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Mathur Y, Shafie A, Alharbi B, Ashour AA, Al-Soud WA, Alhassan HH, Alharethi SH, Anjum F. Genome-Wide Analysis of Kidney Renal Cell Carcinoma: Exploring Differentially Expressed Genes for Diagnostic and Therapeutic Targets. OMICS : A JOURNAL OF INTEGRATIVE BIOLOGY 2023; 27:393-401. [PMID: 37624678 DOI: 10.1089/omi.2023.0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
Kidney renal cell carcinoma (KIRC) is the most common type of renal cancer. Kidney malignancies have been ranked in the top 10 most frequently occurring cancers. KIRC is a prevalent malignancy with a poor prognosis. The disease has risen for the last 40 years, and robust biomarkers for KIRC are needed for precision/personalized medicine. In this bioinformatics study, we utilized genomic data of KIRC patients from The Cancer Genome Atlas for biomarker discovery. A total of 314 samples were used in this study. We identified many differentially expressed genes (DEGs) categorized as upregulated or downregulated. A protein-protein interaction network for the DEGs was then generated and analyzed using the Search Tool for the Retrieval of Interacting Genes plugin of Cytoscape. A set of 10 hub genes was selected based on the Maximum Clique Centrality score defined by the CytoHubba plugin. The elucidated set of genes, that is, CALCA, CRH, TH, CHAT, SLC18A3, FSHB, MYH6, CAV3, KCNA4, and GBX2, were then categorized as potential candidates to be explored as KIRC biomarkers. The survival analysis plots for each gene suggested that alterations in CHAT, CAV3, CRH, MYH6, SLC18A3, and FSHB resulted in decreased survival of KIRC patients. In all, the results suggest that genomic alterations in selected genes can be explored to inform biomarker discovery and for therapeutic predictions in KIRC.
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Affiliation(s)
- Yash Mathur
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, Jamia Nagar, New Delhi, India
| | - Alaa Shafie
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Bandar Alharbi
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Ha'il, Hail, Saudi Arabia
| | - Amal Adnan Ashour
- Department of Oral and Maxillofacial Surgery and Diagnostic Sciences, Faculty of Dentistry, Taif University, Taif, Saudi Arabia
| | - Waleed Abu Al-Soud
- Department of Clinical Laboratory Science, College of Applied Sciences, Jouf University, Sakaka, Saudi Arabia
| | - Hassan H Alhassan
- Department of Clinical Laboratory Science, College of Applied Sciences, Jouf University, Sakaka, Saudi Arabia
| | - Salem Hussain Alharethi
- Department of Biological Science, College of Arts and Science, Najran University, Najran, Saudi Arabia
| | - Farah Anjum
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
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Wang Y, Wang C, Liu M, Xu W, Wang S, Yuan F, Luo X, Xu Q, Yin R, Wang A, Guo M, Lin L, Wang C, Cheng H, Liu Z, Zhang Y, Zeng F, Yan J, Chen Y. Segawa syndrome caused by TH gene mutation and its mechanism. Front Genet 2022; 13:1004307. [PMID: 36568392 PMCID: PMC9772685 DOI: 10.3389/fgene.2022.1004307] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
Dopa-responsive dystonia (DRD), also known as Segawa syndrome, is a rare neurotransmitter disease. The decrease in dopamine caused by tyrosine hydroxylase (TH) gene mutation may lead to dystonia, tremor and severe encephalopathy in children. Although the disease caused by recessive genetic mutation of the tyrosine hydroxylase (TH) gene is rare, we found that the clinical manifestations of seven children with tyrosine hydroxylase gene mutations are similar to dopa-responsive dystonia. To explore the clinical manifestations and possible pathogenesis of the disease, we analyzed the clinical data of seven patients. Next-generation sequencing showed that the TH gene mutation in three children was a reported homozygous mutation (c.698G>A). At the same time, two new mutations of the TH gene were found in other children: c.316_317insCGT, and c.832G>A (p.Ala278Thr). We collected venous blood from four patients with Segawa syndrome and their parents for real-time quantitative polymerase chain reaction analysis of TH gene expression. We predicted the structure and function of proteins on the missense mutation iterative thread assembly refinement (I-TASSER) server and studied the conservation of protein mutation sites. Combined with molecular biology experiments and related literature analysis, the qPCR results of two patients showed that the expression of the TH gene was lower than that in 10 normal controls, and the expression of the TH gene of one mother was lower than the average expression level. We speculated that mutation in the TH gene may clinically manifest by affecting the production of dopamine and catecholamine downstream, which enriches the gene pool of Segawa syndrome. At the same time, the application of levodopa is helpful to the study, diagnosis and treatment of Segawa syndrome.
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Affiliation(s)
- Yilin Wang
- Department of Neurology, Shanghai Children’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Chunmei Wang
- Department of Neurology, Shanghai Children’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Meiyan Liu
- Department of Neurology, Shanghai Children’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Wuhen Xu
- Department of Neurology, Shanghai Children’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Simei Wang
- Department of Neurology, Shanghai Children’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Fang Yuan
- Department of Neurology, Shanghai Children’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Xiaona Luo
- Department of Neurology, Shanghai Children’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Quanmei Xu
- Department of Neurology, Shanghai Children’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Rongrong Yin
- Department of Neurology, Shanghai Children’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Anqi Wang
- Department of Neurology, Shanghai Children’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Miao Guo
- Department of Neurology, Shanghai Children’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Longlong Lin
- Department of Neurology, Shanghai Children’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Chao Wang
- Department of Neurology, Shanghai Children’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Hongyi Cheng
- Department of Neurology, Shanghai Children’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Zhiping Liu
- Department of Neurology, Shanghai Children’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Yuanfeng Zhang
- Department of Neurology, Shanghai Children’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Fanyi Zeng
- Shanghai Key Laboratory of Embryo and Reproduction Engineering, Key Laboratory of Embryo Molecular Biology of National Health Commission, Shanghai Institute of Medical Genetics, Shanghai Chlidren’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Jingbin Yan
- Shanghai Key Laboratory of Embryo and Reproduction Engineering, Key Laboratory of Embryo Molecular Biology of National Health Commission, Shanghai Institute of Medical Genetics, Shanghai Chlidren’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Yucai Chen
- Department of Neurology, Shanghai Children’s Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China,*Correspondence: Yucai Chen,
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Boulghobra A, Abar T, Moussa F, Baudin B, Rodriguez D, Pallandre A, Bonose M. Quantification of monoamine biomarkers in cerebrospinal fluid: comparison of a UHPLC-MS/MS method to a UHPLC coupled to fluorescence detection method. Biomed Chromatogr 2022; 36:e5502. [PMID: 36082489 DOI: 10.1002/bmc.5502] [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: 06/09/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022]
Abstract
Inborn errors of monoamine neurotransmitter metabolism are rare genetic diseases classified as catecholamine and serotonin metabolism disorders or neurotransmitter transportopathies. To diagnose these orphan diseases, monoamine metabolites have been identified and validated as cerebrospinal fluid (CSF) biomarkers: 5-hydroxy-tryptophane, 5-hydroxy-indol-acetic acid, 3-ortho-methyl-DOPA, homovanillic acid, and 3-methoxy-4-hydroxyphenylglycol. The present work presents a UHPLC-MS/MS method developed for the quantification of these metabolites in CSF and compares it to a previously described UHPLC-FD method. MS/MS detection was performed in positive electrospray ionization and multiple reaction monitoring (MRM) mode. The UHPLC-MS/MS and UHPLC-FD methods were validated in terms of accuracy, linearity, precision, and matrix effect. The lower limits of quantification (LLOQ) were ranging between 0.5 nM and 10 nM and between 1 and 5 nM for the UHPLC-MS/MS method and the UHPLC-FD one, respectively. We verified the applicability of both methods by analyzing 30 CSF samples. The measured concentrations were comparable to the reference values described in the literature. The two methods allowed to distinguish pathological samples from healthy ones for clinical diagnosis. UHPLC-MS/MS and UHPLC-FD methods exhibit very close LLOQs. As UHPLC-MS/MS method is more selective, it allows faster analysis with 6 minutes per run versus 10 minutes for the UHPLC-FD method.
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Affiliation(s)
- Ayoub Boulghobra
- Université Paris-Saclay, CNRS, Institut de Chimie Physique, UMR8000, Orsay, FRANCE
| | - Taous Abar
- Université Paris-Saclay, CNRS, Institut de Chimie Physique, UMR8000, Orsay, FRANCE
| | - Fathi Moussa
- Université Paris-Saclay, CNRS, Institut de Chimie Physique, UMR8000, Orsay, FRANCE
| | - Bruno Baudin
- Services de Neuropédiatrie et de Biochimie, Groupe Hospitalier Trousseau Laroche-Guyon, Paris, France
| | - Diana Rodriguez
- Services de Neuropédiatrie et de Biochimie, Groupe Hospitalier Trousseau Laroche-Guyon, Paris, France
| | - Antoine Pallandre
- Université Paris-Saclay, CNRS, Institut de Chimie Physique, UMR8000, Orsay, FRANCE
| | - Myriam Bonose
- Université Paris-Saclay, CNRS, Institut de Chimie Physique, UMR8000, Orsay, FRANCE
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Impact of Nitisinone on the Cerebrospinal Fluid Metabolome of a Murine Model of Alkaptonuria. Metabolites 2022; 12:metabo12060477. [PMID: 35736410 PMCID: PMC9230570 DOI: 10.3390/metabo12060477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Nitisinone-induced hypertyrosinaemia is well documented in Alkaptonuria (AKU), and there is uncertainty over whether it may contribute to a decline in cognitive function and/or mood by altering neurotransmitter metabolism. The aim of this work was to evaluate the impact of nitisinone on the cerebrospinal fluid (CSF) metabolome in a murine model of AKU, with a view to providing additional insight into metabolic changes that occur following treatment with nitisinone. Methods: 17 CSF samples were collected from BALB/c Hgd−/− mice (n = 8, treated with nitisinone—4 mg/L and n = 9, no treatment). Samples were diluted 1:1 with deionised water and analysed using a 1290 Infinity II liquid chromatography system coupled to a 6550 quadrupole time-of-flight mass spectrometry (Agilent, Cheadle, UK). Raw data were processed using a targeted feature extraction algorithm and an established in-house accurate mass retention time database. Matched entities (±10 ppm theoretical accurate mass and ±0.3 min retention time window) were filtered based on their frequency and variability. Experimental groups were compared using a moderated t-test with Benjamini−Hochberg false-discovery rate adjustment. Results: L-Tyrosine, N-acetyl-L-tyrosine, γ-glutamyl-L-tyrosine, p-hydroxyphenylacetic acid, and 3-(4-hydroxyphenyl)lactic acid were shown to increase in abundance (log2 fold change 2.6−6.9, 3/5 were significant p < 0.05) in the mice that received nitisinone. Several other metabolites of interest were matched, but no significant differences were observed, including the aromatic amino acids phenylalanine and tryptophan, and monoamine metabolites adrenaline, 3-methoxy-4-hydroxyphenylglycol, and octopamine. Conclusions: Evaluation of the CSF metabolome of a murine model of AKU revealed a significant increase in the abundance of a limited number of metabolites following treatment with nitisinone. Further work is required to understand the significance of these findings and the mechanisms by which the altered metabolite abundances occur.
