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Zhang M, Niu J, Xu M, Wei E, Liu P, Sheng G. Interplay between mitochondrial dysfunction and lysosomal storage: challenges in genetic metabolic muscle diseases with a focus on infantile onset Pompe disease. Front Cardiovasc Med 2024; 11:1367108. [PMID: 38450370 PMCID: PMC10916335 DOI: 10.3389/fcvm.2024.1367108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/08/2024] [Indexed: 03/08/2024] Open
Abstract
Background Pompe disease (PD) is a rare, progressive autosomal recessive lysosomal storage disorder that directly impacts mitochondrial function, leading to structural abnormalities and potentially culminating in heart failure or cardiogenic shock. The clinical course and molecular mechanisms of the disease remain incompletely understood. Methods We performed a retrospective analysis to examine the clinical manifestations, genetic traits, and the relationship between PD and mitochondrial function in a pediatric patient. This comprehensive evaluation included the use of ultrasound echocardiograms, computed tomography (CT) scans, electrocardiograms, mutagenesis analysis, and structural analysis to gain insights into the patient's condition and the underlying mechanisms of PD. For structural analysis and visualization, the structure of protein data bank ID 5KZX of human GAA was used, and VMD software was used for visualization and analysis. Results The study revealed that a 5-month-old male infant was admitted due to fever, with physical examination finding abnormal cardiopulmonary function and hepatomegaly. Laboratory tests and echocardiography confirmed heart failure and hypertrophic cardiomyopathy. Despite a week of treatment, which normalized body temperature and reduced pulmonary inflammation, cardiac abnormalities did not show significant improvement. Further genetic testing identified a homozygous mutation c.2662G>T (p.E888) in the GAA gene, leading to a diagnosis of Infantile-Onset Pompe Disease (IOPD). Conclusions Although enzyme replacement therapy can significantly improve the quality of life for patients with PD, enhancing mitochondrial function may represent a new therapeutic strategy for treating PD.
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Affiliation(s)
| | | | | | | | | | - Guangyao Sheng
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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2
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Yue D, Jiao K, Xia X, Zhang J, Zhu B, Liu L, Du K, Gao M, Cheng N, Wang N, Luo S, Xi J, Lu J, Zhao C, Zhu W. Diagnostic delay in late-onset Pompe disease among Chinese patients: A retrospective study. JIMD Rep 2024; 65:39-46. [PMID: 38186848 PMCID: PMC10764198 DOI: 10.1002/jmd2.12404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/24/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
Surveys and retrospective studies have revealed considerable delays in diagnosing late-onset Pompe disease (LOPD) in China, where the contributing factors remain poorly represented. Our study analyzed the diagnostic journey of 34 LOPD patients seen at our neuromuscular clinic from 2005 to 2022. We defined diagnostic delay as the time from the onset of the first relevant symptoms and laboratory findings suggestive of LOPD to the eventual diagnosis, and we constructed a correlation matrix to assess relationships among these variables. The cohort consisted of 34 patients with an equal male-to-female ratio, and the mean age at diagnosis was 27.68 ± 10.03 years. We found the median diagnostic delay to be 5 years, with a range of 0.3 to 20 years, with 97.1% having been misdiagnosed previously, most commonly with "Type II Respiratory insufficiency" (36.7%). Notably, patients at earlier onset (mean age, 18.19 years vs. 31 years; p < 0.005) tended to have higher creatine kinase (CK) levels. Furthermore, 92.6% reported difficulty in sitting up from a supine position since childhood. Our research emphasizes the role of early indicators like dyspnea and difficulty performing sit-ups in adolescents for timely LOPD diagnosis and treatment initiation. The importance of early high-risk screening using dried blood spot testing cannot be overstated.
