedical and Clinical Science, University of Exeter College of Medicine and Health, Exeter, UK
| | - Elisa De Franco
- Institute of Biomedical and Clinical Science, University of Exeter College of Medicine and Health, Exeter, UK
| | - Jamal Raza
- National Institute of Child Health, Karachi, Pakistan
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Zhang S, Qiao Y, Wang Z, Zhuang J, Sun Y, Shang X, Li G. Identification of novel compound heterozygous variants in SLC19A2 and the genotype-phenotype associations in thiamine-responsive megaloblastic anemia. Clin Chim Acta 2021; 516:157-168. [PMID: 33571483 DOI: 10.1016/j.cca.2021.01.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 01/24/2021] [Accepted: 01/28/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS Thiamine-responsive megaloblastic anemia (TRMA), caused by SLC19A2 loss-of-function variants, is characterized by the triad of megaloblastic anemia, progressive sensorineural deafness, and non-type 1 diabetes mellitus. Here, we present the case of a Chinese infant with two novel variants segregating in compound heterozygous form in SLC19A2 and reviewed genotype-phenotype associations (GPAs) in patients with TRMA. MATERIALS AND METHODS Whole-exome sequencing was performed to establish a genetic diagnosis. The clinical manifestations and genetic variants were collected by performing a literature review. The bioinformatics software SIFT, PolyPhen2, and Mutation Taster was applied to predict variant effects and analyze GPAs. RESULTS Two novel variants segregating in compound heterozygous form in SLC19A2 (NM_006996.2: exon2:c.336_363del:p.W112fs; exon2:c.358G>T:p.G120X) was identified. Thiamine supplementation corrected anemia and diabetes mellitus but did not improve the hearing defect. In the literature, 183 patients with TRMA with 74 variants in SLC19A2 have been reported, with high incidence in the Middle East, South Asia, and the northern Mediterranean. Patients with biallelic premature termination codon variants presented with more severe phenotypes, and truncating sites on extracellular domains was a protective factor for the hemoglobin level at diagnosis. CONCLUSION Two novel compound heterozygous variants (NM_006996.2: exon2:c.336_363del:p.W112fs; exon2:c.358G>T:p.G120X) were identified, and GPAs in TRMA indicated the predictability of clinical manifestations.
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Affiliation(s)
- Shule Zhang
- Department of Pediatric Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 9677 Jingshi Road, Lixia Area, Jinan, Shandong 250021, China.
| | - Yu Qiao
- Department of Pediatric Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 9677 Jingshi Road, Lixia Area, Jinan, Shandong 250021, China; Department of Pediatric Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 9677 Jingshi Road, Lixia Area, Jinan, Shandong 250021, China.
| | - Zengmin Wang
- Department of Pediatric Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 9677 Jingshi Road, Lixia Area, Jinan, Shandong 250021, China; Department of Pediatric Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 9677 Jingshi Road, Lixia Area, Jinan, Shandong 250021, China.
| | - Jianxin Zhuang
- Department of Pediatric Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 9677 Jingshi Road, Lixia Area, Jinan, Shandong 250021, China; Department of Pediatric Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 9677 Jingshi Road, Lixia Area, Jinan, Shandong 250021, China.
| | - Yan Sun
- Department of Pediatric Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 9677 Jingshi Road, Lixia Area, Jinan, Shandong 250021, China; Department of Pediatric Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 9677 Jingshi Road, Lixia Area, Jinan, Shandong 250021, China.
| | - Xiaohong Shang
- Department of Pediatric Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 9677 Jingshi Road, Lixia Area, Jinan, Shandong 250021, China; Department of Pediatric Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 9677 Jingshi Road, Lixia Area, Jinan, Shandong 250021, China.
| | - Guimei Li
- Department of Pediatric Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, 9677 Jingshi Road, Lixia Area, Jinan, Shandong 250021, China; Department of Pediatric Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 9677 Jingshi Road, Lixia Area, Jinan, Shandong 250021, China.
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Warncke K, Prinz N, Iotova V, Dunstheimer D, Datz N, Karges B, Jali MV, Linsenmeyer D, Olsen BS, Seiwald M, Prahalad P, de Sousa G, Pacaud D. Thiamine-Responsive Megaloblastic Anemia-Related Diabetes: Long-Term Clinical Outcomes in 23 Pediatric Patients From the DPV and SWEET Registries. Can J Diabetes 2020; 45:539-545. [PMID: 33388275 DOI: 10.1016/j.jcjd.2020.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/01/2020] [Accepted: 11/18/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To describe clinical presentation and long-term outcomes in a large cohort of children diagnosed with thiamine-responsive megaloblastic anemia (TRMA)-related diabetes. METHODS Data from the Diabetes Patienten Verlaufsdokumentation (DPV) and Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference (SWEET) registries were used to identify cases. Complementary information was collected through a chart review of each case. Descriptive analyses with medians and interquartile ranges and numbers (proportions) were tabulated. RESULTS We identified 23 cases (52% male) in the 2 registries. Eighteen (78%) had genetic confirmation of TRMA. Median age at diabetes onset was 1.4 (quartiles 0.8 to 3.6) years and median age at initiation of thiamine treatment was 5.9 (2.4 to 12.4) years. At their most recent visit, patients' median age was 14.3 (8.1 to 17.5) years, glycated hemoglobin level was 6.9% (6.1% to 7.9%), insulin dose was 0.9 (0.4 to 1.2) units/kg per day and thiamine dose was 200 (100 to 300) mg/day. Three patients were not treated with insulin or antidiabetic drugs. There was no difference in diabetes outcomes in patients with initiation of thiamine ≤1 year after diabetes onset compared to patients with initiation of thiamine >1 year after diabetes onset. CONCLUSIONS This is the longest case series of pediatric TRMA-related diabetes reported to date. Diabetes onset often occurs several years before initiation of thiamine supplementation. Early initiation of thiamine (within 1 year of diabetes onset) was not linked to improved diabetes outcome. However, the role of thiamine in pancreatic function needs further assessment. Patients with TRMA-related diabetes maintained good glycemic control even after 9 years (median) of follow up.
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Affiliation(s)
- Katharina Warncke
- Department of Pediatrics, Kinderklinik München Schwabing, Technical University of Munich School of Medicine, Munich, Germany.
| | - Nicole Prinz
- Institute of Epidemiology and Medical Biometry, University of Ulm, Zentralinstitut für Biomedizinische Technik, Ulm, Germany; German Centre for Diabetes Research, Munich-Neuherberg, Germany
| | - Violeta Iotova
- Department of Pediatrics, Medical University, Varna, Bulgaria
| | | | - Nicolin Datz
- Diabetes Centre for Children and Adolescents, Children's Hospital Auf der Bult, Hannover, Germany
| | - Beate Karges
- Department of Pediatrics, Bethlehem Hospital, Stolberg, Germany; Division of Endocrinology and Diabetes, Medical Faculty, Rheinisch Westfälische Hochschule Aachen University, Aachen, Germany
| | - Mallikarjun V Jali
- KLE Academy of Higher Education and Medical Research & KLES Dr Prabhakar Kore Hospital's Diabetes Centre, Belgaum, India
| | | | | | - Monika Seiwald
- Department of Pediatrics, Hospital St Vinzenz, Zams, Austria
| | - Priya Prahalad
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University School of Medicine, Stanford, California, United States
| | - Gideon de Sousa
- Children's Hospital Dortmund, Dortmund, Germany; Department of Pediatrics, University of Witten/Herdecke, Witten, Germany; Deceased
| | - Danièle Pacaud
- Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
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Faraji‐Goodarzi M, Tarhani F, Taee N. Dyserythropoiesis and myelodysplasia in thiamine-responsive megaloblastic anemia syndrome. Clin Case Rep 2020; 8:991-994. [PMID: 32577249 PMCID: PMC7303871 DOI: 10.1002/ccr3.2791] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/04/2020] [Accepted: 02/11/2020] [Indexed: 01/19/2023] Open
Abstract
The case of thiamine-responsive megaloblastic anemia (TRMA) presented here speculates the need early diagnosis, continuous monitoring, follow-up, and regulated treatment plan for the patients. Complications and systemic manifestations are likely to enhance in otherwise circumstances.
