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Brankovic M, Ivanovic V, Basta I, Khang R, Lee E, Stevic Z, Ralic B, Tubic R, Seo G, Markovic V, Bozovic I, Svetel M, Marjanovic A, Veselinovic N, Mesaros S, Jankovic M, Savic-Pavicevic D, Jovin Z, Novakovic I, Lee H, Peric S. Whole exome sequencing in Serbian patients with hereditary spastic paraplegia. Neurogenetics 2024:10.1007/s10048-024-00755-x. [PMID: 38499745 DOI: 10.1007/s10048-024-00755-x] [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: 12/14/2023] [Accepted: 03/08/2024] [Indexed: 03/20/2024]
Abstract
Hereditary spastic paraplegia (HSP) is a group of neurodegenerative diseases with a high genetic and clinical heterogeneity. Numerous HSP patients remain genetically undiagnosed despite screening for known genetic causes of HSP. Therefore, identification of novel variants and genes is needed. Our previous study analyzed 74 adult Serbian HSP patients from 65 families using panel of the 13 most common HSP genes in combination with a copy number variation analysis. Conclusive genetic findings were established in 23 patients from 19 families (29%). In the present study, nine patients from nine families previously negative on the HSP gene panel were selected for the whole exome sequencing (WES). Further, 44 newly diagnosed adult HSP patients from 44 families were sent to WES directly, since many studies showed WES may be used as the first step in HSP diagnosis. WES analysis of cohort 1 revealed a likely genetic cause in five (56%) of nine HSP families, including variants in the ETHE1, ZFYVE26, RNF170, CAPN1, and WASHC5 genes. In cohort 2, possible causative variants were found in seven (16%) of 44 patients (later updated to 27% when other diagnosis were excluded), comprising six different genes: SPAST, SPG11, WASCH5, KIF1A, KIF5A, and ABCD1. These results expand the genetic spectrum of HSP patients in Serbia and the region with implications for molecular genetic diagnosis and future causative therapies. Wide HSP panel can be the first step in diagnosis, alongside with the copy number variation (CNV) analysis, while WES should be performed after.
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Affiliation(s)
- Marija Brankovic
- Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, Serbia.
| | - Vukan Ivanovic
- Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, Serbia
| | - Ivana Basta
- Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, Serbia
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | | | | | - Zorica Stevic
- Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, Serbia
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Radoje Tubic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | | | - Vladana Markovic
- Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, Serbia
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ivo Bozovic
- Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, Serbia
| | - Marina Svetel
- Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, Serbia
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ana Marjanovic
- Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, Serbia
| | - Nikola Veselinovic
- Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, Serbia
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Sarlota Mesaros
- Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, Serbia
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milena Jankovic
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Dusanka Savic-Pavicevic
- Center for Human Molecular Genetics, Faculty of Biology, University of Belgrade, Belgrade, Serbia
| | - Zita Jovin
- Neurology Clinic, University Clinical Center of Vojvodina, Novi Sad, Serbia
| | - Ivana Novakovic
- Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, Serbia
| | - Hane Lee
- 3Billion, Inc., Seoul, South Korea
| | - Stojan Peric
- Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, Serbia
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
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Platt I, Bisgin A, Kilavuz S. Ethylmalonic Encephalopathy: a literature review and two new cases of mild phenotype. Neurol Sci 2023; 44:3827-3852. [PMID: 37458841 DOI: 10.1007/s10072-023-06904-8] [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: 01/20/2023] [Accepted: 06/12/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Ethylmalonic encephalopathy (EE) is a rare intoxication-type metabolic disorder with multisystem involvement. It is caused by mutations in ETHE1, which encodes the ETHE1 enzyme in the mitochondrial matrix that plays a key role in hydrogen sulfide (H2S) detoxification acting as a sulphur dioxygenase. RESULTS This review focuses on the clinical, metabolic, genetic and neuroradiological features of 70 reported cases, including two new cases. The common manifestations of EE are psychomotor regression, hypotonia, developmental delay, petechia, pyramidal signs, chronic diarrhoea, orthostatic acrocyanosis and failure to thrive, respectively. A significant difference was found in EMA and C4 levels (p=0.003, p=0.0236) between classical and mild phenotypes. Urinary EMA, C4 and C5 levels were found to exhibit normal values in milder cases during attack-free periods. The most common ETHE1 gene homozygous state mutations were (p.R163Q) (c.488G>A), exon 4 deletion, (p.R163W)(c.487C>T), (p.Glu44ValfsTer62)(c.131_132delAG) and (p.M1I)(c.3G>T) mutations, respectively. Fifty-two patients underwent cranial MRI. Basal ganglia signal alterations were detected in 42 cases. Of the 70 cases, eight had a mild phenotype and slow neurological progression with low levels of ethylmalonic acid (EMA) and C4 acylcarnitine. The current age of alive patients in the published articles with mild phenotype was significantly higher than the classical phenotype. (p=0.002). Reducing the accumulation and inducing detoxification of sulfide is the main long-term treatment strategy for EE, including metronidazole, N-acetylcysteine (NAC), dietary modification, liver transplantation and continuous renal replacement therapy (CRRT). CONCLUSION Measuring EMA and C4 acylcarnitine during metabolic attacks is critical to diagnosing EE, allowing for early treatment initiation to prevent further encephalopathic crises. Experience with liver transplantation, diet and CRRT, is currently limited. An early multidisciplinary approach with combination therapies is vital to prevent irreversible neurological damage.
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Affiliation(s)
| | - Atil Bisgin
- Department of Medical Genetics, Cukurova University AGENTEM (Adana Genetic Diseases Diagnosis and Treatment Center), Adana, Turkey
| | - Sebile Kilavuz
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Marmara University Faculty of Medicine, İstanbul, Turkey.
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Gowda VK, Srinivasan VM, Jetha K, Sugumar K, Bhat M, Shivappa SK, Bhat M, Christopher R. Case Series of Ethylmalonic Encephalopathy from Southern India. J Pediatr Genet 2023; 12:213-218. [PMID: 37575639 PMCID: PMC10421674 DOI: 10.1055/s-0041-1740370] [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: 05/22/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
Ethylmalonic encephalopathy is a rare neurometabolic disorder with central nervous system involvement and vasculopathy. It is presented in infancy with developmental delay, acrocyanosis, petechiae, chronic diarrhea, and early death. This was a retrospective study of confirmed cases of ethylmalonic aciduria from a tertiary care hospital over a period of 5 years from January 2015 to December 2020. Case details including analysis of clinical history, investigations, and outcomes are presented. Of six cases, male-to-female ratio was 4:2. Mean age of presentation was 35.5 months (range: 14-83 months). Consanguinity, global developmental delay, failure to thrive, skin rashes, microcephaly, hypotonia, and exaggerated deep tendon reflexes were observed in all cases. Chronic diarrhea was presented in five cases. The serum levels of C4 carnitine and urinary levels of ethylmalonic acid were increased in all cases. Magnetic resonance imaging (MRI) of the brain showed heterogenous bilateral symmetrical changes in the basal ganglia in five cases, and in one case, MRI could not be done. Genetic testing in two cases showed a homozygous variant in ETHE1 gene. Four children died, while the other two cases showed a decreased in recurrent encephalopathies and diarrhea after starting metronidazole. All children had global developmental delay, failure to thrive, skin rashes, central hypotonia, increased C4 carnitine levels in the serum, and increased ethylmalonic acid in the urine. Chronic diarrhea, acrocyanosis, and basal ganglia change in the MRI of the brain also give important clues for diagnosis. Metronidazole is useful in preventing recurrent episodes of encephalopathy.