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Affiliation(s)
- Dongyue Yue
- Department of NeurologyJing'an District Center Hospital of ShanghaiShanghaiChina
| | - Kexin Jiao
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Xingyu Xia
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Jialong Zhang
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Bochen Zhu
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Lingchun Liu
- The First People's Hospital of Yunnan ProvinceYunnanChina
| | - Kunzhao Du
- Jinshan Hospital Center for Neurosurgery, Jinshan Hospital, Institute for Translational Brain Research, State Key Laboratory of Medical Neurobiology, MOE Frontiers Center for Brain ScienceFudan UniversityShanghaiChina
| | - Mingshi Gao
- Department of PathologyHuashan Hospital, Fudan UniversityShanghaiChina
| | - Nachuan Cheng
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Ningning Wang
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Sushan Luo
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Jianying Xi
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Jiahong Lu
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Chongbo Zhao
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
| | - Wenhua Zhu
- Department of NeurologyHuashan Hospital, Fudan UniversityShanghaiChina
- National Center for Neurological Disorders (NCND)ShanghaiChina
- Huashan Rare Disease CenterShanghai Medical College, Huashan Hospital, Fudan UniversityShanghaiChina
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3
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Malekkou A, Theodosiou A, Alexandrou A, Papaevripidou I, Sismani C, Jacobs EH, Ruijter GJ, Anastasiadou V, Ourani S, Athanasiou E, Drousiotou A, Grafakou O, Petrou PP. GAA variants associated with reduced enzymatic activity but lack of Pompe-related symptoms, incidentally identified by exome sequencing. Mol Genet Metab Rep 2023; 36:100997. [PMID: 37600231 PMCID: PMC10433214 DOI: 10.1016/j.ymgmr.2023.100997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/22/2023] Open
Abstract
Pompe disease is a rare metabolic myopathy caused by pathogenic variants affecting the activity of the lysosomal glycogen-degrading enzyme acid alpha-glucosidase (GAA). Impaired GAA function results in the accumulation of undegraded glycogen within lysosomes in multiple tissues but predominantly affects the skeletal, smooth and cardiac muscle. The degree of residual enzymatic activity appears to roughly correlate with the age of onset and the severity of the clinical symptoms. Here, we report four siblings in which the GAA variants NM_000152.5:c.2237G > C p.(Trp746Ser) and NM_000152.5:c.266G > A p.(Arg89His) were identified as an incidental finding of clinical exome sequencing. These variants are listed in the ClinVar and the Pompe disease GAA variant databases but are reported here for the first time in compound heterozygosity. All four siblings displayed normal urine tetrasaccharide levels and no clinical manifestations related to Pompe disease. Nevertheless, GAA enzymatic activity was within the range for late onset Pompe patients. Our report shows an association between a novel genotype and attenuated GAA enzymatic activity. The clinical significance can only be established by the regular monitoring of these individuals. The study highlights the major challenges for clinical care arising from incidental findings of next generation sequencing.
