1
|
Mangini L, Lawrence R, Lopez ME, Graham TC, Bauer CR, Nguyen H, Su C, Ramphal J, Crawford BE, Hartl TA. Galactokinase 1 is the source of elevated galactose-1-phosphate and cerebrosides are modestly reduced in a mouse model of classic galactosemia. JIMD Rep 2024; 65:280-294. [PMID: 38974607 PMCID: PMC11224506 DOI: 10.1002/jmd2.12438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 05/02/2024] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
Classic galactosemia (CG) arises from loss-of-function mutations in the Galt gene, which codes for the enzyme galactose-1-phosphate uridylyltransferase (GALT), a central component in galactose metabolism. The neonatal fatality associated with CG can be prevented by galactose dietary restriction, but for decades it has been known that limiting galactose intake is not a cure and patients often have lasting complications. Even on a low-galactose diet, GALT's substrate galactose-1-phosphate (Gal1P) is elevated and one hypothesis is that elevated Gal1P is a driver of pathology. Here we show that Gal1P levels were elevated above wildtype (WT) in Galt mutant mice, while mice doubly mutant for Galt and the gene encoding galactokinase 1 (Galk1) had normal Gal1P levels. This indicates that GALK1 is necessary for the elevated Gal1P in CG. Another hypothesis to explain the pathology is that an inability to metabolize galactose leads to diminished or disrupted galactosylation of proteins or lipids. Our studies reveal that levels of a subset of cerebrosides-galactosylceramide 24:1, sulfatide 24:1, and glucosylceramide 24:1-were modestly decreased compared to WT. In contrast, gangliosides were unaltered. The observed reduction in these 24:1 cerebrosides may be relevant to the clinical pathology of CG, since the cerebroside galactosylceramide is an important structural component of myelin, the 24:1 species is the most abundant in myelin, and irregularities in white matter, of which myelin is a constituent, have been observed in patients with CG. Therefore, impaired cerebroside production may be a contributing factor to the brain damage that is a common clinical feature of the human disease.
Collapse
Affiliation(s)
- Linley Mangini
- Research and Early DevelopmentBioMarin Pharmaceutical Inc.San RafaelCaliforniaUSA
| | - Roger Lawrence
- Research and Early DevelopmentBioMarin Pharmaceutical Inc.San RafaelCaliforniaUSA
| | - Manuel E. Lopez
- Research and Early DevelopmentBioMarin Pharmaceutical Inc.San RafaelCaliforniaUSA
| | - Timothy C. Graham
- Research and Early DevelopmentBioMarin Pharmaceutical Inc.San RafaelCaliforniaUSA
| | - Christopher R. Bauer
- Research and Early DevelopmentBioMarin Pharmaceutical Inc.San RafaelCaliforniaUSA
| | - Hang Nguyen
- Research and Early DevelopmentBioMarin Pharmaceutical Inc.San RafaelCaliforniaUSA
| | - Cheng Su
- Research and Early DevelopmentBioMarin Pharmaceutical Inc.San RafaelCaliforniaUSA
| | - John Ramphal
- Research and Early DevelopmentBioMarin Pharmaceutical Inc.San RafaelCaliforniaUSA
| | - Brett E. Crawford
- Research and Early DevelopmentBioMarin Pharmaceutical Inc.San RafaelCaliforniaUSA
| | - Tom A. Hartl
- Research and Early DevelopmentBioMarin Pharmaceutical Inc.San RafaelCaliforniaUSA
| |
Collapse
|
2
|
Teixeira LF, Prauchner GRK, Gusso D, Wyse ATS. Classical Hereditary galactosemia: findings in patients and animal models. Metab Brain Dis 2024; 39:239-248. [PMID: 37702899 DOI: 10.1007/s11011-023-01281-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/21/2023] [Indexed: 09/14/2023]
Abstract
Classic galactosemia is a rare inborn error of metabolism that affects the metabolism of galactose, a sugar derived from milk and derivates. Classic galactosemia is caused by variants of the GALT gene, which lead to absent or misfolded forms of the ubiquitously present galactose-1-phosphate uridylyltransferase enzyme (GALT) driving galactose metabolites to accumulate, damaging cells from neurons to hepatocytes. The disease has different prevalence around the world due to different allele frequencies among populations and its symptoms range from cognitive and psychomotor impairment to hepatic, ophthalmological, and bone structural damage. The practice of newborn screening still varies among countries, dairy restriction treatment is a consensus despite advances in preclinical treatment strategies. Recent clinical studies in Duarte variant suggest dairy restriction could be reconsidered in these cases. Despite noteworthy advances in the classic galactosemia understanding, preclinical trials are still crucial to fully understand the pathophysiology of the disease and help propose new treatments. This review aims to report a comprehensive analysis of past studies and state of art research on galactosemia screening, its clinical and preclinical trials, and treatments with the goal of shedding light on this complex and multisystemic innate error of the metabolism.
Collapse
Affiliation(s)
- Lucas Ferreira Teixeira
- Laboratory of Neuroprotection and Neurometabolic Diseases, Department of Biochemistry - Wyse's Lab - ICBS, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2600-Anexo, Porto Alegre, RS, 90035-003, Brazil
| | - Gustavo R Krupp Prauchner
- Laboratory of Neuroprotection and Neurometabolic Diseases, Department of Biochemistry - Wyse's Lab - ICBS, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2600-Anexo, Porto Alegre, RS, 90035-003, Brazil
| | - Darlan Gusso
- Laboratory of Neuroprotection and Neurometabolic Diseases, Department of Biochemistry - Wyse's Lab - ICBS, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2600-Anexo, Porto Alegre, RS, 90035-003, Brazil
| | - Angela T S Wyse
- Laboratory of Neuroprotection and Neurometabolic Diseases, Department of Biochemistry - Wyse's Lab - ICBS, Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2600-Anexo, Porto Alegre, RS, 90035-003, Brazil.
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Anexo, Porto Alegre, RS, CEP 90035-003, Brazil.
| |
Collapse
|
3
|
Derks B, Rivera-Cruz G, Hagen-Lillevik S, Vos EN, Demirbas D, Lai K, Treacy EP, Levy HL, Wilkins-Haug LE, Rubio-Gozalbo ME, Berry GT. The hypergonadotropic hypogonadism conundrum of classic galactosemia. Hum Reprod Update 2023; 29:246-258. [PMID: 36512573 PMCID: PMC9976963 DOI: 10.1093/humupd/dmac041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/19/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hypergonadotropic hypogonadism is a burdensome complication of classic galactosemia (CG), an inborn error of galactose metabolism that invariably affects female patients. Since its recognition in 1979, data have become available regarding the clinical spectrum, and the impact on fertility. Many women have been counseled for infertility and the majority never try to conceive, yet spontaneous pregnancies can occur. Onset and mechanism of damage have not been elucidated, yet new insights at the molecular level are becoming available that might greatly benefit our understanding. Fertility preservation options have expanded, and treatments to mitigate this complication either by directly rescuing the metabolic defect or by influencing the cascade of events are being explored. OBJECTIVE AND RATIONALE The aims are to review: the clinical picture and the need to revisit the counseling paradigm; insights into the onset and mechanism of damage at the molecular level; and current treatments to mitigate ovarian damage. SEARCH METHODS In addition to the work on this topic by the authors, the PubMed database has been used to search for peer-reviewed articles and reviews using the following terms: 'classic galactosemia', 'gonadal damage', 'primary ovarian insufficiency', 'fertility', 'animal models' and 'fertility preservation' in combination with other keywords related to the subject area. All relevant publications until August 2022 have been critically evaluated and reviewed. OUTCOMES A diagnosis of premature ovarian insufficiency (POI) results in a significant psychological burden with a high incidence of depression and anxiety that urges adequate counseling at an early stage, appropriate treatment and timely discussion of fertility preservation options. The cause of POI in CG is unknown, but evidence exists of dysregulation in pathways crucial for folliculogenesis such as phosphatidylinositol 3-kinase/protein kinase B, inositol pathway, mitogen-activated protein kinase, insulin-like growth factor-1 and transforming growth factor-beta signaling. Recent findings from the GalT gene-trapped (GalTKO) mouse model suggest that early molecular changes in 1-month-old ovaries elicit an accelerated growth activation and burnout of primordial follicles, resembling the progressive ovarian failure seen in patients. Although data on safety and efficacy outcomes are still limited, ovarian tissue cryopreservation can be a fertility preservation option. Treatments to overcome the genetic defect, for example nucleic acid therapy such as mRNA or gene therapy, or that influence the cascade of events are being explored at the (pre-)clinical level. WIDER IMPLICATIONS Elucidation of the molecular pathways underlying POI of any origin can greatly advance our insight into the pathogenesis and open new treatment avenues. Alterations in these molecular pathways might serve as markers of disease progression and efficiency of new treatment options.
Collapse
Affiliation(s)
- Britt Derks
- Department of Pediatrics and Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW, Maastricht University, Maastricht, The Netherlands.,European Reference Network for Hereditary Metabolic Disorders (MetabERN) Member and United for Metabolic Diseases Member
| | - Greysha Rivera-Cruz
- Division of Genetics & Genomics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Synneva Hagen-Lillevik
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Nutrition and Integrative Physiology, University of Utah College of Health, Salt Lake City, UT, USA
| | - E Naomi Vos
- Department of Pediatrics and Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW, Maastricht University, Maastricht, The Netherlands.,European Reference Network for Hereditary Metabolic Disorders (MetabERN) Member and United for Metabolic Diseases Member
| | - Didem Demirbas
- Division of Genetics & Genomics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kent Lai
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Nutrition and Integrative Physiology, University of Utah College of Health, Salt Lake City, UT, USA
| | - Eileen P Treacy
- European Reference Network for Hereditary Metabolic Disorders (MetabERN) Member and United for Metabolic Diseases Member.,National Centre for Inherited Metabolic Disorders, Mater Misericordiae University Hospital, Dublin, Ireland.,School of Medicine, Trinity College, Dublin 2, Ireland.,School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Harvey L Levy
- Division of Genetics & Genomics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Louise E Wilkins-Haug
- Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - M Estela Rubio-Gozalbo
- Department of Pediatrics and Clinical Genetics, Maastricht University Medical Centre+, Maastricht, The Netherlands.,GROW, Maastricht University, Maastricht, The Netherlands.,European Reference Network for Hereditary Metabolic Disorders (MetabERN) Member and United for Metabolic Diseases Member
| | - Gerard T Berry
- Division of Genetics & Genomics, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
Hagen-Lillevik S, Johnson J, Lai K. Early postnatal alterations in follicular stress response and survival in a mouse model of Classic Galactosemia. J Ovarian Res 2022; 15:122. [PMID: 36414970 PMCID: PMC9682695 DOI: 10.1186/s13048-022-01049-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 10/07/2022] [Indexed: 11/24/2022] Open
Abstract
Primary ovarian insufficiency is characterized by accelerated loss of primordial follicles, which results in ovarian failure and concomitant menopause before age 40. About 1-3% of females in the general population are diagnosed with POI; however, greater than 80% of females with the inherited disease Classic Galactosemia will develop POI. Classic Galactosemia is caused by mutations in the GALT gene encoding the enzyme galactose-1 phosphate uridylyltransferase. While dietary restriction of galactose is lifesaving in the neonatal period, the development of complications including primary ovarian insufficiency is not mitigated. Additionally, the pattern(s) of follicle loss have not been completely characterized. The chronic accumulation of aberrant metabolites such as galactose-1-phosphate and galactitol are suspected culprits in the development of the sequelae, yet the mechanisms remain elusive.Our group uses a GalT gene-trapped mouse model to study the pathophysiology of primary ovarian insufficiency in Classic Galactosemia. We recently showed that differences in the Integrated Stress Response pathway occur in mutant ovaries that likely contribute to their primary ovarian insufficiency phenotype. Using immunofluorescent staining of histological sections of ovaries at progressive ages, we saw evidence of altered Integrated Stress Response activity in granulosa cells and primordial oocytes consistent with accelerated primordial follicle growth activation, aberrant DNA damage and/or repair, and increased cellular stress/death. Overall, our findings indicate that abnormal Integrated Stress Response in the Classic Galactosemia model ovary results in accelerated primordial follicle growth activation, sometimes referred to as "burnout." These aberrant early events help further clarify when/how the primary ovarian insufficiency phenotype arises under galactosemic conditions.
Collapse
Affiliation(s)
- Synneva Hagen-Lillevik
- grid.223827.e0000 0001 2193 0096Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84108 USA ,grid.223827.e0000 0001 2193 0096Department of Nutrition and Integrative Physiology, University of Utah College of Health, 250 South 1850 East Room 214, Salt Lake City, UT 84112 USA
| | - Joshua Johnson
- grid.430503.10000 0001 0703 675XDivision of Reproductive Sciences, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Colorado Denver (AMC), Building RC2, Room P15 3103, Mail Stop 8613, Aurora, CO 80045 USA
| | - Kent Lai
- grid.223827.e0000 0001 2193 0096Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84108 USA ,grid.223827.e0000 0001 2193 0096Department of Nutrition and Integrative Physiology, University of Utah College of Health, 250 South 1850 East Room 214, Salt Lake City, UT 84112 USA
| |
Collapse
|
5
|
Katler Q, Stepien KM, Paull N, Patel S, Adams M, Balci MC, Berry GT, Bosch AM, De La O A, Demirbas D, Edman J, Ficicioglu C, Goff M, Hacker S, Knerr I, Lancaster K, Li H, Mendelsohn BA, Nichols B, de Rezende Pinto WBV, Rocha JC, Rubio-Gozalbo ME, Saad-Naguib M, Scholl-Buergi S, Searcy S, de Souza PVS, Wittenauer A, Fridovich-Keil JL. A multinational study of acute and long-term outcomes of Type 1 galactosemia patients who carry the S135L (c.404C > T) variant of GALT. J Inherit Metab Dis 2022; 45:1106-1117. [PMID: 36093991 PMCID: PMC9643640 DOI: 10.1002/jimd.12556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/23/2022] [Accepted: 09/09/2022] [Indexed: 11/08/2022]
Abstract
Patients with galactosemia who carry the S135L (c.404C > T) variant of galactose-1-P uridylyltransferase (GALT), documented to encode low-level residual GALT activity, have been under-represented in most prior studies of outcomes in Type 1 galactosemia. What is known about the acute and long-term outcomes of these patients, therefore, is based on very limited data. Here, we present a study comparing acute and long-term outcomes of 12 patients homozygous for S135L, 25 patients compound heterozygous for S135L, and 105 patients homozygous for two GALT-null (G) alleles. This is the largest cohort of S135L patients characterized to date. Acute disease following milk exposure in the newborn period was common among patients in all 3 comparison groups in our study, as were long-term complications in the domains of speech, cognition, and motor outcomes. In contrast, while at least 80% of both GALT-null and S135L compound heterozygous girls and women showed evidence of an adverse ovarian outcome, prevalence was only 25% among S135L homozygotes. Further, all young women in this study with even one copy of S135L achieved spontaneous menarche; this is true for only about 33% of women with classic galactosemia. Overall, we observed that while most long-term outcomes trended milder among groups of patients with even one copy of S135L, many individual patients, either homozygous or compound heterozygous for S135L, nonetheless experienced long-term outcomes that were not mild. This was true despite detection by newborn screening and both early and life-long dietary restriction of galactose. This information should empower more evidence-based counseling for galactosemia patients with S135L.