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Davison AS, Hughes G, Harrold JA, Clarke P, Griffin R, Ranganath LR. Long-term low dose nitisinone therapy in adults with alkaptonuria shows no cognitive decline or increased severity of depression. JIMD Rep 2022; 63:221-230. [PMID: 35433173 PMCID: PMC8995840 DOI: 10.1002/jmd2.12272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 12/13/2022] Open
Abstract
Little is documented on whether nitisinone-induced hypertyrosinaemia alters cognitive functioning or leads to worsening depression in alkaptonuria (AKU). Wechsler Adult Intelligence Scale-IV (WAIS-IV) and Beck Depression Inventory-II (BDI-II) assessments were performed before and annually following treatment with nitisinone 2 mg daily to assess the impact on cognitive functioning and severity of depression. Serum tyrosine concentrations were also measured annually. WAIS-IV: 63 patients (27 females/36 males: mean age[years] [±standard deviation, range] 55.7[13.7, 26-79]; 60.3[9.6, 19-75]) were included at baseline for assessment of: verbal comprehension (VC), perceptual reasoning (PR), working memory (WM), and processing speed (PS) using separate indices. Over the 6-year period studied 43, 39, 36, 29, 26 and 15 patients had annual assessments. Using a longitudinal model (age and sex adjusted) no significant differences were observed in any of the indices over this period, apart from VC which showed a significant increase after adjustment for sex (p < 0.05). BDI-II: 74 patients (32 females/42 males: mean age[years] [±standard deviation, range] 56.1[13.2, 26-79]; 42 males, 51.5[16.3, 19-70]) were included at baseline. Over the 7-year period studied 48, 47, 38, 34, 32, 24 and 12 patients had annual assessments. No significant differences in BDI-II scores were observed when compared to baseline. Hypertyrosinaemia was observed in all patients following treatment with nitisinone (p < 0.001, at all annual visits). Serum tyrosine was not correlated with WAIS-IV sub-test indices or BDI-II scores pre- or post-nitisinone therapy. These findings suggest that treatment with nitisinone does not affect cognitive functioning and or lead to increased severity of depression.
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Affiliation(s)
- Andrew S. Davison
- Department of Clinical Biochemistry and Metabolic Medicine, Liverpool Clinical LaboratoriesRoyal Liverpool University HospitalLiverpoolUK
| | - Gin Hughes
- Department of PsychologyUniversity of LiverpoolLiverpoolUK
| | | | - Pam Clarke
- Department of PsychologyUniversity of LiverpoolLiverpoolUK
| | - Rebecca Griffin
- Liverpool Cancer Trials UnitUniversity of LiverpoolLiverpoolUK
| | - Lakshminarayan R. Ranganath
- Department of Clinical Biochemistry and Metabolic Medicine, Liverpool Clinical LaboratoriesRoyal Liverpool University HospitalLiverpoolUK
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Havalı C, Dorum S, Ekici A, Görükmez Ö. Approaches for diagnosis and treatment in neurotransmitter disorders of childhood. Metab Brain Dis 2021; 36:2255-2262. [PMID: 34550503 DOI: 10.1007/s11011-021-00838-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
Neurotransmitter disorders are a group of neurometabolic syndromes caused by disturbances of neurotransmitter metabolism. The primary aim of this retrospective study is to present patients with disturbances of monoamine neurotransmitter metabolism. Cerebrospinal fluid (CSF) neurotransmitter measurements and genetic analysis were performed on five patients. Five patients who had various movement disorders and motor and cognitive disabilities were included. Four patients were diagnosed with sepiapterin reductase (SR) deficiency, and one was diagnosed with aromatic L-amino acid decarboxylase (AADC) deficiency. Different treatment responses appeared in patients with SR and AADC deficiency. The responses to drug treatment ranged from good to weak in our patients. The diagnosis process is challenging in patients with SR and AADC deficiency, which present similar clinical features to other neurological and metabolic diseases. Investigations of neurotransmitters in CSF and analysis of related genes are essential to differentiate disturbances of monoamine neurotransmitter metabolism from other neurometabolic diseases. For patients with monoamine neurotransmitter disorders, drugs that target these disturbances should be combined as necessary to produce the appropriate response.
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Affiliation(s)
- Cengiz Havalı
- Department of Pediatrics, Division of Neurology, Bursa Yuksek İhtisas Training and Research Hospital, 16310, Yıldırım/Bursa, Turkey.
| | - Sevil Dorum
- Department of Pediatrics, Division of Metabolism, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Arzu Ekici
- Department of Pediatrics, Division of Neurology, Bursa Yuksek İhtisas Training and Research Hospital, 16310, Yıldırım/Bursa, Turkey
| | - Özlem Görükmez
- Department of Medical Genetics, Bursa Yuksek İhtisas Training and Research Hospital, Bursa, Turkey
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Işıkay S. Late Diagnosis of Pyridoxine-Dependent Epilepsy in Two Adolescent Siblings. Ann Indian Acad Neurol 2021; 24:770-771. [PMID: 35002142 PMCID: PMC8680918 DOI: 10.4103/aian.aian_1282_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 12/29/2020] [Accepted: 03/08/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Sedat Işıkay
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
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Mastrangelo M. Epilepsy in inherited neurotransmitter disorders: Spotlights on pathophysiology and clinical management. Metab Brain Dis 2021; 36:29-43. [PMID: 33095372 DOI: 10.1007/s11011-020-00635-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 10/16/2020] [Indexed: 01/02/2023]
Abstract
Inborn errors of neurotransmitter metabolism are ultrarare disorders affecting neurotransmitter biosynthesis, breakdown or transport or their essential cofactors. Neurotransmitter dysfunctions could also result from the impairment of neuronal receptors, intracellular signaling, vesicle release or other synaptic abnormalities. Epilepsy is the main clinical hallmark in some of these diseases (e.g. disorders of GABA metabolism, glycine encephalopathy) while it is infrequent in others (e.g. all the disorders of monoamine metabolism in exception for dihydropteridine reductase deficiency). This review analyzes the epileptogenic mechanisms, the epilepsy phenotypes and the principle for the clinical management of epilepsy in primary and secondary inherited disorders of neurotransmitter metabolism (disorders of GABA, serine and glycine metabolism, disorders of neurotransmitter receptors and secondary neurotransmitter diseases).
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Affiliation(s)
- Mario Mastrangelo
- Child Neurology and Psychiatry Unit-Department of Human Neuroscience, Sapienza Università di Roma-Umberto I Policlinico di Roma, Via dei Sabelli, 108 - 00141, Roma, Italy.
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Jiang G, Song J, Hu H, Tong X, Dai F. Evaluation of the silkworm lemon mutant as an invertebrate animal model for human sepiapterin reductase deficiency. ROYAL SOCIETY OPEN SCIENCE 2020; 7:191888. [PMID: 32269807 PMCID: PMC7137946 DOI: 10.1098/rsos.191888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/27/2020] [Indexed: 06/11/2023]
Abstract
Human sepiapterin reductase (SR) deficiency is an inherited disease caused by SPR gene mutations and is a monoamine neurotransmitter disorder. Here, we investigated whether the silkworm lemon mutant could serve as a model of SR deficiency. A point mutation in the BmSPR gene led to a five amino acid deletion at the carboxyl terminus in the lemon mutant. In addition, classical phenotypes seen in SR deficient patients were observed in the lemon mutant, including a normal phenylalanine level, a decreased dopamine and serotonin content, and an increased neopterin level. A recovery test showed that the replenishment of l-dopa significantly increased the dopamine level in the lemon mutant. The silkworm lemon mutant also showed negative behavioural abilities. These results suggest that the silkworm lemon mutant has an appropriate genetic basis and meets the biochemical requirements to be a model of SR deficiency. Thus, the silkworm lemon mutant can serve as a candidate animal model of SR deficiency, which may be helpful in facilitating accurate diagnosis and effective treatment options of SR deficiency.
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Affiliation(s)
| | | | | | | | - Fangyin Dai
- Author for correspondence: Fangyin Dai e-mail:
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Monteleone B, Hyland K. Case report: discovery of 2 gene variants for aromatic L-amino acid decarboxylase deficiency in 2 African American siblings. BMC Neurol 2020; 20:12. [PMID: 31918669 PMCID: PMC6953244 DOI: 10.1186/s12883-019-1596-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/30/2019] [Indexed: 11/26/2022] Open
Abstract
Background Aromatic l-amino acid decarboxylase (AADC) deficiency is a rare genetic disorder with heterogeneous phenotypic spectrum resulting from disease-causing variants in the dopa decarboxylase (DDC) gene. Consensus guidelines recommend dopamine agonists, monoamine oxidase inhibitors, and other symptomatic treatments, but most patients have an unrelenting disease course with no response to these therapies. Case presentation We describe 2 African American siblings with AADC deficiency and identify 2 DDC gene variants not previously associated with the disorder. The patients were evaluated for cognitive and neurologic impairments. Diagnosis of AADC deficiency was initially based on evaluation of urine and plasma metabolites, followed by targeted DDC gene sequencing. The first patient, a firstborn African American female, had moderate elevations of vanillactic and vanilpyruvic acids, and slight elevation of N-acetylvanilalanine in urine. The second patient, an African American female and younger sibling of the first patient, had low AADC enzyme activity and elevated 3-O-methyldopa levels in plasma. Genetic testing confirmed that both siblings possessed the same 2 DDC gene variants, which were identified as NM_000790.3: c.48C > A (p.Tyr16Ter) and NM_000790.3: c.116G > C (p.Arg39Pro). Conclusions This report describes 2 previously unknown patients with AADC deficiency and confirmed the presence of 2 DDC gene variants not previously associated with this disorder. Further research is needed to identify disease-modifying treatments for this devastating neurometabolic disorder. Gene therapy with a recombinant adeno-associated viral vector serotype 2 carrying the gene for the human AADC protein (AAV2-hAADC) is currently in clinical development.
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Affiliation(s)
- Berrin Monteleone
- NYU Langone Health Winthrop Pediatric Associates, 120 Mineola Blvd., Suite 210, Mineola, NY, 11501, USA.
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Bayés À. Setting the stage for a role of the postsynaptic proteome in inherited neurometabolic disorders. J Inherit Metab Dis 2018; 41:1093-1101. [PMID: 30132229 PMCID: PMC6326985 DOI: 10.1007/s10545-018-0240-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/26/2018] [Accepted: 08/02/2018] [Indexed: 12/14/2022]
Abstract
Neurotransmitter diseases are a well-defined group of metabolic conditions caused, in most instances, by genes specifically expressed in the presynaptic button. Better understanding of presynaptic molecular physiology, both in normal and pathological conditions, should help develop therapeutical strategies. The clinical relevance of the presynapse in inherited metabolic disorders is in glaring contrast with that of the postsynaptic component, which so far does not seem to play a relevant role in these disorders. This is somewhat surprising, as postsynaptic proteins are known to be involved in many nervous system diseases, particularly in neurodevelopmental and psychiatric disorders. The goal of this article is to explore if defects in the sophisticated postsynaptic machinery could also have a role in neurometabolic disorders.
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Affiliation(s)
- Àlex Bayés
- Molecular Physiology of the Synapse Laboratory, Biomedical Research Institute Sant Pau (IIB Sant Pau), C/Sant Antoni M. Claret, 167, 08025, Barcelona, Spain.
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain.
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Tristán-Noguero A, García-Cazorla À. Synaptic metabolism: a new approach to inborn errors of neurotransmission. J Inherit Metab Dis 2018; 41:1065-1075. [PMID: 30014210 DOI: 10.1007/s10545-018-0235-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/24/2018] [Accepted: 07/05/2018] [Indexed: 01/12/2023]
Abstract
To date, inborn errors of neurotransmitters have been defined based on the classic concept of inborn error of metabolism (IEM), and they include defects in synthesis, catabolism, and transport pathways. However, the omics era is bringing insights into new diseases and is leading to an extended definition of IEM including new categories and mechanisms. Neurotransmission takes place at the synapse, the most specialized tight junction in the brain. The concept of "synaptic metabolism" would point to the specific chemical composition and metabolic functions of the synapse. Based on these specialized functions, we aim to provide a tentative overview about the major categories of IEM susceptible to affect neurotransmission. Small molecule defects (biogenic amines and amino acids) and energy defects are amongst the most prevalent diseases reported to disturb the concentration of CSF neurotransmitters. In these IEM, the neurological phenotypes have been largely described. Disorders of complex molecules are not typically considered as diseases affecting neurotransmission. However, most of them have been recently discovered and are involved in intracellular vesiculation, trafficking, processing, and quality control mechanisms. In this large group, neurotransmission is affected in disorders of chaperones and autophagy, disorders of the synaptic vesicle, and diseases affecting pre-synaptic membranes (synthesis and remodeling of complex lipids, defects of glycosylation). Disorders of the vesicle pools, receptor trafficking, and the chronobiology of neurotransmission are potentially emerging new categories. Finally, although not considered as IEM, channelopathies are a large group of diseases disturbing neurotransmitter homeostasis. New CSF biomarkers will probably contribute to improve the diagnosis of these disorders and find new therapeutic targets.