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Affiliation(s)
- Anna Malekkou
- Biochemical Genetics Department, The Cyprus Institute of Neurology and Genetics, P. O. Box 23462, 1683 Nicosia, Cyprus
| | - Athina Theodosiou
- Cytogenetics and Genomics Department, The Cyprus Institute of Neurology and Genetics, P. O. Box 23462, 1683 Nicosia, Cyprus
| | - Angelos Alexandrou
- Cytogenetics and Genomics Department, The Cyprus Institute of Neurology and Genetics, P. O. Box 23462, 1683 Nicosia, Cyprus
| | - Ioannis Papaevripidou
- Cytogenetics and Genomics Department, The Cyprus Institute of Neurology and Genetics, P. O. Box 23462, 1683 Nicosia, Cyprus
| | - Carolina Sismani
- Cytogenetics and Genomics Department, The Cyprus Institute of Neurology and Genetics, P. O. Box 23462, 1683 Nicosia, Cyprus
| | - Edwin H. Jacobs
- Center for Lysosomal and Metabolic Diseases, Department of Clinical Genetics, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands
| | - George J.G. Ruijter
- Center for Lysosomal and Metabolic Diseases, Department of Clinical Genetics, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015, GD, Rotterdam, the Netherlands
| | - Violetta Anastasiadou
- Clinical Genetics Department, Archbishop Makarios III Hospital, Korytsas 6, 2012 Nicosia, Cyprus
- Karaiskakio Foundation, P.O. Box 22680, 1523 Nicosia, Cyprus
| | - Sofia Ourani
- Clinical Genetics Department, Archbishop Makarios III Hospital, Korytsas 6, 2012 Nicosia, Cyprus
| | - Emilia Athanasiou
- Clinical Genetics Department, Archbishop Makarios III Hospital, Korytsas 6, 2012 Nicosia, Cyprus
| | - Anthi Drousiotou
- Biochemical Genetics Department, The Cyprus Institute of Neurology and Genetics, P. O. Box 23462, 1683 Nicosia, Cyprus
| | - Olga Grafakou
- Inborn Errors of Metabolism Clinic, Department of Pediatrics, Archbishop Makarios III Hospital, Korytsas 6, 2012 Nicosia, Cyprus
| | - Petros P. Petrou
- Biochemical Genetics Department, The Cyprus Institute of Neurology and Genetics, P. O. Box 23462, 1683 Nicosia, Cyprus
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4
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Kubaski F, Sousa I, Amorim T, Pereira D, Silva C, Chaves V, Brusius-Facchin AC, Netto ABO, Soares J, Vairo F, Poletto E, Trometer J, Souza A, Ranieri E, Polo G, Hong X, Herbst ZM, Burlina A, Gelb MH, Giugliani R. Pilot study of newborn screening for six lysosomal diseases in Brazil. Mol Genet Metab 2023; 140:107654. [PMID: 37507255 DOI: 10.1016/j.ymgme.2023.107654] [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: 03/07/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Lysosomal diseases (LDs) are progressive life-threatening disorders that are usually asymptomatic at birth. Specific treatments are available for several LDs, and early intervention improves patient's outcomes. Thus, these diseases benefit from newborn screening (NBS). We have performed a pilot study for six LDs in Brazil by tandem mass spectrometry. METHODS Dried blood spot (DBS) samples of unselected newborns were analyzed by the Neo-LSD™ kit (Perkin-Elmer) by MS/MS. Samples with low enzyme activity were submitted to the evaluation of specific biomarkers by ultra-performance liquid chromatography tandem-mass spectrometry as the second-tier, and were analyzed by a next-generation sequencing (NGS) multi-gene panel as the third-tier. All tests were performed in the same DBS sample. RESULTS In 20,066 newborns analyzed, 15 samples showed activity of one enzyme below the cutoff. Two newborns had biochemical and molecular results compatible with Fabry disease, and five newborns had biochemical results and pathogenic variants or variants of unknown significance (VUS) in GAA. CONCLUSIONS This study indicates that the use of enzyme assay as the first-tier test gives an acceptably low number of positive results that requires second/third tier testing. The possibility to run all tests in a DBS sample makes this protocol applicable to large-scale NBS programs.
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Affiliation(s)
- Francyne Kubaski
- Greenwood Genetic Center, Biochemical Genetics Laboratory, Greenwood, USA; BioDiscovery Laboratory, HCPA, Porto Alegre, Brazil; Medical Genetics Service, HCPA, Porto Alegre, Brazil; PPGBM, UFRGS, Porto Alegre, Brazil.
| | | | - Tatiana Amorim
- APAE Salvador, Salvador, Brazil; Colegiado de Medicina, Universidade do Estado da Bahia, Salvador, Brazil.
| | | | - Camilo Silva
- Waters technologies do Brazil, Sao Paulo, Brazil.
| | - Vitor Chaves
- Waters technologies do Brazil, Sao Paulo, Brazil.