Collapse
Affiliation(s)
- Quinton Katler
- Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia USA
| | - Karolina M. Stepien
- Adult Inherited Metabolic Diseases Department, Salford Royal Foundation NHS Trust, Salford, Greater Manchester, UK
| | - Nathan Paull
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia USA
| | - Sneh Patel
- Emory College, Emory University, Atlanta, Georgia USA
| | - Michael Adams
- UNC School of Medicine, Division of Pediatric Genetics and Metabolism, Chapel Hill, North Carolina USA
| | - Mehmet Cihan Balci
- Department of Pediatric Metabolic Disease, Istanbul Medical School, Fatihİstanbul, Turkey
| | - Gerard T. Berry
- Division of Genetics and Genomics, Department of Pediatrics, The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts USA
| | - Annet M. Bosch
- Amsterdam UMC location University of Amsterdam, Emma Children’s Hospital, Department of Pediatrics, Division of Metabolic Diseases, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef 9, Amsterdam, the Netherlands
| | | | - Didem Demirbas
- Division of Genetics and Genomics, Department of Pediatrics, The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts USA
| | - Julianna Edman
- Department of Pediatric Genetics, University of Illinois-Chicago, Chicago, Illinois USA
| | - Can Ficicioglu
- The Children’s Hospital of Philadelphia, Division of Human Genetics and Metabolism, Perelman School of Medicine at The University of Pennsylvania, Philadelphia, Pennsylvania USA
| | - Melanie Goff
- Division of Genetic and Genomic Medicine, Nationwide Children’s Hospital, Columbus, Ohio USA
| | - Stephanie Hacker
- Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida USA
| | - Ina Knerr
- National Centre for Inherited Metabolic Disorders, Temple St. Children’s University Hospital, Dublin, Ireland
| | - Kristen Lancaster
- UNC School of Medicine, Division of Pediatric Genetics and Metabolism, Chapel Hill, North Carolina USA
| | - Hong Li
- Departments of Human Genetics and Pediatrics, Emory University School of Medicine, Atlanta, Georgia USA
| | - Bryce A. Mendelsohn
- Department of Genetics, Oakland Medical Center, Kaiser Permanente, Oakland, California USA
| | - Brandi Nichols
- Department of Clinical Nutrition, Arkansas Children’s Hospital, Little Rock, Arkansas USA
| | | | - Júlio César Rocha
- Nutrition & Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa Reference Centre of Inherited Metabolic Diseases, Centro Hospitalar Universitário de Lisboa Central, and Center for Health Technology and Services Research (CINTESIS), NOVA Medical School, Lisboa, Portugal
| | - M Estela Rubio-Gozalbo
- Department of Pediatrics, Department of Clinical Genetics, GROW-School for Oncology and Reproduction, European Reference Network for Hereditary Metabolic Disorders (MetabERN) member and United for Metabolic Diseases member, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Michael Saad-Naguib
- Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida USA
| | | | - Sarah Searcy
- Division of Genetic and Genomic Medicine, Nationwide Children’s Hospital, Columbus, Ohio USA
| | | | - Angela Wittenauer
- Department of Human Genetics, Emory University School of Medicine, Atlanta, Georgia USA
| | | |
Collapse
|
6
|
Shakerdi LA, Wallace L, Smyth G, Madden N, Clark A, Hendroff U, McGovern M, Connellan S, Gillman B, Treacy EP. Determination of the lactose and galactose content of common foods: Relevance to galactosemia. Food Sci Nutr 2022; 10:3789-3800. [PMID: 36348783 PMCID: PMC9632185 DOI: 10.1002/fsn3.2976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 11/24/2022] Open
Abstract
Classical galactosemia (CG) is a disorder of galactose metabolism which results from deficiency of the enzyme galactose‐1‐phosphate uridylyl transferase (GALT). Treatment consists of immediately eliminating galactose from the diet in the new‐born and lifelong restriction of dietary galactose. The inclusion of a wider variety of foods for people with CG may provide many benefits, including improved nutritional adequacy and quality of life. Galactose plays an important role in glycosylation of glycoproteins and glycolipids. Moderate liberalization of galactose restriction has been shown to improve immunoglobulin G (IgG) glycosylation for some individuals with CG. Moreover, recent outcome research suggests that strict restriction of nondairy galactose may have more unfavorable outcomes than moderate liberalization in CG patients. In the current work, based on patient feedback, we have analyzed the lactose and galactose content of different foods available in Ireland. These include a range of cheeses, yogurts, pizzas, soups, biscuits, cakes, pastries, crackers, mayonnaises, salad creams, fat spreads, crisps, corn chips, salamis, and gravies. This work provides information to support the development of a practical food‐based approach to facilitate analysis of dietary galactose intake and to possibly increase overall variety of food choices for people with CG.
Collapse
Affiliation(s)
- Loai A. Shakerdi
- National Centre for Inherited Metabolic Disorders Mater Misericordiae University Hospital Dublin 7 Ireland
| | | | | | | | - Anne Clark
- National Centre for Inherited Metabolic Disorders Children's Health Ireland (CHI) at Temple Street Dublin 1 Ireland
| | - Una Hendroff
- National Centre for Inherited Metabolic Disorders Mater Misericordiae University Hospital Dublin 7 Ireland
| | - Marianne McGovern
- National Centre for Inherited Metabolic Disorders Mater Misericordiae University Hospital Dublin 7 Ireland
| | - Sarah Connellan
- National Centre for Inherited Metabolic Disorders Mater Misericordiae University Hospital Dublin 7 Ireland
| | - Barbara Gillman
- National Centre for Inherited Metabolic Disorders Mater Misericordiae University Hospital Dublin 7 Ireland
| | - Eileen P. Treacy
- National Centre for Inherited Metabolic Disorders Mater Misericordiae University Hospital Dublin 7 Ireland
- School of Medicine Trinity College Dublin Dublin 2 Ireland
- UCD School of Medicine University College Dublin Dublin 4 Ireland
| |
Collapse
|
7
|
Delnoy B, Haskovic M, Vanoevelen J, Steinbusch LKM, Vos EN, Knoops K, Zimmermann LJI, Noga M, Lefeber DJ, Martini PGV, Coelho AI, Rubio‐Gozalbo ME. Novel mRNA therapy restores GALT protein and enzyme activity in a zebrafish model of classic galactosemia. J Inherit Metab Dis 2022; 45:748-758. [PMID: 35527402 PMCID: PMC9541528 DOI: 10.1002/jimd.12512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022]
Abstract
Messenger RNA (mRNA) has emerged as a novel therapeutic approach for inborn errors of metabolism. Classic galactosemia (CG) is an inborn error of galactose metabolism caused by a severe deficiency of galactose-1-phosphate:uridylyltransferase (GALT) activity leading to neonatal illness and chronic impairments affecting the brain and female gonads. In this proof of concept study, we used our zebrafish model for CG to evaluate the potential of human GALT mRNA (hGALT mRNA) packaged in two different lipid nanoparticles to restore GALT expression and activity at early stages of development. Both one cell-stage and intravenous single-dose injections resulted in hGALT protein expression and enzyme activity in the CG zebrafish (galt knockout) at 5 days post fertilization (dpf). Moreover, the levels of galactose-1-phosphate (Gal-1-P) and galactonate, metabolites that accumulate because of the deficiency, showed a decreasing trend. LNP-packaged mRNA was effectively translated and processed in the CG zebrafish without signs of toxicity. This study shows that mRNA therapy restores GALT protein and enzyme activity in the CG zebrafish model, and that the zebrafish is a suitable system to test this approach. Further studies are warranted to assess whether repeated injections safely mitigate the chronic impairments of this disease.
Collapse
Affiliation(s)
- Britt Delnoy
- Department of PediatricsMaastricht University Medical Center+Maastrichtthe Netherlands
- GROW, Maastricht UniversityMaastrichtthe Netherlands
| | - Minela Haskovic
- Department of PediatricsMaastricht University Medical Center+Maastrichtthe Netherlands
- GROW, Maastricht UniversityMaastrichtthe Netherlands
| | - Jo Vanoevelen
- GROW, Maastricht UniversityMaastrichtthe Netherlands
- Department of Clinical GeneticsMaastricht University Medical Center+Maastrichtthe Netherlands
| | - Laura K. M. Steinbusch
- Department of Clinical GeneticsMaastricht University Medical Center+Maastrichtthe Netherlands
| | - Esther Naomi Vos
- Department of PediatricsMaastricht University Medical Center+Maastrichtthe Netherlands
| | - Kèvin Knoops
- Microscopy CORE LaboratoryMaastricht UniversityMaastrichtthe Netherlands
| | - Luc J. I. Zimmermann
- Department of PediatricsMaastricht University Medical Center+Maastrichtthe Netherlands
- GROW, Maastricht UniversityMaastrichtthe Netherlands
| | - Marek Noga
- Translational Metabolic LaboratoryRadboud University Medical CenterNijmegenthe Netherlands
| | - Dirk J. Lefeber
- Translational Metabolic LaboratoryRadboud University Medical CenterNijmegenthe Netherlands
- Department of NeurologyDonders Institute for Brain, Cognition and Behavior, Radboud University Medical CenterNijmegenthe Netherlands
| | | | - Ana I. Coelho
- Department of PediatricsMaastricht University Medical Center+Maastrichtthe Netherlands
| | - Maria Estela Rubio‐Gozalbo
- Department of PediatricsMaastricht University Medical Center+Maastrichtthe Netherlands
- GROW, Maastricht UniversityMaastrichtthe Netherlands
- Department of Clinical GeneticsMaastricht University Medical Center+Maastrichtthe Netherlands
| |
Collapse
|
8
|
Na Z, Jiang H, Meng Y, Song J, Feng D, Fang Y, Shi B, Li D. Association of galactose and insulin resistance in polycystic ovary syndrome: A case-control study. EClinicalMedicine 2022; 47:101379. [PMID: 35480079 PMCID: PMC9035629 DOI: 10.1016/j.eclinm.2022.101379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/14/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) is closely linked to metabolic disorders. Recent reports have identified galactose as having strong associations with metabolic disorders, however, the correlation between galactose and PCOS remains largely unknown. METHODS The serum galactose levels of 104 patients with PCOS and 98 controls were measured, and their relationships with several metabolic parameters were analyzed. The study took place at the Center for Reproductive Medicine at Shengjing Hospital of China Medical University, Shenyang, China from July 13 to Oct 20, 2020. The relationships between serum galactose and PCOS as well as PCOS-related insulin resistance were investigated via logistic regression analyses, and the performance of serum galactose as a potential biomarker for PCOS was evaluated using receiver operating characteristic curve analysis. FINDINGS Higher serum galactose levels were observed in the patients with PCOS than in the controls (p = 0.001). There was still a correlation between circulating galactose levels and PCOS after adjusting for covariates (p = 0.002; odds ratio (OR), 1.133; 95% confidence interval (CI) 1.047-1.227). Serum galactose levels were shown to be most closely related to the fasting serum insulin level (r = 0.370, p = 0.001) and were higher in the insulin-resistant subgroup than in the non-insulin-resistant subgroup of patients with PCOS (p = 0.001). There was no difference in serum galactose levels between the insulin-resistant and non-insulin-resistant subgroups of women in the control group (p > 0.05). Furthermore, higher serum galactose levels were shown to be associated with insulin resistance in PCOS (p = 0.004; OR, 26.017; 95% CI, 2.907-232.810). The area under the curve for galactose-mediated prediction of PCOS was 80.0%, with a sensitivity of 71.0% and a specificity of 86.4%. INTERPRETATION Higher circulating galactose levels correlate with PCOS and PCOS-related insulin resistance; therefore, it may serve as a potential biomarker for patients with PCOS. These findings require further validation in a study with a larger sample size. FUNDING National Natural Science Foundation of China (No. 82,071,607 and 32,100,691); LiaoNing Revitalization Talents Program (No. XLYC1907071); Fok Ying Tung Education Foundation (No. 151,039); Key Research and Development Program of Liaoning Province (NO. 2,018,225,062); Outstanding Scientific Fund of Shengjing Hospital (No. 202,003).
Collapse
Affiliation(s)
- Zhijing Na
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, No.36, SanHao Street, Shenyang 110004, China
| | - Hongyu Jiang
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, No.36, SanHao Street, Shenyang 110004, China
| | - Yaxin Meng
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, No.36, SanHao Street, Shenyang 110004, China
| | - Jiahui Song
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, No.36, SanHao Street, Shenyang 110004, China
| | - Di Feng
- Education Center for Clinical Skill Practice, China Medical University, Shenyang 110122, China
| | - Yuanyuan Fang
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, No.36, SanHao Street, Shenyang 110004, China
| | - Bei Shi
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, No.36, SanHao Street, Shenyang 110004, China
- Department of Physiology, School of Life Sciences, China Medical University, Shenyang 110122, China
- Corresponding authors at: Center of Reproductive Medicine, Shengjing Hospital of China Medical University, No.36, SanHao Street, Shenyang 110004, China.
| | - Da Li
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, No.36, SanHao Street, Shenyang 110004, China
- Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling of Liaoning Province, Shenyang 110122, China
- Corresponding authors at: Center of Reproductive Medicine, Shengjing Hospital of China Medical University, No.36, SanHao Street, Shenyang 110004, China.
| |
Collapse
|
9
|
Kruszewska J, Laudy-Wiaderny H, Krzywdzinska S, Grymowicz M, Smolarczyk R, Meczekalski B. Two consecutive pregnancies in a patient with premature ovarian insufficiency in the course of classic galactosemia and a review of the literature. Gynecol Endocrinol 2022; 38:186-189. [PMID: 34730073 DOI: 10.1080/09513590.2021.1998437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AIM To present a case report of a patient with classic galactosemia and the Q188R/K285N GALT mutation, who conceived spontaneously twice despite severe ovarian failure. A review of the literature is included. MATERIALS AND METHODS A 20-year-old patient with classic galactosemia and premature ovarian insufficiency (POI) came to our attention. We performed a routine hormonal and ultrasound examination confirming low ovarian reserve. Due to low rates of pregnancies in individuals with POI (5%-10%), we were almost certain of the infeasibility of pregnancy. RESULTS Surprisingly, several months after hospitalization, the patient conceived without any medical intervention and less than a year after the first birth she became pregnant again. While reviewing the literature, 90 pregnancies among galactosemic patients were identified. CONCLUSIONS Ovarian failure is a long-term diet-independent complication of classic galactosemia, pertaining to about 90% of affected individuals. This case confirms its unpredicted course, as even the presence of unfavorable factors (absence of spontaneous puberty, early diagnosis of POI, undetectable AMH) may not preclude the chance for conception.
Collapse
Affiliation(s)
- Jagoda Kruszewska
- Department of Gynecological Endocrinology, Students' Scientific Society, Medical University of Warsaw, Warsaw, Poland
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Poland
| | - Hanna Laudy-Wiaderny
- Department of Gynecological Endocrinology, Students' Scientific Society, Medical University of Warsaw, Warsaw, Poland
| | - Sandra Krzywdzinska
- Department of Otolaryngology with Division of Cranio-Maxillo-Facial Surgery in Military Institute of Medicine, Warsaw, Poland
| | - Monika Grymowicz
- Department of Gynecological Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Roman Smolarczyk
- Department of Gynecological Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Blazej Meczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznań, Poland
| |
Collapse
|
10
|
Alur-Gupta S, Vu M, Vitek W. Adolescent Fertility Preservation: Where Do We Stand Now. Semin Reprod Med 2021; 40:69-78. [PMID: 34687030 DOI: 10.1055/s-0041-1735891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Adolescence is a period of flux for many body systems. While fertility potential typically increases after menarche, there are diseases where the opposite occurs and fertility preservation options need to be considered early. In cases of cancer, options vary by pubertal status and can include ovarian tissue cryopreservation, oocyte cryopreservation, sperm cryopreservation, and testicular tissue cryopreservation. Much remains to be learned about fertility and preservation options in those with differences in sexual development (DSDs); however, depending on the form of DSD, fertility preservation may not be necessary. Similarly, traditional fertility counseling in children with galactosemia may need to be changed, as data suggest that fertility rates attributed to other causes of premature ovarian insufficiency may not be as applicable to this disease. Adolescents with Turner's syndrome are at high risk for premature ovarian failure; therefore, it is important to consider options as early as possible since ovarian reserves are depleted quickly. On the other hand, transgender and gender diverse adolescents may even be able to undergo fertility preservation after starting hormone therapy. In all cases, there are additional ethical components including technical/surgical risks in childhood, offering experimental therapies without creating false hope and evaluating children's consent and assent capabilities that must be considered.