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Affiliation(s)
- Mojgan Faraji‐Goodarzi
- Department of PediatricsFaculty of MedicineLorestan University of Medical SciencesKhorramabadIran
| | - Fariba Tarhani
- Department of PediatricsFaculty of MedicineLorestan University of Medical SciencesKhorramabadIran
| | - Nadereh Taee
- Department of PediatricsFaculty of MedicineLorestan University of Medical SciencesKhorramabadIran
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Condie AM, Allen TV, Ogle GD. Incidence and characteristics of childhood- and youth-onset diabetes in the Qalandarabad area in northern Pakistan. Diabetes Res Clin Pract 2020; 163:108155. [PMID: 32333971 DOI: 10.1016/j.diabres.2020.108155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/24/2020] [Accepted: 04/17/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES Determine the types, incidence, mortality rate, and clinical status of youth diabetes at Bach Christian Hospital (BCH), Qalandarabad, Pakistan. METHODS Analysis of incidence and mortality data of all patients (<25 year (y)) diagnosed from January 2014-June 2019, and also analysis of clinical status of patients < 25y seen in 2018/2019. RESULTS Ninety-three patients were seen over the study period. Eighty-eight were type 1 diabetes (T1D), 51.1% female. Age of diagnosis was 0.8-24.5 years (y) (mean = 11.4 y, SD = 6.2y). 15.1% were 0-4y, 31.4% 5-9 y, 24.4% 10-14y, 19.8% 15-19y, and 9.3% 20-24y. Minimum incidence for the Mansehra tehsil administrative district was calculated as 1.0 per 100,000 population <15y/y, 1.2 per 100,000 < 20y/y and 1.1 per 100,000 < 25y/y; the degree of ascertainment could not be assessed. A further four patients were diagnosed with thiamine-responsive megaloblastic anaemia (TRMA), all male, three from the same consanguineous family, and were treated with high-dose thiamine. One other patient was diagnosed with type 2 diabetes. Three T1D and one TRMA patient died during the study period. The standardised mortality rate for T1D was 9.4, but vital status was unknown for 13 patients. The mean/median HbA1c of T1D patients seen in 2018/2019 was 9.1%/9.2% (76/77 mmol/mol). CONCLUSIONS Minimum T1D incidence in Mansehra tehsil is double the previously reported value for Pakistan (from 1990 to 1999), although is still low compared to most other countries. Considering the limited resources available, patients attending BCH are achieving fair glycemic control. The TRMA cases show the importance of genetic testing in atypical cases.
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Affiliation(s)
| | - Tiarne Vickie Allen
- Life for a Child Program, Diabetes NSW & ACT, Glebe, NSW 2037, Australia; NHMRC Clinical Trials Centre, University of Sydney, NSW 2006, Australia
| | - Graham David Ogle
- Life for a Child Program, Diabetes NSW & ACT, Glebe, NSW 2037, Australia; NHMRC Clinical Trials Centre, University of Sydney, NSW 2006, Australia.
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Frameshift variance in SLC19A2 gene causing thiamine responsive megaloblastic anemia (TRMA): a case report from Pakistan. Int J Diabetes Dev Ctries 2020. [DOI: 10.1007/s13410-020-00797-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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9
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Mohan V, Patil O, Ravikumar K, Gopi S, Raman T, Radha V. Thiamine-responsive megaloblastic anemia syndrome: A case report. JOURNAL OF DIABETOLOGY 2020. [DOI: 10.4103/jod.jod_51_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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10
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Li X, Cheng Q, Ding Y, Li Q, Yao R, Wang J, Wang X. TRMA syndrome with a severe phenotype, cerebral infarction, and novel compound heterozygous SLC19A2 mutation: a case report. BMC Pediatr 2019; 19:233. [PMID: 31296181 PMCID: PMC6625038 DOI: 10.1186/s12887-019-1608-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/02/2019] [Indexed: 01/19/2023] Open
Abstract
Background Thiamine-responsive megaloblastic anemia (TRMA) is a rare autosomal recessive inherited disease characterized by the clinical triad of megaloblastic anemia, sensorineural deafness, and diabetes mellitus. To date, only 100 cases of TRMA have been reported in the world. Case presentation Here, we describe a six-year-old boy with diabetes mellitus, anemia, and deafness. Additionally, he presented with thrombocytopenia, leukopenia, horizontal nystagmus, hepatomegaly, short stature, ventricular premature beat (VPB), and cerebral infarction. DNA sequencing revealed a novel compound heterozygous mutation in the SLC19A2 gene: (1) a duplication c.405dupA, p.Ala136Serfs*3 (heterozygous) and (2) a nucleotide deletion c.903delG p.Trp301Cysfs*13 (heterozygous). The patient was diagnosed with a typical TRMA. Conclusion Novel mutations in the SLC19A2 gene have been identified, expanding the mutation spectrum of the SLC19A2 gene. For the first time, VPB and cerebral infarction have been identified in patients with TRMA syndrome, providing a new understanding of the phenotype.
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Affiliation(s)
- Xin Li
- Department of Endocrinology and Metabolism, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Pudong New Area, Shanghai, 200127, China
| | - Qing Cheng
- Department of Endocrinology and Metabolism, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Pudong New Area, Shanghai, 200127, China
| | - Yu Ding
- Department of Endocrinology and Metabolism, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Pudong New Area, Shanghai, 200127, China
| | - Qun Li
- Department of Endocrinology and Metabolism, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Pudong New Area, Shanghai, 200127, China
| | - Ruen Yao
- Department of Medical Genetics and Molecular Diagnostics, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Jian Wang
- Department of Medical Genetics and Molecular Diagnostics, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China
| | - Xiumin Wang
- Department of Endocrinology and Metabolism, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, 1678 Dongfang Road, Pudong New Area, Shanghai, 200127, China.
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Dalwadi P, Joshi AS, Thakur DS, Bhagwat NM. Neonatal diabetes mellitus: remission induced by novel therapy. BMJ Case Rep 2019; 12:12/6/e228806. [PMID: 31243025 DOI: 10.1136/bcr-2018-228806] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
A female child with deafness was diagnosed to have neonatal diabetes mellitus at the age of 6 months, on routine evaluation prior to cochlear implant surgery. She presented to us at 11 months of age with diabetic ketoacidosis due to an intercurrent febrile illness. Her haematological parameters showed megaloblastic anaemia and thrombocytopenia. Therefore a possibility of Thiamine Responsive Megaloblastic Anaemia (TRMA) syndrome was considered. She was empirically treated with parenteral thiamine hydrochloride (Hcl). Subsequently, due to the unavailability of pharmacological preparation of oral thiamine Hcl in a recommended dose she was treated with benfotiamine. She had a sustained improvement in all her haematological parameters on oral benfotiamine. The insulin requirement progressively reduced and she is currently in remission for last 2 years. The genetic analysis confirmed the diagnosis of TRMA syndrome. Thus benfotiamine can be considered a new treatment option in management of TRMA syndrome.
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Affiliation(s)
- Pradip Dalwadi
- Endocrinology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Ameya S Joshi
- Endocrinology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Darshana Sudip Thakur
- Endocrinology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Nikhil M Bhagwat
- Endocrinology, Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
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12
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Ion Transporters, Channelopathies, and Glucose Disorders. Int J Mol Sci 2019; 20:ijms20102590. [PMID: 31137773 PMCID: PMC6566632 DOI: 10.3390/ijms20102590] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 01/19/2023] Open
Abstract
Ion channels and transporters play essential roles in excitable cells including cardiac, skeletal and smooth muscle cells, neurons, and endocrine cells. In pancreatic beta-cells, for example, potassium KATP channels link the metabolic signals generated inside the cell to changes in the beta-cell membrane potential, and ultimately regulate insulin secretion. Mutations in the genes encoding some ion transporter and channel proteins lead to disorders of glucose homeostasis (hyperinsulinaemic hypoglycaemia and different forms of diabetes mellitus). Pancreatic KATP, Non-KATP, and some calcium channelopathies and MCT1 transporter defects can lead to various forms of hyperinsulinaemic hypoglycaemia (HH). Mutations in the genes encoding the pancreatic KATP channels can also lead to different types of diabetes (including neonatal diabetes mellitus (NDM) and Maturity Onset Diabetes of the Young, MODY), and defects in the solute carrier family 2 member 2 (SLC2A2) leads to diabetes mellitus as part of the Fanconi–Bickel syndrome. Variants or polymorphisms in some ion channel genes and transporters have been reported in association with type 2 diabetes mellitus.