| | | | - Alice B O Netto
- BioDiscovery Laboratory, HCPA, Porto Alegre, Brazil; PPGBM, UFRGS, Porto Alegre, Brazil.
| | | | - Filippo Vairo
- Department of Clinical Genomics, Center for Individualized Medicine, Mayo Clinic, Rochester, USA.
| | - Edina Poletto
- Medical Genetics Service, HCPA, Porto Alegre, Brazil; PPGBM, UFRGS, Porto Alegre, Brazil
| | | | | | - Enzo Ranieri
- Women's and Children Hospital, Adelaide, Australia.
| | - Giulia Polo
- Division of Inherited Metabolic Diseases, Regional Center for Expanded Neonatal Screening, Department of Women and Children's Health, University Hospital of Padova, Padova, Italy
| | - Xinying Hong
- Department of Chemistry, University of Washington, Seattle, USA; Department of Pathology and Laboratory of Medicine, Children's Hospital of Philadelphia, Philadelphia, USA.
| | - Zackary M Herbst
- Department of Chemistry, University of Washington, Seattle, USA.
| | - Alberto Burlina
- Division of Inherited Metabolic Diseases, Regional Center for Expanded Neonatal Screening, Department of Women and Children's Health, University Hospital of Padova, Padova, Italy.
| | - Michael H Gelb
- Department of Chemistry, University of Washington, Seattle, USA.
| | - Roberto Giugliani
- BioDiscovery Laboratory, HCPA, Porto Alegre, Brazil; Medical Genetics Service, HCPA, Porto Alegre, Brazil; PPGBM, UFRGS, Porto Alegre, Brazil; DASA, Sao Paulo, Brazil; Casa dos Raros, Porto Alegre, Brazil.
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5
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Chan MY, Jalil JA, Yakob Y, Wahab SAA, Ali EZ, Khalid MKNM, Leong HY, Chew HB, Sivabalakrishnan JB, Ngu LH. Genotype, phenotype and treatment outcomes of 17 Malaysian patients with infantile-onset Pompe disease and the identification of 3 novel GAA variants. Orphanet J Rare Dis 2023; 18:231. [PMID: 37542277 PMCID: PMC10403872 DOI: 10.1186/s13023-023-02848-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/28/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Pompe disease is a rare glycogen storage disorder caused by deficiency of the lysosomal enzyme acid alpha-glucosidase (GAA), leading to glycogen deposition in multiple tissues. Infantile-onset Pompe disease (IOPD) patients present within the first year of life with profound hypotonia and hypertrophic cardiomyopathy. Treatment with enzyme replacement therapy (ERT) has significantly improved survival for this otherwise lethal disorder. This study aims to describe the clinical and molecular spectrum of Malaysian IOPD patients, and to analyze their long term treatment outcomes. METHODS Seventeen patients diagnosed with IOPD between 2000 and 2020 were included in this retrospective cohort study. Clinical and biochemical data were collated and analyzed using descriptive statistics. GAA enzyme levels were performed on dried blood spots. Molecular analysis of the GAA gene was performed by polymerase chain reaction and Sanger sequencing. Structural modelling was used to predict the effect of the novel mutations on enzyme structure. RESULTS Our cohort had a median age of presentation of 3 months and median age of diagnosis of 6 months. Presenting features were hypertrophic cardiomyopathy (100%), respiratory insufficiency (94%), hypotonia (88%), failure to thrive (82%), feeding difficulties (76%), and hepatomegaly (76%). Fourteen different mutations in the GAA gene were identified, with three novel mutations, c.1552-14_1552-1del, exons 2-3 deletion and exons 6-10 deletion. The most common mutation identified was c.1935C > A p.(D645E), with an allele frequency of 33%. Sixteen patients received ERT at the median age of 7 months. Overall survival was 29%. Mean age of death was 17.5 months. Our longest surviving patient has atypical IOPD and is currently 20 years old. CONCLUSIONS This is the first study to analyze the genotype and phenotype of Malaysian IOPD patients, and has identified the c.1935C > A p.(D645E) as the most common mutation. The three novel mutations reported in this study expands the mutation spectrum for IOPD. Our low survival rate underscores the importance of early diagnosis and treatment in achieving better treatment outcomes.