Collapse
Affiliation(s)
- Snigdha Alur-Gupta
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
| | - Michelle Vu
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
| | - Wendy Vitek
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
| |
Collapse
|
11
|
Hagen-Lillevik S, Rushing JS, Appiah L, Longo N, Andrews A, Lai K, Johnson J. Pathophysiology and management of classic galactosemic primary ovarian insufficiency. REPRODUCTION AND FERTILITY 2021; 2:R67-R84. [PMID: 35118398 PMCID: PMC8788619 DOI: 10.1530/raf-21-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/25/2021] [Indexed: 12/14/2022] Open
Abstract
Classic galactosemia is an inborn error of carbohydrate metabolism associated with early-onset primary ovarian insufficiency (POI) in young women. Our understanding of the consequences of galactosemia upon fertility and fecundity of affected women is expanding, but there are important remaining gaps in our knowledge and tools for its management, and a need for continued dialog so that the special features of the condition can be better managed. Here, we review galactosemic POI and its reproductive endocrinological clinical sequelae and summarize current best clinical practices for its management. Special consideration is given to the very early-onset nature of the condition in the pediatric/adolescent patient. Afterward, we summarize our current understanding of the reproductive pathophysiology of galactosemia, including the potential action of toxic galactose metabolites upon the ovary. Our work establishing that ovarian cellular stress reminiscent of endoplasmic reticulum (ER) stress is present in a mouse model of galactosemia, as well as work by other groups, are summarized. LAY SUMMARY Patients with the condition of classic galactosemia need to maintain a strict lifelong diet that excludes the sugar galactose. This is due to having mutations in enzymes that process galactose, resulting in the buildup of toxic metabolic by-products of the sugar. Young women with classic galactosemia often lose the function of their ovaries very early in life (termed 'primary ovarian insufficiency'), despite adherence to a galactose-restricted diet. This means that in addition to the consequences of the disease, these women also face infertility and the potential need for hormone replacement therapy. This article summarizes current strategies for managing the care of galactosemic girls and women and also what is known of how the condition leads to early primary ovarian insufficiency.
Collapse
Affiliation(s)
- Synneva Hagen-Lillevik
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Nutrition and Integrative Physiology, University of Utah College of Health, Salt Lake City, Utah, USA
| | - John S Rushing
- Divisions of Reproductive Sciences, Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Colorado Denver (AMC), Aurora, Colorado, USA
| | - Leslie Appiah
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of Colorado Denver (AMC), Anschutz Outpatient Pavilion, Aurora, Colorado, USA
| | - Nicola Longo
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Nutrition and Integrative Physiology, University of Utah College of Health, Salt Lake City, Utah, USA
| | - Ashley Andrews
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Kent Lai
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Department of Nutrition and Integrative Physiology, University of Utah College of Health, Salt Lake City, Utah, USA
| | - Joshua Johnson
- Divisions of Reproductive Sciences, Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Colorado Denver (AMC), Aurora, Colorado, USA
| |
Collapse
|
12
|
Piedade KC, Spencer H, Persani L, Nelson LM. Optimizing Fertility in Primary Ovarian Insufficiency: Case Report and Literature Review. Front Genet 2021; 12:676262. [PMID: 34249096 PMCID: PMC8261244 DOI: 10.3389/fgene.2021.676262] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 04/12/2021] [Indexed: 12/31/2022] Open
Abstract
Primary ovarian insufficiency (POI) is a clinical spectrum of ovarian dysfunction. Overt POI presents with oligo/amenorrhea and hypergonadotropic hypogonadism before age 40 years. Overt POI involves chronic health problems to include increased morbidity and mortality related to estradiol deficiency and the associated osteoporosis and cardiovascular disease as well as psychological and psychiatric disorders related to the loss of reproductive hormones and infertility. Presently, with standard clinical testing, a mechanism for Overt POI can only be identified in about 10% of cases. Now discovery of new mechanisms permits an etiology to be identified in a research setting in 25-30% of overt cases. The most common genetic cause of Overt POI is premutation in FMR1. The associated infertility is life altering. Oocyte donation is effective, although many women prefer to conceive with their own ova. Surprisingly, the majority who have Overt POI still have detectable ovarian follicles (70%). The major mechanism of follicle dysfunction in Overt POI has been histologically defined by a prospective NIH study: inappropriate follicle luteinization due to the tonically elevated serum LH levels. A trial of physiologic hormone replacement therapy, clinically proven to suppress the elevated LH levels in these women, may improve follicle function and increase the chance of ovulation. Here, we report the case of a woman with Overt POI diagnosed at age 35 years. To attempt pregnancy, she elected a trial of intrauterine insemination (IUI) in conjunction with follicle monitoring and physiologic hormone replacement therapy. She conceived on the eighth cycle of treatment and delivered a healthy baby. Our report calls for a concerted effort to define the best methods by which to optimize fertility for women who have POI.
Collapse
Affiliation(s)
| | - Hillary Spencer
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Luca Persani
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
- Department of Endocrine and Metabolic Diseases, Istituto Auxologico Italiano, Milan, Italy
| | | |
Collapse
|
13
|
Flechtner I, Viaud M, Kariyawasam D, Perrissin-Fabert M, Bidet M, Bachelot A, Touraine P, Labrune P, de Lonlay P, Polak M. Puberty and fertility in classic galactosemia. Endocr Connect 2021; 10:240-247. [PMID: 33491660 PMCID: PMC7983486 DOI: 10.1530/ec-21-0013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/20/2021] [Indexed: 11/21/2022]
Abstract
Classic galactosemia is a rare inborn error of galactose metabolism with a birth prevalence of about 1/30,000-60,000. Long-term complications occurring despite dietary treatment consist of premature ovarian insufficiency (POI) and neurodevelopmental impairments. We performed with the French Reference Centers for Rare Diseases a multisite collaborative questionnaire survey for classic galactosemic patients. Its primary objective was to assess their puberty, pregnancy, gonadotropic axis, and pelvic morphology by ultrasound. The secondary objective was to determine predictive factors for pregnancy without oocyte donation. Completed questionnaires from 103 patients, 56 females (median age, 19 years (3-52 years)) and 47 males (median age, 19 years (3-45 years)), were analyzed. Among the 43 females older than 13 years old, mean age for breast development first stage was 13.8 years; spontaneous menarche occurred in 21/31 females at a mean age of 14.6 years. In these 21 women, 62% had spaniomenorrhea and 7/17 older than 30 years had amenorrhea. All age-groups confounded, FSH was above reference range for 65.7% of the patients, anti-Müllerian hormone and inhibin B were undetectable, and the ovaries were small with few or no follicles detected. Among the 5 females who sought to conceive, 4 had pregnancies. Among the 47 males, 1 had cryptorchidism, all have normal testicular function and none had a desire to conceive children. Thus, spontaneous puberty and POI are both common in this population. Spontaneous menarche seems to be the best predictive factor for successful spontaneous pregnancy.
Collapse
Affiliation(s)
- Isabelle Flechtner
- Center for Rare Gynecological Disorders, Centre des Pathologies Gynécologiques Rares, Paris, France
- Department of Paediatric Endocrinology, Gynaecology, and Diabetology, AP-HP, Necker-Enfants Malades University Hospital, IMAGINE Institute affiliate, Paris, France
| | - Magali Viaud
- Center for Rare Gynecological Disorders, Centre des Pathologies Gynécologiques Rares, Paris, France
- Department of Paediatric Endocrinology, Gynaecology, and Diabetology, AP-HP, Necker-Enfants Malades University Hospital, IMAGINE Institute affiliate, Paris, France
| | - Dulanjalee Kariyawasam
- Department of Paediatric Endocrinology, Gynaecology, and Diabetology, AP-HP, Necker-Enfants Malades University Hospital, IMAGINE Institute affiliate, Paris, France
| | - Marie Perrissin-Fabert
- Center for Rare Gynecological Disorders, Centre des Pathologies Gynécologiques Rares, Paris, France
- Department of Paediatric Endocrinology, Gynaecology, and Diabetology, AP-HP, Necker-Enfants Malades University Hospital, IMAGINE Institute affiliate, Paris, France
| | - Maud Bidet
- Center for Rare Gynecological Disorders, Centre des Pathologies Gynécologiques Rares, Paris, France
- Department of Paediatric Endocrinology, Gynaecology, and Diabetology, AP-HP, Necker-Enfants Malades University Hospital, IMAGINE Institute affiliate, Paris, France
| | - Anne Bachelot
- Center for Rare Gynecological Disorders, Centre des Pathologies Gynécologiques Rares, Paris, France
- Department of Endocrinology and Reproductive Medicine, AP-HPIE3M, Hôpital Pitié-Salpêtrière, ICAN, Paris, France
| | - Philippe Touraine
- Center for Rare Gynecological Disorders, Centre des Pathologies Gynécologiques Rares, Paris, France
- Department of Endocrinology and Reproductive Medicine, AP-HPIE3M, Hôpital Pitié-Salpêtrière, ICAN, Paris, France
| | - Philippe Labrune
- Department of Pediatrics, APHP, Centre de Référence des Maladies héréditaires du Métabolisme Hépatique, Hopital Antoine Béclère and Paris Sud University, Clamart, France
| | - Pascale de Lonlay
- Reference Center of Inherited Metabolic Diseases, Université de Paris, Necker Enfants Malades, University Hospital, Paris, France
- Centre for Rare Gynecological Disorders, Hospital Universitaire Necker-Enfants Malades, Paediatric Endocrinology, Gynaecology and Diabetology, AP-HP, Université de Paris, Paris, France
| | - Michel Polak
- Center for Rare Gynecological Disorders, Centre des Pathologies Gynécologiques Rares, Paris, France
- Department of Paediatric Endocrinology, Gynaecology, and Diabetology, AP-HP, Necker-Enfants Malades University Hospital, IMAGINE Institute affiliate, Paris, France
- Centre for Rare Gynecological Disorders, Hospital Universitaire Necker-Enfants Malades, Paediatric Endocrinology, Gynaecology and Diabetology, AP-HP, Université de Paris, Paris, France
- Correspondence should be addressed to M Polak:
| |
Collapse
|
14
|
Delnoy B, Coelho AI, Rubio-Gozalbo ME. Current and Future Treatments for Classic Galactosemia. J Pers Med 2021; 11:jpm11020075. [PMID: 33525536 PMCID: PMC7911353 DOI: 10.3390/jpm11020075] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/23/2021] [Accepted: 01/24/2021] [Indexed: 02/07/2023] Open
Abstract
Type I (classic) galactosemia, galactose 1-phosphate uridylyltransferase (GALT)-deficiency is a hereditary disorder of galactose metabolism. The current therapeutic standard of care, a galactose-restricted diet, is effective in treating neonatal complications but is inadequate in preventing burdensome complications. The development of several animal models of classic galactosemia that (partly) mimic the biochemical and clinical phenotypes and the resolution of the crystal structure of GALT have provided important insights; however, precise pathophysiology remains to be elucidated. Novel therapeutic approaches currently being explored focus on several of the pathogenic factors that have been described, aiming to (i) restore GALT activity, (ii) influence the cascade of events and (iii) address the clinical picture. This review attempts to provide an overview on the latest advancements in therapy approaches.
Collapse
Affiliation(s)
- Britt Delnoy
- Department of Pediatrics, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (B.D.); (A.I.C.)
- Department of Clinical Genetics, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands
- GROW-School for Oncology and Developmental Biology, Maastricht University, 6229 HX Maastricht, The Netherlands
| | - Ana I. Coelho
- Department of Pediatrics, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (B.D.); (A.I.C.)
| | - Maria Estela Rubio-Gozalbo
- Department of Pediatrics, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands; (B.D.); (A.I.C.)
- Department of Clinical Genetics, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands
- GROW-School for Oncology and Developmental Biology, Maastricht University, 6229 HX Maastricht, The Netherlands
- Correspondence: ; Tel.: +31-43-3872920
| |
Collapse
|
15
|
Abstract
Fertility represents a biological and psychological requirement for women. Some genetic diseases represent a rare cause of infertility, being responsible for 10% of cases of premature ovarian insufficiency. Among these, the most frequent and also those most studied by researchers are Turner Syndrome - due to a karyotype abnormality of the X chromosome pair - and the presence of fragile X premutation (FMR1). To exclude these conditions the diagnostic workup for non-iatrogenic premature ovarian insufficiency (POI) involves the performance of a karyotype analysis and the search for the FMR1 gene mutation, as well as the search for the presence of Y-chromosomal material. However, several other mutations and genetic syndromes associated with POI development have recently been highlighted, although they occur rarely, such as the GALT gene mutation in galactosemia or the FOXL2 gene mutation in BPES and many others, and further autosomal genetic testing are indicated if clinical suspicion is present. Mutations of BRCA 1 and 2 genes, make patients at genetically determined high risk of developing early ovarian or breast cancer and of getting POIs for the treatments they must undergo to prevent it (prophylactic bilateral oophorectomy) or treat it (chemotherapy). The management of impaired fertility is not less important than that of other syndromic manifestations for the quality of life of patients. Few data are available regarding the efficiency of cryopreservation of reproductive material (oocytes, embryos or ovarian tissue) in order to preserve fertility in this particular subgroup of patients, but certainly it represents a promising chance and a hope for the future.
Collapse
Affiliation(s)
- Elisa Mastellari
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio La Marca
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy -
- Clinica Eugin Modena, Modena, Italy
| |
Collapse
|
16
|
Ahtam B, Waisbren SE, Anastasoaie V, Berry GT, Brown M, Petrides S, Afacan O, Prabhu SP, Schomer D, Grant PE, Greenstein PE. Identification of neuronal structures and pathways corresponding to clinical functioning in galactosemia. J Inherit Metab Dis 2020; 43:1205-1218. [PMID: 32592186 DOI: 10.1002/jimd.12279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/05/2020] [Accepted: 06/24/2020] [Indexed: 12/27/2022]
Abstract
Classic galactosemia (OMIM# 230400) is an autosomal recessive disorder due to galactose-1-phosphate uridyltransferase deficiency. Newborn screening and prompt treatment with a galactose-free diet prevent the severe consequences of galactosemia, but clinical outcomes remain suboptimal. Five men and five women with classic galactosemia (mean age = 27.2 ± 5.47 years) received comprehensive neurological and neuropsychological evaluations, electroencephalogram (EEG) and magnetic resonance imaging (MRI). MRI data from nine healthy controls (mean age = 30.22 ± 3.52 years) were used for comparison measures. Galactosemia subjects experienced impaired memory, language processing, visual-motor skills, and increased anxiety. Neurological examinations revealed tremor and dysarthria in six subjects. In addition, there was ataxia in three subjects and six subjects had abnormal gait. Mean full scale IQ was 80.4 ± 17.3. EEG evaluations revealed right-sided abnormalities in five subjects and bilateral abnormalities in one subject. Compared to age- and gender-matched controls, subjects with galactosemia had reduced volume in left cerebellum white matter, bilateral putamen, and left superior temporal sulcus. Galactosemia patients also had lower fractional anisotropy and higher radial diffusivity values in the dorsal and ventral language networks compared to the controls. Furthermore, there were significant correlations between neuropsychological test results and the T1 volume and diffusivity scalars. Our findings help to identify anatomic correlates to motor control, learning and memory, and language in subjects with galactosemia. The results from this preliminary assessment may provide insights into the pathophysiology of this inborn error of metabolism.