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Jungtrakoon P, Shirakawa J, Buranasupkajorn P, Gupta MK, De Jesus DF, Pezzolesi MG, Panya A, Hastings T, Chanprasert C, Mendonca C, Kulkarni RN, Doria A. Loss-of-Function Mutation in Thiamine Transporter 1 in a Family With Autosomal Dominant Diabetes. Diabetes 2019; 68:1084-1093. [PMID: 30833467 PMCID: PMC6477897 DOI: 10.2337/db17-0821] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 02/23/2019] [Indexed: 01/19/2023]
Abstract
Solute Carrier Family 19 Member 2 (SLC19A2) encodes thiamine transporter 1 (THTR1), which facilitates thiamine transport across the cell membrane. SLC19A2 homozygous mutations have been described as a cause of thiamine-responsive megaloblastic anemia (TRMA), an autosomal recessive syndrome characterized by megaloblastic anemia, diabetes, and sensorineural deafness. Here we describe a loss-of-function SLC19A2 mutation (c.A1063C: p.Lys355Gln) in a family with early-onset diabetes and mild TRMA traits transmitted in an autosomal dominant fashion. We show that SLC19A2-deficient β-cells are characterized by impaired thiamine uptake, which is not rescued by overexpression of the p.Lys355Gln mutant protein. We further demonstrate that SLC19A2 deficit causes impaired insulin secretion in conjunction with mitochondrial dysfunction, loss of protection against oxidative stress, and cell cycle arrest. These findings link SLC19A2 mutations to autosomal dominant diabetes and suggest a role of SLC19A2 in β-cell function and survival.
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Affiliation(s)
- Prapaporn Jungtrakoon
- Department of Medicine, Harvard Medical School, Boston, MA
- Section on Genetics and Epidemiology, Joslin Diabetes Center, Boston, MA
- Section on Islet Cell and Regenerative Biology, Joslin Diabetes Center, Boston, MA
| | - Jun Shirakawa
- Department of Medicine, Harvard Medical School, Boston, MA
- Division of Molecular Medicine, Research Department, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patinut Buranasupkajorn
- Department of Medicine, Harvard Medical School, Boston, MA
- Section on Genetics and Epidemiology, Joslin Diabetes Center, Boston, MA
- Division of Hospital and Ambulatory Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Manoj K Gupta
- Department of Medicine, Harvard Medical School, Boston, MA
- Division of Molecular Medicine, Research Department, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Dario F De Jesus
- Department of Medicine, Harvard Medical School, Boston, MA
- Division of Molecular Medicine, Research Department, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Marcus G Pezzolesi
- Division of Nephrology and Hypertension, University of Utah School of Medicine, Salt Lake City, UT
| | - Aussara Panya
- Department of Medicine, Harvard Medical School, Boston, MA
- Section on Genetics and Epidemiology, Joslin Diabetes Center, Boston, MA
- Section on Islet Cell and Regenerative Biology, Joslin Diabetes Center, Boston, MA
| | - Timothy Hastings
- Section on Genetics and Epidemiology, Joslin Diabetes Center, Boston, MA
| | - Chutima Chanprasert
- Section on Islet Cell and Regenerative Biology, Joslin Diabetes Center, Boston, MA
| | - Christine Mendonca
- Section on Genetics and Epidemiology, Joslin Diabetes Center, Boston, MA
| | - Rohit N Kulkarni
- Department of Medicine, Harvard Medical School, Boston, MA
- Division of Molecular Medicine, Research Department, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Alessandro Doria
- Department of Medicine, Harvard Medical School, Boston, MA
- Section on Genetics and Epidemiology, Joslin Diabetes Center, Boston, MA
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14
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Lu H, Lu H, Vaucher J, Tran C, Vollenweider P, Castioni J. [Thiamine-responsive megaloblastic anemia or Rogers syndrome: A literature review]. Rev Med Interne 2018; 40:20-27. [PMID: 30031565 DOI: 10.1016/j.revmed.2018.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/28/2018] [Accepted: 06/17/2018] [Indexed: 01/30/2023]
Abstract
Thiamine-responsive megaloblastic anemia (TRMA), also known as Rogers syndrome, is a rare autosomal recessive disease characterized by three main components: megaloblastic anemia, diabetes mellitus and sensorineural deafness. Those features occur in infancy but may arise during adolescence. Diagnosis relies on uncovering genetic variations (alleles) in the SLC19A2 gene, encoding for a high affinity thiamine transporter. This transporter is essentially present in hematopoietic stem cells, pancreatic beta cells and inner ear cells, explaining the clinical manifestations of the disease. Based on a multidisciplinary approach, treatment resides on lifelong thiamine oral supplementation at pharmacological doses, which reverses anemia and may delay development of diabetes. However, thiamine supplementation does not alleviate already existing hearing defects.
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Affiliation(s)
- H Lu
- Service de médecine interne, centre hospitalier universitaire vaudois (CHUV), rue du Bugnon, 46, 1011 Lausanne, Suisse.
| | - H Lu
- Service des urgences adultes, centre hospitalier universitaire Antoine-Béclère, Assistance publique-Hôpitaux de Paris (AP-HP), 157, rue de la Porte de Trivaux, 92140 Clamart, France
| | - J Vaucher
- Service de médecine interne, centre hospitalier universitaire vaudois (CHUV), rue du Bugnon, 46, 1011 Lausanne, Suisse
| | - C Tran
- Service de médecine génétique, centre hospitalier universitaire vaudois (CHUV), rue du Bugnon, 46, 1011 Lausanne, Suisse
| | - P Vollenweider
- Service de médecine interne, centre hospitalier universitaire vaudois (CHUV), rue du Bugnon, 46, 1011 Lausanne, Suisse
| | - J Castioni
- Service de médecine interne, centre hospitalier universitaire vaudois (CHUV), rue du Bugnon, 46, 1011 Lausanne, Suisse
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15
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Habeb AM, Flanagan SE, Zulali MA, Abdullah MA, Pomahačová R, Boyadzhiev V, Colindres LE, Godoy GV, Vasanthi T, Al Saif R, Setoodeh A, Haghighi A, Haghighi A, Shaalan Y, Hattersley AT, Ellard S, De Franco E. Pharmacogenomics in diabetes: outcomes of thiamine therapy in TRMA syndrome. Diabetologia 2018; 61:1027-1036. [PMID: 29450569 PMCID: PMC6449001 DOI: 10.1007/s00125-018-4554-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 12/07/2017] [Indexed: 02/06/2023]
Abstract
AIMS/HYPOTHESIS Diabetes is one of the cardinal features of thiamine-responsive megaloblastic anaemia (TRMA) syndrome. Current knowledge of this rare monogenic diabetes subtype is limited. We investigated the genotype, phenotype and response to thiamine (vitamin B1) in a cohort of individuals with TRMA-related diabetes. METHODS We studied 32 individuals with biallelic SLC19A2 mutations identified by Sanger or next generation sequencing. Clinical details were collected through a follow-up questionnaire. RESULTS We identified 24 different mutations, of which nine are novel. The onset of the first TRMA symptom ranged from birth to 4 years (median 6 months [interquartile range, IQR 3-24]) and median age at diabetes onset was 10 months (IQR 5-27). At presentation, three individuals had isolated diabetes and 12 had asymptomatic hyperglycaemia. Follow-up data was available for 15 individuals treated with thiamine for a median 4.7 years (IQR 3-10). Four patients were able to stop insulin and seven achieved better glycaemic control on lower insulin doses. These 11 patients were significantly younger at diabetes diagnosis (p = 0.042), at genetic testing (p = 0.01) and when starting thiamine (p = 0.007) compared with the rest of the cohort. All patients treated with thiamine became transfusion-independent and adolescents achieved normal puberty. There were no additional benefits of thiamine doses >150 mg/day and no reported side effects up to 300 mg/day. CONCLUSIONS/INTERPRETATION In TRMA syndrome, diabetes can be asymptomatic and present before the appearance of other features. Prompt recognition is essential as early treatment with thiamine can result in improved glycaemic control, with some individuals becoming insulin-independent. DATA AVAILABILITY SLC19A2 mutation details have been deposited in the Decipher database ( https://decipher.sanger.ac.uk/ ).
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Affiliation(s)
- Abdelhadi M Habeb
- Paediatric Department, Prince Mohammed bin Abdulaziz Hospital, National Guard Ministry, P.O. Box 40740, Al Madinah, 41511, Kingdom of Saudi Arabia.
| | - Sarah E Flanagan
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK
| | - Mohamed A Zulali
- Paediatric Department, College of Medicine, Taibah University, Madinah, Kingdom of Saudi Arabia
| | | | - Renata Pomahačová
- Department of Paediatrics, Charles University, Medical Faculty and University Hospital Pilsen, Pilsen, Czech Republic
| | | | | | | | | | - Ramlah Al Saif
- Paediatric Department, Maternity and Children's Hospital, Dammam, Kingdom of Saudi Arabia
| | - Aria Setoodeh
- Growth & Development Research Centre, University of Tehran, Medical Sciences, Tehran, Iran
| | - Amirreza Haghighi
- Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Alireza Haghighi
- Department of Genetics and Medicine, Harvard Medical School, Boston, MA, USA
- Broad Institutes of Harvard and MIT, Cambridge, MA, USA
- Partners HealthCare Laboratory for Molecular Medicine, Cambridge, MA, USA
| | | | - Andrew T Hattersley
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK
| | - Sian Ellard
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK
| | - Elisa De Franco
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK.