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Affiliation(s)
- Vykuntaraju K. Gowda
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Varunvenkat M. Srinivasan
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Kapil Jetha
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Kiruthiga Sugumar
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Meenakshi Bhat
- Department of Genetics, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Sanjay K. Shivappa
- Department of Pediatric Medicine, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Maya Bhat
- Department of Neuroradiology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Rita Christopher
- Department of Neurochemistry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Salazar D, Kloke KM, Guerrero RB, Ferreira CR, Blau N. Clinical and biochemical footprints of inherited metabolic disorders. XI. Gastrointestinal symptoms. Mol Genet Metab 2023; 138:107528. [PMID: 36774919 PMCID: PMC10509718 DOI: 10.1016/j.ymgme.2023.107528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/28/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
Inherited metabolic disorders presenting with gastrointestinal (GI) symptoms are characterized by the dysfunction of the esophagus, stomach, small and large intestines, and pancreas. We have summarized associations of signs and symptoms in 339 inherited metabolic diseases presenting with GI symptoms. Feeding difficulties represent the most common abnormality reported for IMDs with GI involvement (37%) followed by intestinal problems (30%), vomiting (22%), stomach and pancreas involvement (8% each), and esophagus involvement (4%). This represents the eleventh of a series of articles attempting to create and maintain a comprehensive list of clinical and metabolic differential diagnoses according to system involvement.
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Affiliation(s)
- Denise Salazar
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, United States of America.
| | - Karen M Kloke
- Mayo Clinic Laboratories, Rochester, MN, United States of America.
| | | | - Carlos R Ferreira
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States of America.
| | - Nenad Blau
- Division of Metabolism, University Children's Hospital, Zürich, Switzerland.
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Cardelo Autero N, Cordón Martínez AM, Ramos-Fernández JM. Ethylmalonic encephalopathy: phenotype-genotype description and review of its management. NEUROLOGÍA (ENGLISH EDITION) 2021; 36:729-731. [PMID: 34274260 DOI: 10.1016/j.nrleng.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/31/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- N Cardelo Autero
- Servicio de Pediatría, Hospital Regional Universitario Materno-Infantil de Málaga, Málaga, Spain
| | - A M Cordón Martínez
- Servicio de Pediatría (lactantes), Hospital Regional Universitario Materno-Infantil de Málaga, Málaga, Spain
| | - J M Ramos-Fernández
- Sección de Neurología Pediátrica, Grupo IBIMA, Servicio de Pediatría, Hospital Regional Universitario Materno-Infantil de Málaga, Málaga, Spain.
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6
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Lim J, Shayota BJ, Lay E, Elsea SH, Bekheirnia MR, Tessier MEM, Kralik SF, Rice GM, Soler-Alfonso C, Scaglia F. Acute Strokelike Presentation and Long-term Evolution of Diffusion Restriction Pattern in Ethylmalonic Encephalopathy. J Child Neurol 2021; 36:841-852. [PMID: 33900143 DOI: 10.1177/08830738211006507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ethylmalonic encephalopathy is a rare autosomal recessive mitochondrial disorder caused by pathogenic biallelic variants in the ETHE1 gene. The phenotype of this disease has been attributed to deficiency in the mitochondrial sulfur dioxygenase leading to many downstream effects. Ethylmalonic encephalopathy classically presents with developmental regression, petechiae, acrocyanosis, and chronic diarrhea. The neurologic phenotype includes hypotonia, spastic diplegia, ataxia, and developmental delay. As more patients with this condition are described, the neurologic phenotype continues to expand. Although strokelike episodes or metabolic strokes have been studied in other mitochondrial disorders, they have not been thoroughly reported in this disorder. Herein, we describe 3 patients with ethylmalonic encephalopathy who presented clinically with strokelike episodes and strokelike abnormalities on brain magnetic resonance imaging in the setting of acute illness, and the long-term sequelae with evolution into cystic changes in one of these subjects.
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Affiliation(s)
- Jaehyung Lim
- Division of Pediatric Neurology and Developmental Neurosciences, 3989Baylor College of Medicine, Houston, TX, USA
| | - Brian J Shayota
- Department of Molecular and Human Genetics, 3989Baylor College of Medicine, Houston, TX, USA.,3984Texas Children's Hospital, Houston, TX, USA
| | - Erica Lay
- Department of Molecular and Human Genetics, 3989Baylor College of Medicine, Houston, TX, USA.,3984Texas Children's Hospital, Houston, TX, USA
| | - Sarah H Elsea
- Department of Molecular and Human Genetics, 3989Baylor College of Medicine, Houston, TX, USA
| | - Mir Reza Bekheirnia
- Department of Molecular and Human Genetics, 3989Baylor College of Medicine, Houston, TX, USA.,3984Texas Children's Hospital, Houston, TX, USA.,Renal Section, Department of Pediatrics, 3989Baylor College of Medicine, Houston, TX, USA
| | - Mary Elizabeth M Tessier
- Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology and Nutrition 3989Baylor College of Medicine Houston TX, USA
| | - Stephen F Kralik
- Department of Radiology, 3984Texas Children's Hospital, Houston, TX, USA
| | - Gregory M Rice
- Department of Pediatrics and the Waisman Center, 5232University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Claudia Soler-Alfonso
- Department of Molecular and Human Genetics, 3989Baylor College of Medicine, Houston, TX, USA.,3984Texas Children's Hospital, Houston, TX, USA
| | - Fernando Scaglia
- Department of Molecular and Human Genetics, 3989Baylor College of Medicine, Houston, TX, USA.,3984Texas Children's Hospital, Houston, TX, USA.,Joint 3989BCM-CUHK Center of Medical Genetics, Prince of Wales Hospital, Shatin, Hong Kong SAR
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Olivieri G, Martinelli D, Longo D, Grimaldi C, Liccardo D, Di Meo I, Pietrobattista A, Sidorina A, Semeraro M, Dionisi-Vici C. Ethylmalonic encephalopathy and liver transplantation: long-term outcome of the first treated patient. Orphanet J Rare Dis 2021; 16:229. [PMID: 34011365 PMCID: PMC8136189 DOI: 10.1186/s13023-021-01867-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
Background Ethylmalonic encephalopathy (EE) is a severe intoxication-type metabolic disorder with multisystem clinical features and leading to early death. In 2014, based on the promising results obtained by liver-targeted gene therapy in Ethe1−/− mouse model, we successfully attempted liver transplantation in a 9-month-old EE girl. Here we report her long-term follow-up, lasting over 6 years, with a comprehensive evaluation of clinical, instrumental and biochemical assessments. Results Neurological signs initially reverted, with a clinical stabilization during the entire follow-up course. Accordingly, gross motor functions improved and then stabilized. Psychomotor evaluations documented an increasing communicative intent, the acquisition of new social skills and the capability to carry out simple orders. Neurophysiological assessments, which included EEG, VEP/ERG and BAEPs, remained unchanged. Brain MRI also stabilized, showing no further lesions and cerebral atrophy improvement. Compared to pre-transplant assessments, urinary ethylmalonic acid strikingly reduced, and plasma thiosulphate fully normalized. The child maintained good clinical conditions and never experienced metabolic crises nor epileptic seizures. Conclusions The long-term follow-up of the first EE transplanted patient demonstrates that liver transplantation stabilizes, or even improves, disease course, therefore representing a potentially elective option especially in early-diagnosed patients, such as those detected by newborn screening, before irreversible neurological damage occurs.