Collapse
Affiliation(s)
- Banu Ahtam
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Susan E Waisbren
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Vera Anastasoaie
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Gerard T Berry
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
- The Manton Center for Orphan Disease Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Matthew Brown
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Stephanie Petrides
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Onur Afacan
- Computational Radiology Laboratory, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sanjay P Prabhu
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Donald Schomer
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - P Ellen Grant
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Fetal-Neonatal Neuroimaging & Developmental Science Center, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Division of Newborn Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Patricia E Greenstein
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
17
|
El Bakly W, Medhat M, Shafei M, Tash R, Elrefai M, Shoukry Y, Omar NN. Optimized platelet rich plasma releasate (O-rPRP) repairs galactosemia-induced ovarian follicular loss in rats by activating mTOR signaling and inhibiting apoptosis. Heliyon 2020; 6:e05006. [PMID: 33005806 PMCID: PMC7509792 DOI: 10.1016/j.heliyon.2020.e05006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/25/2020] [Accepted: 09/17/2020] [Indexed: 11/30/2022] Open
Abstract
Platelet rich plasma contains a collection of growth factors, and an optimal formulation, named O-rPRP, contains the highest possible concentration of growth factors. Purpose Challenging the healing power of O-rPRP in a high-galactose diet-induced premature ovarian insufficiency (POI) experimental rat model. Methods Rats were divided into four groups of ten rats each and treated for four week as follows; 1) the control group, fed with normal diet and received intraperitoneal (i.p.) injection of PBS once/week; 2) the POI group, fed with galactose diet (50%) and received PBS (i.p.) once/week; 3) the POI/O-rPRP group, fed a 50% galactose diet and received O-rPRP (i.p.) once/week; 4) the O-rPRP group (negative control), fed with a normal diet and received O-rPRP (i.p.) once/week. The levels of galactose, follicle stimulating hormone, 17 β-estradiol, anti-mullerian hormone and inhibin B were measured in serum samples. Western blotting and quantitative real-time PCR assays were employed to investigate the levels of miR-223, β1 integrin, p70S6k and MCL-1 in ovarian tissues. Results After O-rPRP treatment, β1 integrin expression was enhanced, and miR-223 expression was decreased. Unlike the untreated galactose group, in the group treated with O-rPRP, p70S6k and MCL-1 expression levels were increased, indicating that the mTOR growth signaling pathway was active and that apoptosis was inactive. After the introduction of O-rPRP, the number of follicles and the follicular maturation improved, which was consistent with the improvement of inhibin B levels and subsequent inhibition of FSH. Conclusion O-rPRP inhibited galactose-induced excessive atresia and provided an overall protective effect on the ovarian follicles.
Collapse
Affiliation(s)
- Wesam El Bakly
- Department of Pharmacology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Marwa Medhat
- Department of Pharmacology, National Center for Social & Criminological Research, Egypt
| | - Mohamed Shafei
- Obstetrician and Gynecologist at Sidnawy Health Insurance Hospital, Cairo, Egypt.,Dar Alshifa Hospital, Kuwait
| | - Reham Tash
- Department of Anatomy and Embryology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Department of Anatomy and Embryology, Faculty of Medicine in Rabigh, King Abdulaziz University, Saudi Arabia
| | - Mohamed Elrefai
- Department of Anatomy and Embryology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Basic Medical Science Department, Faculty of Medicine, Hashemite University, Alzarqa, Jordan
| | - Yousef Shoukry
- Department of Anatomy and Embryology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nesreen Nabil Omar
- Department of Biochemistry, Faculty of Pharmacy, Modern University for Technology and Information, 11 Saudia Buildings, Nozha Street, 11371, Cairo, Egypt
| |
Collapse
|
18
|
Insights into the Pathophysiology of Infertility in Females with Classical Galactosaemia. Int J Mol Sci 2019; 20:ijms20205236. [PMID: 31652573 PMCID: PMC6834160 DOI: 10.3390/ijms20205236] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 11/26/2022] Open
Abstract
Classical galactosaemia (CG) (OMIM 230400) is a rare inborn error of galactose metabolism caused by the deficiency of the enzyme galactose-1-phosphate uridylyltransferase (GALT, EC 2.7.7.12). Primary ovarian insufficiency (POI) is the most common long-term complication experienced by females with CG, presenting with hypergonadotrophic hypoestrogenic infertility affecting at least 80% of females despite new-born screening and lifelong galactose dietary restriction. In this review, we describe the hypothesized pathophysiology of POI from CG, implications of timing of the ovarian dysfunction, and the new horizons and future prospects for treatments and fertility preservation.
Collapse
|
19
|
Sozen B, Ozekinci M, Erman M, Gunduz T, Demir N, Akouri R. Dehydroepiandrosterone supplementation attenuates ovarian ageing in a galactose-induced primary ovarian insufficiency rat model. J Assist Reprod Genet 2019; 36:2181-2189. [PMID: 31422495 DOI: 10.1007/s10815-019-01560-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 08/07/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Almost every female classic galactosemia patient develops primary ovarian insufficiency (POI). The unique pathophysiology of classic galactosemia, with a severely reduced follicle pool at an early age, requires a new therapeutic approach. This study evaluated the effect of dehydroepiandrosterone (DHEA) on ovarian tissue in a galactose-induced POI rat model. METHODS Pregnant rats were fed with either a normal or a 35% galactose-containing diet from day 3 of conception continuing through weaning of the litters. Galactose-exposed female offspring were further divided into 5 groups on PND21. The first group received no application. Treatment groups were fed orally by gavage once daily with sesame oil (group 2), or DHEA at doses of 0.1 mg/kg (group 3), 1 mg/kg (group 4) or 10 mg/kg (group 5) until PND70. Fertility rates of mothers with galactosemia, body weights (BWs), and ovarian weights of the litters from PND21 to PND70 were recorded. Ovarian follicle count, immunohistochemistry for proliferation and apoptosis marker expressions and TUNEL for cell death assessment were performed in offspring ovaries. RESULTS Decreased fertility, ovarian/body weights were observed under galactosemic conditions, together with decreased follicle number and increased atresia. Improved postnatal development, primordial follicle recruitment and follicular growth were observed after DHEA treatment. After DHEA treatment, the expression of Ki67 protein was found to be increased; elevated expression of cleaved-caspase-3 under galactosemia was found to be reduced. CONCLUSIONS Our data suggests that DHEA treatment may be a potentially useful clinical therapy to improve ovarian ageing in women with POI-induced by galactosemia.
Collapse
Affiliation(s)
- Berna Sozen
- Department of Histology and Embryology, School of Medicine, Akdeniz University, Campus, 07070, Antalya, Turkey.,Department of Physiology, Development and Neuroscience, University of Cambridge, Downing Street, Cambridge, CB2 3EG, UK
| | - Murat Ozekinci
- Department of Obstetrics and Gynecology, Akdeniz University School of Medicine, 07058, Antalya, Turkey. .,IVF Andrologia and Genetics Center, Antalya Memorial Hospital, Yildirim Beyazit St. Kepez, 07025, Antalya, Turkey.
| | - Munire Erman
- Department of Obstetrics and Gynecology, Akdeniz University School of Medicine, 07058, Antalya, Turkey
| | - Tonguc Gunduz
- Department of Obstetrics and Gynecology, Memorial Private Hospital, Antalya, Turkey
| | - Necdet Demir
- Department of Histology and Embryology, School of Medicine, Akdeniz University, Campus, 07070, Antalya, Turkey
| | - Randa Akouri
- Department of Obstetrics and Gynecology, Goteburg University, Gothenburg, Sweden
| |
Collapse
|
20
|
Sharma M, Yadav P, Sharma M. Novel electrochemical sensing of galactose using GalOxNPs/CHIT modified pencil graphite electrode. Carbohydr Res 2019; 483:107749. [PMID: 31374378 DOI: 10.1016/j.carres.2019.107749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/13/2019] [Accepted: 07/16/2019] [Indexed: 11/16/2022]
Abstract
For the construction of galactose biosensor, chitosan was electropolymerised onto the pencil graphite electrode. This chitosan modified pencil graphite electrode acts as good matrix for immobilization of enzyme nanoparticles of galactose oxidase. Development of this nanocomposite was further confirmed by Fourier transform infrared spectroscopy and scanning electron microscopy. The presence of chitosan makes the present galactose biosensor more efficient, reproducible and stable. The sensitivity was reported 7 × 10-3 mA/mM/cm2 with linear range from 0.05 to 25 mM and better detection limit of 0.05 mM. When the solution of galactose was spiked with 0.5 mM and 1 mM, the analytical recoveries were found 98.6% and 97.6%. A better storage stability was achieved (90days) when compared to earlier reported biosensors.
Collapse
Affiliation(s)
- Mamta Sharma
- Department of Zoology, Maharshi Dayanand University, Rohtak, 124001, Haryana, India
| | - Pooja Yadav
- Department of Zoology, Maharshi Dayanand University, Rohtak, 124001, Haryana, India
| | - Minakshi Sharma
- Department of Zoology, Maharshi Dayanand University, Rohtak, 124001, Haryana, India.
| |
Collapse
|
21
|
Rubio-Gozalbo ME, Haskovic M, Bosch AM, Burnyte B, Coelho AI, Cassiman D, Couce ML, Dawson C, Demirbas D, Derks T, Eyskens F, Forga MT, Grunewald S, Häberle J, Hochuli M, Hubert A, Huidekoper HH, Janeiro P, Kotzka J, Knerr I, Labrune P, Landau YE, Langendonk JG, Möslinger D, Müller-Wieland D, Murphy E, Õunap K, Ramadza D, Rivera IA, Scholl-Buergi S, Stepien KM, Thijs A, Tran C, Vara R, Visser G, Vos R, de Vries M, Waisbren SE, Welsink-Karssies MM, Wortmann SB, Gautschi M, Treacy EP, Berry GT. The natural history of classic galactosemia: lessons from the GalNet registry. Orphanet J Rare Dis 2019; 14:86. [PMID: 31029175 PMCID: PMC6486996 DOI: 10.1186/s13023-019-1047-z] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/12/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Classic galactosemia is a rare inborn error of carbohydrate metabolism, caused by a severe deficiency of the enzyme galactose-1-phosphate uridylyltransferase (GALT). A galactose-restricted diet has proven to be very effective to treat the neonatal life-threatening manifestations and has been the cornerstone of treatment for this severe disease. However, burdensome complications occur despite a lifelong diet. For rare diseases, a patient disease specific registry is fundamental to monitor the lifespan pathology and to evaluate the safety and efficacy of potential therapies. In 2014, the international Galactosemias Network (GalNet) developed a web-based patient registry for this disease, the GalNet Registry. The aim was to delineate the natural history of classic galactosemia based on a large dataset of patients. METHODS Observational data derived from 15 countries and 32 centers including 509 patients were acquired between December 2014 and July 2018. RESULTS Most affected patients experienced neonatal manifestations (79.8%) and despite following a diet developed brain impairments (85.0%), primary ovarian insufficiency (79.7%) and a diminished bone mineral density (26.5%). Newborn screening, age at onset of dietary treatment, strictness of the galactose-restricted diet, p.Gln188Arg mutation and GALT enzyme activity influenced the clinical picture. Detection by newborn screening and commencement of diet in the first week of life were associated with a more favorable outcome. A homozygous p.Gln188Arg mutation, GALT enzyme activity of ≤ 1% and strict galactose restriction were associated with a less favorable outcome. CONCLUSION This study describes the natural history of classic galactosemia based on the hitherto largest data set.
