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Peña-Quintana L, Scherer G, Curbelo-Estévez ML, Jiménez-Acosta F, Hartmann B, La Roche F, Meavilla-Olivas S, Pérez-Cerdá C, García-Segarra N, Giguère Y, Huppke P, Mitchell GA, Mönch E, Trump D, Vianey-Saban C, Trimble ER, Vitoria-Miñana I, Reyes-Suárez D, Ramírez-Lorenzo T, Tugores A. Tyrosinemia type II: Mutation update, 11 novel mutations and description of 5 independent subjects with a novel founder mutation. Clin Genet 2017; 92:306-317. [PMID: 28255985 DOI: 10.1111/cge.13003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 01/27/2017] [Accepted: 02/27/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Tyrosinemia type II, also known as Richner-Hanhart Syndrome, is an extremely rare autosomal recessive disorder, caused by mutations in the gene encoding hepatic cytosolic tyrosine aminotransferase, leading to the accumulation of tyrosine and its metabolites which cause ocular and skin lesions, that may be accompanied by neurological manifestations, mostly intellectual disability. AIMS To update disease-causing mutations and current clinical knowledge of the disease. MATERIALS AND METHODS Genetic and clinical information were obtained from a collection of both unreported and previously reported cases. RESULTS We report 106 families, represented by 143 individuals, carrying a total of 36 genetic variants, 11 of them not previously known to be associated with the disease. Variants include 3 large deletions, 21 non-synonymous and 5 nonsense amino-acid changes, 5 frameshifts and 2 splice variants. We also report 5 patients from Gran Canaria, representing the largest known group of unrelated families sharing the same P406L mutation. CONCLUSIONS Data analysis did not reveal a genotype-phenotype correlation, but stressed the need of early diagnosis: All patients improved the oculocutaneous lesions after dietary treatment but neurological symptoms prevailed. The discovery of founder mutations in isolated populations, and the benefits of early intervention, should increase diagnostic awareness in newborns.
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Affiliation(s)
- L Peña-Quintana
- Department of Pediatrics, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain.,CIBER OBN, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - G Scherer
- Institute of Human Genetics, University of Freiburg, Freiburg, Germany
| | - M L Curbelo-Estévez
- Department of Pediatrics, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - F Jiménez-Acosta
- Mediteknia Dermatology and Hair Transplant Clinic, Medical Pathology Group, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - B Hartmann
- Institute of Human Genetics, University of Freiburg, Freiburg, Germany
| | - F La Roche
- Department of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - S Meavilla-Olivas
- Section of Gastroenterology, Hepatology and Nutrition, Metabolopathies Unit Hospital Sant Joan de Déu, Barcelona, Spain
| | - C Pérez-Cerdá
- Centro de Diagnóstico de Enfermedades Moleculares, Universidad Autónoma de Madrid, CIBERER, IdiPAZ, Madrid, Spain
| | - N García-Segarra
- Center for Molecular Diseases, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Y Giguère
- Programme québécois de dépistage néonatal sanguin, CHU de Québec, and Department of Molecular Biology, Medical Biochemistry and Pathology, Faculty of Medicine, Université Laval, Quebec, Canada
| | - P Huppke
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - G A Mitchell
- Division of Medical Genetics, Department of Pediatrics, CHU Sainte-Justine and Université de Montréal, Montréal, Canada
| | - E Mönch
- Charité University Medical Center, Campus Virchow-Klinikum, Berlin, Germany
| | - D Trump
- Department of Medical Genetics, Addenbrooke's Hospital, Cambridge, UK
| | | | - E R Trimble
- Department of Clinical Biochemistry, Royal Victoria Hospital, Belfast, UK
| | - I Vitoria-Miñana
- Unidad de Nutrición y Metabolopatías, Hospital La Fe, Valencia, Spain
| | - D Reyes-Suárez
- Department of Pediatrics, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - T Ramírez-Lorenzo
- Research Unit, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - A Tugores
- Research Unit, Complejo Hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canaria, Spain
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Gokay S, Kendirci M, Ustkoyuncu PS, Kardas F, Bayram AK, Per H, Poyrazoğlu HG. Tyrosinemia type II: Novel mutations in TAT in a boy with unusual presentation. Pediatr Int 2016; 58:1069-1072. [PMID: 27285949 DOI: 10.1111/ped.13062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 04/28/2016] [Accepted: 05/24/2016] [Indexed: 12/01/2022]
Abstract
Tyrosinemia type II is a rare autosomal recessive disorder caused by deficiency of tyrosine aminotransferase (TAT). It may occur with ocular and cutaneous symptoms with or without mental retardation, but epileptic seizure is a rare presentation of this disease. Herein we report the clinical, biochemical and genetic features of a 4-year-old boy who presented with afebrile seizure and photophobia. Genomic DNA was obtained from peripheral blood leukocytes from the whole family. Sequencing analysis was performed using the MiSeq next-generation sequencing platform. Sequencing of TAT indicated two new homozygous mutations p.L312P (c.935T>C) and p.T408M (c.1223C>T) for the proband and his asymptomatic sister. During a 2 year follow-up period, the patient had overall poor compliance with protein-restricted diet, but his asymptomatic sister had good compliance with the diet. Cognitive function of the patient worsened steadily, but his asymptomatic sister maintained normal mental status. Tyrosinemia type II should be considered in the differential diagnosis of children presenting with epileptic seizure and photophobia; furthermore, early diagnosis and protein-restricted regimen are important to reduce the risk of long-term complications of tyrosinemia type II such as mental disability.