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16
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Sun C, Pei Z, Zhang M, Sun B, Yang L, Zhao Z, Cheng R, Luo F. Recovered insulin production after thiamine administration in permanent neonatal diabetes mellitus with a novel solute carrier family 19 member 2 (SLC19A2) mutation. J Diabetes 2018; 10:50-58. [PMID: 28371426 DOI: 10.1111/1753-0407.12556] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 03/08/2017] [Accepted: 03/23/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Solute carrier family 19 member 2 (SLC19A2) gene deficiency is one of the causes of permanent neonatal diabetes mellitus (PNDM) and can be effectively managed by thiamine supplementation. Herein we report on a male patient with a novel SLC19A2 mutation and summarize the clinical characteristics of patients with SLC19A2 deficiency. METHODS The genetic diagnosis of the patient with PNDM was made by sequencing and quantitative polymerase chain reaction. The clinical characteristics of PNDM were summarized on the basis of a systematic review of the literature. RESULTS The patient with PNDM had c.848G>A (p.W283X) homozygous mutation in SLC19A2. His father had a wild-type SLC19A2 (c.848G) and his mother was c.848G/A heterozygous. The patient and his father both had a diploid genotype (c.848A/A and c.848G/G). After oral thiamine administration, the patient's fasting C-peptide levels increased gradually, and there was a marked decrease in insulin requirements. A search of the literature revealed that thiamine treatment was effective and improved diabetes in 63% of patients with SLC19A2 deficiency. CONCLUSIONS A novel SLC19A2 mutation (c.848G>A; p.W283X) was identified, which was most likely inherited as segmental uniparental isodisomy. Insulin insufficiency in PNDM caused by SLC19A2 deficiency can be corrected by thiamine supplementation. The differential diagnosis of SLC19A2 deficiency should be considered in children with PNDM accompanied by anemia or hearing defects to allow for early treatment.
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Affiliation(s)
- Chengjun Sun
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Zhou Pei
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Miaoying Zhang
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Bijun Sun
- The Molecular Genetic Diagnosis Center, Pediatrics Research Institute, Children's Hospital of Fudan University, Shanghai, China
| | - Lin Yang
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China
- The Molecular Genetic Diagnosis Center, Pediatrics Research Institute, Children's Hospital of Fudan University, Shanghai, China
| | - Zhuhui Zhao
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Ruoqian Cheng
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China
| | - Feihong Luo
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China
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17
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olety SS, Vellakampadi D. TRMA syndrome (thiamine-responsive megaloblastic anaemia): An example of rare monogenic diabetes: is thiamine a magic pill for anaemia and diabetes? Int J Diabetes Dev Ctries 2016. [DOI: 10.1007/s13410-016-0478-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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18
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Manimaran P, Subramanian VS, Karthi S, Gandhimathi K, Varalakshmi P, Ganesh R, Rathinavel A, Said HM, Ashokkumar B. Novel nonsense mutation (p.Ile411Metfs*12) in the SLC19A2 gene causing Thiamine Responsive Megaloblastic Anemia in an Indian patient. Clin Chim Acta 2015; 452:44-9. [PMID: 26549656 DOI: 10.1016/j.cca.2015.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 11/02/2015] [Accepted: 11/04/2015] [Indexed: 01/19/2023]
Abstract
Thiamine-responsive megaloblastic anemia (TRMA), an autosomal recessive disorder, is caused by mutations in SLC19A2 gene encodes a high affinity thiamine transporter (THTR-1). The occurrence of TRMA is diagnosed by megaloblastic anemia, diabetes mellitus, and sensorineural deafness. Here, we report a female TRMA patient of Indian descent born to 4th degree consanguineous parents presented with retinitis pigmentosa and vision impairment, who had a novel homozygous mutation (c.1232delT/ter422; p.Ile411Metfs*12) in 5th exon of SLC19A2 gene that causes premature termination of hTHTR-1. PROSITE analysis predicted to abrogate GPCRs family-1 signature motif in the variant by this mutation c.1232delT/ter422, suggesting uncharacteristic rhodopsin function leading to cause RP clinically. Thiamine transport activity by the clinical variant was severely inhibited than wild-type THTR-1. Confocal imaging had shown that the variant p.I411Mfs*12 is targeted to the cell membrane and showed no discrepancy in membrane expression than wild-type. Our findings are the first report, to the best of our knowledge, on this novel nonsense mutation of hTHTR-1 causing TRMA in an Indian patient through functionally impaired thiamine transporter activity.
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Affiliation(s)
| | - Veedamali S Subramanian
- Departments of Medicine, Physiology/Biophysics, University of California, Irvine, CA; Department of Veterans Affairs Medical Center, Long Beach, CA 90822, USA
| | - Sellamuthu Karthi
- School of Biotechnology, Madurai Kamaraj University, Madurai 625 021, India
| | | | | | - Ramasamy Ganesh
- Kanchi Kamakoti CHILDS Trust Hospital, Nungambakkam, Chennai 600 034, India
| | - Andiappan Rathinavel
- Department of Cardiothoracic Surgery, Madurai Medical College, Madurai 625 020, India
| | - Hamid M Said
- Departments of Medicine, Physiology/Biophysics, University of California, Irvine, CA; Department of Veterans Affairs Medical Center, Long Beach, CA 90822, USA
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A novel homozygous SLC19A2 mutation in a Portuguese patient with diabetes mellitus and thiamine-responsive megaloblastic anaemia. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2015; 2015:6. [PMID: 25878670 PMCID: PMC4397709 DOI: 10.1186/s13633-015-0002-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 01/19/2015] [Indexed: 01/19/2023]
Abstract
Thiamine-responsive megaloblastic anaemia (TRMA) is a rare syndrome where patients present with early onset diabetes mellitus, megaloblastic anaemia and sensorineural deafness. This report describes a new case of TRMA syndrome in a female patient of Portuguese descent, born to unrelated parents. The patient was found to have a novel homozygous change R397X in exon 4 of the SLC19A2 gene, leading to a premature stop codon. The patient’s diabetes and anaemia showed a good response to daily thiamine doses, reducing the daily insulin dose requirement. The report further indicates that TRMA is not only limited to consanguineous or ethnically isolated families, and should be considered as a differential diagnosis for patients presenting with suggestive clinical symptoms.
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20
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Mikstiene V, Songailiene J, Byckova J, Rutkauskiene G, Jasinskiene E, Verkauskiene R, Lesinskas E, Utkus A. Thiamine responsive megaloblastic anemia syndrome: A novel homozygousSLC19A2gene mutation identified. Am J Med Genet A 2015; 167:1605-9. [DOI: 10.1002/ajmg.a.37015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/19/2015] [Indexed: 01/19/2023]
Affiliation(s)
- Violeta Mikstiene
- Department of Human and Medical Genetics, Faculty of Medicine; Vilnius University; Vilnius Lithuania
| | - Jurgita Songailiene
- Department of Human and Medical Genetics, Faculty of Medicine; Vilnius University; Vilnius Lithuania
| | - Jekaterina Byckova
- Centre of Ear, Nose and Throat Diseases; Vilnius University Hospital Santariškių Clinics; Vilnius Lithuania
| | - Giedre Rutkauskiene
- Pediatric Oncology and Hematology Unit; Hospital of Lithuanian university of Health Sciences, Kaunas Clinics; Kaunas Lithuania
| | - Edita Jasinskiene
- Department of Endocrinology; Hospital of Lithuanian University of Health Science, Kaunas Clinics; Kaunas Lithuania
| | - Rasa Verkauskiene
- Department of Endocrinology; Hospital of Lithuanian University of Health Science, Kaunas Clinics; Kaunas Lithuania
| | - Eugenijus Lesinskas
- Centre of Ear, Nose and Throat Diseases; Vilnius University Hospital Santariškių Clinics; Vilnius Lithuania
| | - Algirdas Utkus
- Department of Human and Medical Genetics, Faculty of Medicine; Vilnius University; Vilnius Lithuania
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21
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Jafari A, Abedi P, Sayahi M, Torkashvand R. The effect of vitamin B1 on bleeding and spotting in women using an intrauterine device: a double-blind randomised controlled trial. EUR J CONTRACEP REPR 2014; 19:180-6. [PMID: 24738933 DOI: 10.3109/13625187.2014.893425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Excessive menstrual bleeding, the most common complication caused by intrauterine devices (IUDs), often leads to discontinuation of use. Our study investigates the effect of vitamin B1 on menstrual bleeding and spotting after insertion of the TCu380A IUD. METHODS This double-blind, randomised controlled trial involved 110 Iranian women. We recruited women who noted that their menstrual flow (duration, amount, and number of sanitary pads needed) or intermenstrual spotting had increased one month after the insertion of a TCu380A, and randomly assigned them to two groups. The intervention group and the control group received 100 mg of vitamin B1 or a placebo, respectively, daily, for three months. We followed all participants for four months. The Higham scale was used for estimating the volume of menstrual bleeding. The Mann-Whitney test, paired t-test, independent t-test and Repeated Measure test were used for statistical purposes. RESULTS In the intervention group the duration of menstrual bleeding, the number of sanitary pads and the amount of spotting decreased significantly compared to the control group (p < 0.001). CONCLUSION Vitamin B1 is a safe, natural and cost-effective supplement that is devoid of side effects and reduces menstrual bleeding and spotting caused by a copper bearing-IUD.