Collapse
Affiliation(s)
- M E Rubio-Gozalbo
- Department of Pediatrics and Clinical Genetics, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - M Haskovic
- Department of Pediatrics and Clinical Genetics, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - A M Bosch
- Amsterdam UMC, University of Amsterdam, Pediatric Metabolic Diseases, Emma Children's Hospital, Amsterdam, Netherlands
| | - B Burnyte
- Institute of Biomedical Sciences of the Faculty of Medicine of Vilnius University, Vilnius, Lithuania
| | - A I Coelho
- Department of Pediatrics and Clinical Genetics, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, P. Debyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - D Cassiman
- Metabolic Center, Department of Gastroenterology-Hepatology, Leuven University Hospitals and KU Leuven, Leuven, Belgium
| | - M L Couce
- Unit of Diagnosis and Treatment of Congenital Metabolic Diseases, S. Neonatology, Department of Pediatrics, Hospital Clínico Universitario de Santiago de Compostela, CIBERER, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - C Dawson
- Department of Endocrinology, Queen Elizabeth Hospital Birmingham, London, UK
| | - D Demirbas
- Manton Center for Orphan Disease Research, Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - T Derks
- Section of Metabolic Diseases, Beatrix Children's Hospital, and Groningen University Institute for Drug Exploration (GUIDE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - F Eyskens
- Antwerp University Hospital, Antwerp, Belgium
| | - M T Forga
- Hospital Clinic Barcelona, Barcelona, Spain
| | - S Grunewald
- Metabolic Medicine Department, Great Ormond Street Hospital, Institute for Child Health UCL, London, UK
| | - J Häberle
- Division of Metabolism and Children's Research Center, University Children's Hospital, Zurich, Switzerland
| | - M Hochuli
- Department of Endocrinology, Diabetes, and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland
| | - A Hubert
- APHP, HUPS, Hôpital Antoine Béclère, Centre de Référence Maladies Héréditaires Hépatiques, Clamart, France.,Université Paris Sud-Paris Saclay, and INSERM U 1195, Paris, France
| | - H H Huidekoper
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - P Janeiro
- Department of Pediatrics, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - J Kotzka
- Institute for Clinical Biochemistry and Pathobiochemistry, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - I Knerr
- National Centre for Inherited Metabolic Disorders, Temple Street Children's University Hospital, Temple Street, Dublin, Ireland
| | - P Labrune
- APHP, HUPS, Hôpital Antoine Béclère, Centre de Référence Maladies Héréditaires Hépatiques, Clamart, France.,Université Paris Sud-Paris Saclay, and INSERM U 1195, Paris, France
| | - Y E Landau
- Metabolic Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J G Langendonk
- Department of Internal Medicine, Center for Lysosomal and Metabolic Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D Möslinger
- Department for Pediatrics and Adolescent Medicine, Inborn Errors of Metabolism, Medical University of Vienna, Vienna, Austria
| | - D Müller-Wieland
- Clinical Research Center, Department of Medicine I, University Hospital RWTH Aachen, Aachen, Germany
| | - E Murphy
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - K Õunap
- Department of Clinical Genetics, United Laboratories and Institute of Clinical Medicine, Tartu University Hospital, Tartu, Estonia
| | - D Ramadza
- Department of Pediatrics, University Hospital Centre, Zagreb, Croatia
| | - I A Rivera
- Research Institute for Medicines (iMed.ULisboa), and Department of Biochemistry and Human Biology, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - S Scholl-Buergi
- Universitätsklink für Pädiatrie, Tirol Kliniken GmbH, Innsbruck, Austria
| | - K M Stepien
- Mark Holland Metabolic Unit, Adult Inherited Metabolic Disorders Department, Salford Royal NHS Foundation Trust, Salford, M6 8HD, UK
| | - A Thijs
- Vrije Universiteit Amsterdam, Internal Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - C Tran
- Center for Molecular Diseases, Division of Genetic Medicine, University Hospital Lausanne, Lausanne, Switzerland
| | - R Vara
- Department of Paediatric Inherited Metabolic Disease, Evelina London Children's Hospital, London, UK
| | - G Visser
- Department of Pediatrics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - R Vos
- Department of Methodology and Statistics, CAPHRI School for Primary Care and Public Health, Faculty Health Medicine and Life Sciences, Maastricht, The Netherlands
| | - M de Vries
- Department of Pediatrics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S E Waisbren
- Department of Pediatrics, Division of Genomics and Genetics, Harvard Medical School and Boston Children's Hospital, Boston, USA
| | - M M Welsink-Karssies
- Amsterdam UMC, University of Amsterdam, Pediatric Metabolic Diseases, Emma Children's Hospital, Amsterdam, Netherlands
| | - S B Wortmann
- University Children's Hospital, Parcelsus Medical University (PMU), Salzburg, Austria
| | - M Gautschi
- Department of Pediatrics and Institute of Clinical Chemistry, Inselspital, University Hospital Bern, Bern, Switzerland
| | - E P Treacy
- Metabolic Disease Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,National Centre for Inherited Metabolic Disorders, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - G T Berry
- Manton Center for Orphan Disease Research, Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
22
|
Colhoun HO, Rubio Gozalbo EM, Bosch AM, Knerr I, Dawson C, Brady J, Galligan M, Stepien K, O’Flaherty R, Catherine Moss C, Peter Barker P, Fitzgibbon M, Doran PP, Treacy EP. Fertility in classical galactosaemia, a study of N-glycan, hormonal and inflammatory gene interactions. Orphanet J Rare Dis 2018; 13:164. [PMID: 30231941 PMCID: PMC6146524 DOI: 10.1186/s13023-018-0906-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/03/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Classical Galactosaemia (CG) (OMIM #230400) is a rare inborn error of galactose metabolism caused by deficiency of the enzyme galactose-1-phosphate uridylyltransferase (GALT). Long-term complications persist in treated patients despite dietary galactose restriction with significant variations in outcomes suggesting epigenetic glycosylation influences. Primary Ovarian Insufficiency (POI) is a very significant complication affecting females with follicular depletion noted in early life. We studied specific glycan synthesis, leptin system and inflammatory gene expression in white blood cells as potential biomarkers of infertility in 54 adults with CG adults (27 females and 27 males) (age range 17-51 yr) on a galactose-restricted diet in a multi-site Irish and Dutch study. Gene expression profiles were tested for correlation with a serum Ultra-high Performance Liquid Chromatography (UPLC)-Immunoglobulin (IgG)-N-glycan galactose incorporation assay and endocrine measurements. RESULTS Twenty five CG females (93%) had clinical and biochemical evidence of POI. As expected, the CG female patients, influenced by hormone replacement therapy, and the healthy controls of both genders showed a positive correlation between log leptin and BMI but this correlation was not apparent in CG males. The strongest correlations between serum leptin levels, hormones, G-ratio (galactose incorporation assay) and gene expression data were observed between leptin, its gene and G-Ratios data (rs = - 0.68) and (rs = - 0.94) respectively with lower circulating leptin in CG patients with reduced IgG galactosylation. In CG patients (males and females analysed as one group), the key glycan synthesis modifier genes MGAT3 and FUT8, which influence glycan chain bisecting and fucosylation and subsequent cell signalling and adhesion, were found to be significantly upregulated (p < 0.01 and p < 0.05) and also the glycan synthesis gene ALG9 (p < 0.01). Both leptin signalling genes LEP and LEPR were found to be upregulated (p < 0.01) as was the inflammatory genes ANXA1 and ICAM1 and the apoptosis gene SEPT4 (p < 0.01). CONCLUSIONS These results validate our previous findings and provide novel experimental evidence for dysregulation of genes LEP, LEPR, ANXA1, ICAM1 and SEPT4 for CG patients and combined with our findings of abnormalities of IgG glycosylation, hormonal and leptin analyses elaborate on the systemic glycosylation and cell signalling abnormalities evident in CG which likely influence the pathophysiology of POI.
Collapse
Affiliation(s)
| | - Estela M. Rubio Gozalbo
- Department of Pediatrics and Department of Clinical Genetics, Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - Annet M. Bosch
- Department of Pediatrics, Division of Metabolic Disorders, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Ina Knerr
- National Centre for Inherited Metabolic Disorders, Temple Street Children’s University Hospital and Mater Misericordiae University Hospital, Dublin, Ireland
| | - Charlotte Dawson
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, B15 2TH, Birmingham, UK
| | - Jennifer Brady
- Department of Clinical Biochemistry and Diagnostic Endocrinology, The Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Karolina Stepien
- Mark Holland Metabolic Unit, Salford Royal NHS Foundation Trust, M6 8HD, Manchester, UK
| | - Roisin O’Flaherty
- NIBRT GlycoScience Group, National Institute for Bioprocessing, Research and Training, Mount Merrion, Blackrock, Co, Dublin, Ireland
| | - C. Catherine Moss
- Core Genomics Facility, Conway Institute, University College, Dublin, Ireland
| | - P. Peter Barker
- Core Biochemical Assay Laboratory (CBAL), Clinical Biochemistry, Box 232, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ UK
| | - Maria Fitzgibbon
- Department of Clinical Biochemistry and Diagnostic Endocrinology, The Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Eileen P. Treacy
- Department of Paediatrics, Trinity College, Dublin, Ireland
- National Centre for Inherited Metabolic Disorders, Temple Street Children’s University Hospital and Mater Misericordiae University Hospital, Dublin, Ireland
- National Centre for Inherited Metabolic Diseases, The Mater Misericordiae University Hospital, Eccles St, Dublin, 7 Ireland
| |
Collapse
|
23
|
Haskovic M, Poot WJ, van Golde RJT, Benneheij SH, Oussoren E, de Wert GMWR, Krumeich A, Rubio-Gozalbo ME. Intrafamilial oocyte donation in classic galactosemia: ethical and societal aspects. J Inherit Metab Dis 2018; 41:791-797. [PMID: 29671189 PMCID: PMC6133175 DOI: 10.1007/s10545-018-0179-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/03/2018] [Accepted: 03/26/2018] [Indexed: 11/24/2022]
Abstract
Classic galactosemia is a rare inherited disorder of galactose metabolism. Primary ovarian insufficiency (POI) with subfertility affects > 80% of female patients and is an important concern for patients and their parents. Healthcare providers are often consulted for subfertility treatment possibilities. An option brought up by the families is intrafamilial oocyte donation (mother-to-daughter or sister-to-sister). In addition to POI, galactosemia patients can also present varying cognitive and neurological impairments, which may not be fully clear at the time when mother-to-daughter oocyte donation is considered. Ethical and societal aspects arise when exploring this option. This study aimed to provide guidance in aspects to consider based on the views of different groups involved in the oocyte donation process. A qualitative study using in-depth semi-structured interviews with > 50 participants (patients, family members, and healthcare providers) was conducted. From these interviews, themes of concern emerged, which are illustrated and reviewed: (1) family relations, (2) medical impact, (3) patients' cognitive level, (4) agreements to be made in advance and organization of counseling, (5) disclosure to the child, and (6) need for follow-up. We conclude that discussing and carrying out intrafamilial oocyte donation in galactosemia patients requires carefully addressing these themes. This study adds value to the already existing recommendations on intrafamilial oocyte donation in general, since it highlights important additional aspects from the perspectives of patients and their families.
Collapse
Affiliation(s)
- M Haskovic
- Department of Pediatrics and Department of Clinical Genetics, Maastricht University Medical Center+, P. Debeylaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - W J Poot
- Department of Pediatrics and Department of Clinical Genetics, Maastricht University Medical Center+, P. Debeylaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - R J T van Golde
- Department of Obstetrics & Gynecology, Maastricht University Medical Center+, Maastricht, The Netherlands
- GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - S H Benneheij
- Department of Obstetrics & Gynecology, Division of Reproductive Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - E Oussoren
- Department of Pediatrics, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - G M W R de Wert
- GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
- Department of Health, Ethics & Society, Maastricht University, Maastricht, The Netherlands
| | - A Krumeich
- Department of Health, Ethics & Society, Maastricht University, Maastricht, The Netherlands
| | - M Estela Rubio-Gozalbo
- Department of Pediatrics and Department of Clinical Genetics, Maastricht University Medical Center+, P. Debeylaan 25, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
| |
Collapse
|
24
|
Demirbas D, Coelho AI, Rubio-Gozalbo ME, Berry GT. Hereditary galactosemia. Metabolism 2018; 83:188-196. [PMID: 29409891 DOI: 10.1016/j.metabol.2018.01.025] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/19/2018] [Accepted: 01/24/2018] [Indexed: 10/18/2022]
Abstract
Hereditary galactosemia is an inborn error of carbohydrate metabolism. Galactose is metabolized by Leloir pathway enzymes; galactokinase (GALK), galactose-1-phosphate uridylyltransferase (GALT) and UDP-galactose 4-epimerase (GALE). The defects in these enzymes cause galactosemia in an autosomal recessive manner. The severe GALT deficiency, or classic galactosemia, is life-threatening in the newborn period. The treatment for classic galactosemia is dietary restriction of lactose. Although implementation of lactose restricted diet is efficient in resolving the acute complications, it is not sufficient to prevent long-term complications affecting the brain and female gonads, the two main target organs of damage. Implementation of molecular genetics diagnostic tools and GALT enzyme assays are instrumental in distinguishing classic galactosemia from clinical and biochemical variant forms of GALT deficiency. Better understanding of mechanisms responsible for the phenotypic variation even within the same genotype is essential to provide appropriate counseling for families. Utilization of a lactose restricted diet is also recommended for GALK deficiency and some rare forms of GALE deficiency. Novel modes of therapies are being explored; they may be beneficial if access issues to the affected tissues are circumvented and optimum use of therapeutic window is achieved.
Collapse
Affiliation(s)
- Didem Demirbas
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ana I Coelho
- Department of Pediatrics, Department of Clinical Genetics, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M Estela Rubio-Gozalbo
- Department of Pediatrics, Department of Clinical Genetics, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Gerard T Berry
- Division of Genetics and Genomics, The Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
25
|
Cryopreservation of ovarian tissue may be considered in young girls with galactosemia. J Assist Reprod Genet 2018; 35:1209-1217. [PMID: 29804175 DOI: 10.1007/s10815-018-1209-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 05/09/2018] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The aim was to describe the first experience with fertility preservation by cryopreservation of ovarian tissue (OTC) in pre-pubertal girls with galactosemia and further to characterize ovarian follicular morphology and expression of proteins important for ovarian function. METHODS Retrospectively, follicle density was estimated in ovarian cortical tissues from 6 pre-pubertal girls below the age of 12 years diagnosed with galactosemia and from 31 girls below the age of 18 years who had one ovary removed for fertility preservation for other reasons prior to gonadotoxic treatment. Additionally, expression of 4 glycoproteins important for follicle development were analyzed with immunohistochemistry in two galactosemic ovaries (aged 0.9 and 1.7 years) and compared to normal age-matched controls. The proteins included were: anti-Müllerian hormone (AMH) pro-mature and C-terminal, growth differentiation factor-9 (GDF-9), bone morphogenetic protein 15 (BMP-15), and pregnancy-associated plasma protein A (PAPP-A). RESULTS Girls with galactosemia below the age of 5 years presented with morphological normal follicles and follicle densities within the 95% confidence interval (CI) of controls. No follicles were detected in the ovary from an 11.7-year-old girl with galactosemia. Expression of AMH, GDF-9, BMP-15, and PAPP-A appeared similar in follicles from girls with galactosemia and controls. CONCLUSIONS These findings suggest that young girls with galactosemia maintain follicles in early childhood and fertility cryopreservation may be considered an option in this patient group. The pathophysiology of galactosemia leading to an accelerated follicle loss is unknown and it is currently unknown to what extent transplanted ovarian tissue can sustain fertility in adult life.
Collapse
|
26
|
Yan Z, Dai Y, Fu H, Zheng Y, Bao D, Yin Y, Chen Q, Nie X, Hao Q, Hou D, Cui Y. Curcumin exerts a protective effect against premature ovarian failure in mice. J Mol Endocrinol 2018; 60:261-271. [PMID: 29437881 PMCID: PMC5863768 DOI: 10.1530/jme-17-0214] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 02/07/2018] [Indexed: 12/16/2022]
Abstract
This study was designed to investigate the protective effect of curcumin against d-galactose (d-gal)-induced premature ovarian failure (POF) in mice. A mouse POF model was induced by subcutaneous injection of d-gal (200 mg/kg/day) daily for 42 days. Mice in the curcumin group received both d-gal treatment and intraperitoneal injection of curcumin (100 mg/kg/day) for 42 days. Ovarian function, oxidative stress and apoptosis were evaluated. The P, E2 and SOD levels were higher, and the FSH, LH and MDA levels were significantly lower in the curcumin group than those in the d-gal group. The proportion of primordial follicles was also significantly higher in the curcumin group than that in the d-gal group. In addition, curcumin treatment after d-gal administration resulted in significantly lower Sod2, Cat, 8-OhdG, 4-HNE, NTY and senescence-associated protein P16 expression levels, higher Amh expression levels and less apoptosis in granulosa cells than was observed in the d-gal group. Moreover, the p-Akt, Nrf2 and HO-1 protein expression levels were significantly higher and the apoptosis-related cleaved caspase-3 and -9 protein expression levels were markedly lower in the curcumin group than in the d-gal group. In conclusion, curcumin effectively inhibited d-gal-induced oxidative stress, apoptosis and ovarian injury via a mechanism involving the Nrf2/HO-1 and PI3K/Akt signaling pathways, suggesting that curcumin is a potential protective agent against POF.