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Affiliation(s)
- Alba Tristán-Noguero
- Synaptic Metabolism Laboratory, Department of Neurology, Fundació Sant Joan de Déu, Institut Pediàtric de Recerca, Barcelona, Spain
| | - Àngels García-Cazorla
- Synaptic Metabolism Laboratory, Department of Neurology, Fundació Sant Joan de Déu, Institut Pediàtric de Recerca, Barcelona, Spain.
- Neurology Department, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu, 2, 08950, Esplugues, Barcelona, Spain.
- Neurometabolic Unit and Synaptic Metabolism Lab. Department of Neurology, Institut Pediàtric de Recerca, Hospital Sant Joan de Déu and CIBERER (ISCIII), Barcelona, Spain.
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The use of microwave irradiation for quantitative analysis of neurotransmitters in the mouse brain. J Neurosci Methods 2018; 307:188-193. [DOI: 10.1016/j.jneumeth.2018.05.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 05/02/2018] [Accepted: 05/21/2018] [Indexed: 11/23/2022]
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Kantamneni T, Mondok L, Parikh S. Inborn Errors of Metabolism with Movement Disorders: Defects in Metal Transport and Neurotransmitter Metabolism. Pediatr Clin North Am 2018; 65:301-315. [PMID: 29502915 DOI: 10.1016/j.pcl.2017.11.010] [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] [Indexed: 11/16/2022]
Abstract
Movement disorders in the pediatric age group are largely of the hyperkinetic type. Metal ion accumulation in the central nervous system presents predominantly with movement disorders and over time leads to psychomotor decline. Abnormalities in monoamine and amino acidergic neurotransmitter metabolism present in individuals with a combination of abnormal movements, epilepsy, and cognitive and motor delay. Detailed clinical history, careful examination, appropriate diagnostic work-up with metabolic screening, cerebrospinal fluid neurotransmitters, and targeted genetic testing help with accurate diagnosis and appropriate treatment. This article provides an overview on movement disorders present in childhood secondary to inborn errors of metal transport and neurotransmitter metabolism.
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Affiliation(s)
- Trishna Kantamneni
- Department of Neurology, Neurological Institute, Center for Pediatric Neurology, Cleveland Clinic, 9500 Euclid Avenue, S60, Cleveland, OH 44195, USA
| | - Lileth Mondok
- Department of Neurology, Neurological Institute, Center for Pediatric Neurology, Cleveland Clinic, 9500 Euclid Avenue, S60, Cleveland, OH 44195, USA
| | - Sumit Parikh
- Department of Neurology, Neurological Institute, Center for Pediatric Neurology, Cleveland Clinic, 9500 Euclid Avenue, S60, Cleveland, OH 44195, USA.
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Abstract
Many inherited metabolic diseases or inborn errors of metabolism (IEM) cause movement disorders in children. This review focuses on chorea, dystonia, myoclonus, tremor, and parkinsonism. Broad neurometabolic categories commonly responsible for pediatric movement disorders include mitochondrial cytopathies, organic acidemias, mineral metabolism and transport disorders, neurotransmitter diseases, purine metabolism abnormalities, lipid storage conditions, and creatine metabolism dysfunction. Each movement disorder can be caused by many IEM and several of them can cause multiple movement abnormalities. Dietary modifications, medications, and increasingly specific therapy can improve outcomes in children with movement disorders caused by IEM. Recognition and characterization of secondary movement disorders in children facilitate their management and diagnosis, and possible treatment of an underlying IEM.
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Affiliation(s)
- Celanie K Christensen
- Department of Neurology, Section of Child Neurology, Indiana University School of Medicine, Indianapolis, IN; Department of Pediatrics, Section of Developmental Pediatrics, Indiana University School of Medicine, Indianapolis, IN.
| | - Laurence Walsh
- Department of Neurology, Section of Child Neurology, Indiana University School of Medicine, Indianapolis, IN; Department of Pediatrics, Section of Developmental Pediatrics, Indiana University School of Medicine, Indianapolis, IN; Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN
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Lee W, Park NH, Ahn TB, Chung BC, Hong J. Profiling of a wide range of neurochemicals in human urine by very-high-performance liquid chromatography-tandem mass spectrometry combined with in situ selective derivatization. J Chromatogr A 2017; 1526:47-57. [PMID: 29031967 DOI: 10.1016/j.chroma.2017.10.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/28/2017] [Accepted: 10/06/2017] [Indexed: 01/19/2023]
Abstract
Development of a reliable analytical method of neurochemicals in biological fluids is important to discover potential biomarkers for the diagnosis, treatment and prognosis of neurological disorders. However, neurochemical profiling of biological samples is challenging because of highly different polarities between basic and acidic neurochemicals, low physiological levels, and high matrix interference in biological samples. In this study, an ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS) method combined with in situ selective derivatization for comprehensive profiling of 20 neurochemicals in urine was developed for a wide range of neurochemicals. In situ selective derivatization greatly improved the peak capacity on a reversed-phase C18 column and sensitive mass detection in LC-ESI-MS/MS-positive ion mode due to reduction of the distinct physicochemical properties between acidic and basic neurochemicals. The MS/MS spectra of neurochemicals exhibited specific ions, such as losses of amine, methanol, or methyl formate molecules from protonated molecules, enabling selection of appropriate multiple reaction monitoring (MRM) ions for selective and sensitive detection. The developed method was validated in terms of linearity, limit of detection (LOD) and limit of quantification (LOQ), precision, accuracy, and recovery. The correlation coefficients (R2) of calibration curves were above 0.9961. The ranges of LODs and LOQs were 0.1-3.6ng/mL and 0.3-12.0ng/mL, respectively. The overall precision and accuracy were 0.52-16.74% and 82.26-118.17%, respectively. The method was successfully applied to simultaneously profile the metabolic pathways of tyrosine, tryptophan, and glutamate in Parkinson's disease patient urine (PD, n=21) and control urine (n=10). Significant differences (P≤0.01) between two groups in the activity of phenylethanolamine N-methyltransferase (PNMT) and alcohol dehydrogenase (ADH) were observed. In conclusion, this method provides reliable quantification of a wide range of neurochemicals in human urine and would be helpful for finding biomarkers related to specific neuronal diseases.
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Affiliation(s)
- Wonwoong Lee
- College of Pharmacy, Kyung Hee University, Seoul 02447, South Korea
| | - Na Hyun Park
- College of Pharmacy, Kyung Hee University, Seoul 02447, South Korea
| | - Tae-Beom Ahn
- Department of Neurology, College of Medicine, Kyung Hee University, Seoul 02447, South Korea
| | - Bong Chul Chung
- Molecular Recognition Research Center, Korea Institute of Science and Technology, Seoul 02792, South Korea
| | - Jongki Hong
- College of Pharmacy, Kyung Hee University, Seoul 02447, South Korea.
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17
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Zhang W, Zhou Z, Li X, Huang Y, Li T, Lin Y, Shao Y, Hu H, Liu H, Liu L. Dopa-responsive dystonia in Chinese patients: Including a novel heterozygous mutation in the GCH1 gene with an intermediate phenotype and one case of prenatal diagnosis. Neurosci Lett 2017; 644:48-54. [DOI: 10.1016/j.neulet.2017.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/04/2017] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
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18
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Akiyama T, Hayashi Y, Hanaoka Y, Shibata T, Akiyama M, Nakamura K, Tsuyusaki Y, Kubota M, Yoshinaga H, Kobayashi K. Simultaneous measurement of monoamine metabolites and 5-methyltetrahydrofolate in the cerebrospinal fluid of children. Clin Chim Acta 2017; 465:5-10. [DOI: 10.1016/j.cca.2016.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 12/05/2016] [Indexed: 11/29/2022]
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Efficacy of the Ketogenic Diet for the Treatment of Refractory Childhood Epilepsy: Cerebrospinal Fluid Neurotransmitters and Amino Acid Levels. Pediatr Neurol 2015; 53:422-6. [PMID: 26476148 DOI: 10.1016/j.pediatrneurol.2015.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 07/21/2015] [Accepted: 07/26/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The mechanisms of the ketogenic diet remain unclear, but several predictors of response have been proposed. We aimed is to study the relationship between the etiology of epilepsy, cerebrospinal fluid neurotransmitters, pterins, and amino acids, and response to a ketogenic diet. METHODS We studied 60 patients who began classic ketogenic diet treatment for refractory epilepsy. In 24 of 60 individuals, we analyzed cerebrospinal fluid neurotransmitters, pterins, and amino acids in baseline conditions. Mean age at epilepsy onset was 24 months, 83.3% were focal epilepsies, and in 51.7% the etiology of the epilepsy was unknown. RESULTS Six months after initiating the ketogenic diet, it was effective (greater than a 50% reduction in seizure frequency) in 31.6% of patients. We did not find a link between rate of efficacy for the ketogenic diet and etiologies of epilepsy, nor did we find a link between the rate of efficacy for the ketogenic diet and cerebrospinal fluid pterins and biogenic amines concentrations. However, we found statistically significant differences for lysine and arginine values in the cerebrospinal fluid between ketogenic diet responders and nonresponders, but not for the other amino acids analyzed. SIGNIFICANCE The values of some amino acids were significantly different in relationship with the ketogenic diet efficacy; however, the epilepsy etiology and the cerebrospinal fluid biogenic amine and pterin values were not.
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Rodan LH, Gibson KM, Pearl PL. Clinical Use of CSF Neurotransmitters. Pediatr Neurol 2015; 53:277-86. [PMID: 26194033 DOI: 10.1016/j.pediatrneurol.2015.04.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 04/04/2015] [Accepted: 04/06/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cerebrospinal fluid neurotransmitter collection, analysis, and follow-up are integral to the diagnosis and management of multiple inborn metabolic errors, some of which require prompt identification and intervention to improve outcome. Cerebrospinal fluid pterins and monoamine metabolites are diagnostic in a range of primary neurotransmitter disorders, including disorders of biogenic amine synthesis, metabolism, and transport. RELEVANT DISORDERS Recently described mutations of the human dopamine transporter are associated with an elevated cerebrospinal fluid homovanillic acid:hydroxyindoleacetic acid ratio. Disorders of pyridoxine metabolism are also detectable via cerebrospinal fluid quantification of bioamines, amino acids, and pyridoxal-5-phosphate levels. Cerebrospinal fluid amino acids are diagnostic in disorders of gamma aminobutyric acid, glycine, and serine metabolism. A wide range of acquired and genetic disorders has also been associated with secondary alterations in cerebrospinal fluid levels of monoamine metabolites, glycine, and neopterin. CONCLUSIONS Lumbar puncture is required to detect abnormal cerebrospinal fluid metabolites in a significant proportion of these disorders, including treatable entities such as dopa-responsive deficiencies of guanosine-5'-triphosphate cyclohydrolase I (Segawa disease), sepiapterin reductase, and tyrosine hydroxylase.
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Affiliation(s)
- Lance H Rodan
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - K Michael Gibson
- Department of Experimental & Systems Pharmacology, College of Pharmacology, Washington State University, Spokane, Washington
| | - Phillip L Pearl
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
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Lapalme-Remis S, Lewis EC, De Meulemeester C, Chakraborty P, Gibson KM, Torres C, Guberman A, Salomons GS, Jakobs C, Ali-Ridha A, Parviz M, Pearl PL. Natural history of succinic semialdehyde dehydrogenase deficiency through adulthood. Neurology 2015; 85:861-5. [PMID: 26268900 DOI: 10.1212/wnl.0000000000001906] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 03/20/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The natural history of succinic semialdehyde dehydrogenase (SSADH) deficiency in adulthood is unknown; we elucidate the clinical manifestations of the disease later in life. METHODS A 63-year-old man with long-standing intellectual disability was diagnosed with SSADH deficiency following hospitalization for progressive decline, escalating seizures, and prolonged periods of altered consciousness. We present a detailed review of his clinical course and reviewed our SSADH deficiency database adult cohort to derive natural history information. RESULTS Of 95 patients in the database for whom age at diagnosis is recorded, there are 40 individuals currently aged 18 years or older. Only 3 patients were diagnosed after age 18 years. Of 25 adults for whom data are available after age 18, 60% have a history of epilepsy. Predominant seizure types are generalized tonic-clonic, absence, and myoclonic. EEGs showed background slowing or generalized epileptiform discharges in two-thirds of adults for whom EEG data were collected. History of psychiatric symptoms was prominent, with frequent anxiety, sleep disturbances, and obsessive-compulsive disorder. CONCLUSIONS We identified patients older than 18 years with SSADH deficiency in our database following identification and review of a patient diagnosed in the seventh decade of life. The illness had a progressive course with escalating seizures in the index case, with fatality at age 63. Diagnosis in adulthood is rare. Epilepsy is more common in the adult than the pediatric SSADH deficiency cohort; neuropsychiatric morbidity remains prominent.