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Affiliation(s)
- Mei-Yan Chan
- Department of Genetics, Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Pahang, 50586, Kuala Lumpur, Malaysia.
| | - Julaina Abdul Jalil
- Unit of Biochemistry, Institute for Medical Research, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Yusnita Yakob
- Unit of Molecular Diagnostics, Specialised Diagnostics Centre, National Institutes of Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Siti Aishah Abdul Wahab
- Unit of Molecular Diagnostics, Specialised Diagnostics Centre, National Institutes of Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Ernie Zuraida Ali
- Unit of Inborn Errors of Metabolism and Genetic, Nutrition, Metabolism and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Mohd Khairul Nizam Mohd Khalid
- Unit of Molecular Diagnostics, Specialised Diagnostics Centre, National Institutes of Health, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Huey-Yin Leong
- Department of Genetics, Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Pahang, 50586, Kuala Lumpur, Malaysia
| | - Hui-Bein Chew
- Department of Genetics, Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Pahang, 50586, Kuala Lumpur, Malaysia
| | | | - Lock-Hock Ngu
- Department of Genetics, Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Pahang, 50586, Kuala Lumpur, Malaysia
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6
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Cesar S, Coll M, Fiol V, Fernandez-Falgueras A, Cruzalegui J, Iglesias A, Moll I, Perez-Serra A, Martínez-Barrios E, Ferrer-Costa C, del Olmo B, Puigmulè M, Alcalde M, Lopez L, Pico F, Berrueco R, Brugada J, Zschaeck I, Natera-de Benito D, Carrera-García L, Exposito-Escudero J, Ortez C, Nascimento A, Brugada R, Sarquella-Brugada G, Campuzano O. LMNA-related muscular dystrophy: Identification of variants in alternative genes and personalized clinical translation. Front Genet 2023; 14:1135438. [PMID: 37035729 PMCID: PMC10080029 DOI: 10.3389/fgene.2023.1135438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/17/2023] [Indexed: 04/11/2023] Open
Abstract
Background: Laminopathies are caused by rare alterations in LMNA, leading to a wide clinical spectrum. Though muscular dystrophy begins at early ages, disease progression is different in each patient. We investigated variability in laminopathy phenotypes by performing a targeted genetic analysis of patients diagnosed with LMNA-related muscular dystrophy to identify rare variants in alternative genes, thereby explaining phenotypic differences. Methods: We analyzed 105 genes associated with muscular diseases by targeted sequencing in 26 pediatric patients of different countries, diagnosed with any LMNA-related muscular dystrophy. Family members were also clinically assessed and genetically analyzed. Results: All patients carried a pathogenic rare variant in LMNA. Clinical diagnoses included Emery-Dreifuss muscular dystrophy (EDMD, 13 patients), LMNA-related congenital muscular dystrophy (L-CMD, 11 patients), and limb-girdle muscular dystrophy 1B (LGMD1B, 2 patients). In 9 patients, 10 additional rare genetic variants were identified in 8 genes other than LMNA. Genotype-phenotype correlation showed additional deleterious rare variants in five of the nine patients (3 L-CMD and 2 EDMD) with severe phenotypes. Conclusion: Analysis f known genes related to muscular diseases in close correlation with personalized clinical assessments may help identify additional rare variants of LMNA potentially associated with early onset or most severe disease progression.
