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Mills SL, Roberts P, Ashfaq M, Leal K, Northrup H, Brown DL, Rodriguez‐Buritica D, Farach LS. Arginase deficiency masked by cerebral palsy and coagulopathy-Three varied presentations of Latin American origin. JIMD Rep 2023; 64:434-439. [PMID: 37927486 PMCID: PMC10623097 DOI: 10.1002/jmd2.12397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 11/07/2023] Open
Abstract
Arginase deficiency (ARG1-D) is an autosomal recessive inborn error of metabolism that is often misdiagnosed. Classic presentation of ARG1-D includes progressive symptoms of spasticity, delayed development, cognitive impairment, protein avoidance, and seizures. Patients who present atypically may evade diagnosis and require a thoughtful diagnostic workup. Here, we discuss three females of Latin American origin with differing clinical presentations, but who all have the same intronic pathogenic variant in ARG1. Importantly, we found that each case included elevated coagulopathy on laboratory testing and discussed one case in particular with manifestation of bleeding. When diagnosed early, treatment is favorable and can prevent progressive decline. While many states have added ARG1-D to their expanded newborn screening panels, still many states and countries do not screen for ARG1-D, and it can be missed in a healthy newborn. We aim to bring awareness to not only the classic presentation as a necessary consideration for otherwise unexplained spastic diplegia but also to the varied presentations of ARG1-D.
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Affiliation(s)
- Shelby L. Mills
- Department of Pediatrics, Division of Medical GeneticsMcGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children's Memorial Hermann HospitalHoustonTexasUSA
- College of Osteopathic Medicine of the Pacific‐NorthwestWestern University of Health SciencesLebanonOregonUSA
| | - Paige Roberts
- Department of Pediatrics, Division of Medical GeneticsMcGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children's Memorial Hermann HospitalHoustonTexasUSA
| | - Myla Ashfaq
- Department of Pediatrics, Division of Medical GeneticsMcGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children's Memorial Hermann HospitalHoustonTexasUSA
| | - Kathryn Leal
- Department of Pediatrics, Division of Medical GeneticsMcGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children's Memorial Hermann HospitalHoustonTexasUSA
| | - Hope Northrup
- Department of Pediatrics, Division of Medical GeneticsMcGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children's Memorial Hermann HospitalHoustonTexasUSA
| | - Deborah L. Brown
- Department of Pediatrics, Division of Hematology OncologyMcGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children's Memorial Hermann HospitalHoustonTexasUSA
| | - David Rodriguez‐Buritica
- Department of Pediatrics, Division of Medical GeneticsMcGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children's Memorial Hermann HospitalHoustonTexasUSA
| | - Laura S. Farach
- Department of Pediatrics, Division of Medical GeneticsMcGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children's Memorial Hermann HospitalHoustonTexasUSA
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Hadj TB, Te VLT, Le Guyader M, Voyer A, Durand-Maugard C, Galmiche A, Garçon L, Demagny J. Argininemia and vitamin K-dependent coagulation factors deficiency: A case report and a brief review of the literature. Thromb Res 2023; 229:42-45. [PMID: 37393626 DOI: 10.1016/j.thromres.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/21/2023] [Accepted: 06/29/2023] [Indexed: 07/04/2023]
Affiliation(s)
- Tasnim Bel Hadj
- Service d'Hématologie Biologique, CHU Amiens-Picardie, Amiens, France
| | - Valérie Li Thiao Te
- Service d'Oncologie-Hématologie Pédiatrique, CHU Amiens-Picardie, Amiens, France
| | - Maïlys Le Guyader
- Service d'Hématologie Biologique, CHU Amiens-Picardie, Amiens, France
| | - Annelise Voyer
- Service d'Hématologie Biologique, CHU Amiens-Picardie, Amiens, France
| | | | | | - Loïc Garçon
- Service d'Hématologie Biologique, CHU Amiens-Picardie, Amiens, France; HEMATIM UR4666, Univ. Picardie Jules Verne, Amiens, France
| | - Julien Demagny
- Service d'Hématologie Biologique, CHU Amiens-Picardie, Amiens, France; HEMATIM UR4666, Univ. Picardie Jules Verne, Amiens, France.
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Zhang C, Dha D, Cheng Y, Ma Y, Meng Y, Tse D, Ngawang D, Dekyi P, Jiang T, Shu Y, Cui J, Li J, Tian Y. A preliminary investigation of amino acid and acylcarnitine levels in neonates from the Tibet autonomous. Front Genet 2022; 13:941938. [PMID: 36299584 PMCID: PMC9589887 DOI: 10.3389/fgene.2022.941938] [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: 07/14/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background: The purpose of the study was to investigate the levels of amino acids and acylcarnitines in newborns of the Tibet Autonomous Region for the first time and to provide an experimental basis for the diagnosis of genetic metabolic diseases. Methods: We detected concentrations of 43 kinds of amino acids, acylcarnitines and succinylacetone in the dried blood spots of 18482 newborns using liquid chromatography tandem mass spectrometry and diagnose the case by gene sequencing. We compared the indexes between Tibet and our lab, where most data come from an inland area and Han Chinese people. Then we compared amino acid and acylcarnitine levels of seven regions in Tibet and explored their impact factors. Results: We described the levels of amino acids and acylcarnitines in Tibet newborns using 95% confidence intervals. The distribution of amino acid and acylcarnitines were different in Tibet. Conclusion: This study has contributed to filling in the blanks of Tibet newborn screening, which should be considered in the newborn metabolic disease screening in this area.