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Affiliation(s)
- Giorgia Olivieri
- Division of Metabolism, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Diego Martinelli
- Division of Metabolism, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Daniela Longo
- Neuroradiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Chiara Grimaldi
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | - Daniela Liccardo
- Division of Hepatology and Gastroenterology, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | - Ivano Di Meo
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Andrea Pietrobattista
- Division of Hepatology and Gastroenterology, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | - Anna Sidorina
- Division of Metabolism, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Michela Semeraro
- Division of Metabolism, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Carlo Dionisi-Vici
- Division of Metabolism, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
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Cardelo Autero N, Cordón Martínez AM, Ramos-Fernández JM. Ethylmalonic encephalopathy: Phenotype-genotype description and review of its management. Neurologia 2021; 36:S0213-4853(21)00009-8. [PMID: 33722452 DOI: 10.1016/j.nrl.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/24/2021] [Accepted: 01/31/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- N Cardelo Autero
- Servicio de Pediatría, Hospital Regional Universitario Materno-Infantil de Málaga, Málaga, España
| | - A M Cordón Martínez
- Servicio de Pediatría (lactantes), Hospital Regional Universitario Materno-Infantil de Málaga, Málaga, España
| | - J M Ramos-Fernández
- Sección de Neurología Pediátrica, Grupo IBIMA, Servicio de Pediatría, Hospital Regional Universitario Materno-Infantil de Málaga, Málaga, España.
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9
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Grings M, Wajner M, Leipnitz G. Mitochondrial Dysfunction and Redox Homeostasis Impairment as Pathomechanisms of Brain Damage in Ethylmalonic Encephalopathy: Insights from Animal and Human Studies. Cell Mol Neurobiol 2020; 42:565-575. [DOI: 10.1007/s10571-020-00976-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/29/2020] [Indexed: 12/13/2022]
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10
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Identification of a novel homozygous nonsense variant in a Chinese patient with ethylmalonic encephalopathy and a genotype-phenotype spectrum review. Clin Chim Acta 2020; 509:8-17. [DOI: 10.1016/j.cca.2020.05.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 11/23/2022]
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Ersoy M, Tiranti V, Zeviani M. Ethylmalonic encephalopathy: Clinical course and therapy response in an uncommon mild case with a severe ETHE1 mutation. Mol Genet Metab Rep 2020; 25:100641. [PMID: 32923369 PMCID: PMC7476058 DOI: 10.1016/j.ymgmr.2020.100641] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/15/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023] Open
Abstract
Ethylmalonic encephalopathy (EE) is a rare metabolic disorder caused by dysfunction of ETHE1 protein, a mitochondrial dioxygenase involved in hydrogen sulfide (H2S) detoxification. EE is usually a fatal disease with a severe clinical course mainly associated with developmental delay and regression, recurrent petechiae, orthostatic acrocyanosis, and chronic diarrhoea. Treatment includes antioxidants, antibiotics that lower H2S levels and antispastic medications, which are not curative. The mutations causing absence of the ETHE1 protein, as is the case for the described patient, usually entail a severe fatal phenotype. Although there are rare reported cases with mild clinical findings, the mechanism leading to these milder cases is also unclear. Here, we describe an 11-year-old boy with an ETHE1 gene mutation who has no neurocognitive impairment but chronic diarrhoea, which is controlled by oral medical treatment, and progressive spastic paraparesis that responded to Achilles tendon lengthening.
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Key Words
- 3-MST, 3-mercaptopyruvate sulfurtransferase
- CAT, cysteine aminotransferase
- CBS, cystathionine β-synthase
- CSE, cystathionine γ-lyase
- EE, ethylmalonic encephalopathy
- EMA, ethylmalonic acid
- ETHE1 gene
- GSH, glutathione
- H2S
- H2S, hydrogen sulfide
- H2SO3, persulfide
- MTZ, metronidazole
- Mild course
- NAC, N-acetylcysteine
- SCAD, short-chain acyl-CoA dehydrogenase
- SDO, sulfur dioxygenase
- SQR, sulfide quinone oxidoreductase
- SUOX, sulfite oxidase
- TST, thiosulfate sulfur transferase
- Therapy response
- UQ, quinone
- cIII, complex III
- cIV, complex IV
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Affiliation(s)
- Melike Ersoy
- Department of Pediatrics, Division of Pediatric Metabolism, Health Sciences University, Bakirkoy Dr. Sadi Konuk Research and Education Hospital, Istanbul, Turkey
| | - Valeria Tiranti
- Molecular Pathogenesis of Mitochondrial Disorders Unit of Medical Genetics and Neurogenetics Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Massimo Zeviani
- The Clinical School, University of Padova Department of Neurosciences Veneto Institute of Molecular Medicine Via Orus 2, Padova, Italy
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Riboflavin Deficiency-Implications for General Human Health and Inborn Errors of Metabolism. Int J Mol Sci 2020; 21:ijms21113847. [PMID: 32481712 PMCID: PMC7312377 DOI: 10.3390/ijms21113847] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 01/13/2023] Open
Abstract
As an essential vitamin, the role of riboflavin in human diet and health is increasingly being highlighted. Insufficient dietary intake of riboflavin is often reported in nutritional surveys and population studies, even in non-developing countries with abundant sources of riboflavin-rich dietary products. A latent subclinical riboflavin deficiency can result in a significant clinical phenotype when combined with inborn genetic disturbances or environmental and physiological factors like infections, exercise, diet, aging and pregnancy. Riboflavin, and more importantly its derivatives, flavin mononucleotide (FMN) and flavin adenine dinucleotide (FAD), play a crucial role in essential cellular processes including mitochondrial energy metabolism, stress responses, vitamin and cofactor biogenesis, where they function as cofactors to ensure the catalytic activity and folding/stability of flavoenzymes. Numerous inborn errors of flavin metabolism and flavoenzyme function have been described, and supplementation with riboflavin has in many cases been shown to be lifesaving or to mitigate symptoms. This review discusses the environmental, physiological and genetic factors that affect cellular riboflavin status. We describe the crucial role of riboflavin for general human health, and the clear benefits of riboflavin treatment in patients with inborn errors of metabolism.