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Affiliation(s)
- Sergi Cesar
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies pediàtriques, Cardiologia Genètica i Mort sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, Netherlands
| | - Monica Coll
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Victoria Fiol
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies pediàtriques, Cardiologia Genètica i Mort sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, Netherlands
| | - Anna Fernandez-Falgueras
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Jose Cruzalegui
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies pediàtriques, Cardiologia Genètica i Mort sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, Netherlands
| | - Anna Iglesias
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Isaac Moll
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies pediàtriques, Cardiologia Genètica i Mort sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, Netherlands
| | - Alexandra Perez-Serra
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Estefanía Martínez-Barrios
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies pediàtriques, Cardiologia Genètica i Mort sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, Netherlands
| | - Carles Ferrer-Costa
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Bernat del Olmo
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Marta Puigmulè
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Medical Science Department, School of Medicine, Universitat de Girona, Girona, Catalonia, Spain
| | - Mireia Alcalde
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Laura Lopez
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ferran Pico
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Rubén Berrueco
- Pediatric Hematology Service, Hospital Sant Joan de Déu Barcelona, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu de Barcelona (IRP-HSJD), Universitat de Barcelona, Barcelona, Spain
| | - Josep Brugada
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies pediàtriques, Cardiologia Genètica i Mort sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, Netherlands
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Arrhythmia Section, Cardiology Service, Hospital Clínic, Barcelona, Spain
| | - Irene Zschaeck
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies pediàtriques, Cardiologia Genètica i Mort sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, Netherlands
- Neuromuscular Unit, Department of Neurology, Hospital Sant Joan de Déu, Barcelona, Spain
- Investigación Aplicada en Enfermedades Neuromusculares Neurociències Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Daniel Natera-de Benito
- Neuromuscular Unit, Department of Neurology, Hospital Sant Joan de Déu, Barcelona, Spain
- Investigación Aplicada en Enfermedades Neuromusculares Neurociències Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Laura Carrera-García
- Neuromuscular Unit, Department of Neurology, Hospital Sant Joan de Déu, Barcelona, Spain
- Investigación Aplicada en Enfermedades Neuromusculares Neurociències Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Jessica Exposito-Escudero
- Neuromuscular Unit, Department of Neurology, Hospital Sant Joan de Déu, Barcelona, Spain
- Investigación Aplicada en Enfermedades Neuromusculares Neurociències Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Carlos Ortez
- Neuromuscular Unit, Department of Neurology, Hospital Sant Joan de Déu, Barcelona, Spain
- Investigación Aplicada en Enfermedades Neuromusculares Neurociències Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Andrés Nascimento
- Neuromuscular Unit, Department of Neurology, Hospital Sant Joan de Déu, Barcelona, Spain
- Investigación Aplicada en Enfermedades Neuromusculares Neurociències Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Instituto Nacional de Investigación Biomédica de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Ramon Brugada
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Medical Science Department, School of Medicine, Universitat de Girona, Girona, Catalonia, Spain
- Cardiology Department, Hospital Josep Trueta, Girona, Catalonia, Spain
| | - Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Barcelona, Spain
- Arrítmies pediàtriques, Cardiologia Genètica i Mort sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), Amsterdam, Netherlands
- Medical Science Department, School of Medicine, Universitat de Girona, Girona, Catalonia, Spain
- *Correspondence: Oscar Campuzano, ; Georgia Sarquella-Brugada,
| | - Oscar Campuzano
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Medical Science Department, School of Medicine, Universitat de Girona, Girona, Catalonia, Spain
- *Correspondence: Oscar Campuzano, ; Georgia Sarquella-Brugada,
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7