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Affiliation(s)
- Chunyan Zhang
- Birth defect prevention and Control Technology Research Center, Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China
| | - Drun Dha
- Department of Pediatrics, Maternity and children’s Hospital of Tibet Autonomous Region, Tibet, China
| | - Yuxuan Cheng
- Birth defect prevention and Control Technology Research Center, Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China
| | - Ya Ma
- Department of pediatrics, The second people’s hospital of Tibet Autonomous Region, Tibet, China
| | - Yan Meng
- Department of Pediatrics, Chinese PLA General Hospital, Beijing, China
| | - Drun Tse
- Department of Pediatrics, Maternity and children’s Hospital of Tibet Autonomous Region, Tibet, China
| | - Dolma Ngawang
- Department of Women and children, Health commission of Tibet autonomous region, Tibet, China
| | - Pedrun Dekyi
- Department of Women and children, Health commission of Tibet autonomous region, Tibet, China
| | - Tao Jiang
- Birth defect prevention and Control Technology Research Center, Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China
| | - Yang Shu
- Birth defect prevention and Control Technology Research Center, Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China
| | - Jiayi Cui
- Birth defect prevention and Control Technology Research Center, Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China
| | - Jing Li
- Department of cardiology, Beijing hospital, Beijing, China
| | - Yaping Tian
- Birth defect prevention and Control Technology Research Center, Medical Innovation Research Division, Chinese PLA General Hospital, Beijing, China,*Correspondence: Yaping Tian,
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Cui B, Wei L, Sun LY, Qu W, Zeng ZG, Liu Y, Zhu ZJ. The effect of liver transplantation for argininemia-the largest experiences in a single center. Transl Pediatr 2022; 11:495-504. [PMID: 35558983 PMCID: PMC9085954 DOI: 10.21037/tp-21-576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/27/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Argininemia, a rare urea cycle disorder resulting from an arginase-1 deficiency, is characterized by a progressive spastic paraplegia. While advances in diagnosis and treatment have increased the management of this condition, not all symptoms are resolved in response to traditional therapies. Interestingly, there exist some rare reports on the use of liver transplantation (LT) for the treatment of argininemia. METHODS We conducted a retrospective study of eleven patients with argininemia receiving a LT as performed at our center over the period from January 2015 to November 2019. These patients were included due to their poor responses to protein restriction diets and alternative therapies of nitrogen scavengers. Detailed information on coagulation, liver function, histopathological and morphological examination of liver samples, and other clinical presentations were extracted from these patients. A grading scale was used for evaluating the neurological status, classification of physical growth and quality of life of these patients in response to the LT. RESULTS Prior to LT, high levels of arginine were detected in all of argininemia patients and liver enzymes were elevated in nine of those patients. Nine patients presented with coagulation dysfunction without bleeding symptoms. Spastic paraplegia, irritability, intellectual developmental disability, and growth deficits were hallmarks of these nine patients, while four patients showed repeated, generalized tonic-clonic seizures before the operation. Seven novel mutations were found in these patients. The indication for LT in this series of patients was a presentation of progressive neurological impairments. After LT, the coagulation index and plasma arginine levels returned to normal and episodes of seizure were controlled in four patients. To date, all patients have survived and their LT has resulted a restoration of arginine metabolism and liver function, along with preventing further neurological deterioration, all of which provided an opportunity for future recuperation. Overall, the neurological status, growth deficits and quality of life were all significantly improved after LT with no evidence of severe complications. CONCLUSIONS LT can serve as an effective treatment for argininemia in patients who respond poorly to traditional therapy. An early intervention of LT should be conducted in these patients to prevent neurological damage and improve their quality of life.
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Affiliation(s)
- Bin Cui
- Liver Transplantation Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, China.,National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Lin Wei
- Liver Transplantation Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, China.,National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Li-Ying Sun
- Liver Transplantation Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, China.,National Clinical Research Center for Digestive Diseases, Beijing, China.,Department of Critical Liver Diseases, Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wei Qu
- Liver Transplantation Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, China.,National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Zhi-Gui Zeng
- Liver Transplantation Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, China.,National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Ying Liu
- Liver Transplantation Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, China.,National Clinical Research Center for Digestive Diseases, Beijing, China
| | - Zhi-Jun Zhu
- Liver Transplantation Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Clinical Center for Pediatric Liver Transplantation, Capital Medical University, Beijing, China.,National Clinical Research Center for Digestive Diseases, Beijing, China
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Cui D, Liu Y, Jin L, Hu L, Cao L. A novel compound heterozygous mutation in the arginase-1 gene identified in a Chinese patient with argininemia: A case report. Medicine (Baltimore) 2020; 99:e21634. [PMID: 32769929 PMCID: PMC7593080 DOI: 10.1097/md.0000000000021634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Arginineemia, also known as arginase deficiency, is a rare autosomal recessive metabolic disease. The diagnosis sometimes may be delayed due to atypical clinical manifestations. Confirmation of arginineemia depends on genetic testing. PATIENT CONCERNS We reported a Chinese male child presenting with hyperargininemia and progressive spastic diplegia, who has a novel compound heterozygous mutation in the arginase-1 (ARG1) gene (c.263-266delAGAA, p.K88Rfs45;c.674T>C,p.L216P), respectively, coming from his mother and father. DIAGNOSIS The patient was diagnosed with argininemia with a novel compound homozygous mutation of the ARG1 gene at the age of 12 years. INTERVENTIONS The patient had a low-protein diet (0.8 g/kg/day). Baclofen, eperisone hydrochloride, botulinum toxin, and rehabilitation training were used to improve his spastic diplegia symptoms for 3 months. OUTCOMES The patient's blood arginine was still high after 3 months' low-protein diet. His spastic diplegia symptoms had not aggravated after 3 months' treatment. CONCLUSIONS Argininemia should be considered in a patient with slowly progressive neurologic manifestations, especially spastic diplegia. This case also suggests that tandem mass spectrometry should be used as an effective tool in the validity of neonatal screening for early diagnosis.
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