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Affiliation(s)
- Azam Jafari
- * Department of Midwifery, College of Paramedical Sciences, Borujerd Branch, Islamic Azad University , Borujerd , Iran
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22
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Beshlawi I, Al Zadjali S, Bashir W, Elshinawy M, Alrawas A, Wali Y. Thiamine responsive megaloblastic anemia: the puzzling phenotype. Pediatr Blood Cancer 2014; 61:528-31. [PMID: 24249281 DOI: 10.1002/pbc.24849] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/15/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Thiamine responsive megaloblastic anemia (TRMA) is characterized by a triad of megaloblastic anemia, non-type 1 diabetes mellitus and sensorineural deafness. Other clinical findings have been described in few cases. The SLC19A2 gene on chromosome 1q 23.3 is implicated in all cases with TRMA. Our aim is to discuss the clinical manifestations of all Omani children diagnosed with TRMA and determine genotype-phenotype relationship. PROCEDURE Clinical and laboratory data of all patients diagnosed in Oman were retrospectively collected. Mutation analysis of affected families was conducted using two Microsatellite markers. Genotyping was performed with fluorescent-labeled PCR primers. To define the deletion breakpoint region, PCR reactions were carried out using different primer pairs located at the introns 3 and 3'-untranslated region with Expand Long Template PCR kit. RESULTS A total of six children have been diagnosed with this syndrome. They were five females and one male. They all presented with sensorineural deafness at birth while the age of anemia presentation ranged between 6 weeks to 19 months. They all belong to same family with complex interfamilial marriages and presented with the typical triad. Of interest is the very rare presentation of one patient with Uhl cardiac anomaly (total absence of right ventricular myocardium with apposition of endocardium and pericardium) that has never been described before in patients with TRMA. All patients have a novel large deletion of 5,224 bp involving exons 4, 5, and 6 of SLC19A2. CONCLUSIONS TRMA is a disease of expanding phenotypic spectrum with poor genotype-phenotype correlation.
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Affiliation(s)
- Ismail Beshlawi
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
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23
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Srikrupa NN, Meenakshi S, Arokiasamy T, Murali K, Soumittra N. Leber’s Congenital Amaurosis as the Retinal Degenerative Phenotype in Thiamine Responsive Megaloblastic Anemia: A Case Report. Ophthalmic Genet 2013; 35:119-24. [DOI: 10.3109/13816810.2013.793363] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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24
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Setoodeh A, Haghighi A, Saleh-Gohari N, Ellard S, Haghighi A. Identification of a SLC19A2 nonsense mutation in Persian families with thiamine-responsive megaloblastic anemia. Gene 2013; 519:295-7. [PMID: 23454484 PMCID: PMC3725413 DOI: 10.1016/j.gene.2013.02.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 02/11/2013] [Accepted: 02/12/2013] [Indexed: 01/19/2023]
Abstract
Thiamine-responsive megaloblastic anemia (TRMA) is an autosomal recessive syndrome characterized by early-onset anemia, diabetes, and hearing loss caused by mutations in the SLC19A2 gene. We studied the genetic cause and clinical features of this condition in patients from the Persian population. A clinical and molecular investigation was performed in four patients from three families and their healthy family members. All had the typical diagnostic criteria. The onset of hearing loss in three patients was at birth and one patient also had a stroke and seizure disorder. Thiamine treatment effectively corrected the anemia in all of our patients but did not prevent hearing loss. Diabetes was improved in one patient who presented at the age of 8months with anemia and diabetes after 2months of starting thiamine. The coding regions of SLC19A2 were sequenced in all patients. The identified mutation was tested in all members of the families. Molecular analyses identified a homozygous nonsense mutation c.697C>T (p.Gln233*) as the cause of the disease in all families. This mutation was previously reported in a Turkish patient with TRMA and is likely to be a founder mutation in the Persian population.
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Affiliation(s)
- Aria Setoodeh
- Growth & Development Research Centre, University of Tehran, Medical Sciences, Tehran, Iran
| | - Amirreza Haghighi
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Sian Ellard
- Institute of Biomedical and Clinical Science, Peninsula College of Medicine and Dentistry, University of Exeter, Exeter, UK
| | - Alireza Haghighi
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
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Robledo R, Corrias L, Bachis V, Puddu N, Mameli A, Vona G, Calò CM. Analysis of a Genetic Isolate: The Case of Carloforte (Italy). Hum Biol 2012; 84:735-54. [DOI: 10.3378/027.084.0602] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2013] [Indexed: 01/19/2023]
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26
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Akın L, Kurtoğlu S, Kendirci M, Akın MA, Karakükçü M. Does early treatment prevent deafness in thiamine-responsive megaloblastic anaemia syndrome? J Clin Res Pediatr Endocrinol 2011; 3:36-9. [PMID: 21448333 PMCID: PMC3065315 DOI: 10.4274/jcrpe.v3i1.08] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 11/25/2010] [Indexed: 01/19/2023] Open
Abstract
Thiamine-responsive megaloblastic anaemia (TRMA; OMIM 249270) syndrome is an autosomal recessive disorder characterized by diabetes mellitus, megaloblastic anaemia, and sensorineural deafness. Progressive hearing loss is one of the cardinal findings of the syndrome and is known to be irreversible. Whether the deafness in TRMA syndrome can be prevented is not yet known. Here, we report a four-month-old female infant diagnosed with TRMA syndrome at an early age. There was no hearing loss at the time of diagnosis. The patient's initial auditory evoked brainstem response measurements were normal. Although she was given thiamine supplementation regularly following the diagnosis, the patient developed moderate sensorineural hearing loss at 20 months of age, indicating that early diagnosis and treatment with oral thiamine (100 mg/day) could not prevent deafness in TRMA syndrome. It would be premature to draw general conclusions from one case, but we believe that further patient-based observations can shed light on the pathophysiology of this rare syndrome as well as prediction of its prognosis.
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Affiliation(s)
- Leyla Akın
- Erciyes University, Faculty of Medicine Department of Pediatric Endocrinology, Kayseri, Turkey.
| | - Selim Kurtoğlu
- Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Mustafa Kendirci
- Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Mustafa Ali Akın
- Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Musa Karakükçü
- Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
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Crouzet-Ozenda Luci L, De Smet S, Monpoux F, Ferrero-Vacher C, Giuliano F, Sirvent N. Galactosémie congénitale associée à un syndrome de Rogers chez une petite fille de 10 mois. Arch Pediatr 2011; 18:54-7. [DOI: 10.1016/j.arcped.2010.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 03/30/2010] [Accepted: 10/08/2010] [Indexed: 01/19/2023]
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28
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Saedi S, Maleki M, Pezeshki S. Right ventricular dysfunction in thiamine-responsive megaloblastic anaemia syndrome: a case report. HEART ASIA 2011; 3:140-2. [PMID: 27326013 PMCID: PMC4898568 DOI: 10.1136/heartasia-2011-010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Sedigheh Saedi
- Department of Cardiology, Rajayee Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Maleki
- Department of Cardiology, Rajayee Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sepideh Pezeshki
- Department of Cardiology, Rajayee Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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30
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Neuwirth AK, Sahai I, Falcone JF, Fleming J, Bagg A, Borgna-Pignatti C, Casey R, Fabris L, Hexner E, Mathews L, Ribeiro ML, Wierenga KJ, Neufeld EJ. Thiamine-responsive megaloblastic anemia: identification of novel compound heterozygotes and mutation update. J Pediatr 2009; 155:888-892.e1. [PMID: 19643445 PMCID: PMC2858590 DOI: 10.1016/j.jpeds.2009.06.017] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 03/25/2009] [Accepted: 06/08/2009] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To determine causative mutations and clinical status of 7 previously unreported kindreds with TRMA syndrome, (thiamine-responsive megaloblastic anemia, online Mendelian inheritance in man, no. 249270), a recessive disorder of thiamine transporter Slc19A2. STUDY DESIGN Genomic DNA was purified from blood, and SLC19A2 mutations were characterized by sequencing polymerase chain reaction-amplified coding regions and intron-exon boundaries of all probands. Compound heterozygotes were further analyzed by sequencing parents, or cloning patient genomic DNA, to ascertain that mutations were in trans. RESULTS We detected 9 novel SLC19A2 mutations. Of these, 5 were missense, 3 were nonsense, and 1 was insertion. Five patients from 4 kindreds were compound heterozygotes, a finding not reported previously for this disorder, which has mostly been found in consanguineous kindreds. CONCLUSION SLC19A2 mutation sites in TRMA are heterogeneous; with no regional "hot spots." TRMA can be caused by heterozygous compound mutations; in these cases, the disorder is found in outbred populations. To the extent that heterozygous patients were ascertained at older ages, a plausible explanation is that if one or more allele(s) is not null, partial function might be preserved. Phenotypic variability may lead to underdiagnosis or diagnostic delay, as the average time between the onset of symptoms and diagnosis was 8 years in this cohort.