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Chen X, Han L, Yao H. Novel Compound Heterozygous Variants of ETHE1 Causing Ethylmalonic Encephalopathy in a Chinese Patient: A Case Report. Front Genet 2020; 11:341. [PMID: 32362910 PMCID: PMC7181787 DOI: 10.3389/fgene.2020.00341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 03/23/2020] [Indexed: 01/22/2023] Open
Abstract
Ethylmalonic encephalopathy (EE) is a very rare autosomal recessive metabolic disorder that primarily affects children. Less than one hundred EE patients have been diagnosed worldwide. The clinical manifestations include chronic diarrhea, petechiae, orthostatic acrocyanosis, psychomotor delay and regression, seizures, and hypotonia. The ETHE1 gene has been shown to be associated with EE, and genetic sequencing provides concrete evidence for diagnosis. To date, only 37 variants of ETHE1 have been reported as disease-causing in EE patients. We identified two novel ETHE1 variants, i.e., c.595+1G>T at the canonical splice site and the missense variant c.586G>C (p. D196H), in a 3-year-old Chinese boy with EE. The patient had mild symptoms with only chronic diarrhea. The typical symptoms, including spontaneous petechiae, acrocyanosis, and hypotonia, were all absent. Herein, we report on the clinical, biochemical, and genetic findings of our patient and review the phenotypes and genotypes of all patients with EE caused by ETHE1 variants with available information. This study supports the early assessment and diagnosis of EE.
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Affiliation(s)
- Xiaohong Chen
- Department of Endocrinology and Metabolism, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Han
- Running Gene Inc., Beijing, China
| | - Hui Yao
- Department of Endocrinology and Metabolism, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Govindaraj P, Parayil Sankaran B, Nagappa M, Arvinda HR, Deepha S, Jessiena Ponmalar JN, Sinha S, Gayathri N, Taly AB. Child Neurology: Ethylmalonic encephalopathy. Neurology 2020; 94:e1336-e1339. [PMID: 32111695 DOI: 10.1212/wnl.0000000000009144] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Periyasamy Govindaraj
- From the Departments of Neuropathology (P.G., S.D., N.G.), Neurology (B.P.S., M.N., S.S., A.B.T.), Neuroimaging and Interventional Radiology (H.R.A.), and Neuromuscular Laboratory-Neurobiology Research Centre (P.G., B.P.S., M.N., S.D., J.N.J.P., N.G., A.B.T.), National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Bindu Parayil Sankaran
- From the Departments of Neuropathology (P.G., S.D., N.G.), Neurology (B.P.S., M.N., S.S., A.B.T.), Neuroimaging and Interventional Radiology (H.R.A.), and Neuromuscular Laboratory-Neurobiology Research Centre (P.G., B.P.S., M.N., S.D., J.N.J.P., N.G., A.B.T.), National Institute of Mental Health and Neurosciences, Bengaluru, India.
| | - Madhu Nagappa
- From the Departments of Neuropathology (P.G., S.D., N.G.), Neurology (B.P.S., M.N., S.S., A.B.T.), Neuroimaging and Interventional Radiology (H.R.A.), and Neuromuscular Laboratory-Neurobiology Research Centre (P.G., B.P.S., M.N., S.D., J.N.J.P., N.G., A.B.T.), National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Hanumanthapura R Arvinda
- From the Departments of Neuropathology (P.G., S.D., N.G.), Neurology (B.P.S., M.N., S.S., A.B.T.), Neuroimaging and Interventional Radiology (H.R.A.), and Neuromuscular Laboratory-Neurobiology Research Centre (P.G., B.P.S., M.N., S.D., J.N.J.P., N.G., A.B.T.), National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Sekar Deepha
- From the Departments of Neuropathology (P.G., S.D., N.G.), Neurology (B.P.S., M.N., S.S., A.B.T.), Neuroimaging and Interventional Radiology (H.R.A.), and Neuromuscular Laboratory-Neurobiology Research Centre (P.G., B.P.S., M.N., S.D., J.N.J.P., N.G., A.B.T.), National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - J N Jessiena Ponmalar
- From the Departments of Neuropathology (P.G., S.D., N.G.), Neurology (B.P.S., M.N., S.S., A.B.T.), Neuroimaging and Interventional Radiology (H.R.A.), and Neuromuscular Laboratory-Neurobiology Research Centre (P.G., B.P.S., M.N., S.D., J.N.J.P., N.G., A.B.T.), National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Sanjib Sinha
- From the Departments of Neuropathology (P.G., S.D., N.G.), Neurology (B.P.S., M.N., S.S., A.B.T.), Neuroimaging and Interventional Radiology (H.R.A.), and Neuromuscular Laboratory-Neurobiology Research Centre (P.G., B.P.S., M.N., S.D., J.N.J.P., N.G., A.B.T.), National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Narayanappa Gayathri
- From the Departments of Neuropathology (P.G., S.D., N.G.), Neurology (B.P.S., M.N., S.S., A.B.T.), Neuroimaging and Interventional Radiology (H.R.A.), and Neuromuscular Laboratory-Neurobiology Research Centre (P.G., B.P.S., M.N., S.D., J.N.J.P., N.G., A.B.T.), National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Arun B Taly
- From the Departments of Neuropathology (P.G., S.D., N.G.), Neurology (B.P.S., M.N., S.S., A.B.T.), Neuroimaging and Interventional Radiology (H.R.A.), and Neuromuscular Laboratory-Neurobiology Research Centre (P.G., B.P.S., M.N., S.D., J.N.J.P., N.G., A.B.T.), National Institute of Mental Health and Neurosciences, Bengaluru, India
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15
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Grings M, Seminotti B, Karunanidhi A, Ghaloul-Gonzalez L, Mohsen AW, Wipf P, Palmfeldt J, Vockley J, Leipnitz G. ETHE1 and MOCS1 deficiencies: Disruption of mitochondrial bioenergetics, dynamics, redox homeostasis and endoplasmic reticulum-mitochondria crosstalk in patient fibroblasts. Sci Rep 2019; 9:12651. [PMID: 31477743 PMCID: PMC6718683 DOI: 10.1038/s41598-019-49014-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 08/14/2019] [Indexed: 01/21/2023] Open
Abstract