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Affiliation(s)
- Samuel Lapalme-Remis
- From the Division of Neurology, Department of Medicine (S.L.-R., C.D.M., A.G.) and Department of Radiology (C.T.), The Ottawa Hospital, University of Ottawa, Ontario, Canada; Division of Neurology (E.C.L.) and Department of Pediatrics (P.C.), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada; Division of Experimental and Systems Pharmacology (K.M.G.), Washington State University College of Pharmacy, Spokane, WA; Department of Clinical Chemistry (G.S.S., C.J.), Metabolic Unit, Polikliniek rec. K (PK 1X 009), VU University Medical Center, Amsterdam, the Netherlands; University of Ottawa Eye Institute (A.A.-R.), Ottawa, Ontario, Canada; and Department of Epilepsy & Clinical Neurophysiology (M.P., P.L.P.), Harvard Medical School, Boston Children's Hospital, Boston, MA. Dr. Lapalme-Remis is currently with the Mayo Clinic, Rochester, MN. Dr. Lewis is currently with The Hospital for Sick Children, Toronto, Ontario, Canada. Dr. Ali-Ridha is currently with McGill University, Montreal, Quebec, Canada.
| | - Evan Cole Lewis
- From the Division of Neurology, Department of Medicine (S.L.-R., C.D.M., A.G.) and Department of Radiology (C.T.), The Ottawa Hospital, University of Ottawa, Ontario, Canada; Division of Neurology (E.C.L.) and Department of Pediatrics (P.C.), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada; Division of Experimental and Systems Pharmacology (K.M.G.), Washington State University College of Pharmacy, Spokane, WA; Department of Clinical Chemistry (G.S.S., C.J.), Metabolic Unit, Polikliniek rec. K (PK 1X 009), VU University Medical Center, Amsterdam, the Netherlands; University of Ottawa Eye Institute (A.A.-R.), Ottawa, Ontario, Canada; and Department of Epilepsy & Clinical Neurophysiology (M.P., P.L.P.), Harvard Medical School, Boston Children's Hospital, Boston, MA. Dr. Lapalme-Remis is currently with the Mayo Clinic, Rochester, MN. Dr. Lewis is currently with The Hospital for Sick Children, Toronto, Ontario, Canada. Dr. Ali-Ridha is currently with McGill University, Montreal, Quebec, Canada
| | - Christine De Meulemeester
- From the Division of Neurology, Department of Medicine (S.L.-R., C.D.M., A.G.) and Department of Radiology (C.T.), The Ottawa Hospital, University of Ottawa, Ontario, Canada; Division of Neurology (E.C.L.) and Department of Pediatrics (P.C.), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada; Division of Experimental and Systems Pharmacology (K.M.G.), Washington State University College of Pharmacy, Spokane, WA; Department of Clinical Chemistry (G.S.S., C.J.), Metabolic Unit, Polikliniek rec. K (PK 1X 009), VU University Medical Center, Amsterdam, the Netherlands; University of Ottawa Eye Institute (A.A.-R.), Ottawa, Ontario, Canada; and Department of Epilepsy & Clinical Neurophysiology (M.P., P.L.P.), Harvard Medical School, Boston Children's Hospital, Boston, MA. Dr. Lapalme-Remis is currently with the Mayo Clinic, Rochester, MN. Dr. Lewis is currently with The Hospital for Sick Children, Toronto, Ontario, Canada. Dr. Ali-Ridha is currently with McGill University, Montreal, Quebec, Canada
| | - Pranesh Chakraborty
- From the Division of Neurology, Department of Medicine (S.L.-R., C.D.M., A.G.) and Department of Radiology (C.T.), The Ottawa Hospital, University of Ottawa, Ontario, Canada; Division of Neurology (E.C.L.) and Department of Pediatrics (P.C.), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada; Division of Experimental and Systems Pharmacology (K.M.G.), Washington State University College of Pharmacy, Spokane, WA; Department of Clinical Chemistry (G.S.S., C.J.), Metabolic Unit, Polikliniek rec. K (PK 1X 009), VU University Medical Center, Amsterdam, the Netherlands; University of Ottawa Eye Institute (A.A.-R.), Ottawa, Ontario, Canada; and Department of Epilepsy & Clinical Neurophysiology (M.P., P.L.P.), Harvard Medical School, Boston Children's Hospital, Boston, MA. Dr. Lapalme-Remis is currently with the Mayo Clinic, Rochester, MN. Dr. Lewis is currently with The Hospital for Sick Children, Toronto, Ontario, Canada. Dr. Ali-Ridha is currently with McGill University, Montreal, Quebec, Canada
| | - K Michael Gibson
- From the Division of Neurology, Department of Medicine (S.L.-R., C.D.M., A.G.) and Department of Radiology (C.T.), The Ottawa Hospital, University of Ottawa, Ontario, Canada; Division of Neurology (E.C.L.) and Department of Pediatrics (P.C.), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada; Division of Experimental and Systems Pharmacology (K.M.G.), Washington State University College of Pharmacy, Spokane, WA; Department of Clinical Chemistry (G.S.S., C.J.), Metabolic Unit, Polikliniek rec. K (PK 1X 009), VU University Medical Center, Amsterdam, the Netherlands; University of Ottawa Eye Institute (A.A.-R.), Ottawa, Ontario, Canada; and Department of Epilepsy & Clinical Neurophysiology (M.P., P.L.P.), Harvard Medical School, Boston Children's Hospital, Boston, MA. Dr. Lapalme-Remis is currently with the Mayo Clinic, Rochester, MN. Dr. Lewis is currently with The Hospital for Sick Children, Toronto, Ontario, Canada. Dr. Ali-Ridha is currently with McGill University, Montreal, Quebec, Canada
| | - Carlos Torres
- From the Division of Neurology, Department of Medicine (S.L.-R., C.D.M., A.G.) and Department of Radiology (C.T.), The Ottawa Hospital, University of Ottawa, Ontario, Canada; Division of Neurology (E.C.L.) and Department of Pediatrics (P.C.), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada; Division of Experimental and Systems Pharmacology (K.M.G.), Washington State University College of Pharmacy, Spokane, WA; Department of Clinical Chemistry (G.S.S., C.J.), Metabolic Unit, Polikliniek rec. K (PK 1X 009), VU University Medical Center, Amsterdam, the Netherlands; University of Ottawa Eye Institute (A.A.-R.), Ottawa, Ontario, Canada; and Department of Epilepsy & Clinical Neurophysiology (M.P., P.L.P.), Harvard Medical School, Boston Children's Hospital, Boston, MA. Dr. Lapalme-Remis is currently with the Mayo Clinic, Rochester, MN. Dr. Lewis is currently with The Hospital for Sick Children, Toronto, Ontario, Canada. Dr. Ali-Ridha is currently with McGill University, Montreal, Quebec, Canada
| | - Alan Guberman
- From the Division of Neurology, Department of Medicine (S.L.-R., C.D.M., A.G.) and Department of Radiology (C.T.), The Ottawa Hospital, University of Ottawa, Ontario, Canada; Division of Neurology (E.C.L.) and Department of Pediatrics (P.C.), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada; Division of Experimental and Systems Pharmacology (K.M.G.), Washington State University College of Pharmacy, Spokane, WA; Department of Clinical Chemistry (G.S.S., C.J.), Metabolic Unit, Polikliniek rec. K (PK 1X 009), VU University Medical Center, Amsterdam, the Netherlands; University of Ottawa Eye Institute (A.A.-R.), Ottawa, Ontario, Canada; and Department of Epilepsy & Clinical Neurophysiology (M.P., P.L.P.), Harvard Medical School, Boston Children's Hospital, Boston, MA. Dr. Lapalme-Remis is currently with the Mayo Clinic, Rochester, MN. Dr. Lewis is currently with The Hospital for Sick Children, Toronto, Ontario, Canada. Dr. Ali-Ridha is currently with McGill University, Montreal, Quebec, Canada
| | - Gajja S Salomons
- From the Division of Neurology, Department of Medicine (S.L.-R., C.D.M., A.G.) and Department of Radiology (C.T.), The Ottawa Hospital, University of Ottawa, Ontario, Canada; Division of Neurology (E.C.L.) and Department of Pediatrics (P.C.), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada; Division of Experimental and Systems Pharmacology (K.M.G.), Washington State University College of Pharmacy, Spokane, WA; Department of Clinical Chemistry (G.S.S., C.J.), Metabolic Unit, Polikliniek rec. K (PK 1X 009), VU University Medical Center, Amsterdam, the Netherlands; University of Ottawa Eye Institute (A.A.-R.), Ottawa, Ontario, Canada; and Department of Epilepsy & Clinical Neurophysiology (M.P., P.L.P.), Harvard Medical School, Boston Children's Hospital, Boston, MA. Dr. Lapalme-Remis is currently with the Mayo Clinic, Rochester, MN. Dr. Lewis is currently with The Hospital for Sick Children, Toronto, Ontario, Canada. Dr. Ali-Ridha is currently with McGill University, Montreal, Quebec, Canada
| | - Cornelis Jakobs
- From the Division of Neurology, Department of Medicine (S.L.-R., C.D.M., A.G.) and Department of Radiology (C.T.), The Ottawa Hospital, University of Ottawa, Ontario, Canada; Division of Neurology (E.C.L.) and Department of Pediatrics (P.C.), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada; Division of Experimental and Systems Pharmacology (K.M.G.), Washington State University College of Pharmacy, Spokane, WA; Department of Clinical Chemistry (G.S.S., C.J.), Metabolic Unit, Polikliniek rec. K (PK 1X 009), VU University Medical Center, Amsterdam, the Netherlands; University of Ottawa Eye Institute (A.A.-R.), Ottawa, Ontario, Canada; and Department of Epilepsy & Clinical Neurophysiology (M.P., P.L.P.), Harvard Medical School, Boston Children's Hospital, Boston, MA. Dr. Lapalme-Remis is currently with the Mayo Clinic, Rochester, MN. Dr. Lewis is currently with The Hospital for Sick Children, Toronto, Ontario, Canada. Dr. Ali-Ridha is currently with McGill University, Montreal, Quebec, Canada
| | - Andre Ali-Ridha
- From the Division of Neurology, Department of Medicine (S.L.-R., C.D.M., A.G.) and Department of Radiology (C.T.), The Ottawa Hospital, University of Ottawa, Ontario, Canada; Division of Neurology (E.C.L.) and Department of Pediatrics (P.C.), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada; Division of Experimental and Systems Pharmacology (K.M.G.), Washington State University College of Pharmacy, Spokane, WA; Department of Clinical Chemistry (G.S.S., C.J.), Metabolic Unit, Polikliniek rec. K (PK 1X 009), VU University Medical Center, Amsterdam, the Netherlands; University of Ottawa Eye Institute (A.A.-R.), Ottawa, Ontario, Canada; and Department of Epilepsy & Clinical Neurophysiology (M.P., P.L.P.), Harvard Medical School, Boston Children's Hospital, Boston, MA. Dr. Lapalme-Remis is currently with the Mayo Clinic, Rochester, MN. Dr. Lewis is currently with The Hospital for Sick Children, Toronto, Ontario, Canada. Dr. Ali-Ridha is currently with McGill University, Montreal, Quebec, Canada
| | - Mahsa Parviz
- From the Division of Neurology, Department of Medicine (S.L.-R., C.D.M., A.G.) and Department of Radiology (C.T.), The Ottawa Hospital, University of Ottawa, Ontario, Canada; Division of Neurology (E.C.L.) and Department of Pediatrics (P.C.), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada; Division of Experimental and Systems Pharmacology (K.M.G.), Washington State University College of Pharmacy, Spokane, WA; Department of Clinical Chemistry (G.S.S., C.J.), Metabolic Unit, Polikliniek rec. K (PK 1X 009), VU University Medical Center, Amsterdam, the Netherlands; University of Ottawa Eye Institute (A.A.-R.), Ottawa, Ontario, Canada; and Department of Epilepsy & Clinical Neurophysiology (M.P., P.L.P.), Harvard Medical School, Boston Children's Hospital, Boston, MA. Dr. Lapalme-Remis is currently with the Mayo Clinic, Rochester, MN. Dr. Lewis is currently with The Hospital for Sick Children, Toronto, Ontario, Canada. Dr. Ali-Ridha is currently with McGill University, Montreal, Quebec, Canada
| | - Phillip L Pearl
- From the Division of Neurology, Department of Medicine (S.L.-R., C.D.M., A.G.) and Department of Radiology (C.T.), The Ottawa Hospital, University of Ottawa, Ontario, Canada; Division of Neurology (E.C.L.) and Department of Pediatrics (P.C.), Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada; Division of Experimental and Systems Pharmacology (K.M.G.), Washington State University College of Pharmacy, Spokane, WA; Department of Clinical Chemistry (G.S.S., C.J.), Metabolic Unit, Polikliniek rec. K (PK 1X 009), VU University Medical Center, Amsterdam, the Netherlands; University of Ottawa Eye Institute (A.A.-R.), Ottawa, Ontario, Canada; and Department of Epilepsy & Clinical Neurophysiology (M.P., P.L.P.), Harvard Medical School, Boston Children's Hospital, Boston, MA. Dr. Lapalme-Remis is currently with the Mayo Clinic, Rochester, MN. Dr. Lewis is currently with The Hospital for Sick Children, Toronto, Ontario, Canada. Dr. Ali-Ridha is currently with McGill University, Montreal, Quebec, Canada
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22
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Cirillo M, Venkatesan C, Millichap JJ, Stack CV, Nordli DR. Case Report: Intravenous and Oral Pyridoxine Trial for Diagnosis of Pyridoxine-Dependent Epilepsy. Pediatrics 2015; 136:e257-61. [PMID: 26101365 DOI: 10.1542/peds.2014-2423] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pyridoxine-dependent epilepsy is a rare, autosomal recessive, treatable cause of neonatal seizures. Genetic testing can confirm mutations in the ALDH7A1 gene, which encodes antiquitin. To avoid delays in initiating treatment while awaiting confirmatory genetic testing, it is recommended that all neonates with unexplained seizures should receive trial of intravenous (IV) pyridoxine to assess for responsiveness. However, oral pyridoxine is not commonly continued in the absence of the typical EEG changes. Two cases are presented that highlight the potential inadequacy of this single-step approach. One neonate ultimately diagnosed with pyridoxine-dependent seizures had no EEG changes after administration of IV pyridoxine. In contrast, another neonate who did not have this diagnosis had profound EEG changes after pyridoxine administration. We present 2 cases that highlight the difficulties in using initial EEG response to IV pyridoxine in establishing a diagnosis of pyridoxine-dependent seizures in the neonate. Given the availability of biochemical markers and gene testing, we suggest that oral pyridoxine treatment should be continued until biochemical and/or genetic testing has confirmed the presence or absence of pyridoxine-dependent epilepsy.