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Affiliation(s)
- Anke K. Neuwirth
- Division of Hematology and Oncology, Children’s Hospital Boston and Harvard Medical School, Boston, Massachusetts
| | - Inderneel Sahai
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jill F. Falcone
- Division of Hematology and Oncology, Children’s Hospital Boston and Harvard Medical School, Boston, Massachusetts
| | - Judy Fleming
- Translational Research Program, Children’s Hospital Boston and Harvard Medical School, Boston, Massachusetts
| | - Adam Bagg
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia
| | | | - Robin Casey
- Department of Medical Genetics, Alberta Children’s Hospital & University of Calgary, Alberta, Canada
| | - Luca Fabris
- Department of Surgical and Gastroenterological Sciences University of Padova, Italy
| | - Elizabeth Hexner
- Department of Medicine, University of Pennsylvania, Philadelphia
| | - Lulu Mathews
- Department of Pediatrics, Medical College Calicut, Kerala, India
| | | | - Klaas J. Wierenga
- Division of Genetics, Department of Pediatrics, University of Miami, Miller School of Medicine, Florida
| | - Ellis J. Neufeld
- Division of Hematology and Oncology, Children’s Hospital Boston and Harvard Medical School, Boston, Massachusetts, Dana-Farber Cancer Institute, Boston, Massachusetts
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Diabetic acido-ketosis revealing thiamine-responsive megaloblastic anemia. ANNALES D'ENDOCRINOLOGIE 2009; 70:477-9. [PMID: 19922902 DOI: 10.1016/j.ando.2009.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2007] [Revised: 07/04/2008] [Accepted: 09/08/2009] [Indexed: 01/19/2023]
Abstract
Thiamine-responsive megaloblastic anemia (TRMA) is a rare autosomal recessive disorder characterized by megaloblastic anemia, diabetes mellitus and progressive sensorineural deafness. We report the cases of two infants, aged 4 and 5 months, hospitalized for diabetic ketoacidosis requiring insulin therapy. Laboratory tests revealed megaloblasic anemia, thrombocytopenia and normal thiamine level. Neurosensorial investigations showed bilateral deafness and ophthalmic involvement. Treatment with oral thiamine normalized hematological disorders and controlled diabetes; however, thiamine therapy had no impact on neurosensorial disorders.
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Borgna-Pignatti C, Azzalli M, Pedretti S. Thiamine-responsive megaloblastic anemia syndrome: long term follow-up. J Pediatr 2009; 155:295-7. [PMID: 19619756 DOI: 10.1016/j.jpeds.2009.01.062] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Revised: 12/30/2008] [Accepted: 01/21/2009] [Indexed: 01/19/2023]
Abstract
Thiamine-responsive megaloblastic anemia is a rare autosomal recessive disorder whose main symptoms are anemia, diabetes mellitus, and sensorineural deafness. We describe a 20-year follow-up of 2 previously reported patients and of 1 patient diagnosed before onset of symptoms and treated with thiamine since the first sign of disease.
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Affiliation(s)
- Caterina Borgna-Pignatti
- Department of Clinical and Experimental Medicine-Pediatrics, University of Ferrara, Ferrara, Italy.
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33
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Yeşilkaya E, Bideci A, Temizkan M, Kaya Z, Camurdan O, Koç A, Bozkaya D, Koçak U, Cinaz P. A novel mutation in the SLC19A2 gene in a Turkish female with thiamine-responsive megaloblastic anemia syndrome. J Trop Pediatr 2009; 55:265-7. [PMID: 18614593 DOI: 10.1093/tropej/fmn060] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Reported here is a 2-year-old girl who was diagnosed to have thiamine-responsive megaloblastic anemia during evaluations for her bilateral neurosensorial deafness. Besides reporting a new mutation on the gene SLC19A2 for the first time in the literature, we highlight the recognition of this syndrome--when megaloblastic anemia and diabetes mellitus coexists--and the role of thiamine replacement for the treatment of both disorders.
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Affiliation(s)
- Ediz Yeşilkaya
- Department of Pediatric Endocrinology, Gazi University Medical School, Ankara, Turkey.
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34
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Meire F, Van Genderen M, Lemmens K, Ens-Dokkum M. Thiamine-responsive megaloblastic anemia syndrome (TRMA) with cone-rod dystrophy. Ophthalmic Genet 2009. [DOI: 10.1076/1381-6810(200012)2141-hft243] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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35
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Ganesh R, Ezhilarasi S, Vasanthi T, Gowrishankar K, Rajajee S. Thiamine responsive megaloblastic anemia syndrome. Indian J Pediatr 2009; 76:313-4. [PMID: 19347672 DOI: 10.1007/s12098-009-0058-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Accepted: 10/30/2007] [Indexed: 01/19/2023]
Abstract
Thiamine responsive megaloblastic anemia syndrome (TRMA) is a clinical triad characterized by thiamine-responsive anemia, diabetes mellitus and sensorineural deafness. We report a 4-year-old girl with TRMA whose anemia improved following administration of thiamine and this case report sensitizes the early diagnosis and treatment with thiamine in children presenting with anemia, diabetes and deafness.
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Affiliation(s)
- Ramaswamy Ganesh
- Kanchi Kamakoti CHILDS Trust Hospital, Nageswara road, Nungambakkam, Chennai, Tamilnadu, India.
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36
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Bouyahia O, Ouderni M, Mansour FB, Matoussi N, Khaldi F. Diabetic Acido-Ketosis Revealing Thiamine Responsive Megaloblastic Anemia. Qatar Med J 2008. [DOI: 10.5339/qmj.2008.2.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Thiamine-responsive megaloblastic anemia (TRMA) is a rare autosomal recessive disorder including megaloblastic anemia, thrombocytopaenia, diabetes mellitus and progressive sensorineural deafness. We report cases of two infants, aged respectively four and five months, hospitalized for diabetic-acido-ketosis requiring insulin therapy. Laboratory tests revealed megaloblasic anemia, thrombocytopenia and normal thiamine-levels. Neurosensorial investigations showed bilateral deafness and ophthalmic involvements. Treatment with oral thiamine normalized hematological parameters and ameliorated diabetes.
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Affiliation(s)
- O. Bouyahia
- Service de Medicine Infantile A, Hospital d’ Enfants de Tunis Tunis, Tunisia
| | - M. Ouderni
- Service de Medicine Infantile A, Hospital d’ Enfants de Tunis Tunis, Tunisia
| | - F. B. Mansour
- Service de Medicine Infantile A, Hospital d’ Enfants de Tunis Tunis, Tunisia
| | - N. Matoussi
- Service de Medicine Infantile A, Hospital d’ Enfants de Tunis Tunis, Tunisia
| | - F. Khaldi
- Service de Medicine Infantile A, Hospital d’ Enfants de Tunis Tunis, Tunisia
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Kristiansson K, Naukkarinen J, Peltonen L. Isolated populations and complex disease gene identification. Genome Biol 2008; 9:109. [PMID: 18771588 PMCID: PMC2575505 DOI: 10.1186/gb-2008-9-8-109] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Isolated populations can be useful for the identification of genes underlying common complex diseases. The utility of genetically isolated populations (population isolates) in the mapping and identification of genes is not only limited to the study of rare diseases; isolated populations also provide a useful resource for studies aimed at improved understanding of the biology underlying common diseases and their component traits. Well characterized human populations provide excellent study samples for many different genetic investigations, ranging from genome-wide association studies to the characterization of interactions between genes and the environment.