Collapse
Affiliation(s)
- Zhengjie Yan
- College of Animal Science and TechnologyYangzhou University, Yangzhou, People's Republic of China
- State Key Laboratory of Reproductive MedicineCenter of Clinical Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| | - Youjin Dai
- Key Laboratory of the Model Animal ResearchAnimal Core Facility of Nanjing Medical University, Nanjing Medical University, Nanjing, People's Republic of China
| | - Heling Fu
- Key Laboratory of the Model Animal ResearchAnimal Core Facility of Nanjing Medical University, Nanjing Medical University, Nanjing, People's Republic of China
| | - Yuan Zheng
- Key Laboratory of the Model Animal ResearchAnimal Core Facility of Nanjing Medical University, Nanjing Medical University, Nanjing, People's Republic of China
| | - Dan Bao
- Key Laboratory of the Model Animal ResearchAnimal Core Facility of Nanjing Medical University, Nanjing Medical University, Nanjing, People's Republic of China
| | - Yuan Yin
- Key Laboratory of the Model Animal ResearchAnimal Core Facility of Nanjing Medical University, Nanjing Medical University, Nanjing, People's Republic of China
| | - Qin Chen
- Key Laboratory of the Model Animal ResearchAnimal Core Facility of Nanjing Medical University, Nanjing Medical University, Nanjing, People's Republic of China
| | - Xiaowei Nie
- Department of Reproductive MedicineAffiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Qingting Hao
- Key Laboratory of the Model Animal ResearchAnimal Core Facility of Nanjing Medical University, Nanjing Medical University, Nanjing, People's Republic of China
| | - Daorong Hou
- Key Laboratory of the Model Animal ResearchAnimal Core Facility of Nanjing Medical University, Nanjing Medical University, Nanjing, People's Republic of China
| | - Yugui Cui
- State Key Laboratory of Reproductive MedicineCenter of Clinical Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China
| |
Collapse
|
27
|
Thakur M, Feldman G, Puscheck EE. Primary ovarian insufficiency in classic galactosemia: current understanding and future research opportunities. J Assist Reprod Genet 2017; 35:3-16. [PMID: 28932969 DOI: 10.1007/s10815-017-1039-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 09/03/2017] [Indexed: 02/06/2023] Open
Abstract
Classic galactosemia is an inborn error of the metabolism with devastating consequences. Newborn screening has been successful in markedly reducing the acute neonatal symptoms from this disorder. The dramatic response to dietary treatment is one of the major success stories of newborn screening. However, as children with galactosemia achieve adulthood, they face long-term complications. A majority of women with classic galactosemia develop primary ovarian insufficiency and resulting morbidity. The underlying pathophysiology of this complication is not clear. This review focuses on the reproductive issues seen in girls and women with classic galactosemia. Literature on the effects of classic galactosemia on the female reproductive system was reviewed by an extensive Pubmed search (publications from January 1975 to January 2017) using the keywords: galactosemia, ovarian function/dysfunction, primary ovarian insufficiency/failure, FSH, oxidative stress, fertility preservation. In addition, articles cited in the search articles and literature known to the authors was also included in the review. Our understanding of the role of galactose metabolism in the ovary is limited and the pathogenic mechanisms involved in causing primary ovarian insufficiency are unclear. The relative rarity of galactosemia makes it difficult to accumulate data to determine factors defining timing of ovarian dysfunction or treatment/fertility preservation options for this group of women. In this review, we present reproductive challenges faced by women with classic galactosemia, highlight the gaps in our understanding of mechanisms leading to primary ovarian insufficiency in this population, discuss new advances in fertility preservation options, and recommend collaboration between reproductive medicine and metabolic specialists to improve fertility in these women.
Collapse
Affiliation(s)
- Mili Thakur
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, The C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI, 48201, USA. .,Division of Genetic, Genomic and Metabolic Disorders, Department of Pediatrics and Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, 48201, USA. .,The Fertility Center, 3230 Eagle Park Dr. NE, Suite 100, Grand Rapids, MI, 49525, USA.
| | - Gerald Feldman
- Division of Genetic, Genomic and Metabolic Disorders, Department of Pediatrics and Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, 48201, USA.,Department of Pathology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Elizabeth E Puscheck
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, The C.S. Mott Center for Human Growth and Development, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| |
Collapse
|
28
|
Coelho AI, Bierau J, Lindhout M, Achten J, Kramer BW, Rubio-Gozalbo ME. Classic Galactosemia: Study on the Late Prenatal Development of GALT Specific Activity in a Sheep Model. Anat Rec (Hoboken) 2017; 300:1570-1575. [PMID: 28545161 DOI: 10.1002/ar.23616] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/14/2016] [Accepted: 12/27/2016] [Indexed: 11/06/2022]
Abstract
Classic galactosemia results from deficient activity of galactose-1-phosphate uridylyltransferase (GALT), a key enzyme of galactose metabolism. Despite early diagnosis and early postnatal therapeutic intervention, patients still develop neurologic and fertility impairments. Prenatal developmental toxicity has been hypothesized as a determinant factor of disease. In order to shed light on the importance of prenatal GALT activity, several studies have examined GALT activity throughout development. GALT was shown to increase with gestational age in 7-28 weeks human fetuses; later stages were not investigated. Prenatal studies in animals focused exclusively on brain and hepatic GALT activity. In this study, we aim to examine GALT specific activity in late prenatal and adult stages, using a sheep model. Galactosemia acute target-organs-liver, small intestine and kidney-had the highest late prenatal activity, whereas the chronic target-organs-brain and ovary-did not exhibit a noticeable pre- or postnatal different activity compared with nontarget organs. This is the first study on GALT specific activity in the late prenatal stage for a wide variety of organs. Our findings suggest that GALT activity cannot be the sole pathogenic factor accounting for galactosemia long-term complications, and that some organs/cells might have a greater susceptibility to galactose toxicity. Anat Rec, 300:1570-1575, 2017. © 2017 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Ana I Coelho
- Department of Pediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jörgen Bierau
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Martijn Lindhout
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jelle Achten
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Boris W Kramer
- Department of Pediatrics/Neonatology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M Estela Rubio-Gozalbo
- Department of Pediatrics, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| |
Collapse
|
29
|
van Erven B, Berry GT, Cassiman D, Connolly G, Forga M, Gautschi M, Gubbels CS, Hollak CEM, Janssen MC, Knerr I, Labrune P, Langendonk JG, Õunap K, Thijs A, Vos R, Wortmann SB, Rubio-Gozalbo ME. Fertility in adult women with classic galactosemia and primary ovarian insufficiency. Fertil Steril 2017; 108:168-174. [PMID: 28579413 DOI: 10.1016/j.fertnstert.2017.05.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 04/28/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To study pregnancy chance in adult women with classic galactosemia and primary ovarian insufficiency. Despite dietary treatment, >90% of women with classic galactosemia develop primary ovarian insufficiency, resulting in impaired fertility. For many years, chance of spontaneous conception has not been considered, leading to counseling for infertility. But an increasing number of reports on pregnancies in this group questions whether current counseling approaches are correct. DESIGN Multicenter retrospective observational study. SETTING Metabolic centers. PATIENT(S) Adult women (aged >18 y) with confirmed classic galactosemia and primary ovarian insufficiency were included. INTERVENTION(S) Participants and medical records were consulted to obtain study data in a standardized manner with the use of a questionnaire. MAIN OUTCOME MEASURE(S) Conception opportunities, time to pregnancy, pregnancy outcome, hormone replacement therapy use, fertility counseling, and the participants' vision of fertility were evaluated. Potential predictive factors for increased pregnancy chance were explored. RESULT(S) Eighty-five women with classic galactosemia and primary ovarian insufficiency participated. Twenty-one women actively attempted to conceive or did not take adequate contraceptive precautions. Of these 21 women, nine became pregnant spontaneously (42.9%). This was higher than reported in primary ovarian insufficiency due to other causes (5%-10%). After a period of 12 months, a cumulative proportion of 27.8% of couples had conceived, which increased to 48.4% after 24 months and 61.3% after 27 months. Predictive factors could not be identified. A considerable miscarriage rate of 30% was observed (6 of 20 pregnancies). Although a substantial proportion of women expressed a child-wish (n = 28/53; 52.8%), the vast majority of participants (n = 43/57; 75.4%) considered conceiving to be highly unlikely, owing to negative counseling in the past. CONCLUSION(S) The pregnancy rate in women with classic galactosemia and primary ovarian insufficiency was higher than for women with primary ovarian insufficiency of any cause. This shifting paradigm carries significant implications for fertility counseling and potential application of fertility preservation techniques.
Collapse
Affiliation(s)
- Britt van Erven
- Department of Pediatrics and Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Gerard T Berry
- Division of Genetics and Genomics, Manton Center for Orphan Disease Research, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Cassiman
- Department of Gastroenterology-Hepatology, Metabolic Center, University Hospitals Leuven, Leuven, Belgium
| | - Geraldine Connolly
- Rotunda Hospital and Temple Street Children's University Hospital, Dublin, Ireland
| | - Maria Forga
- Endocrinology and Nutrition Department, Hospital Clinic, Barcelona, Spain
| | - Matthias Gautschi
- University Children's Hospital, Pediatric Endocrinology, Diabetes, and Metabolism, and Institute of Clinical Chemistry, Inselspital, University of Bern, Bern, Switzerland
| | - Cynthia S Gubbels
- Division of Genetics and Genomics, Boston Children's Hospital/Harvard Medical School/Broad Institute of Massachusetts Institute of Technology and Harvard, Boston, Massachusetts
| | - Carla E M Hollak
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Mirian C Janssen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ina Knerr
- National Centre for Inherited Metabolic Disorders, Temple Street Children's University Hospital, Dublin, Ireland
| | - Philippe Labrune
- Hôpital Antoine Béclère, Centre de Référence Maladies Héréditaires du Métabolisme Hépatique, Hôpitaux Universitaires Paris Sud, Clamart, France
| | - Janneke G Langendonk
- Center for Lysosomal and Metabolic Diseases, Department of Internal Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Katrin Õunap
- Department of Clinical Genetics, United Laboratories, Tartu University Hospital, and Department of Pediatrics, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Abel Thijs
- Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Rein Vos
- Department of Methodology and Statistics, School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Saskia B Wortmann
- Children's Hospital, Salzburger Landeskliniken and Paracelsus Medical University, Salzburg, Austria
| | - M Estela Rubio-Gozalbo
- Department of Pediatrics and Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands.
| |
Collapse
|
30
|
Coelho AI, Rubio-Gozalbo ME, Vicente JB, Rivera I. Sweet and sour: an update on classic galactosemia. J Inherit Metab Dis 2017; 40:325-342. [PMID: 28281081 PMCID: PMC5391384 DOI: 10.1007/s10545-017-0029-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/14/2017] [Accepted: 02/20/2017] [Indexed: 02/03/2023]
Abstract
Classic galactosemia is a rare inherited disorder of galactose metabolism caused by deficient activity of galactose-1-phosphate uridylyltransferase (GALT), the second enzyme of the Leloir pathway. It presents in the newborn period as a life-threatening disease, whose clinical picture can be resolved by a galactose-restricted diet. The dietary treatment proves, however, insufficient in preventing severe long-term complications, such as cognitive, social and reproductive impairments. Classic galactosemia represents a heavy burden on patients' and their families' lives. After its first description in 1908 and despite intense research in the past century, the exact pathogenic mechanisms underlying galactosemia are still not fully understood. Recently, new important insights on molecular and cellular aspects of galactosemia have been gained, and should open new avenues for the development of novel therapeutic strategies. Moreover, an international galactosemia network has been established, which shall act as a platform for expertise and research in galactosemia. Herein are reviewed some of the latest developments in clinical practice and research findings on classic galactosemia, an enigmatic disorder with many unanswered questions warranting dedicated research.
Collapse
Affiliation(s)
- Ana I Coelho
- Department of Pediatrics and Department of Clinical Genetics, Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
| | - M Estela Rubio-Gozalbo
- Department of Pediatrics and Department of Clinical Genetics, Maastricht University Medical Centre, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - João B Vicente
- Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Oeiras, Portugal
| | - Isabel Rivera
- Metabolism & Genetics Group, Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
- Department of Biochemistry and Human Biology, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
31
|
Galactose and its Metabolites Deteriorate Metaphase II Mouse Oocyte Quality and Subsequent Embryo Development by Disrupting the Spindle Structure. Sci Rep 2017; 7:231. [PMID: 28331195 PMCID: PMC5427935 DOI: 10.1038/s41598-017-00159-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 02/13/2017] [Indexed: 11/23/2022] Open
Abstract
Premature ovarian insufficiency (POI) is a frequent long-term complication of classic galactosemia. The majority of women with this disorder develop POI, however rare spontaneous pregnancies have been reported. Here, we evaluate the effect of D-galactose and its metabolites, galactitol and galactose 1-phosphate, on oocyte quality as well as embryo development to elucidate the mechanism through which these compounds mediate oocyte deterioration. Metaphase II mouse oocytes (n = 240), with and without cumulus cells (CCs), were exposed for 4 hours to D-galactose (2 μM), galactitol (11 μM) and galactose 1-phosphate (0.1 mM), (corresponding to plasma concentrations in patients on galactose-restricted diet) and compared to controls. The treated oocytes showed decreased quality as a function of significant enhancement in production of reactive oxygen species (ROS) when compared to controls. The presence of CCs offered no protection, as elevated ROS was accompanied by increased apoptosis of CCs. Our results suggested that D-galactose and its metabolites disturbed the spindle structure and chromosomal alignment, which was associated with significant decline in oocyte cleavage and blastocyst development after in-vitro fertilization. The results provide insight into prevention and treatment strategies that may be used to extend the window of fertility in these patients.
Collapse
|
32
|
Rossetti R, Ferrari I, Bonomi M, Persani L. Genetics of primary ovarian insufficiency. Clin Genet 2016; 91:183-198. [PMID: 27861765 DOI: 10.1111/cge.12921] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/10/2016] [Accepted: 11/11/2016] [Indexed: 12/15/2022]
Abstract
Primary ovarian insufficiency (POI) is characterized by a loss of ovarian function before the age of 40 and account for one major cause of female infertility. POI relevance is continuously growing because of the increasing number of women desiring conception beyond 30 years of age, when POI prevalence is >1%. POI is highly heterogeneous and can present with ovarian dysgenesis and primary amenorrhea, or with secondary amenorrhea, and it can be associated with other congenital or acquired abnormalities. In most cases POI remains classified as idiopathic. However, the age of menopause is an inheritable trait and POI has a strong genetic component. This is confirmed by the existence of several candidate genes, experimental and natural models. The variable expressivity of POI defect may indicate that, this disease may frequently be considered as a multifactorial or oligogenic defect. The most common genetic contributors to POI are the X chromosome-linked defects. Here, we review the principal X-linked and autosomal genes involved in syndromic and non-syndromic forms of POI with the expectation that this list will soon be upgraded, thus allowing the possibility to predict the risk of an early age at menopause in families with POI.
Collapse
Affiliation(s)
- R Rossetti
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - I Ferrari
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - M Bonomi
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - L Persani
- Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| |
Collapse
|
33
|
Timson DJ. The molecular basis of galactosemia — Past, present and future. Gene 2016; 589:133-41. [DOI: 10.1016/j.gene.2015.06.077] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/18/2015] [Accepted: 06/29/2015] [Indexed: 12/19/2022]
|
34
|
Maratha A, Colhoun HO, Knerr I, Coss KP, Doran P, Treacy EP. Classical Galactosaemia and CDG, the N-Glycosylation Interface. A Review. JIMD Rep 2016; 34:33-42. [PMID: 27502837 PMCID: PMC5509556 DOI: 10.1007/8904_2016_5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 06/21/2016] [Accepted: 06/23/2016] [Indexed: 12/11/2022] Open
Abstract
Classical galactosaemia is a rare disorder of carbohydrate metabolism caused by galactose-1-phosphate uridyltransferase (GALT) deficiency (EC 2.7.7.12). The disease is life threatening if left untreated in neonates and the only available treatment option is a long-term galactose restricted diet. While this is lifesaving in the neonate, complications persist in treated individuals, and the cause of these, despite early initiation of treatment, and shared GALT genotypes remain poorly understood. Systemic abnormal glycosylation has been proposed to contribute substantially to the ongoing pathophysiology. The gross N-glycosylation assembly defects observed in the untreated neonate correct over time with treatment. However, N-glycosylation processing defects persist in treated children and adults.Congenital disorders of glycosylation (CDG) are a large group of over 100 inherited disorders affecting largely N- and O-glycosylation.In this review, we compare the clinical features observed in galactosaemia with a number of predominant CDG conditions.We also summarize the N-glycosylation abnormalities, which we have described in galactosaemia adult and paediatric patients, using an automated high-throughput HILIC-UPLC analysis of galactose incorporation into serum IgG with analysis of the corresponding N-glycan gene expression patterns and the affected pathways.