Ethylmalonic encephalopathy protein 1 (ETHE1) and molybdenum cofactor (MoCo) deficiencies are hereditary disorders that affect the catabolism of sulfur-containing amino acids. ETHE1 deficiency is caused by mutations in the ETHE1 gene, while MoCo deficiency is due to mutations in one of three genes involved in MoCo biosynthesis (MOCS1, MOCS2 and GPHN). Patients with both disorders exhibit abnormalities of the mitochondrial respiratory chain, among other biochemical findings. However, the pathophysiology of the defects has not been elucidated. To characterize cellular derangements, mitochondrial bioenergetics, dynamics, endoplasmic reticulum (ER)-mitochondria communication, superoxide production and apoptosis were evaluated in fibroblasts from four patients with ETHE1 deficiency and one with MOCS1 deficiency. The effect of JP4-039, a promising mitochondrial-targeted antioxidant, was also tested on cells. Our data show that mitochondrial respiration was decreased in all patient cell lines. ATP depletion and increased mitochondrial mass was identified in the same cells, while variable alterations in mitochondrial fusion and fission were seen. High superoxide levels were found in all cells and were decreased by treatment with JP4-039, while the respiratory chain activity was increased by this antioxidant in cells in which it was impaired. The content of VDAC1 and IP3R, proteins involved in ER-mitochondria communication, was decreased, while DDIT3, a marker of ER stress, and apoptosis were increased in all cell lines. These data demonstrate that previously unrecognized broad disturbances of cellular function are involved in the pathophysiology of ETHE1 and MOCS1 deficiencies, and that reduction of mitochondrial superoxide by JP4-039 is a promising strategy for adjuvant therapy of these disorders.
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Affiliation(s)
- Mateus Grings
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Anexo, CEP 90035-003, Porto Alegre, RS, Brazil. .,Division of Medical Genetics, Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, 15224, USA.
| | - Bianca Seminotti
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Anexo, CEP 90035-003, Porto Alegre, RS, Brazil.,Division of Medical Genetics, Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, 15224, USA
| | - Anuradha Karunanidhi
- Division of Medical Genetics, Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, 15224, USA
| | - Lina Ghaloul-Gonzalez
- Division of Medical Genetics, Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, 15224, USA.,Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Al-Walid Mohsen
- Division of Medical Genetics, Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, 15224, USA.,Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Peter Wipf
- Departments of Chemistry, Pharmaceutical Sciences and Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - Johan Palmfeldt
- Research Unit for Molecular Medicine, Aarhus University Hospital, Skejby, Denmark
| | - Jerry Vockley
- Division of Medical Genetics, Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, 15224, USA.,Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Guilhian Leipnitz
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Anexo, CEP 90035-003, Porto Alegre, RS, Brazil. .,Division of Medical Genetics, Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, 15224, USA. .,Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Anexo, CEP 90035-003, Porto Alegre, RS, Brazil.
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16
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Kitzler TM, Gupta IR, Osterman B, Poulin C, Trakadis Y, Waters PJ, Buhas DC. Acute and Chronic Management in an Atypical Case of Ethylmalonic Encephalopathy. JIMD Rep 2018; 45:57-63. [PMID: 30349987 DOI: 10.1007/8904_2018_136] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/01/2018] [Accepted: 08/17/2018] [Indexed: 12/19/2022] Open
Abstract
Ethylmalonic encephalopathy (EE) is caused by mutations in the ETHE1 gene. ETHE1 is vital for the catabolism of hydrogen sulfide (H2S). Patients with pathogenic mutations in ETHE1 have markedly increased thiosulfate, which is a reliable index of H2S levels. Accumulation of H2S is thought to cause the characteristic metabolic derangement found in EE. Recently introduced treatment strategies in EE, such as combined use of metronidazole (MNZ) and N-acetylcysteine (NAC), are aimed at lowering chronic H2S load. Experience with treatment strategies directed against acute episodes of metabolic decompensation (e.g., hemodialysis) is limited. Here we present an unusually mild, molecularly confirmed, case of EE in a 19-year-old male on chronic treatment with MNZ and NAC. During an acute episode of metabolic decompensation, we employed continuous renal replacement therapy (CRRT) to regain metabolic control. On continuous treatment with NAC and MNZ during the months preceding the acute event, plasma thiosulfate levels ranged from 1.6 to 4 μg/mL (reference range up to 2 μg/mL) and had a mean value of 2.5 μg/mL. During the acute decompensation, thiosulfate levels were 6.7 μg/mL, with hyperlactatemia and perturbed organic acid, acylglycine, and acylcarnitine profiles. CRRT decreased thiosulfate within 24 h to 1.4 μg/mL. Following discontinuation of CRRT, mean thiosulfate levels were 3.2 μg/mL (range, 2.4-3.7 μg/mL) accompanied by clinical improvement with metabolic stabilization of blood gas, acylcarnitine, organic acid, and acylglycine profiles. In conclusion, CRRT may help to regain metabolic control in patients with EE who have an acute metabolic decompensation on chronic treatment with NAC and MNZ.
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Affiliation(s)
- Thomas M Kitzler
- Department of Medical Genetics, McGill University Health Centre, Montreal, QC, Canada.
| | - Indra R Gupta
- Department of Pediatrics, Division of Nephrology, McGill University Health Centre, Montreal, QC, Canada
| | - Bradley Osterman
- Department of Pediatric Neurology, Centre Hospitalier de l'Université Laval (CHUL), Quebec City, QC, Canada
| | - Chantal Poulin
- Department of Pediatrics, Division of Neurology, McGill University Health Centre, Montreal, QC, Canada
| | - Yannis Trakadis
- Department of Medical Genetics, McGill University Health Centre, Montreal, QC, Canada
| | - Paula J Waters
- Medical Genetics Service, Department of Pediatrics, University of Sherbrooke Hospital Centre (CHUS), Sherbrooke, QC, Canada
| | - Daniela C Buhas
- Department of Medical Genetics, McGill University Health Centre, Montreal, QC, Canada
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17
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Cavusoglu D, Hismi BO, Dundar NO, Oztekin O, Koc A, Canda E, Arican P, Gencpinar P. An unusual cause of cavitating leukoencephalopathy: ethylmalonic encephalopathy. Acta Neurol Belg 2018; 118:309-312. [PMID: 29464661 DOI: 10.1007/s13760-018-0902-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 02/13/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Dilek Cavusoglu
- Department of Pediatric Neurology, Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey
| | - Burcu Ozturk Hismi
- Department of Pediatric Metabolism and Nutrition, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Nihal Olgac Dundar
- Department of Pediatric Neurology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey.