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Affiliation(s)
- Kati Kristiansson
- National Public Health Institute and FIMM, Institute for Molecular Medicine Finland, Helsinki 00300, Finland
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38
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39
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Thankachan P, Muthayya S, Walczyk T, Kurpad AV, Hurrell RF. An Analysis of the Etiology of Anemia and Iron Deficiency in Young Women of Low Socioeconomic Status in Bangalore, India. Food Nutr Bull 2007; 28:328-36. [DOI: 10.1177/156482650702800309] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Anemia and iron deficiency are significant public health problems in India, particularly among women and children. Recent figures suggest that nearly 50% of young Indian women are anemic. Objectives Few studies have comprehensively assessed etiologic factors contributing to anemia and iron deficiency in India. Hence, this study assessed the relative importance of various factors contributing to these problems in young women of low socioeconomic status in Bangalore, India. Methods A random sample of 100 nonpregnant, nonlactating women 18 to 35 years of age, selected from among 511 women living in a poor urban settlement, participated in this study. Data were obtained on demography, socioeconomic status, anthropometry, three-day dietary intake, blood hemoglobin, hemoglobinopathies, serum ferritin, serum C-reactive protein, and stool parasites. Results The prevalence rates of anemia and iron deficiency were 39% and 62%, respectively; 95% of the anemic women were iron deficient. The mean dietary iron intake was 9.5 mg per day, predominantly from the consumption of cereals, pulses, and vegetables (77%). The estimated bioavailability of nonheme iron in this diet was 2.8%. Dietary intakes were suboptimal for several nutrients. Blood hemoglobin was significantly correlated with dietary intake of fat, riboflavin, milk and yogurt, and coffee. Serum ferritin was significantly correlated with intake of niacin, vitamin B12, and selenium. Parasitic infestation was low. Conclusions An inadequate intake of dietary iron, its poor bioavailability, and concurrent inadequate intake of dietary micronutrients appear to be the primary factors responsible for the high prevalence of anemia and iron deficiency in this population.
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40
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Alzahrani AS, Baitei E, Zou M, Shi Y. Thiamine transporter mutation: an example of monogenic diabetes mellitus. Eur J Endocrinol 2006; 155:787-92. [PMID: 17132746 DOI: 10.1530/eje.1.02305] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Thiamine-responsive megaloblastic anemia (TRMA) is a rare syndrome characterized by diabetes mellitus (DM), anemia, and sensorineural deafness. We describe the clinical course and the molecular defect of a young woman who was diagnosed to have this syndrome. CASE The patient is an 18-year-old girl who was born to non-consanguous parents. She was noted to be deaf-mute in the first year of life. She was diagnosed with DM at the age of 9 months and with severe anemia at the age of 2 years. An extensive work up could not identify the cause. She was treated with blood transfusions every 3-4 weeks for the past 16 years. A diagnosis of TRMA was suspected and the patient was treated with thiamine hydrochloride. Hemoglobin and platelets increased to normal values after a few weeks of thiamine therapy. Diabetic control significantly improved but she had no noticeable changes in the deafness. METHODS Peripheral blood DNA was extracted from the patient, her mother, aunt, and a healthy sister. Exons and exon-intron boundaries of the thiamine transporter gene SLC19A2 were PCR amplified and directly sequenced. RESULTS A G515C homozygous mutation was identified in the SLC19A2 gene of the patient. This mutation changes Gly to Arg at codon 172 (G172R). The mother, an aunt, and a sister had a heterozygous G172R mutation. CONCLUSIONS Mutations in thiamine transporter gene, SLC19A2, causes a rare form of monogenic diabetes, anemia, and sensorineural deafness. Thiamine induces a remarkable hematological response and improvement in the diabetic control but has no effect on deafness.
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Affiliation(s)
- Ali S Alzahrani
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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41
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Clark JA, Burny I, Sarnaik AP, Audhya TK. Acute thiamine deficiency in diabetic ketoacidosis: Diagnosis and management. Pediatr Crit Care Med 2006; 7:595-9. [PMID: 17006386 DOI: 10.1097/01.pcc.0000244463.59230.da] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Persistent encephalopathy in a patient with diabetic ketoacidosis is often feared as a sign of cerebral edema. Although thiamine deficiency is a rare diagnosis in children, marginal nutritional status and osmotic diuresis may be risk factors. The objective was to describe a heretofore unreported cause of encephalopathy in a child with diabetic ketoacidosis and review the mechanisms and pathophysiology of thiamine deficiency in this clinical scenario. DESIGN Case report and review of the literature. SETTING Pediatric intensive care unit of a tertiary care pediatric hospital. PATIENT A 13-yr-old girl. INTERVENTIONS Treatment of dehydration and hyperglycemia, osmotherapy, and intravenous thiamine administration. MEASUREMENTS AND MAIN RESULTS The patient presented with new-onset diabetes mellitus, severe diabetic ketoacidosis, and significant encephalopathy. Despite biochemical improvement with treatment of dehydration and hyperglycemia, her encephalopathy persisted. Computed tomography did not show cerebral edema and she showed no response to osmotherapy. Quantitative and functional assays revealed severe thiamine deficiency. The patient showed an immediate and dramatic response to intravenous thiamine administration. CONCLUSIONS The clinical improvement as well as lab investigations suggests that thiamine deficiency was the cause of this child's encephalopathy. Because potential mechanisms exist for thiamine deficiency in diabetes mellitus and institution of insulin and glucose therapy may stress thiamine body stores, thiamine deficiency should be considered in children with diabetic ketoacidosis whose encephalopathy does not improve with improvement of biochemical status.
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Affiliation(s)
- Jeff A Clark
- Division of Critical Care Medicine, Children's Hospital of Michigan/Wayne State University, Detroit, MI, USA
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42
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Ricketts CJ, Minton JA, Samuel J, Ariyawansa I, Wales JK, Lo IF, Barrett TG. Thiamine-responsive megaloblastic anaemia syndrome: long-term follow-up and mutation analysis of seven families. Acta Paediatr 2006; 95:99-104. [PMID: 16373304 DOI: 10.1080/08035250500323715] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
AIM Thiamine-responsive megaloblastic anaemia syndrome (TRMA) is the association of diabetes mellitus, anaemia and deafness, due to mutations in SLC19A2, encoding a thiamine transporter protein. This is a unique monogenic form of vitamin-dependent diabetes for which there is limited long-term data. We aimed to study genotype-phenotype relationships and long-term follow-up in our cohort. METHODS We have studied 13 patients from seven families and have follow-up data for a median of 9 y (2-30 y). RESULTS All patients originated from Kashmir or Punjab, and presented with non-immune, insulin-deficient diabetes mellitus, sensorineural deafness and a variable anaemia in the first 5 y of life, the anaemia progressing to megaloblastic and sideroblastic changes in the bone marrow. The anaemia and diabetes mellitus responded to oral thiamine hydrochloride 25 mg/d, but during puberty thiamine supplements became ineffective, and almost all patients require insulin therapy and regular blood transfusions in adulthood. All patients are homozygous for mutations in the SLC19A2 gene. We have identified a novel missense mutation (T158R) that was excluded in 100 control alleles. CONCLUSION Diabetes in this syndrome is due to an insulin insufficiency that initially responds to thiamine supplements; however, most patients become fully insulin dependent after puberty. A mutation screening strategy is feasible and likely to identify mutations in almost all cases.
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Affiliation(s)
- Christopher J Ricketts
- Medical and Molecular Genetics, Medical School, University of Birmingham, Birmingham, UK
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43
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Boros LG, Steinkamp MP, Fleming JC, Lee WNP, Cascante M, Neufeld EJ. Defective RNA ribose synthesis in fibroblasts from patients with thiamine-responsive megaloblastic anemia (TRMA). Blood 2003; 102:3556-61. [PMID: 12893755 DOI: 10.1182/blood-2003-05-1537] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Fibroblasts from patients with thiamine-responsive megaloblastic anemia (TRMA) syndrome with diabetes and deafness undergo apoptotic cell death in the absence of supplemental thiamine in their cultures. The basis of megaloblastosis in these patients has not been determined. Here we use the stable [1,2-13C2]glucose isotope-based dynamic metabolic profiling technique to demonstrate that defective high-affinity thiamine transport primarily affects the synthesis of nucleic acid ribose via the nonoxidative branch of the pentose cycle. RNA ribose isolated from TRMA fibroblasts in thiamine-depleted cultures shows a time-dependent decrease in the fraction of ribose derived via transketolase, a thiamine-dependent enzyme in the pentose cycle. The fractional rate of de novo ribose synthesis from glucose is decreased several fold 2 to 4 days after removal of thiamine from the culture medium. No such metabolic changes are observed in wild-type fibroblasts or in TRMA mutant cells in thiamine-containing medium. Fluxes through glycolysis are similar in TRMA versus control fibroblasts in the pentose and TCA cycles. We conclude that reduced nucleic acid production through impaired transketolase catalysis is the underlying biochemical disturbance that likely induces cell cycle arrest or apoptosis in bone marrow cells and leads to the TRMA syndrome in patients with defective high-affinity thiamine transport.