Collapse
Affiliation(s)
- Ashwini Maratha
- National Centre for Inherited Metabolic Disorders, Children's University Hospital, Temple Street, Dublin, Ireland
- University College Dublin Clinical Research Centre, Eccles Street, Dublin, Ireland
| | | | - Ina Knerr
- National Centre for Inherited Metabolic Disorders, Children's University Hospital, Temple Street, Dublin, Ireland
| | - Karen P Coss
- Faculty of Life Sciences and Medicine, Department of Infectious Diseases, King's College London, Guy's Hospital, London, UK
| | - Peter Doran
- University College Dublin Clinical Research Centre, Eccles Street, Dublin, Ireland
| | - Eileen P Treacy
- National Centre for Inherited Metabolic Disorders, Children's University Hospital, Temple Street, Dublin, Ireland.
- University College Dublin Clinical Research Centre, Eccles Street, Dublin, Ireland.
- Trinity College, Dublin, Ireland.
- Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland.
| |
Collapse
|
35
|
Salman TM, Olayaki LA, Alagbonsi IA, Oyewopo AO. Spermatotoxic effects of galactose and possible mechanisms of action. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2016. [DOI: 10.1016/j.mefs.2015.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
36
|
Knerr I, Coss KP, Kratzsch J, Crushell E, Clark A, Doran P, Shin Y, Stöckmann H, Rudd PM, Treacy E. Effects of temporary low-dose galactose supplements in children aged 5-12 y with classical galactosemia: a pilot study. Pediatr Res 2015; 78:272-9. [PMID: 26053138 DOI: 10.1038/pr.2015.107] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 02/27/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Classical galactosemia is caused by severe galactose-1-phosphate uridyltransferase deficiency. Despite life-long galactose-restriction, many patients experience long-term complications. Intoxication by galactose and its metabolites as well as over-restriction of galactose may contribute to the pathophysiology. We provided temporary low-dose galactose supplements to patients. We assessed tolerance and potential beneficial effects with clinical monitoring and measurement of biochemical, endocrine, and IgG N-glycosylation profiles. METHODS We enrolled 26 patients (8.6 ± 1.9 y). Thirteen were provided with 300 mg of galactose/day followed by 500 mg for 2 wk each (13 patient controls). RESULTS We observed no clinical changes with the intervention. Temporary mild increase in galactose-1-phosphate occurred, but renal, liver, and bone biochemistry remained normal. Patients in the supplementation group had slightly higher leptin levels at the end of the study than controls. We identified six individuals as "responders" with an improved glycosylation pattern (decreased G0/G2 ratio, P < 0.05). There was a negative relationship between G0/G2 ratio and leptin receptor sOb-R in the supplementation group (P < 0.05). CONCLUSION Temporary low-dose galactose supplementation in children over 5 y is well tolerated in the clinical setting. It leads to changes in glycosylation in "responders". We consider IgG N-glycan monitoring to be useful for determining individual optimum galactose intake.
Collapse
Affiliation(s)
- Ina Knerr
- National Centre for Inherited Metabolic Disorders, Temple Street Children's University Hospital, Dublin, Ireland
| | - Karen Patricia Coss
- University College Dublin, Clinical Research Centre, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Jürgen Kratzsch
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - Ellen Crushell
- National Centre for Inherited Metabolic Disorders, Temple Street Children's University Hospital, Dublin, Ireland
| | - Anne Clark
- National Centre for Inherited Metabolic Disorders, Temple Street Children's University Hospital, Dublin, Ireland
| | - Peter Doran
- University College Dublin, Clinical Research Centre, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Yoon Shin
- Molecular Genetics and Metabolism Laboratory, Munich, Germany
| | - Henning Stöckmann
- The National Institute for Bioprocessing Research and Training, Blackrock, Co., Dublin, Ireland
| | - Pauline Mary Rudd
- The National Institute for Bioprocessing Research and Training, Blackrock, Co., Dublin, Ireland
| | - Eileen Treacy
- National Centre for Inherited Metabolic Disorders, Temple Street Children's University Hospital, Dublin, Ireland
| |
Collapse
|
37
|
Davies P, Connor E, MacKenzie J, Jamieson MA. Spontaneous Recovery of Ovarian Function in an Adolescent with Galactosemia and Apparent Premature Ovarian Insufficiency. J Pediatr Adolesc Gynecol 2015; 28:e101-3. [PMID: 26024933 DOI: 10.1016/j.jpag.2014.09.003] [Citation(s) in RCA: 3] [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: 04/30/2014] [Revised: 08/31/2014] [Accepted: 09/02/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Galactosemia is an inborn error of metabolism resulting in premature ovarian insufficiency in 80-90% of females. There have been no reported cases of biochemical ovarian failure followed by normal menses. CASE A 12-year-old girl with galactosemia presented for gynecologic consultation. Her follicle-stimulating hormone (FSH) and estradiol levels were 52.9 U/L and less than 100 pmol/L, respectively. She started exogenous estrogen to stimulate puberty. At 16, she had spontaneous regular menstrual cycles. FSH and luteinizing hormone (LH) levels reflected normal ovarian function. Hormonal contraception was provided. One year later, she was found to be in ovarian failure (FSH 86.6 U/L, LH 33.3 U/L), and both estradiol and anti-Müllerian hormone were undetectable. SUMMARY AND CONCLUSIONS This case documents spontaneous resumption of ovarian function after galactosemia-related ovarian failure. The use of FSH and LH is potentially limited in predicting ovarian function in this population.
Collapse
Affiliation(s)
- Paul Davies
- Department of Obstetrics and Gynecology, Queens University, Kingston, Ontario, Canada
| | - Ellen Connor
- Department of Pediatric Endocrinology, University of Wisconsin, Madison, Wisconsin
| | - Jennifer MacKenzie
- Department of Medical Genetics, Queens University, Kingston, Ontario, Canada
| | - Mary Anne Jamieson
- Department of Obstetrics and Gynecology, Queens University, Kingston, Ontario, Canada.
| |
Collapse
|
38
|
Timmers I, van den Hurk J, Hofman PA, Zimmermann LJ, Uludağ K, Jansma BM, Rubio-Gozalbo ME. Affected functional networks associated with sentence production in classic galactosemia. Brain Res 2015; 1616:166-76. [PMID: 25979518 DOI: 10.1016/j.brainres.2015.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 04/07/2015] [Accepted: 05/05/2015] [Indexed: 01/13/2023]
Abstract
Patients with the inherited metabolic disorder classic galactosemia have language production impairments in several planning stages. Here, we assessed potential deviations in recruitment and connectivity across brain areas responsible for language production that may explain these deficits. We used functional magnetic resonance imaging (fMRI) to study neural activity and connectivity while participants carried out a language production task. This study included 13 adolescent patients and 13 age- and gender-matched healthy controls. Participants passively watched or actively described an animated visual scene using two conditions, varying in syntactic complexity (single words versus a sentence). Results showed that patients recruited additional and more extensive brain regions during sentence production. Both groups showed modulations with syntactic complexity in left inferior frontal gyrus (IFG), a region associated with syntactic planning, and in right insula. In addition, patients showed a modulation with syntax in left superior temporal gyrus (STG), whereas the controls did not. Further, patients showed increased activity in right STG and right supplementary motor area (SMA). The functional connectivity data showed similar patterns, with more extensive connectivity with frontal and motor regions, and restricted and weaker connectivity with superior temporal regions. Patients also showed higher baseline cerebral blood flow (CBF) in right IFG and trends towards higher CBF in bilateral STG, SMA and the insula. Taken together, the data demonstrate that language abnormalities in classic galactosemia are associated with specific changes within the language network. These changes point towards impairments related to both syntactic planning and speech motor planning in these patients.
Collapse
Affiliation(s)
- Inge Timmers
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Job van den Hurk
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands; Maastricht Brain Imaging Center (M-BIC), Maastricht, The Netherlands; Laboratory of Biological Psychology, University of Leuven, Leuven, Belgium
| | - Paul Am Hofman
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Luc Ji Zimmermann
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Kâmil Uludağ
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands; Maastricht Brain Imaging Center (M-BIC), Maastricht, The Netherlands
| | - Bernadette M Jansma
- Department of Cognitive Neuroscience, Maastricht University, Maastricht, The Netherlands; Maastricht Brain Imaging Center (M-BIC), Maastricht, The Netherlands
| | - M Estela Rubio-Gozalbo
- Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands; Laboratory of Genetic Metabolic Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands.
| |
Collapse
|
39
|
Murphy E. Medical Problems in Obstetrics: Inherited Metabolic Disease. Best Pract Res Clin Obstet Gynaecol 2015; 29:707-20. [PMID: 26088792 DOI: 10.1016/j.bpobgyn.2015.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 04/06/2015] [Accepted: 04/07/2015] [Indexed: 11/26/2022]
Abstract
An increasing number of women with rare inherited disorders of metabolism are becoming pregnant. Although, in general, outcomes for women and their children are good, there are a number of issues that need to be considered. Currently, limited specific guidance on the management of these conditions in pregnancy is available. Prepregnancy counselling with information on inheritance, options for reproduction, teratogenicity risk, potential impact on maternal health and long-term health of children should be offered. With appropriate specialist management, the teratogenic risk of conditions such as maternal phenylketonuria (PKU) can be eliminated, and the risk of metabolic decompensation in disorders of energy metabolism or intoxication significantly reduced. Multidisciplinary management, and close liaison between obstetricians and other specialists, is required for those women in whom there is cardiac, renal, respiratory, joint or other organ involvement.
Collapse
Affiliation(s)
- Elaine Murphy
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK.
| |
Collapse
|
40
|
Abstract
An increasing number of women with rare inherited disorders of metabolism are becoming pregnant. Whilst, in general, outcomes for women and their children are good, there are issues that need to be considered. Due to the rarity of many conditions, there is limited specific guidance available on best management. Prepregnancy counselling with information on inheritance, options for reproduction, teratogenicity risk, potential impact on maternal health and long-term health of children should be offered. With appropriate specialist management, the teratogenic risk of conditions such as maternal phenylketonuria (PKU) can be eliminated, and the risk of metabolic decompensation in other disorders of intoxication or energy metabolism significantly reduced. Newer therapies, such as enzyme replacement therapy, appear to be safe in pregnancy, but specific advice should be sought. Multidisciplinary management, and close liaison between obstetricians and other specialists is required for women in whom there is cardiac, renal, respiratory, joint or other organ involvement.
Collapse
Affiliation(s)
- Elaine Murphy
- Inherited Metabolic Disease, Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| |
Collapse
|
41
|
Consensus on the guidelines for the dietary management of classical galactosemia. Clin Nutr ESPEN 2015; 10:e1-e4. [PMID: 28531441 DOI: 10.1016/j.clnme.2014.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 10/21/2014] [Accepted: 10/22/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIM Worldwide there is scientific discussion about the dietary management of galactosemia. The dietary management is very different in several countries among Europe, the US and Canada. The main points of discussion are related to the fact that i) despite a strict diet some patients still have poor outcomes; ii) there is lack of scientific knowledge about the role of endogenous production of galactose on disease evolution, with or without diet. The aim of the current work was the creation of a Belgian consensus on dietary guidelines for the management of galactosemia. METHODS A step-wise approach was used to achieve a consensus, including: a workshop, a Delphi round, discussion groups and a round table of different Belgian experts. RESULTS The consensus is an agreement between strict guidelines (strict limitation of fruits, vegetables and soybean products/French guidelines) and the more liberal guidelines (comparable with a diet free of lactose/guidelines of UK and the Netherlands). The consensus document consists of different modules, including the medical context, the theoretical background of dietary guidelines and the age-specific practical dietary guidelines. CONCLUSION A Belgian consensus on the guidelines for the dietary management of classical galactosemia was developed despite the uncertainties of the efficacy and practical application of these guidelines. The final consensus is based on scientific knowledge and practical agreement among experts. In the future, regular revision of the guidelines is recommended and a uniform European guideline is desirable.
Collapse
|
42
|
Cocanougher B, Aypar U, McDonald A, Hasadsri L, Bennett MJ, Edward Highsmith W, D'Aco K. Compound heterozygosity with a novel S222N GALT mutation leads to atypical galactosemia with loss of GALT activity in erythrocytes but little evidence of clinical disease. Mol Genet Metab Rep 2015. [PMID: 28649529 PMCID: PMC5471153 DOI: 10.1016/j.ymgmr.2014.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Galactosemia is an inborn error of galactose metabolism caused by mutations in the GALT gene. Though early detection and galactose restriction prevent severe liver disease, affected individuals have persistently elevated biomarkers and often neuro-developmental symptoms. We present a teenage compound heterozygote for a known pathogenic mutation (H132Q) and a novel variant of unknown significance (S222N), with nearly absent erythrocyte GALT enzyme activity but normal biomarkers and only mild anxiety despite diet non-adherence. This case is similar to a previously reported S135L mutation. In this report we investigate the novel S222N variant and critically evaluate a clinically puzzling case.
Collapse
Affiliation(s)
- Benjamin Cocanougher
- University of Rochester School of Medicine and Dentistry, Department of Pediatrics, Division of Genetics, Rochester, NY, USA
| | - Umut Aypar
- Molecular Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Amber McDonald
- Molecular Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Linda Hasadsri
- Molecular Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Michael J Bennett
- Metabolic Disease Laboratory, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - W Edward Highsmith
- Molecular Genetics Laboratory, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Kristin D'Aco
- University of Rochester School of Medicine and Dentistry, Department of Pediatrics, Division of Genetics, Rochester, NY, USA
| |
Collapse
|
43
|
Jeon YJ, Kim YR, Lee BE, Cha SH, Moon MJ, Oh D, Lee WS, Kim NK. Association of five common polymorphisms in the plasminogen activator inhibitor-1 gene with primary ovarian insufficiency. Fertil Steril 2013; 101:825-32. [PMID: 24355042 DOI: 10.1016/j.fertnstert.2013.11.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 10/25/2013] [Accepted: 11/11/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To investigate the association between potentially functional plasminogen activator inhibitor-1 (PAI-1) genetic polymorphisms and primary ovarian insufficiency (POI). DESIGN Case-control study. SETTING Urban university-based hospital. PATIENT(S) A cohort of 137 POI patients and 227 controls. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Genotyping of five PAI-1 polymorphisms (-844G>A [rs2227631], -675 4G/5G [rs1799889], 43G>A (Ala>Thr) [rs6092], 9785G>A [rs2227694], and 11053T>G [rs7242]) was assessed by polymerase chain reaction-restriction fragment length polymorphism assay. RESULT(S) PAI-1 polymorphisms 9785GA+AA, -844A/9785A, 4G/9785A, and 9785A/11053G were associated with POI occurrence. Moreover, -844GA+AA and 11053TG+GG were associated with lower serum E2 levels in controls. CONCLUSION(S) We have identified an association between five PAI-1 polymorphisms and POI occurrence. However, the mechanism underlying the function of these polymorphisms in POI remains to be determined. Further studies are needed to improve understanding of the roles of PAI-1 polymorphisms and genes in related pathways, using a larger and more heterogeneous cohort.