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Affiliation(s)
- Songul Gokay
- Division of Pediatric Nutrition and Metabolism, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
| | - Mustafa Kendirci
- Division of Pediatric Nutrition and Metabolism, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Pembe Soylu Ustkoyuncu
- Division of Pediatric Nutrition and Metabolism, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Fatih Kardas
- Division of Pediatric Nutrition and Metabolism, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Ayse Kacar Bayram
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Hüseyin Per
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Hatice Gamze Poyrazoğlu
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Fırat University, Elazığ, Turkey
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Arnoux JB, Le Quan Sang KH, Brassier A, Grisel C, Servais A, Wippf J, Dubois S, Sireau N, Job-Deslandre C, Ranganath L, de Lonlay P. Old treatments for new insights and strategies: proposed management in adults and children with alkaptonuria. J Inherit Metab Dis 2015; 38:791-6. [PMID: 25860819 DOI: 10.1007/s10545-015-9844-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 03/06/2015] [Accepted: 03/18/2015] [Indexed: 02/03/2023]
Abstract
Alkaptonuria (AKU) is caused by deficiency of the enzyme homogentisate 1,2 dioxygenase. It results in an accumulation of homogentisate which oxidizes spontaneously to benzoquinone acetate, a highly oxidant compound, which polymerises to a melanin-like structure, in a process called ochronosis. Asymptomatic during childhood, this accumulation will lead from the second decade of life to a progressive and severe spondylo-arthopathy, associated with multisystem involvement: osteoporosis/fractures, stones (renal, prostatic, gall bladder, salivary glands), ruptures of tendons/muscle/ligaments, renal failure and aortic valve disease. The pathophysiological mechanisms of AKU remain poorly understood, but recent advances lead us to reconsider the treatment strategy in AKU patients. Besides the supporting therapies (pain killers, anti-inflammatory drugs, physiotherapy, joints replacements and others), specific therapies have been considered (anti-oxidant, low protein diet, nitisinone), but clinical studies have failed to prove efficiency on the rheumatological lesions of the disease. Here we propose a treatment strategy for children and adults with AKU, based on a review of the latest findings on AKU and lessons from other aminoacipathies, especially tyrosinemias.
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Affiliation(s)
- Jean-Baptiste Arnoux
- Reference Centre for Inherited Metabolic Diseases Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, 149 rue de Sèvres, Paris, 75015, France,
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van Karnebeek CDM, Stockler S. Treatable inborn errors of metabolism causing intellectual disability: a systematic literature review. Mol Genet Metab 2012; 105:368-81. [PMID: 22212131 DOI: 10.1016/j.ymgme.2011.11.191] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 11/17/2011] [Accepted: 11/17/2011] [Indexed: 12/30/2022]
Abstract
BACKGROUND Intellectual disability ('developmental delay' at age<5 years) affects 2.5% of population worldwide. Recommendations to investigate genetic causes of intellectual disability are based on frequencies of single conditions and on the yield of diagnostic methods, rather than availability of causal therapy. Inborn errors of metabolism constitute a subgroup of rare genetic conditions for which an increasing number of treatments has become available. To identify all currently treatable inborn errors of metabolism presenting with predominantly intellectual disability, we performed a systematic literature review. METHODS We applied Cochrane Collaboration guidelines in formulation of PICO and definitions, and searched in Pubmed (1960-2011) and relevant (online) textbooks to identify 'all inborn errors of metabolism presenting with intellectual disability as major feature'. We assessed levels of evidence of treatments and characterised the effect of treatments on IQ/development and related outcomes. RESULTS We identified a total of 81 'treatable inborn errors of metabolism' presenting with intellectual disability as a major feature, including disorders of amino acids (n=12), cholesterol and bile acid (n=2), creatine (n=3), fatty aldehydes (n=1); glucose homeostasis and transport (n=2); hyperhomocysteinemia (n=7); lysosomes (n=12), metals (n=3), mitochondria (n=2), neurotransmission (n=7); organic acids (n=19), peroxisomes (n=1), pyrimidines (n=2), urea cycle (n=7), and vitamins/co-factors (n=8). 