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Affiliation(s)
- László G Boros
- Stable Isotope Research Laboratory, Harbor-University of California, Los Angeles Research and Education Institute, UCLA School of Medicine, 1124 West Carson St, RB1, Torrance, CA 90502, USA.
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Lorber A, Gazit AZ, Khoury A, Schwartz Y, Mandel H. Cardiac manifestations in thiamine-responsive megaloblastic anemia syndrome. Pediatr Cardiol 2003; 24:476-81. [PMID: 14627317 DOI: 10.1007/s00246-002-0215-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Thiamine-responsive megaloblastic anemia (TRMA) syndrome is a rare autosomal recessive disorder defined by the occurrence of megaloblastic anemia, diabetes mellitus, and sensorineural deafness, responding in varying degrees to thiamine treatment. Other features of this syndrome gradually develop. We describe three TRMA patients with heart rhythm abnormalities and structural cardiac anomalies. Eight other reported TRMA patients also had cardiac anomalies. Recently, the TRMA gene, SLC19A2, was identified, encoding a functional thiamine transporter. Characterization of the metabolic defect of TRMA may shed light on the role of thiamine in common cardiac abnormalities.
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Affiliation(s)
- A Lorber
- Department of Pediatric Cardiology, Rambam Medical Center, PO Box 9602, Haifa 31096, Israel
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45
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Ozdemir MA, Akcakus M, Kurtoglu S, Gunes T, Torun YA. TRMA syndrome (thiamine-responsive megaloblastic anemia): a case report and review of the literature. Pediatr Diabetes 2002; 3:205-9. [PMID: 15016149 DOI: 10.1034/j.1399-5448.2002.30407.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Thiamine-responsive megaloblastic anemia syndrome (TRMA) is an autosomal recessive disorder with features that include megaloblastic anemia, mild thrombocytopenia and leukopenia, sensorineural deafness and diabetes mellitus. In this disease, the active thiamine uptake into cells is disturbed. Treatment with pharmacological doses of thiamine ameliorates the megaloblastic anemia and diabetes mellitus. Previous studies have demonstrated that the disease is caused by mutations in the SLC19A2 gene encoding a high-affinity thiamine transporter. We present a 5-yr-old-boy with TRMA and, because of its rarity, we review the literature.
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Affiliation(s)
- Mehmet Akif Ozdemir
- Erciyes University School of Medicine Department of Pediatrics, Kayseri, Turkey.
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46
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Abstract
The sideroblastic anemias are a heterogeneous group of acquired and inherited bone marrow disorders defined by the presence of pathologic iron deposits in erythroblast mitochondria. While the pathogenesis of almost all cases of acquired sideroblastic anemia is unknown, the molecular genetic basis for several of the inherited forms have now been described. Initially, mutations in ALAS2 in X-linked sideroblastic anemia (XLSA) focused attention on the heme biosynthetic pathway as a primary cause of sideroblastic anemia. However, the subsequent description of the genes involved in XLSA with ataxia, thiamine-responsive megaloblastic anemia, and Pearson marrow-pancreas syndrome have implicated other pathways, including mitochondrial oxidative phosphorylation, thiamine metabolism, and iron-sulfur cluster biosynthesis, as primary defects in sideroblastic anemias that may only secondarily impact heme metabolism.
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Affiliation(s)
- Mark D Fleming
- Department of Pathology, Children's Hospital, Boston, MA 02115, USA
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47
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Balamurugan K, Said HM. Functional role of specific amino acid residues in human thiamine transporter SLC19A2: mutational analysis. Am J Physiol Gastrointest Liver Physiol 2002; 283:G37-43. [PMID: 12065289 DOI: 10.1152/ajpgi.00547.2001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
SLC19A2 is a membrane thiamine transporter expressed in a variety of human tissues, including the gastrointestinal tract. Little is currently known about the structure/function relationship of SLC19A2. We examined the effect of introducing mutations in SLC19A2 identical to those found in thiamine-responsive megaloblastic anemia syndrome (TRMA), on functional activity and membrane expression of the transporter. We also examined the effect of mutating the only conserved anionic residue (E138) in the transmembrane (TM) domains of the SLC19A2 and that of the putative glycosylation sites (N63, N314). Northern blot analysis showed SLC19A2 mRNA was expressed at the same level in HeLa cells transfected with wild-type or mutated SLC19A2. Introducing the clinically relevant mutations (D93H, S143F, G172D) or mutation at the conserved anionic residue (E138A) of SLC19A2 led to a significant (P < 0.01) inhibition of thiamine uptake. Mutations of the two potential N-linked glycosylation sites (N63Q, N314Q) of SLC19A2 did not affect functional activity; they did, however, lead to a noticeable reduction in apparent molecular weight of protein. Western blot analysis showed all proteins (except D93H) were expressed in the membrane (not the cytoplasmic) fraction of HeLa cells. These results provide direct confirmation that clinically relevant mutations in SLC19A2 observed in TRMA cause malfunctioning of the transporter and/or a defect in its translation/stability. Results also show conserved TM anionic residue of the SLC19A2 protein is critical for its function. Furthermore, native SLC19A2 is glycosylated, but this is not important for its function.
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48
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Neufeld EJ, Fleming JC, Tartaglini E, Steinkamp MP. Thiamine-responsive megaloblastic anemia syndrome: a disorder of high-affinity thiamine transport. Blood Cells Mol Dis 2001; 27:135-8. [PMID: 11358373 DOI: 10.1006/bcmd.2000.0356] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Thiamine-responsive megaloblastic anemia (TRMA) syndrome (OMIM No. 249270) comprises a distinctive triad of clinical features: megaloblastic anemia with ringed sideroblasts, diabetes mellitus, and progressive sensorineural deafness. The TRMA gene has been mapped and cloned. Designated "SLC19A2" as a member of the solute carrier gene superfamily, this gene is mutated in all TRMA kindreds studied to date. The product of the SLC19A2 gene is a membrane protein which transports thiamine (vitamin B1) with sub-micromolar affinity. Cells from TRMA patients are uniquely sensitive to thiamine depletion to the nanomolar range, while pharmacologic doses of vitamin B1 ameliorate the anemia and diabetes. Here we review the current status of studies aimed at understanding the pathophysiology of this unique transport defect.
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Affiliation(s)
- E J Neufeld
- Division of Hematology, Children's Hospital, Boston, Massachusetts 02115, USA.
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Abstract
Inherited diabetes syndromes are individually rare but collectively make up a significant proportion of patients attending diabetes clinics, some of whom have multiple handicaps. This chapter focuses on syndromes in which major advances have been made in our understanding of the underlying molecular genetics. These conditions demonstrate novel genetic mechanisms such as maternal inheritance and genetic imprinting. They are also fascinating as they aid our understanding of insulin metabolism, both normal and abnormal. As the causative genes are identified, future issues will be the availability of genetic testing, their contribution to the genetic heterogeneity of the more common types of diabetes, and functional studies of the relevant proteins. It is probable that other subtypes of diabetes will be identified as the relevant metabolic pathways are characterized. This is an exciting time to be a diabetes physician as diabetology returns to being a diagnostic rather than a mainly management-based speciality.
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Affiliation(s)
- T G Barrett
- Department of Endocrinology, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK
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50
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Gritli S, Omar S, Tartaglini E, Guannouni S, Fleming JC, Steinkamp MP, Berul CI, Hafsia R, Jilani SB, Belhani A, Hamdi M, Neufeld EJ. A novel mutation in the SLC19A2 gene in a Tunisian family with thiamine-responsive megaloblastic anaemia, diabetes and deafness syndrome. Br J Haematol 2001; 113:508-13. [PMID: 11380424 DOI: 10.1046/j.1365-2141.2001.02774.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Thiamine-responsive megaloblastic anaemia (TRMA) syndrome with diabetes and deafness was found in two patients from a Tunisian kindred. The proband was homozygous for a novel mutation, 287delG, in the high-affinity thiamine transporter gene, SLC19A2. We demonstrated that fibroblasts from this patient exhibited defective thiamine transport. These data confirm that the SLC19A2 gene is the high-affinity thiamine carrier and that this novel mutation is responsible for TRMA syndrome.
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Affiliation(s)
- S Gritli
- Division of Hematology and Oncology, Children's Hospital and Dana Farber Cancer Institute, Boston 02115, USA
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