| | - Ozgur Oztekin
- Department of Radiology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Altug Koc
- Department of Medical Genetics, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Ebru Canda
- Department of Pediatric Metabolism and Nutrition, Ege University, Izmir, Turkey
| | - Pinar Arican
- Department of Pediatric Neurology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Pinar Gencpinar
- Department of Pediatric Neurology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
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18
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Bulut FD, Kör D, Şeker-Yılmaz B, Gül-Mert G, Kılavuz S, Önenli-Mungan N. Turkish case of ethylmalonic encephalopathy misdiagnosed as short chain acyl-CoA dehydrogenase deficiency. Metab Brain Dis 2018; 33:977-979. [PMID: 29159724 DOI: 10.1007/s11011-017-0152-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
Abstract
Ethylmalonic encephalopathy is a very rare autosomal recessively inherited inborn error of metabolism; characterized by encephalopathy, recurrent petechiae without bleeding diathesis, chronic diarrhea, and orthostatic acrocyanosis. Here, we describe a case of ethylmalonic encephalopathy with late onset neurologic symptoms and a confusing family history of two deceased brothers with the wrong suspicion of short chain acyl-CoA dehydrogenase deficiency.
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Affiliation(s)
- Fatma Derya Bulut
- Department of Pediatric Metabolism and Nutrition, Çukurova University, Adana, Turkey.
| | - Deniz Kör
- Adana Numune Teaching and Research Hospital, Adana, Turkey
| | | | - Gülen Gül-Mert
- Adana Numune Teaching and Research Hospital, Adana, Turkey
| | - Sebile Kılavuz
- Department of Pediatric Metabolism and Nutrition, Çukurova University, Adana, Turkey
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19
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Boyer M, Sowa M, Di Meo I, Eftekharian S, Steenari MR, Tiranti V, Abdenur JE. Response to medical and a novel dietary treatment in newborn screen identified patients with ethylmalonic encephalopathy. Mol Genet Metab 2018. [PMID: 29526615 DOI: 10.1016/j.ymgme.2018.02.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ethylmalonic encephalopathy (EE) is a devastating neurodegenerative disease caused by mutations in the ETHE1 gene critical for hydrogen sulfide (H2S) detoxification. Patients present in infancy with hypotonia, developmental delay, diarrhea, orthostatic acrocyanosis and petechiae. Biochemical findings include elevated C4, C5 acylcarnitines and lactic and ethylmalonic acid (EMA) in body fluids. Current treatment modalities include metronidazole and N-acetylcysteine (NAC) to lower the production and promote detoxification of toxic H2S. Patients are typically identified after the onset of clinical symptoms and there is limited information about long term response to treatment. We report the findings of two unrelated patients with EE, identified through newborn screening, who were managed with conventional treatment (NAC, metronidazole alternated with neomycin) and in patient 2, a novel dietary treatment restricting sulfur containing amino acids. Pathogenic mutations were confirmed in the ETHE1 gene (homozygous splice site mutation in patient 1, c.505 + 1G > A; compound heterozygous mutations in patient 2, c.131_132delAG + c.566delG). Both patients were started on metronidazole and NAC by 10 weeks of age and treated for 23 months. Patient 1 did not accept the metabolic formula due to palatability and parental refusal for gastrostomy tube placement. She demonstrated improved biomarkers (EMA, lactic acid and thiosulfate) and an attenuated clinical course. Patient 2 was started on a low methionine and cysteine diet at 8 months of age utilizing SOD Anamix® Early Years, (Nutricia). Baseline EMA levels were (642 mg/g Cr; n = 2) and decreased with medical treatment by 38% to a mean of 399 (n = 4, SD = 71, p 0.0013). With dietary treatment EMA levels were further reduced by 42% to a mean of 233 (n = 8, SD = 52, p 0.0030). Lactic acid, thiosulfates and clinical outcomes were also improved. Our long-term follow-up confirms previous reports of clinical improvement with NAC and metronidazole treatment. Additionally, our studies suggest that a diet restricted in sulfur-containing amino acids results in further improvement in clinical outcomes and biochemical markers.
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Affiliation(s)
- M Boyer
- Division of Metabolic Disorders, CHOC Children's Hospital, Orange, CA, United States
| | - M Sowa
- Division of Metabolic Disorders, CHOC Children's Hospital, Orange, CA, United States
| | - I Di Meo
- Unit of Molecular Neurogenetics, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - S Eftekharian
- Division of Metabolic Disorders, CHOC Children's Hospital, Orange, CA, United States
| | - M R Steenari
- Division of Pediatric Neurology, CHOC Children's Hospital, Orange, CA, United States; Department of Pediatrics, University of California-Irvine, Orange, CA, United States
| | - V Tiranti
- Unit of Molecular Neurogenetics, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - J E Abdenur
- Division of Metabolic Disorders, CHOC Children's Hospital, Orange, CA, United States; Department of Pediatrics, University of California-Irvine, Orange, CA, United States.
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20
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Kılıç M, Dedeoğlu Ö, Göçmen R, Kesici S, Yüksel D. Successful treatment of a patient with ethylmalonic encephalopathy by intravenous N-acetylcysteine. Metab Brain Dis 2017; 32:293-296. [PMID: 27830356 DOI: 10.1007/s11011-016-9928-5] [Citation(s) in RCA: 14] [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: 06/29/2016] [Accepted: 11/01/2016] [Indexed: 12/28/2022]
Abstract
Ethylmalonic encephalopathy (EE) is an autosomal recessive devastating metabolic disorder affecting the brain, gastrointestinal tract, peripheral vessels and rarely the other vascular organs. We report a 10-month-old girl who presented as a meningococcemia clinic but later diagnosed ethylmalonic encephalopathy. Molecular analyses revealed a homozygous c.554 T > G; p. L185R mutation in ETHE1 gene. She was only partially benefited from riboflavine, coenzyme Q10, metronidazole, N-acetylcysteine and symptomatic treatment and discharged from hospital with the sequela of oxygene dependance and developmental delay. We observed N-acetylcysteine 100 mg/kg/day intravenous infusion theraphy may be the most important drug especially in comatous EE patients.