62% (n=50) of all disorders are identified by metabolic screening tests in blood (plasma amino acids, homocysteine) and urine (creatine metabolites, glycosaminoglycans, oligosaccharides, organic acids, pyrimidines). For the remaining disorders (n=31) a 'single test per single disease' approach including primary molecular analysis is required. Therapeutic modalities include: sick-day management, diet, co-factor/vitamin supplements, substrate inhibition, stemcell transplant, gene therapy. Therapeutic effects include improvement and/or stabilisation of psychomotor/cognitive development, behaviour/psychiatric disturbances, seizures, neurologic and systemic manifestations. The levels of available evidence for the various treatments range from Level 1b,c (n=5); Level 2a,b,c (n=14); Level 4 (n=45), Level 4-5 (n=27). In clinical practice more than 60% of treatments with evidence level 4-5 is internationally accepted as 'standard of care'. CONCLUSION This literature review generated the evidence to prioritise treatability in the diagnostic evaluation of intellectual disability. Our results were translated into digital information tools for the clinician (www.treatable-id.org), which are part of a diagnostic protocol, currently implemented for evaluation of effectiveness in our institution. Treatments for these disorders are relatively accessible, affordable and with acceptable side-effects. Evidence for the majority of the therapies is limited however; international collaborations, patient registries, and novel trial methodologies are key in turning the tide for rare diseases such as these.
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Affiliation(s)
- Clara D M van Karnebeek
- Division of Biochemical Diseases, Department of Pediatrics, BC Children's Hospital, Vancouver BC V6H 3V4, Vancouver, Canada.
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6
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Macsai MS, Schwartz TL, Hinkle D, Hummel MB, Mulhern MG, Rootman D. Tyrosinemia type II: nine cases of ocular signs and symptoms. Am J Ophthalmol 2001; 132:522-7. [PMID: 11589874 DOI: 10.1016/s0002-9394(01)01160-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To report nine cases of tyrosinemia type II, with ocular signs and symptoms. METHODS Participants included nine patients (18 eyes) who were followed for a mean follow-up period of 6.5 years (range, 2 to 8 years). Intervention included dietary restriction of tyrosine and phenylalanine, which led to resolution of ocular and cutaneous lesions, improved behavior in one patient, and may have prevented developmental delay in others. The main outcome measures were visual acuity and serum tyrosine levels to determine the response to dietary therapy. Intelligence testing and developmental screening were performed when appropriate. RESULTS All patients presented with ocular signs and symptoms as the primary manifestation of disease and serve to illustrate the typical ocular findings of this syndrome. Three patients presented with cutaneous manifestations, and one patient had mild mental impairment at the time of diagnosis. CONCLUSIONS Recalcitrant pseudodendritic keratitis may be the presenting sign in tyrosinemia type II. Awareness of the presenting signs and symptoms may accelerate the diagnosis and dietary intervention. Initiation of a tyrosine-restricted and phenylalanine-restricted diet in infancy is most effective in preventing cognitive impairment.
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Affiliation(s)
- M S Macsai
- Division of Ophthalmology, Evanston Northwestern Healthcare, Northwestern University School of Medicine, 2050 Pfingsten Rd., Glenview, IL 60025, USA.
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el-Badramany MH, Fawzy AR, Farag TI. Familial richner-Hanhart syndrome in Kuwait: twelve-year clinical reassessment by a multidisciplinary approach. AMERICAN JOURNAL OF MEDICAL GENETICS 1995; 60:353-5. [PMID: 8546145 DOI: 10.1002/ajmg.1320600502] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Farag TI. Dietetic therapy of Richner-Hanhart syndrome. J R Soc Med 1993; 86:495. [PMID: 8078067 PMCID: PMC1294081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Letters to the Editor. Med Chir Trans 1993. [DOI: 10.1177/014107689308600825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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10
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Paige DG, Clayton P, Bowron A, Harper JI. Richner-Hanhart Syndrome (Oculo-Cutaneous Tyrosinaemia, Tyrosinaemia Type II). Med Chir Trans 1992; 85:759-60. [PMID: 1362969 PMCID: PMC1293768 DOI: 10.1177/014107689208501216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- D G Paige
- Department of Dermatology, Hospitals for Sick Children, London
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