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Affiliation(s)
- Melissa Cirillo
- Division of Neurology, and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Charu Venkatesan
- Division of Neurology, and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John J Millichap
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois Epilepsy Center, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and
| | - Cynthia V Stack
- Division of Neurology, and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Douglas R Nordli
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois Epilepsy Center, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; and
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23
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Stafstrom CE, Carmant L. Seizures and epilepsy: an overview for neuroscientists. Cold Spring Harb Perspect Med 2015; 5:5/6/a022426. [PMID: 26033084 DOI: 10.1101/cshperspect.a022426] [Citation(s) in RCA: 386] [Impact Index Per Article: 42.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Epilepsy is one of the most common and disabling neurologic conditions, yet we have an incomplete understanding of the detailed pathophysiology and, thus, treatment rationale for much of epilepsy. This article reviews the clinical aspects of seizures and epilepsy with the goal of providing neuroscientists an introduction to aspects that might be amenable to scientific investigation. Seizures and epilepsy are defined, diagnostic methods are reviewed, various clinical syndromes are discussed, and aspects of differential diagnosis, treatment, and prognosis are considered to enable neuroscientists to formulate basic and translational research questions.
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Affiliation(s)
- Carl E Stafstrom
- Division of Pediatric Neurology, Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287
| | - Lionel Carmant
- Division of Neurology, Department of Pediatrics, Sainte-Justine Hospital, Universite Montreal, Montreal, Quebec H3T 1C5, Canada
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24
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Mercimek-Mahmutoglu S, Sidky S, Hyland K, Patel J, Donner EJ, Logan W, Mendoza-Londono R, Moharir M, Raiman J, Schulze A, Siriwardena K, Yoon G, Kyriakopoulou L. Prevalence of inherited neurotransmitter disorders in patients with movement disorders and epilepsy: a retrospective cohort study. Orphanet J Rare Dis 2015; 10:12. [PMID: 25758715 PMCID: PMC4342151 DOI: 10.1186/s13023-015-0234-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/27/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Inherited neurotransmitter disorders are primary defects of neurotransmitter metabolism. The main purpose of this retrospective cohort study was to identify prevalence of inherited neurotransmitter disorders. METHODS This retrospective cohort study does not have inclusion criteria; rather included all patients who underwent cerebrospinal fluid (CSF) homovanillic and 5-hydroxyindol acetic acid measurements. Patients with CSF neurotransmitter investigations suggestive of an inherited neurotransmitter disorder and patients with normal or non-diagnostic CSF neurotransmitter investigations underwent direct sequencing of single gene disorders. RESULTS There were 154 patients between October 2004 and July 2013. Four patients were excluded due to their diagnosis prior to this study dates. Two major clinical feature categories of patients who underwent lumbar puncture were movement disorders or epilepsy in our institution. Twenty out of the 150 patients (13.3%) were diagnosed with a genetic disorder including inherited neurotransmitter disorders (6 patients) (dihydropteridine reductase, 6-pyruvoyl-tetrahydropterin synthase, guanosine triphosphate cyclohydrolase I, tyrosine hydroxylase, pyridoxine dependent epilepsy due to mutations in the ALDH7A1 gene and pyridoxamine-5-phosphate oxidase deficiencies) and non-neurotransmitter disorders (14 patients). CONCLUSION Prevalence of inherited neurotransmitter disorders was 4% in our retrospective cohort study. Eight out of the 150 patients (5.3%) had one of the treatable inherited metabolic disorders with favorable short-term neurodevelopmental outcomes, highlighting the importance of an early and specific diagnosis. Whole exome or genome sequencing might shed light to unravel underlying genetic defects of new inherited neurotransmitter disorders in near future.
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Affiliation(s)
- Saadet Mercimek-Mahmutoglu
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada. .,Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada. .,Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, Genetic and Genome Biology, Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
| | - Sarah Sidky
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
| | | | - Jaina Patel
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
| | - Elizabeth J Donner
- Division of Neurology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
| | - William Logan
- Division of Neurology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
| | - Roberto Mendoza-Londono
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
| | - Mahendranath Moharir
- Division of Neurology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
| | - Julian Raiman
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
| | - Andreas Schulze
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada. .,Genetics and Genome Biology, Research Institute, The Hospital for Sick Children, Toronto, Canada.
| | - Komudi Siriwardena
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
| | - Grace Yoon
- Division of Clinical and Metabolic Genetics, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada. .,Division of Neurology, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
| | - Lianna Kyriakopoulou
- Biochemical Genetics Laboratory, Department of Laboratory Medicine, University of Toronto, The Hospital for Sick Children, Toronto, Canada.
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Chen PW, Lee NC, Chien YH, Wu JY, Wang PC, Hwu WL. Diagnosis of aromatic l-amino acid decarboxylase deficiency by measuring 3-O-methyldopa concentrations in dried blood spots. Clin Chim Acta 2014; 431:19-22. [DOI: 10.1016/j.cca.2014.01.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/22/2014] [Accepted: 01/22/2014] [Indexed: 11/16/2022]
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Serotonin metabolites in the cerebrospinal fluid in sudden infant death syndrome. J Neuropathol Exp Neurol 2014; 73:115-22. [PMID: 24423636 DOI: 10.1097/nen.0000000000000034] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Forensic biomarkers are needed in sudden infant death syndrome (SIDS) to help identify this group among other sudden unexpected deaths in infancy. Previously, we reported multiple serotonergic (5-HT) abnormalities in nuclei of the medulla oblongata that help mediate protective responses to homeostatic stressors. As a first step toward their assessment as forensic biomarkers of medullary pathology, here we test the hypothesis that 5-HT-related measures are abnormal in the cerebrospinal fluid (CSF) of SIDS infants compared with those of autopsy controls. Levels of CSF 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA), the degradative products of 5-HT and dopamine, respectively, were measured by high-performance liquid chromatography in 52 SIDS and 29 non-SIDS autopsy cases. Tryptophan (Trp) and tyrosine (Tyr), the substrates of 5-HT and dopamine, respectively, were also measured. There were no significant differences in 5-HIAA, Trp, HVA, or Tyr levels between the SIDS and non-SIDS groups. These data preclude the use of 5-HIAA, HVA, Trp, or Tyr measurements as CSF autopsy biomarkers of 5-HT medullary pathology in infants who have died suddenly and unexpectedly. They do, however, provide important information about monoaminergic measurements in human CSF at autopsy and their developmental profile in infancy that is applicable to multiple pediatric disorders beyond SIDS.
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Koht J, Rengmark A, Opladen T, Bjørnarå KA, Selberg T, Tallaksen CME, Blau N, Toft M. Clinical and genetic studies in a family with a novel mutation in the sepiapterin reductase gene. Acta Neurol Scand 2014:7-12. [PMID: 24588500 DOI: 10.1111/ane.12230] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Sepiapterin reductase deficiency is a rare, but treatable inherited disorder of tetrahydrobiopterin and neurotransmitter metabolism. This disorder is most probably underdiagnosed. To date, only 44 cases have been described in the literature. We present the clinical and genetic investigations in a family with a complex movement disorder. MATERIALS AND METHODS We examined two affected sisters and three healthy family members. The cerebrospinal fluid was analyzed for neurotransmitter and pterins, and the sepiapterin reductase gene (SPR) was sequenced. RESULTS The sisters had a complex movement disorders with dystonia and diurnal fluctuations. Both had oculogyric crises, and the older sister also hypersomnia. Both sisters had raised prolactin levels twice above the reference level. One sister had a dramatic response to levodopa, the other responded, but developed dyskinesia despite low doses. Both patients improved dramatically over time with levodopa (2.3 and 1.5 mg/kg/day). Very low levels of homovanillic acid and 5-hydroxyindoleacetic acid and increased levels of sepiapterin and dihydrobiopterin were measured in the cerebrospinal fluid before treatment. DNA analyses revealed a novel homozygous mutation in exon 2 in the SPR gene, c.364A>G/p.(Tyr123Cys), located in a highly conserved region in the gene. Both parents and the healthy sister were carriers for the same mutation. CONCLUSIONS A new homozygous mutation in the SPR gene was found in two sisters with dopa-responsive dystonia. This important and treatable neurotransmitter disorder must be considered in patients with a complex movement disorder with diurnal fluctuations with or without intellectual impairment. Patients with these symptoms should undergo levodopa trial, cerebrospinal fluid investigations, and genetic analyses.