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Affiliation(s)
- Mustafa Kılıç
- Metabolism Unit, Sami Ulus Children Hospital, Babur cad. No: 44 Altındağ, 06080, Ankara, Turkey.
| | - Özge Dedeoğlu
- Pediatric Neurology Unit, Sami Ulus Children Hospital, Ankara, Turkey
| | - Rahşan Göçmen
- Deparment of Radiology, Hacettepe University, Ankara, Turkey
| | - Selman Kesici
- Pediatric Intensive Care Unit, Sami Ulus Children Hospital, Ankara, Turkey
| | - Deniz Yüksel
- Pediatric Neurology Unit, Sami Ulus Children Hospital, Ankara, Turkey
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21
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Neurological Disorders Associated with Striatal Lesions: Classification and Diagnostic Approach. Curr Neurol Neurosci Rep 2016; 16:54. [PMID: 27074771 DOI: 10.1007/s11910-016-0656-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Neostriatal abnormalities can be observed in a very large number of neurological conditions clinically dominated by the presence of movement disorders. The neuroradiological picture in some cases has been described as "bilateral striatal necrosis" (BSN). BSN represents a condition histo-pathologically defined by the involvement of the neostriata and characterized by initial swelling of putamina and caudates followed by degeneration and cellular necrosis. After the first description in 1975, numerous acquired and hereditary conditions have been associated with the presence of BSN. At the same time, a large number of disorders involving neostriata have been described as BSN, in some cases irrespective of the presence of signs of cavitation on MRI. As a consequence, the etiological spectrum and the nosographic boundaries of the syndrome have progressively become less clear. In this study, we review the clinical and radiological features of the conditions associated with MRI evidence of bilateral striatal lesions. Based on MRI findings, we have distinguished two groups of disorders: BSN and other neostriatal lesions (SL). This distinction is extremely helpful in narrowing the differential diagnosis to a small group of known conditions. The clinical picture and complementary exams will finally lead to the diagnosis. We provide an update on the etiological spectrum of BSN and propose a diagnostic flowchart for clinicians.
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22
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Lin B, Ma G, Liu Y. Mechanism of the Glutathione Persulfide Oxidation Process Catalyzed by Ethylmalonic Encephalopathy Protein 1. ACS Catal 2016. [DOI: 10.1021/acscatal.6b01417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Beibei Lin
- School of Chemistry and Chemical
Engineering, Shandong University, Jinan, Shandong 250100, China
| | - Guangcai Ma
- School of Chemistry and Chemical
Engineering, Shandong University, Jinan, Shandong 250100, China
| | - Yongjun Liu
- School of Chemistry and Chemical
Engineering, Shandong University, Jinan, Shandong 250100, China
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23
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Dionisi-Vici C, Diodato D, Torre G, Picca S, Pariante R, Giuseppe Picardo S, Di Meo I, Rizzo C, Tiranti V, Zeviani M, De Ville De Goyet J. Liver transplant in ethylmalonic encephalopathy: a new treatment for an otherwise fatal disease. Brain 2016; 139:1045-51. [PMID: 26917598 DOI: 10.1093/brain/aww013] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/16/2015] [Indexed: 12/30/2022] Open
Abstract
Ethylmalonic encephalopathy is a fatal, rapidly progressive mitochondrial disorder caused by ETHE1 mutations, whose peculiar clinical and biochemical features are due to the toxic accumulation of hydrogen sulphide and of its metabolites, including thiosulphate. In mice with ethylmalonic encephalopathy, liver-targeted adeno-associated virus-mediated ETHE1 gene transfer dramatically improved both clinical course and metabolic abnormalities. Reasoning that the same achievement could be accomplished by liver transplantation, we performed living donor-liver transplantation in an infant with ethylmalonic encephalopathy. Unlike the invariably progressive deterioration of the disease, 8 months after liver transplantation, we observed striking neurological improvement with remarkable achievements in psychomotor development, along with dramatic reversion of biochemical abnormalities. These results clearly indicate that liver transplantation is a viable therapeutic option for ETHE1 disease.
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Affiliation(s)
- Carlo Dionisi-Vici
- Division of Metabolism, Department of Paediatric Medicine, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | - Daria Diodato
- Division of Metabolism, Department of Paediatric Medicine, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy Neuromuscular and Neurodegenerative Diseases Unit, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | - Giuliano Torre
- Division of Hepatology and Gastroenterology, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | - Stefano Picca
- Division of Nephrology and Dialysis, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | - Rosanna Pariante
- Division of Intensive Care and Anaesthesia, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | - Sergio Giuseppe Picardo
- Division of Intensive Care and Anaesthesia, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | - Ivano Di Meo
- Unit of Molecular Neurogenetics-Pierfranco and Luisa Mariani Centre for the Study of Mitochondrial Disorders in Children, Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy
| | - Cristiano Rizzo
- Division of Metabolism, Department of Paediatric Medicine, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
| | - Valeria Tiranti
- Unit of Molecular Neurogenetics-Pierfranco and Luisa Mariani Centre for the Study of Mitochondrial Disorders in Children, Foundation IRCCS Neurological Institute Carlo Besta, Milan, Italy
| | | | - Jean De Ville De Goyet
- Department of Surgery and Transplantation, Bambino Gesù Children's Research Hospital IRCCS, Rome, Italy
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24
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Papetti L, Garone G, Schettini L, Giordano C, Nicita F, Papoff P, Zeviani M, Leuzzi V, Spalice A. Severe early onset ethylmalonic encephalopathy with West syndrome. Metab Brain Dis 2015; 30:1537-45. [PMID: 26194623 DOI: 10.1007/s11011-015-9707-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 06/26/2015] [Indexed: 10/23/2022]
Abstract
Ethylmalonic encephalopathy (EE) is a rare autosomal recessive disorder characterized by early onset encephalopathy, chronic diarrhoea, petechiae, orthostatic acrocyanosis and defective cytochrome c oxidase (COX) in muscle and brain. High levels of lactic, ethylmalonic and methylsuccinic acids are detected in body fluids. EE is caused by mutations in ETHE1 gene, a mitochondrial sulfur dioxygenase. Neurologic signs and symptoms include progressively delayed development, hypotonia, seizures, and abnormal movements. We report on the clinical, electroencephalographic and MRI findings of a baby with a severe early onset encephalopathy associated with novel ETHE1 gene mutation. This is the first case described in literature with an early pure epileptic onset, presenting with West syndrome.