Collapse
Affiliation(s)
- Young Joo Jeon
- Institute for Clinical Research, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam 463-712, South Korea
| | - Young Ran Kim
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam 463-712, South Korea
| | - Bo Eun Lee
- Institute for Clinical Research, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam 463-712, South Korea
| | - Sun Hee Cha
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam 463-712, South Korea
| | - Myoung-Jin Moon
- Department of Obstetrics and Gynecology, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam 463-712, South Korea
| | - Doyeun Oh
- Department of Internal Medicine, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam 463-712, South Korea
| | - Woo Sik Lee
- Fertility Center of CHA Gangnam Medical Center, CHA University, Seoul 135-081, South Korea
| | - Nam Keun Kim
- Institute for Clinical Research, CHA Bundang Medical Center, School of Medicine, CHA University, Seongnam 463-712, South Korea.
| |
Collapse
|
44
|
van Erven B, Gubbels CS, van Golde RJ, Dunselman GA, Derhaag JG, de Wert G, Geraedts JP, Bosch AM, Treacy EP, Welt CK, Berry GT, Rubio-Gozalbo ME. Fertility preservation in female classic galactosemia patients. Orphanet J Rare Dis 2013; 8:107. [PMID: 23866841 PMCID: PMC3718676 DOI: 10.1186/1750-1172-8-107] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 07/11/2013] [Indexed: 11/29/2022] Open
Abstract
Almost every female classic galactosemia patient develops primary ovarian insufficiency (POI) as a diet-independent complication of the disease. This is a major concern for patients and their parents, and physicians are often asked about possible options to preserve fertility. Unfortunately, there are no recommendations on fertility preservation in this group. The unique pathophysiology of classic galactosemia with a severely reduced follicle pool at an early age requires an adjusted approach. In this article recommendations for physicians based on current knowledge concerning galactosemia and fertility preservation are made. Fertility preservation is only likely to be successful in very young prepubertal patients. In this group, cryopreservation of ovarian tissue is currently the only available technique. However, this technique is not ready for clinical application, it is considered experimental and reduces the ovarian reserve. Fertility preservation at an early age also raises ethical questions that should be taken into account. In addition, spontaneous conception despite POI is well described in classic galactosemia. The uncertainty surrounding fertility preservation and the significant chance of spontaneous pregnancy warrant counseling towards conservative application of these techniques. We propose that fertility preservation should only be offered with appropriate institutional research ethics approval to classic galactosemia girls at a young prepubertal age.
Collapse
Affiliation(s)
- Britt van Erven
- Department of Pediatrics and Department of Genetic Metabolic Diseases Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
- GROW, Research school for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| | - Cynthia S Gubbels
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands
- Currently: The Manton Center for Orphan Disease Research, Division of Genetics, Boston Children’s Hospital, Harvard Medical School, Boston, USA
| | - Ron J van Golde
- GROW, Research school for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Gerard A Dunselman
- GROW, Research school for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Josien G Derhaag
- GROW, Research school for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
- Department of Obstetrics and Gynecology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Guido de Wert
- GROW, Research school for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
- Department of Health, Ethics & Society, Maastricht University, Maastricht, the Netherlands
| | - Joep P Geraedts
- GROW, Research school for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Annet M Bosch
- Department of Pediatrics, Academic Medical Center, Amsterdam, the Netherlands
| | - Eileen P Treacy
- National Centre for Inherited Metabolic Disorders, Children’s University Hospital, Trinity College, Dublin, Ireland
| | - Corrine K Welt
- Reproductive Endocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Gerard T Berry
- The Manton Center for Orphan Disease Research, Division of Genetics, Boston Children’s Hospital, Harvard Medical School, Boston, USA
| | - M Estela Rubio-Gozalbo
- Department of Pediatrics and Department of Genetic Metabolic Diseases Laboratory, Maastricht University Medical Center, Maastricht, the Netherlands
- GROW, Research school for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
45
|
Spencer JB, Badik JR, Ryan EL, Gleason TJ, Broadaway KA, Epstein MP, Fridovich-Keil JL. Modifiers of ovarian function in girls and women with classic galactosemia. J Clin Endocrinol Metab 2013; 98:E1257-65. [PMID: 23690308 PMCID: PMC3701263 DOI: 10.1210/jc.2013-1374] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
CONTEXT Classic galactosemia is a potentially lethal genetic disorder resulting from profound impairment of galactose-1P uridylyltransferase (GALT). More than 80% of girls and women with classic galactosemia experience primary or premature ovarian insufficiency despite neonatal diagnosis and rigorous lifelong dietary galactose restriction. OBJECTIVE The goal of this study was to test the relationship between markers of ovarian reserve, cryptic residual GALT activity, and spontaneous pubertal development in girls with classic galactosemia. DESIGN AND SETTING This was a cross-sectional study with some longitudinal follow-up in a university research environment. PATIENTS Patients included girls and women with classic galactosemia and unaffected controls, <1 month to 30 years old. MAIN OUTCOME MEASURES We evaluated plasma anti-Müllerian hormone (AMH) and FSH levels, antral follicle counts ascertained by ultrasound, and ovarian function as indicated by spontaneous vs assisted menarche. RESULTS More than 73% of the pre- and postpubertal girls and women with classic galactosemia in this study, ages >3 months to 30 years, demonstrated AMH levels below the 95% confidence interval for AMH among controls of the same age, and both pre- and postpubertal girls and women with classic galactosemia also demonstrated abnormally low antral follicle counts relative to age-matched controls. Predicted residual GALT activity ≥ 0.4% significantly increased the likelihood that a girl with classic galactosemia would demonstrate an AMH level ≥ 0.1 ng/mL. CONCLUSIONS A majority of girls with classic galactosemia demonstrate evidence of diminished ovarian reserve by 3 months of age, and predicted cryptic residual GALT activity is a modifier of ovarian function in galactosemic girls and women.
Collapse
Affiliation(s)
- Jessica B Spencer
- Division of Reproductive Endocrinology and Infertility, Emory University School of Medicine, Atlanta, Georgia 30322, USA
| | | | | | | | | | | | | |
Collapse
|
46
|
Rubio-Agusti I, Carecchio M, Bhatia KP, Kojovic M, Parees I, Chandrashekar HS, Footitt EJ, Burke D, Edwards MJ, Lachmann RH, Murphy E. Movement Disorders in Adult Patients With Classical Galactosemia. Mov Disord 2013; 28:804-10. [DOI: 10.1002/mds.25348] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Revised: 11/27/2012] [Accepted: 12/09/2012] [Indexed: 12/12/2022] Open
Affiliation(s)
- Ignacio Rubio-Agusti
- Charles Dent Metabolic Unit; National Hospital for Neurology and Neurosurgery; London United Kingdom
- Sobell Department for Movement Disorders and Clinical Neuroscience; Institute of Neurology; National Hospital for Neurology and Neurosurgery; London United Kingdom
- Movement Disorders Unit; Department of Neurology; Hospital Universtiari La Fe; Valencia Spain
| | - Miryam Carecchio
- Sobell Department for Movement Disorders and Clinical Neuroscience; Institute of Neurology; National Hospital for Neurology and Neurosurgery; London United Kingdom
- Department of Neurology; Amedeo Avogadro University; Novara Italy
| | - Kailash P. Bhatia
- Sobell Department for Movement Disorders and Clinical Neuroscience; Institute of Neurology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - Maja Kojovic
- Sobell Department for Movement Disorders and Clinical Neuroscience; Institute of Neurology; National Hospital for Neurology and Neurosurgery; London United Kingdom
- Department of Neurology; University of Ljubljana; Ljubljana Slovenia
| | - Isabel Parees
- Sobell Department for Movement Disorders and Clinical Neuroscience; Institute of Neurology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - Hoskote S. Chandrashekar
- Lysholm Department of Neuroradiology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - Emma J. Footitt
- Clinical and Molecular Genetics Unit; UCL Institute of Child Health, Great Ormond Street Hospital; London United Kingdom
| | - Derek Burke
- Clinical and Molecular Genetics Unit; UCL Institute of Child Health, Great Ormond Street Hospital; London United Kingdom
| | - Mark J. Edwards
- Sobell Department for Movement Disorders and Clinical Neuroscience; Institute of Neurology; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - Robin H.L. Lachmann
- Charles Dent Metabolic Unit; National Hospital for Neurology and Neurosurgery; London United Kingdom
| | - Elaine Murphy
- Charles Dent Metabolic Unit; National Hospital for Neurology and Neurosurgery; London United Kingdom
| |
Collapse
|
47
|
Gubbels CS, Land JA, Evers JLH, Bierau J, Menheere PPCA, Robben SGF, Rubio-Gozalbo ME. Primary ovarian insufficiency in classic galactosemia: role of FSH dysfunction and timing of the lesion. J Inherit Metab Dis 2013; 36:29-34. [PMID: 22729817 PMCID: PMC3543609 DOI: 10.1007/s10545-012-9497-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Revised: 04/20/2012] [Accepted: 05/10/2012] [Indexed: 11/23/2022]
Abstract
FSH inactivity due to secondary hypoglycosylation has been suggested as a potential mechanism for primary ovarian insufficiency in classic galactosemia. To investigate the role of FSH and to gain insight in the timing of the damage, ovarian stimulation tests were performed and data on ovarian imaging collected. Fifteen patients with primary ovarian insufficiency underwent ovarian stimulation with gonadotropins. Only one patient showed a normal increase in estradiol level, all the others had a low or no estradiol response. Anti-Müllerian hormone measurement in all girls and women showed levels below the detection limit of 0.10 μg/l. Ovarian volumes were evaluated by MRI in 14 patients and compared to age matched controls, prepubertal controls and postmenopausal controls. The ovarian volumes of the galactosemic girls were smaller than those of the age matched controls (p = 0.001) and the prepubertal ovaries (p = 0.008), and did not differ significantly from postmenopausal ovarian volumes (p = 0.161). In conclusion we found no evidence that FSH inactivity plays a role in primary ovarian insufficiency in classic galactosemia. Moreover, ovarian imaging results point to an early onset of ovarian failure in this disease.
Collapse
Affiliation(s)
- Cynthia S. Gubbels
- Departments of Pediatrics and Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jolande A. Land
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes L. H. Evers
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jörgen Bierau
- Genetic Metabolic Disease Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Paul P. C. A. Menheere
- Department of Clinical Chemistry, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Simon G. F. Robben
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - M. Estela Rubio-Gozalbo
- Department of Pediatrics and Genetic Metabolic Disease Laboratory, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Pediatrics, Maastricht University Medical center, P.O. Box 5800, NL-6202 AZ Maastricht, The Netherlands
| |
Collapse
|
48
|
Coss KP, Doran PP, Owoeye C, Codd MB, Hamid N, Mayne PD, Crushell E, Knerr I, Monavari AA, Treacy EP. Classical Galactosaemia in Ireland: incidence, complications and outcomes of treatment. J Inherit Metab Dis 2013; 36:21-7. [PMID: 22870861 DOI: 10.1007/s10545-012-9507-9] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 05/08/2012] [Accepted: 06/11/2012] [Indexed: 11/30/2022]
Abstract
Newborn screening for the inborn error of metabolism, classical galactosaemia prevents life-threatening complications in the neonatal period. It does not however influence the development of long-term complications and the complex pathophysiology of this rare disease remains poorly understood. The objective of this study was to report the development of a healthcare database (using Distiller Version 2.1) to review the epidemiology of classical galactosaemia in Ireland since initiation of newborn screening in 1972 and the long-term clinical outcomes of all patients attending the National Centre for Inherited Metabolic Disorders (NCIMD). Since 1982, the average live birth incidence rate of classical galactosaemia in the total Irish population was approximately 1:16,476 births. This reflects a high incidence in the Irish 'Traveller' population, with an estimated birth incidence of 1:33,917 in the non-Traveller Irish population. Despite early initiation of treatment (dietary galactose restriction), the long-term outcomes of classical galactosaemia in the Irish patient population are poor; 30.6 % of patients ≥ 6 yrs have IQs <70, 49.6 % of patients ≥ 2.5 yrs have speech or language impairments and 91.2 % of females ≥ 13 yrs suffer from hypergonadotrophic hypogonadism (HH) possibly leading to decreased fertility. These findings are consistent with the international experience. This emphasizes the requirement for continued clinical research in this complex disorder.
Collapse
Affiliation(s)
- K P Coss
- Clinical Research Centre, Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Leptin levels in children and adults with classic galactosaemia. JIMD Rep 2012; 9:125-131. [PMID: 23430559 DOI: 10.1007/8904_2012_191] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 09/03/2012] [Accepted: 10/04/2012] [Indexed: 12/16/2022] Open
Abstract
Among the long-term complications of Classic Galactosaemia (Gal) is premature ovarian insufficiency (POI) in female patients with subtle abnormalities of reproductive function also reported in male patients. Leptin is a circulating hormone which reflects body energy stores and which affects the neuroendocrine reproductive axis and pubertal development.We measured serum leptin in 28 children (10 girls, 18 boys; mean age 7.6 years, range 0.5-17.9 years) and in 22 adults (10 females, 12 males; mean age 23.9 years, range 18-37 years) with Gal on a strict galactose-restricted diet in comparison with control data.Leptin levels (expressed as SDS for gender and pubertal stage) were lower in Gal children than controls (mean leptin-SDS = -0.71 for girls, p < 0.05, -0.97 for boys compared with SDS = 0 for controls, p < 0.05). In an age-related analysis, leptin levels did not correlate with age in children with Gal for both sexes as it did for matched controls.As expected, females had higher leptin levels than males in either group. In adults with Gal, leptin concentrations were within normal limits for both sexes when adjusted for gender and BMI. There was a linear relationship between log-leptin and BMI in children with Gal and in controls. For Gal women, log-leptin was also associated with BMI. However, for Gal men, and hence for the entire group of adult Gal patients, this association between log-leptin and BMI was not detectable. Our findings suggest that leptin dysregulation may play a role in fertility issues in individuals with Gal from an early age.
Collapse
|
50
|
Jumbo-Lucioni PP, Garber K, Kiel J, Baric I, Berry GT, Bosch A, Burlina A, Chiesa A, Pico MLC, Estrada SC, Henderson H, Leslie N, Longo N, Morris AAM, Ramirez-Farias C, Schweitzer-Krantz S, Silao CLT, Vela-Amieva M, Waisbren S, Fridovich-Keil JL. Diversity of approaches to classic galactosemia around the world: a comparison of diagnosis, intervention, and outcomes. J Inherit Metab Dis 2012; 35:1037-49. [PMID: 22450714 PMCID: PMC3774053 DOI: 10.1007/s10545-012-9477-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 02/29/2012] [Accepted: 03/05/2012] [Indexed: 11/30/2022]
Abstract
Without intervention, classic galactosemia is a potentially fatal disorder in infancy. With the benefit of early diagnosis and dietary restriction of galactose, the acute sequelae of classic galactosemia can be prevented or reversed. However, despite early and lifelong dietary treatment, many galactosemic patients go on to experience serious long-term complications including cognitive disability, speech problems, neurological and/or movement disorders and, in girls and women, ovarian dysfunction. Further, there remains uncertainty surrounding what constitutes a 'best practice' for treating this disorder. To explore the extent and implications of this uncertainty, we conducted a small but global survey of healthcare providers who follow patients with classic galactosemia, seeking to compare established protocols for diagnosis, intervention, and follow-up, as well as the outcomes and outcome frequencies seen in the patient populations cared for by these providers. We received 13 survey responses representing five continents and 11 countries. Respondents underscored disparities in approaches to diagnosis, management and follow-up care. Notably, we saw no clear relationship between differing approaches to care and long-term outcomes in the populations studied. Negative outcomes occurred in the majority of cases regardless of when treatment was initiated, how tightly galactose intake was restricted, or how closely patients were monitored. We document here what is, to our knowledge, the first global comparison of healthcare approaches to classic galactosemia. These data reinforce the idea that there is currently no one best practice for treating patients with classic galactosemia, and underscore the need for more extensive and statistically powerful comparative studies to reveal potential positive or negative impacts of differing approaches.
Collapse
Affiliation(s)
- Patricia P Jumbo-Lucioni
- Department of Human Genetics, Emory University School of Medicine, Rm. 325.2 Whitehead Bldg, 615 Michael St, Atlanta, GA 30322, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|