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Affiliation(s)
- J. Koht
- Department of Neurology; Drammen Hospital; Vestre Viken Health Trust; Drammen Norway
| | - A. Rengmark
- Department of Neurology; Oslo University Hospital; Rikshospitalet; Oslo Norway
| | - T. Opladen
- Department of General Pediatrics; University of Heidelberg; Heidelberg Germany
| | - K. A. Bjørnarå
- Department of Neurology; Drammen Hospital; Vestre Viken Health Trust; Drammen Norway
| | - T. Selberg
- Department of Habilitation; Drammen Hospital; Vestre Viken Health Trust; Drammen Norway
| | - C. M. E. Tallaksen
- Faculty of Medicine; University of Oslo; Oslo Norway
- Department of Neurology; Oslo University Hospital; Ullevål Norway
| | - N. Blau
- Department of General Pediatrics; University of Heidelberg; Heidelberg Germany
| | - M. Toft
- Department of Neurology; Oslo University Hospital; Rikshospitalet; Oslo Norway
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Abstract
Selecting the appropriate treatment for dystonia begins with proper classification of disease based on age, distribution, and underlying etiology. The therapies available for dystonia include oral medications, botulinum toxin, and surgical procedures. Oral medications are generally reserved for generalized and segmental dystonia. Botulinum toxin revolutionized the treatment of focal dystonia when it was introduced for therapeutic purposes in the 1980s. Surgical procedures are available for medication-refractory dystonia, markedly affecting an individual's quality of life.
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Affiliation(s)
- Mary Ann Thenganatt
- Parkinson’s Disease Center & Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 6550 Fannin, Suite 1801, Houston, TX 77030 USA
| | - Joseph Jankovic
- Parkinson’s Disease Center & Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, 6550 Fannin, Suite 1801, Houston, TX 77030 USA
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Ganos C, Biskup S, Krüger S, Meyer-Osores A, Hodecker S, Hagel C, Schöls L, Bhatia KP, Münchau A. Dystonia with aphonia, slow horizontal saccades, epilepsy and photic myoclonus: a novel syndrome? Parkinsonism Relat Disord 2013; 20:328-31. [PMID: 24359844 DOI: 10.1016/j.parkreldis.2013.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/05/2013] [Accepted: 11/15/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dystonia with anarthria and/or aphonia is a rare syndromic association. Here we present two cases with slowly progressive, severe generalized dystonia and aphonia, slow horizontal saccades, epilepsy and photic myoclonus. METHODS Detailed clinical data were collected over two decades in the female (index) patient and for nine years in her similarly affected son. Sanger sequencing followed by exome sequencing was performed. RESULTS Both patients had leg onset generalized dystonia with gradual rostral spread including prominent facial and oro-mandibular involvement. The index patient was anarthric, her son aphonic. Both had saccadic slowing, more marked for the horizontal plane, and subclinical epileptic activity. The index patient also had photic myoclonus and a combined axonal and demyelinating neuropathy. Known genetic causes of similar syndromes were not identified. CONCLUSION These cases with caudo-rostrally spreading generalized dystonia with prominent facial and oro-mandibular involvement, severe speech impairment, marked slowing of horizontal saccades, and photic myoclonus likely represent a novel entity.
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Affiliation(s)
- Christos Ganos
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, United Kingdom; Department of Neurology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany; Department of Paediatric and Adult Movement Disorders and Neuropsychiatry, Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.
| | - Saskia Biskup
- Department of Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, Germany; German Center for Neurogenerative Diseases, Tübingen, Germany; CeGaT GmbH, Tübingen, Germany
| | - Stefanie Krüger
- Department of Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, Germany; German Center for Neurogenerative Diseases, Tübingen, Germany; CeGaT GmbH, Tübingen, Germany
| | - Aracelli Meyer-Osores
- Clinic for Degenerative Brain Diseases, Department of Pediatrics, University Medical, Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
| | - Sibylle Hodecker
- Department of Neurology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christian Hagel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
| | - Ludger Schöls
- Department of Neurology and Hertie Institute for Clinical Brain Research, University of Tübingen, Germany; German Center for Neurogenerative Diseases, Tübingen, Germany
| | - Kailash P Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, United Kingdom
| | - Alexander Münchau
- Department of Paediatric and Adult Movement Disorders and Neuropsychiatry, Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
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Papetti L, Parisi P, Leuzzi V, Nardecchia F, Nicita F, Ursitti F, Marra F, Paolino MC, Spalice A. Metabolic epilepsy: an update. Brain Dev 2013; 35:827-41. [PMID: 23273990 DOI: 10.1016/j.braindev.2012.11.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 10/23/2012] [Accepted: 11/25/2012] [Indexed: 10/27/2022]
Abstract
Inborn errors of metabolism comprise a large class of genetic diseases involving disorders of metabolism. Presentation is usually in the neonatal period or infancy but can occur at any time, even in adulthood. Seizures are frequent symptom in inborn errors of metabolism, with no specific seizure types or EEG signatures. The diagnosis of a genetic defect or an inborn error of metabolism often results in requests for a vast array of biochemical and molecular tests leading to an expensive workup. However a specific diagnosis of metabolic disorders in epileptic patients may provide the possibility of specific treatments that can improve seizures. In a few metabolic diseases, epilepsy responds to specific treatments based on diet or supplementation of cofactors (vitamin-responsive epilepsies), but for most of them specific treatment is unfortunately not available, and conventional antiepileptic drugs must be used, often with no satisfactory success. In this review we present an overview of metabolic epilepsies based on various criteria such as treatability, age of onset, seizure type, and pathogenetic background.
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Affiliation(s)
- Laura Papetti
- Department of Pediatrics, Child Neurology Division, Sapienza University of Rome, Italy
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31
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Abstract
Pediatric neurotransmitter disorders refer to a constellation of inherited neurometabolic syndromes attributable to disturbances of neurotransmitter synthesis, degradation, or transport. Monoamine deficiencies represent defects in synthesis of dopamine, serotonin, norepinephrine, and epinephrine or in availability of tetrahydrobiopterin, an important cofactor for monoamine synthesis. Some disorders do not manifest peripheral hyperphenyalaninemia and require CSF neurotransmitter metabolite assay for diagnosis. These include Segawa dopa-responsive dystonia and enzymatic deficiencies of aromatic amino acid decarboxylase, tyrosine hydroxylase, and sepiapterin reductase. The first, autosomal dominantly inherited GTP cyclohydrolase deficiency, has a satisfying response to therapy at any age with benefits maintained over time. The others have more severe and treatment-refractory phenotypes, typically with manifestations well beyond movement disorders. Disorders detectable by elevated serum phenylalanine are deficiencies of GTP cyclohydrolase (homozygous), pterin-carbinolamine dehydratase, dihydropteridine reductase, and pyruvoyl-tetrahydropterin synthase. The latter is the most prevalent and heterogeneous but typically has infantile onset with extrapyramidal as well as bulbar, hypothalamic, limbic, and epileptic manifestations. There are therapeutic roles for neurotransmitter supplementation, and dopaminergic agonists. Basal ganglia calcifications in dihydropteridine reductase deficiency are reversible with folinic acid. Deficiencies of monoamine degradation lead to cognitive, behavioral, and autonomic disorders.
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Affiliation(s)
- Phillip L Pearl
- Children's National Medical Center, George Washington University School of Medicine and Columbian College of Arts and Sciences, Washington, DC, USA.
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32
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Brumback RA. "3 . . 2 . . 1 . . Impact [factor]: target [academic career] destroyed!": just another statistical casualty. J Child Neurol 2012. [PMID: 23183597 DOI: 10.1177/0883073812465014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
"Publish or perish" is the time-honored "principle" for academicians who race to accumulate lines under the "publications" section of a curriculum vitae. The original intent of publication-to inform others of findings and further scientific knowledge-has been corrupted by factors including (1) exponential growth of journals and the journal industry, fueled in part by intrusion of the Internet into all aspects of academic life; and (2) adoption of journal metrics (rather than written content) as the measure of scientific quality. The proprietary Thomson Reuters Impact Factor is the most pernicious metric, having caused editors and publishers to change editorial practices to boost the number. At the same time, gullible administrators and government agencies have been persuaded that metrics for the journal in which materials are published can be used as a measure of the worth of individual investigators (and institutions) and their research efforts: simple numbers can be substituted for the burdensome effort required to read and assess research quality. Thus, granting of research funds, awarding of academic rank and tenure, and determination of salaries (including bonus payments) have become tied to manipulable journal metrics rather than the significance or quality of reported research. Therefore, it is no wonder that the integrity of science is more often being questioned. How should a young investigator approach the "publish or perish" dilemma? Performing sound research and preparing optimal materials for publication must remain the overriding goals: properly articulate the question addressed by the study; thoroughly document all methods and case information; carefully describe results including any conflicting or negative findings; discuss the importance of the findings along with how the results address the initial question and whether findings refute or confirm previous studies; prepare properly cited bibliographic references; list all author contributions, potential conflicts of interest, financial support, and required ethical approvals; and provide a catchy title and an abstract containing sufficient information that other investigators perusing scientific indices will be enticed to read the published article. Submit the completed manuscript to the most appropriate journal based on that journal's previously published content and relevance to the field of study regardless of journal metrics. On publication, notify investigators in the same field to ask for their comments on the work. Thus, an individual will become known for the quality of his or her work product and the worshiping of publication metrics will be unnecessary.
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Abstract
Neuronal ceroid lipofuscinosis is a severe neurodegenerative lysosomal storage disorder. Gamma-aminobutyric acid and glutamate deficiency have been reported with CLN1, CLN3, and CLN6. Isolated biopterin/neopterin without dopamine deficiency has been reported in 1 patient with a CLN2 mutation. This report describes a patient with a CLN2 mutation with symptomatic biopterin and dopamine deficiency. A 4-year-old boy presented with intractable epilepsy and developmental regression starting 1 year previously. His exam showed retinopathy, scanning speech, dysmetria, and ataxic fenestrating gait with stooped posture. Electroencephalogram showed generalized spikes with occipital spikes on slow photic stimulation. Brain magnetic resonance images 1 year apart showed significant diffuse atrophy. CLN2 gene sequencing showed pathogenic compound heterozygous mutations. Cerebrospinal fluid neurotransmitters showed low homovanillic acid and tetrahydrobiopterin. Levodopa-carbidopa resulted in dramatic improvement of gait. Dopamine/biopterin deficiency is a possible secondary manifestation of CLN2 mutations. Levodopa and dopamine agonists might be useful in treating these secondary abnormalities and improving quality of life in these patients.
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Affiliation(s)
- Ngoc Minh D Le
- Center for Pediatric Neurology, Cleveland Clinic, Cleveland, OH 44195, USA
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Szentiványi K, Hansíková H, Krijt J, Vinšová K, Tesařová M, Rozsypalová E, Klement P, Zeman J, Honzík T. Novel Mutations in the Tyrosine Hydroxylase Gene in the First Czech Patient with Tyrosine Hydroxylase Deficiency. Prague Med Rep 2012; 113:136-46. [DOI: 10.14712/23362936.2015.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Tyrosine hydroxylase deficiency manifests mainly in early childhood and includes two clinical phenotypes: an infantile progressive hypokinetic-rigid syndrome with dystonia (type A) and a neonatal complex encephalopathy (type B). The biochemical diagnostics is exclusively based on the quantitative determination of the neurotransmitters or their metabolites in cerebrospinal fluid (CSF). The implementation of neurotransmitter analysis in clinical praxis is necessary for early diagnosis and adequate treatment. Neurotransmitter metabolites in CSF were analyzed in 82 children (at the age 1 month to 17 years) with clinical suspicion for neurometabolic disorders using high performance liquid chromatography (HPLC) with electrochemical detection. The CSF level of homovanillic acid (HVA) was markedly decreased in three children (64, 79 and 94 nmol/l) in comparison to age related controls (lower limit 218–450 nmol/l). Neurological findings including severe psychomotor retardation, quadruspasticity and microcephaly accompanied with marked dystonia, excessive sweating in the first patient was compatible with the diagnosis of tyrosine hydroxylase (TH) deficiency (type B) and subsequent molecular analysis revealed two novel heterozygous mutations c.636A>C and c.1124G>C in theTHgene. The treatment with L-DOPA/carbidopa resulted in the improvement of dystonia. Magnetic resonance imaging studies in two other patients with microcephaly revealed postischaemic brain damage, therefore secondary HVA deficit was considered in these children. Diagnostic work-up in patients with neurometabolic disorders should include analysis of neurotransmitter metabolites in CSF.