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MESH Headings
- Amino Acid Sequence
- Biomarkers/blood
- Brain/pathology
- Brain Diseases, Metabolic, Inborn/complications
- Brain Diseases, Metabolic, Inborn/genetics
- Brain Diseases, Metabolic, Inborn/pathology
- Electroencephalography
- Female
- Humans
- Infant
- Magnetic Resonance Imaging
- Mitochondrial Proteins/genetics
- Molecular Sequence Data
- Muscle, Skeletal/metabolism
- Muscle, Skeletal/pathology
- Mutation/genetics
- Nucleocytoplasmic Transport Proteins/genetics
- Purpura/complications
- Purpura/genetics
- Purpura/pathology
- Spasms, Infantile/complications
- Spasms, Infantile/genetics
- Spasms, Infantile/pathology
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Affiliation(s)
- Laura Papetti
- Division of Child Neurology, Department of Paediatrics, Sapienza University of Rome, Rome, Italy
| | - Giacomo Garone
- Division of Child Neurology, Department of Paediatrics, Sapienza University of Rome, Rome, Italy
| | - Livia Schettini
- Division of Child Neurology, Department of Paediatrics, Sapienza University of Rome, Rome, Italy
| | - Carla Giordano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Francesco Nicita
- Division of Child Neurology, Department of Paediatrics, Sapienza University of Rome, Rome, Italy
| | - Paola Papoff
- Pediatric Emergency and Intensive Care, Department of Paediatrics, Sapienza University of Rome, Rome, Italy
| | | | - Vincenzo Leuzzi
- Division of Child Neurology, Department of Paediatrics, Sapienza University of Rome, Rome, Italy
| | - Alberto Spalice
- Division of Child Neurology, Department of Paediatrics, Sapienza University of Rome, Rome, Italy.
- Department of Pediatrics - Child Neurology Division, Università "Sapienza" Roma, Viale Regina Elena 324, 00161, Rome, Italy.
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Pettinati I, Brem J, McDonough MA, Schofield CJ. Crystal structure of human persulfide dioxygenase: structural basis of ethylmalonic encephalopathy. Hum Mol Genet 2015; 24:2458-69. [PMID: 25596185 PMCID: PMC4383860 DOI: 10.1093/hmg/ddv007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/13/2015] [Indexed: 01/08/2023] Open
Abstract
The ethylmalonic encephalopathy protein 1 (ETHE1) catalyses the oxygen-dependent oxidation of glutathione persulfide (GSSH) to give persulfite and glutathione. Mutations to the hETHE1 gene compromise sulfide metabolism leading to the genetic disease ethylmalonic encephalopathy. hETHE1 is a mono-iron binding member of the metallo-β-lactamase (MBL) fold superfamily. We report crystallographic analysis of hETHE1 in complex with iron to 2.6 Å resolution. hETHE1 contains an αββα MBL-fold, which supports metal-binding by the side chains of an aspartate and two histidine residues; three water molecules complete octahedral coordination of the iron. The iron binding hETHE1 enzyme is related to the ‘classical’ di-zinc binding MBL hydrolases involved in antibiotic resistance, but has distinctive features. The histidine and aspartate residues involved in iron-binding in ETHE1, occupy similar positions to those observed across both the zinc 1 and zinc 2 binding sites in classical MBLs. The active site of hETHE1 is very similar to an ETHE1-like enzyme from Arabidopsis thaliana (60% sequence identity). A channel leading to the active site is sufficiently large to accommodate a GSSH substrate. Some of the observed hETHE1 clinical mutations cluster in the active site region. The structure will serve as a basis for detailed functional and mechanistic studies on ETHE1 and will be useful in the development of selective MBL inhibitors.
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Affiliation(s)
- Ilaria Pettinati
- Chemistry Research Laboratory, University of Oxford, 12 Mansfield Road, Oxford OX1 3TA, UK
| | - Jürgen Brem
- Chemistry Research Laboratory, University of Oxford, 12 Mansfield Road, Oxford OX1 3TA, UK
| | - Michael A McDonough
- Chemistry Research Laboratory, University of Oxford, 12 Mansfield Road, Oxford OX1 3TA, UK
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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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Dweikat I, Naser E, Damsah N, Libdeh BA, Bakri I. Ethylmalonic encephalopathy associated with crescentic glomerulonephritis. Metab Brain Dis 2012; 27:613-6. [PMID: 22584649 DOI: 10.1007/s11011-012-9313-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 05/03/2012] [Indexed: 11/28/2022]
Abstract
Ethylmalonic encephalopathy (EE) is a rare autosomal recessive disorder caused by mutations in the ETHE1 gene and characterized by chronic diarrhea, encephalopathy, relapsing petechiae and acrocyanosis. Nephrotic syndrome has been described in an infant with EE but the renal histology findings were not described in previous reports. We report a Palestinian girl with EE who presented with chronic diarrhea, encephalopathy, petechial rash and acrocyanosis. Subsequently, she developed progressive deterioration of renal function caused by rapidly progressive glomerulonephritis resulting in death within few days. This is, to our knowledge, the first reported occurrence of rapidly progressive glomerulonephritis in a child with ethylmalonic encephalopathy. Its presence is a serious complication associated with poor prognosis and may be explained by the diffuse vascular damage.
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Affiliation(s)
- Imad Dweikat
- Makassed Hospital, Al-Quds University, Jerusalem, Israel.
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Ueki I, Roman HB, Valli A, Fieselmann K, Lam J, Peters R, Hirschberger LL, Stipanuk MH. Knockout of the murine cysteine dioxygenase gene results in severe impairment in ability to synthesize taurine and an increased catabolism of cysteine to hydrogen sulfide. Am J Physiol Endocrinol Metab 2011; 301:E668-84. [PMID: 21693692 PMCID: PMC3191547 DOI: 10.1152/ajpendo.00151.2011] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cysteine homeostasis is dependent on the regulation of cysteine dioxygenase (CDO) in response to changes in sulfur amino acid intake. CDO oxidizes cysteine to cysteinesulfinate, which is further metabolized to either taurine or to pyruvate plus sulfate. To gain insight into the physiological function of CDO and the consequence of a loss of CDO activity, mice carrying a null CDO allele (CDO(+/-) mice) were crossed to generate CDO(-/-), CDO(+/-), and CDO(+/+) mice. CDO(-/-) mice exhibited postnatal mortality, growth deficit, and connective tissue pathology. CDO(-/-) mice had extremely low taurine levels and somewhat elevated cysteine levels, consistent with the lack of flux through CDO-dependent catabolic pathways. However, plasma sulfate levels were slightly higher in CDO(-/-) mice than in CDO(+/-) or CDO(+/+) mice, and tissue levels of acid-labile sulfide were elevated, indicating an increase in cysteine catabolism by cysteine desulfhydration pathways. Null mice had lower hepatic cytochrome c oxidase levels, suggesting impaired electron transport capacity. Supplementation of mice with taurine improved survival of male pups but otherwise had little effect on the phenotype of the CDO(-/-) mice. H(2)S has been identified as an important gaseous signaling molecule as well as a toxicant, and pathology may be due to dysregulation of H(2)S production. Control of cysteine levels by regulation of CDO may be necessary to maintain low H(2)S/sulfane sulfur levels and facilitate the use of H(2)S as a signaling molecule.
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Affiliation(s)
- Iori Ueki
- Division of Nutritional Sciences, Cornell University, Ithaca, New York 14853, USA
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