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Lee HCH, Lai CK, Yau KCE, Siu TS, Mak CM, Yuen YP, Chan KY, Tam S, Lam CW, Chan AYW. Non-invasive urinary screening for aromatic l-amino acid decarboxylase deficiency in high-prevalence areas: A pilot study. Clin Chim Acta 2012; 413:126-30. [DOI: 10.1016/j.cca.2011.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Revised: 09/06/2011] [Accepted: 09/07/2011] [Indexed: 10/17/2022]
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Kinney HC, Broadbelt KG, Haynes RL, Rognum IJ, Paterson DS. The serotonergic anatomy of the developing human medulla oblongata: implications for pediatric disorders of homeostasis. J Chem Neuroanat 2011; 41:182-99. [PMID: 21640183 DOI: 10.1016/j.jchemneu.2011.05.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 04/25/2011] [Accepted: 05/06/2011] [Indexed: 12/18/2022]
Abstract
The caudal serotonergic (5-HT) system is a critical component of a medullary "homeostatic network" that regulates protective responses to metabolic stressors such as hypoxia, hypercapnia, and hyperthermia. We define anatomically the caudal 5-HT system in the human medulla as 5-HT neuronal cell bodies located in the raphé (raphé obscurus, raphé magnus, and raphé pallidus), extra-raphé (gigantocellularis, paragigantocellularis lateralis, intermediate reticular zone, lateral reticular nucleus, and nucleus subtrigeminalis), and ventral surface (arcuate nucleus). These 5-HT neurons are adjacent to all of the respiratory- and autonomic-related nuclei in the medulla where they are positioned to modulate directly the responses of these effector nuclei. In the following review, we highlight the topography and development of the caudal 5-HT system in the human fetus and infant, and its inter-relationships with nicotinic, GABAergic, and cytokine receptors. We also summarize pediatric disorders in early life which we term "developmental serotonopathies" of the caudal (as well as rostral) 5-HT domain and which are associated with homeostatic imbalances. The delineation of the development and organization of the human caudal 5-HT system provides the critical foundation for the neuropathologic elucidation of its disorders directly in the human brain.
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Affiliation(s)
- Hannah C Kinney
- Department of Pathology, Children's Hospital Boston and Harvard Medical School, Boston, MA 02115, United States
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Yeung WL, Wong VCN, Chan KY, Hui J, Fung CW, Yau E, Ko CH, Lam CW, Mak CM, Siu S, Low L. Expanding phenotype and clinical analysis of tyrosine hydroxylase deficiency. J Child Neurol 2011; 26:179-87. [PMID: 20823027 DOI: 10.1177/0883073810377014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study included 12 Chinese patients with a wide spectrum of phenotypes of tyrosine hydroxylase deficiency. Seven females and 5 males, aged 2.2 to 41 years, had phenotypes ranging from severe type with onset at infancy to mild type with onset after 3 years of age. Patients with the severe type had encephalopathy with poor treatment response or infantile parkinsonism with motor delay. Patients with the less common mild type had dopa-responsive dystonia or a newly recognized predominant symptom of myopathy. Female siblings had more severe phenotypes. The phenotype and treatment outcomes were strongly related to a homovanillic acid level and homovanillic acid/5-hydroxyindolacetic acid ratio of less than 1 in the cerebrospinal fluid. Hyperprolactinemia was found in 50% of the severe cases. Levodopa was the mainstay of treatment, and early addition of selegiline resulted in a remarkable response in some patients. Treatment response for mild-type patients is universally good even with a treatment delay of 10 years after onset of neurological symptoms.
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Affiliation(s)
- Wai-Lan Yeung
- Department of Paediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
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Clinical and molecular characterisation of hereditary dopamine transporter deficiency syndrome: an observational cohort and experimental study. Lancet Neurol 2010; 10:54-62. [PMID: 21112253 PMCID: PMC3002401 DOI: 10.1016/s1474-4422(10)70269-6] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND dopamine transporter deficiency syndrome is the first identified parkinsonian disorder caused by genetic alterations of the dopamine transporter. We describe a cohort of children with mutations in the gene encoding the dopamine transporter (SLC6A3) with the aim to improve clinical and molecular characterisation, reduce diagnostic delay and misdiagnosis, and provide insights into the pathophysiological mechanisms. METHODS 11 children with a biochemical profile suggestive of dopamine transporter deficiency syndrome were enrolled from seven paediatric neurology centres in the UK, Germany, and the USA from February, 2009, and studied until June, 2010. The syndrome was characterised by detailed clinical phenotyping, biochemical and neuroradiological studies, and SLC6A3 mutation analysis. Mutant constructs of human dopamine transporter were used for in-vitro functional analysis of dopamine uptake and cocaine-analogue binding. FINDINGS children presented in infancy (median age 2·5 months, range 0·5-7) with either hyperkinesia (n=5), parkinsonism (n=4), or a mixed hyperkinetic and hypokinetic movement disorder (n=2). Seven children had been initially misdiagnosed with cerebral palsy. During childhood, patients developed severe parkinsonism-dystonia associated with an eye movement disorder and pyramidal tract features. All children had raised ratios of homovanillic acid to 5-hydroxyindoleacetic acid in cerebrospinal fluid, of range 5·0-13·2 (normal range 1·3-4·0). Homozygous or compound heterozygous SLC6A3 mutations were detected in all cases. Loss of function in all missense variants was recorded from in-vitro functional studies, and was supported by the findings of single photon emission CT DaTSCAN imaging in one patient, which showed complete loss of dopamine transporter activity in the basal nuclei. INTERPRETATION dopamine transporter deficiency syndrome is a newly recognised, autosomal recessive disorder related to impaired dopamine transporter function. Careful characterisation of patients with this disorder should provide novel insights into the complex role of dopamine homoeostasis in human disease, and understanding of the pathophysiology could help to drive drug development.
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West PR, Weir AM, Smith AM, Donley EL, Cezar GG. Predicting human developmental toxicity of pharmaceuticals using human embryonic stem cells and metabolomics. Toxicol Appl Pharmacol 2010; 247:18-27. [DOI: 10.1016/j.taap.2010.05.007] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 05/11/2010] [Accepted: 05/13/2010] [Indexed: 10/19/2022]
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Allen GFG, Neergheen V, Oppenheim M, Fitzgerald JC, Footitt E, Hyland K, Clayton PT, Land JM, Heales SJR. Pyridoxal 5'-phosphate deficiency causes a loss of aromatic L-amino acid decarboxylase in patients and human neuroblastoma cells, implications for aromatic L-amino acid decarboxylase and vitamin B(6) deficiency states. J Neurochem 2010; 114:87-96. [PMID: 20403077 DOI: 10.1111/j.1471-4159.2010.06742.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pyridoxal 5'-phosphate, the active form of vitamin B(6), is an essential cofactor for multiple enzymes, including aromatic l-amino acid decarboxylase that catalyses the final stage in the production of the neurotransmitters dopamine and serotonin. In two patients with inherited disorders of vitamin B(6) metabolism, we observed reductions in plasma aromatic l-amino acid decarboxylase activity. In one patient, this change was related to an increase in K(m) for pyridoxal 5'-phosphate. Furthermore, pyridoxal 5'-phosphate-deficient human SH-SY5Y neuroblastoma cells were found to exhibit reduced levels of aromatic l-amino acid decarboxylase activity and protein but with no alteration in expression. Further reductions in activity and protein were observed with the addition of the vitamin B(6) antagonist 4-deoxypyridoxine, which also reduced aromatic l-amino acid decarboxylase mRNA levels. Neither pyridoxal 5'-phosphate deficiency nor the addition of 4-deoxypyridoxine affected aromatic l-amino acid decarboxylase stability over 8 h with protein synthesis inhibited. Increasing extracellular availability of pyridoxal 5'-phosphate was not found to have any significant effect on intracellular pyridoxal 5'-phosphate concentrations or on aromatic l-amino acid decarboxylase. These findings suggest that maintaining adequate pyridoxal 5'-phosphate availability may be important for optimal treatment of aromatic l-amino acid decarboxylase deficiency and l-dopa-responsive conditions.
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Affiliation(s)
- George F G Allen
- Department of Molecular Neuroscience, UCL Institute of Neurology, London WC1N 3BG, UK.
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41
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Mak CM, Lam CW, Siu TS, Chan KY, Siu WK, Yeung WL, Hui J, Wong VCN, Low LCK, Ko CH, Fung CW, Chen SP, Yuen YP, Lee HC, Yau E, Chan B, Tong SF, Tam S, Chan YW. Biochemical and molecular characterization of tyrosine hydroxylase deficiency in Hong Kong Chinese. Mol Genet Metab 2010; 99:431-3. [PMID: 20056467 DOI: 10.1016/j.ymgme.2009.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 12/15/2009] [Accepted: 12/15/2009] [Indexed: 11/15/2022]
Abstract
Tyrosine hydroxylase deficiency is a rare neurotransmitter disorder affecting the rate-limiting step in catecholamine biosynthesis. There are about 40 cases reported worldwide. Here, we report the biochemical and molecular findings of eight unrelated Chinese patients with tyrosine hydroxylase deficiency. We have identified eight novel mutations with 5 missense, 2 nonsense and 1 splicing mutations in the TH gene, namely p.R153X, p.R169X, p.G294R, p.G315S, p.A385V, p.I394T, p.G408R, and c.1163+5G>C. The mutations of the TH gene in Chinese are heterogeneous.
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Affiliation(s)
- C M Mak
- Department of Pathology, Princess Margaret Hospital, Hong Kong SAR, China
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42
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Pearl PL, Shamim S, Theodore WH, Gibson KM, Forester K, Combs SE, Lewin D, Dustin I, Reeves-Tyer P, Jakobs C, Sato S. Polysomnographic abnormalities in succinic semialdehyde dehydrogenase (SSADH) deficiency. Sleep 2009; 32:1645-8. [PMID: 20041601 PMCID: PMC2786049 DOI: 10.1093/sleep/32.12.1645] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Patients with SSADH deficiency, a disorder of chronically elevated endogenous GABA and GHB, were studied for sleep symptoms and polysomnography. We hypothesized that patients would have excessive daytime somnolence and decreased REM sleep. DESIGN Polysomnography and MSLT were performed on patients enrolled for comprehensive clinical studies of SSADH deficiency. SETTING Sleep studies were obtained in the sleep laboratories at CNMC and NIH. PATIENTS Sleep recordings were obtained in 10 patients with confirmed SSADH deficiency. INTERVENTIONS Thirteen overnight polysomnograms were obtained in 10 patients (7 male, 3 female, ages 11-27 y). Eleven MSLT studies were completed in 8 patients. MEASUREMENTS AND RESULTS Polysomnograms showed prolongation of REM stage latency (mean 272 +/- 89 min) and decreased percent stage REM (mean 8.9%, range 0.3% to 13.8%). Decreased mean sleep latency was present in 6 of 11 MSLTs. CONCLUSIONS SSADH deficiency is associated with prolonged latency to stage REM and decreased percent stage REM. This disorder represents a model of chronic GABA and GHB accumulation associated with suppression of REM sleep.
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Affiliation(s)
- Phillip L Pearl
- Neuroscience Center, CNMC, George Washington University School of Medicine, Washington, DC, USA.
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43
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Pons R. The phenotypic spectrum of paediatric neurotransmitter diseases and infantile parkinsonism. J Inherit Metab Dis 2009; 32:321-32. [PMID: 19107571 DOI: 10.1007/s10545-008-1007-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2008] [Revised: 10/15/2008] [Accepted: 10/17/2008] [Indexed: 11/28/2022]
Abstract
Paediatric neurotransmitter diseases are a group of inherited disorders attributable to a disturbance of neurotransmitter metabolism. The monoamines, catecholamines and serotonin, also called biogenic amines, are neurotransmitters with multiple roles including psychomotor function, hormone secretion, cardiovascular, respiratory and gastrointestinal control, sleep mechanisms, body temperature and pain. Given the multiple functions of monoamines, disorders of their metabolism comprise a wide spectrum of manifestations, with motor dysfunction being the most prominent clinical feature. The severity of the clinical manifestations ranges from mild to severe. Patients with severe and intermediate phenotypes may present with infantile parkinsonism that differs in a number of aspects from the parkinsonism in nigrostriatal degeneration. Analysis of monoamine metabolites and pterins in spinal fluid assists in the diagnosis of these disorders. Treatment options include tetrahydrobiopterin supplementation, L: -dopa, 5-hydroxytryptophan, and medications that potentiate monoamine transmission. Response to treatment is variable.
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Affiliation(s)
- R Pons
- First Department of Paediatrics, Agia Sofia Hospital, Thivon & Papadiamantopoulou, Athens 115 27, Greece.
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44
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Rotstein M, Kang UJ. Consideration of gene therapy for paediatric neurotransmitter diseases. J Inherit Metab Dis 2009; 32:387-94. [PMID: 19259783 PMCID: PMC4848069 DOI: 10.1007/s10545-009-1054-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 12/29/2008] [Accepted: 01/09/2009] [Indexed: 11/26/2022]
Abstract
The paediatric neurotransmitter diseases (PNDs) are a group of inborn errors of metabolism characterized by abnormalities of neurotransmitter synthesis or metabolism. Although some children may react favourably to neurotransmitter augmentation treatment, optimal response is not universal and other modes of treatment should be sought. The genes involved in many of the currently known monoamine PNDs have been utilized in pre-clinical and in phase I clinical trials in Parkinson disease (PD) and the basic principles could be applied to the therapy of PNDs with some modifications regarding the targeting and distribution of vectors. However, issues that go beyond neurotransmitter replacement are important considerations in PD and even more so in PNDs. Understanding the pathophysiology of PNDs including abnormal development resulting from the neurotransmitter deficiency will be critical for rational therapeutic approaches. Better animal models of PNDs are necessary to test gene therapy before clinical trials can be attempted.
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Affiliation(s)
- Michael Rotstein
- Department of Neurology, Neurologic Institute of New York, Columbia University Medical Center, New York, NY
| | - Un Jung Kang
- Department of Neurology, University of Chicago, Chicago, IL
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45
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Evans S, Forester K, Pettiford JM, Morozova O. Increasing physical function through physiatric intervention for children with paediatric neurotransmitter disorders. J Inherit Metab Dis 2009; 32:381-6. [PMID: 19449166 DOI: 10.1007/s10545-009-1190-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 03/18/2009] [Accepted: 03/19/2009] [Indexed: 11/30/2022]
Abstract
Most children with paediatric neurotransmitter diseases have global functional deficits secondary to central nervous system damage. Paediatric physiatrists, working in conjunction with a multi-disciplinary team, help to improve physical function by normalizing muscle tone and improving body position. Components of spasticity, rigidity, and dystonia may all need to be considered in a comprehensive treatment programme. Complications of disordered tone include skin breakdown, pain, sleep disturbance, and dysphagia. With an integrated approach to use of medications and equipment as well as implementation of therapy and therapeutic exercise, physiatrists can help maximize functional independence for children with this group of disorders. Pharmacological treatment includes GABA-agonists including baclofen and benzodiazepines, alpha-2 adrenergic agonists, L: -dopa and dopaminergic agents, and dantrolene. Intrathecal baclofen may be used in patients refractory to these medications. In addition, physicians may utilize botulinum toxin, phenol, or surgical interventions such as selective dorsal rhizotomy or tendon lengthening. Pharmacological treatment must be used in conjunction with appropriate adaptive equipment in order to maximize therapeutic benefit. Focus on function in an attempt to increase independence is targeted to improve the child's quality of life. We present a framework and rationale to the management of the functional consequences of the paediatric neurotransmitter diseases.
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Affiliation(s)
- S Evans
- Department of Physiatry, Childrens National Medical Center, The George Washington University School of Medicine, 111 Michigan Avenue, NW, Washington, DC 20010, USA.
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46
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Kurian MA, Zhen J, Cheng SY, Li Y, Mordekar SR, Jardine P, Morgan NV, Meyer E, Tee L, Pasha S, Wassmer E, Heales SJR, Gissen P, Reith MEA, Maher ER. Homozygous loss-of-function mutations in the gene encoding the dopamine transporter are associated with infantile parkinsonism-dystonia. J Clin Invest 2009; 119:1595-603. [PMID: 19478460 DOI: 10.1172/jci39060] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Accepted: 04/08/2009] [Indexed: 11/17/2022] Open
Abstract
Genetic variants of the SLC6A3 gene that encodes the human dopamine transporter (DAT) have been linked to a variety of neuropsychiatric disorders, particularly attention deficit hyperactivity disorder. In addition, the homozygous Slc6a3 knockout mouse displays a hyperactivity phenotype. Here, we analyzed 2 unrelated consanguineous families with infantile parkinsonism-dystonia (IPD) syndrome and identified homozygous missense SLC6A3 mutations (p.L368Q and p.P395L) in both families. Functional studies demonstrated that both mutations were loss-of-function mutations that severely reduced levels of mature (85-kDa) DAT while having a differential effect on the apparent binding affinity of dopamine. Thus, in humans, loss-of-function SLC6A3 mutations that impair DAT-mediated dopamine transport activity are associated with an early-onset complex movement disorder. Identification of the molecular basis of IPD suggests SLC6A3 as a candidate susceptibility gene for other movement disorders associated with parkinsonism and/or dystonic features.
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Affiliation(s)
- Manju A Kurian
- Department of Medical and Molecular Genetics, University of Birmingham School of Medicine, Institute of Biomedical Research, Birmingham, United Kingdom
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47
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Allen GFG, Land JM, Heales SJR. A new perspective on the treatment of aromatic L-amino acid decarboxylase deficiency. Mol Genet Metab 2009; 97:6-14. [PMID: 19231266 DOI: 10.1016/j.ymgme.2009.01.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 01/16/2009] [Accepted: 01/16/2009] [Indexed: 11/26/2022]
Abstract
The final step in production of the neurotransmitters dopamine and serotonin is catalyzed by aromatic l-amino acid decarboxylase (AADC). AADC deficiency is a debilitating genetic condition that results in a deficit in these neurotransmitters, and manifests in infancy as a severe movement disorder with developmental delay. Response to current treatments is often disappointing. We have reviewed the literature to look for improvements to the current treatment strategy and also for new directions for AADC deficiency treatment. There may be differences in the mode of action, side-effect risk and effectiveness between different dopamine agonists and monoamine oxidase inhibitors currently used for AADC deficiency treatment. The range of these drugs used requires re-evaluation as some may have greater efficacy than others. Pyridoxal 5'-phosphate, the AADC cofactor may stabilize AADC and could increase AADC activity. Pyridoxal 5'-phosphate could have advantages as a treatment instead of pyridoxine. Atypical neuroleptics and peripheral AADC inhibitors both increase AADC activity in vivo and could be a future direction for AADC deficiency treatment and related conditions. Parkinson's disease gene therapy to deliver and express the human AADC gene in striatum is being tested in humans. Consequently gene therapy for AADC deficiency could be a realistic aim however an animal model of AADC deficiency is important for further progression.
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Affiliation(s)
- George F G Allen
- Department of Molecular Neuroscience, UCL Institute of Neurology, Queen Square House, Queen Square, London WC1N 3BG, UK.
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48
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Comparative genomics of aldehyde dehydrogenase 5a1 (succinate semialdehyde dehydrogenase) and accumulation of gamma-hydroxybutyrate associated with its deficiency. Hum Genomics 2009; 3:106-20. [PMID: 19164088 PMCID: PMC2657722 DOI: 10.1186/1479-7364-3-2-106] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Succinic semialdehyde dehydrogenase (SSADH; aldehyde dehydrogenase 5A1 [ALDH5A1]; locus 6p22) occupies a central position in central nervous system (CNS) neurotransmitter metabolism as one of two enzymes necessary for γ-aminobutyric acid (GABA) recycling from the synaptic cleft. Its importance is highlighted by the neurometabolic disease associated with its inherited deficiency in humans, as well as the severe epileptic phenotype observed in Aldh5a1-/- knockout mice. Expanding evidence now suggests, however, that even subtle decreases in human SSADH activity, associated with rare and common single nucleotide polymorphisms, may produce subclinical pathological effects. SSADH, in conjunction with aldo-keto reductase 7A2 (AKR7A2), represent two neural enzymes responsible for further catabolism of succinic semialdehyde, producing either succinate (SSADH) or γ-hydroxybutyrate (GHB; AKR7A2). A GABA analogue, GHB is a short-chain fatty alcohol with unusual properties in the CNS and a long pharmacological history. Moreover, SSADH occupies a further role in the CNS as the enzyme responsible for further metabolism of the lipid peroxidation aldehyde 4-hydroxy-2-nonenal (4-HNE), an intermediate known to induce oxidant stress. Accordingly, subtle decreases in SSADH activity may have the capacity to lead to regional accumulation of neurotoxic intermediates (GHB, 4-HNE). Polymorphisms in SSADH gene structure may also associate with quantitative traits, including intelligence quotient and life expectancy. Further population-based studies of human SSADH activity promise to reveal additional properties of its function and additional roles in CNS tissue.
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49
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Neurotransmitter alterations in embryonic succinate semialdehyde dehydrogenase (SSADH) deficiency suggest a heightened excitatory state during development. BMC DEVELOPMENTAL BIOLOGY 2008; 8:112. [PMID: 19040727 PMCID: PMC2642797 DOI: 10.1186/1471-213x-8-112] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Accepted: 11/28/2008] [Indexed: 11/10/2022]
Abstract
BACKGROUND SSADH (aldehyde dehydrogenase 5a1 (Aldh5a1); gamma-hydroxybutyric (GHB) aciduria) deficiency is a defect of GABA degradation in which the neuromodulators GABA and GHB accumulate. The human phenotype is that of nonprogressive encephalopathy with prominent bilateral discoloration of the globi pallidi and variable seizures, the latter displayed prominently in Aldh5a1-/- mice with lethal convulsions. Metabolic studies in murine neural tissue have revealed elevated GABA [and its derivatives succinate semialdehyde (SSA), homocarnosine (HC), 4,5-dihydroxyhexanoic acid (DHHA) and guanidinobutyrate (GB)] and GHB [and its analogue D-2-hydroxyglutarate (D-2-HG)] at birth. Because of early onset seizures and the neurostructural anomalies observed in patients, we examined metabolite features during Aldh5a1-/- embryo development. METHODS Embryos were obtained from pregnant dams sacrificed at E (embryo day of life) 10-13, 14-15, 16-17, 18-19 and newborn mice. Intact embryos were extracted and metabolites quantified by isotope dilution mass spectrometry (n = 5-15 subjects, Aldh5a1+/+ and Aldh5a1-/-) for each gestational age group. Data was evaluated using the t test and one-way ANOVA with Tukey post hoc analysis. Significance was set at the 95th centile. RESULTS GABA and DHHA were significantly elevated at all gestational ages in Aldh5a1-/- mice, while GB was increased only late in gestation; SSA was not elevated at any time point. GHB and D-2-HG increased in an approximately linear fashion with gestational age. Correlative studies in human amniotic fluid from SSADH-deficient pregnancies (n = 5) also revealed significantly increased GABA. CONCLUSION Our findings indicate early GABAergic alterations in Aldh5a1-/- mice, possibly exacerbated by other metabolites, which likely induce a heightened excitatory state that may predispose neural networks to epilepsy in these animals.
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50
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Crutchfield SR, Haas RH, Nyhan WL, Gibson KM. 'Succinic semialdehyde dehydrogenase deficiency: phenotype evolution in an adolescent patient at 20-year follow-up'. Dev Med Child Neurol 2008; 50:880-1. [PMID: 18811705 PMCID: PMC2668832 DOI: 10.1111/j.1469-8749.2008.03116.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Susan R Crutchfield
- Department of Neurosciences; University of California San Diego, La Jolla, CA
| | - Richard H Haas
- Department of Neurosciences; University of California San Diego, La Jolla, CA,Department of Pediatrics; University of California San Diego, La Jolla, CA
| | - William L Nyhan
- Department of Neurosciences; University of California San Diego, La Jolla, CA,Center for Molecular Genetics, University of California San Diego, La Jolla, CA
| | - K Michael Gibson
- Division of Medical Genetics, Departments of Pediatrics, Pathology and Human Genetics, University of Pittsburgh School of Medicine and the Graduate School of Public Health, Children's Hospital of Pittsburgh of UPMC, Clinical Biochemical Genetics Laboratory, Pittsburgh, PA, USA.,Correspondence to:
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