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Jiao K, Dong J, Luo S, Yu L, Ke Q, Wang Z, Luan X, Zhang X, Guo J, Chen Y, Li X, Tan S, Qian F, Jiang J, Yu X, Yue D, Liu C, Luo L, Li J, Qu Y, Chen L, Tu J, Sun C, Yan C, Song J, Xi J, Lin J, Lu J, Zhao C, Zhu W, Fang Q. High-risk screening of late-onset Pompe disease: A different early portrait in China. Front Neurol 2022; 13:965207. [PMID: 36237614 PMCID: PMC9553204 DOI: 10.3389/fneur.2022.965207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/05/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction The lack of knowledge regarding the differences between Chinese and other ethnicities in the early manifestation of late-onset Pompe disease (LOPD) prohibits the development of an effective screening strategy. We conducted a multicenter screening study to determine LOPD prevalence in high-risk populations and define the early manifestation of LOPD in China. Methods Between August 2020 and April 2021, the participants were prospectively identified through medical examination at 20 centers from inpatient departments and outpatient neuromuscular clinics in China. The inclusion criteria were as follows: (1) age ≥ 1 year and (2) either one of the following conditions: (a) persistent hyperCKemia, (b) muscle weakness of the axial and/or limb-girdle muscles, or (c) unexplained restrictive respiratory insufficiency (RI). Enzymatic activity of acid α-glucosidase (GAA) was measured in a dried blood spot (DBS) using a tandem mass spectrometry (MS/MS) assay. Next-generation sequencing (NGS) was used to evaluate all samples with decreased GAA activity, searching for GAA mutations and pseudodeficiency alleles. Results Among the 492 cases, 26 positive samples (5.3%) were detected in the DBS test. Molecular studies confirmed a diagnosis of LOPD in eight cases (1.6%). Using MS/MS assay, GAA activities in individuals with pseudodeficiency could be distinguished from those in patients with LOPD. The median interval from the onset of symptoms to diagnosis was 5 years. All patients also showed RI, with a mean forced vital capacity (FVC) of 48%, in addition to axial/proximal muscle weakness. The creatine kinase (CK) level ranged from normal to no more than 5-fold the upper normal limit (UNL). LOPD with isolated hyperCKemia was not identified. Conclusion Less frequent hyperCKemia and predominant RI depict a different early portrait of adult Chinese patients with LOPD. A modified high-risk screening strategy should be proposed for the early diagnosis of Chinese patients with LOPD.
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Affiliation(s)
- Kexin Jiao
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
| | - Jihong Dong
- Department of Neurology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Sushan Luo
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
| | - Liqiang Yu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Shanghai, China
| | - Qing Ke
- Department of Neurology, The First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, Zhejiang, China
| | - Zhiqiang Wang
- Department of Neurology, Institute of Neurology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xinghua Luan
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xiaojie Zhang
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Junhong Guo
- Department of Neurology, First Hospital, Shanxi Medical University, Taiyuan, China
| | - Yan Chen
- Department of Neurology, Tongji Hospital, Tongji University, Shanghai, China
| | - Xihua Li
- Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Song Tan
- Department of Neurology, School of Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Fangyuan Qian
- Department of Neurology, School of Medicine, Affiliated ZhongDa Hospital, Research Institution of Neuropsychiatry, Southeast University, Nanjing, China
| | - Jianming Jiang
- Department of Neurology, First Affiliated Hospital to Naval Medical University, Shanghai, China
| | - Xuen Yu
- Affiliated Hospital of the Institute of Neurology, Anhui University of Chinese Medicine, Hefei, China
| | - Dongyue Yue
- Department of Neurology, Jing'an District Center Hospital of Shanghai, Fudan University, Shanghai, China
| | - Changxia Liu
- Department of Neurology, The Fourth Affiliated Hospital of Nantong University, Yancheng, China
| | - Lijun Luo
- Department of Neurology, Wuhan No.1 Hospital, Wuhan, China
| | - Jianping Li
- Department of Geriatrics, School of Medicine, Renji Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yanzhou Qu
- Department of Neurology, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, China
| | - Lan Chen
- Department of Neurology, Nantong first people's Hospital, Nantong, Jiangsu, China
| | - Jianglong Tu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chong Sun
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
| | - Chong Yan
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Song
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
| | - Jianying Xi
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Lin
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
| | - Jiahong Lu
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
| | - Chongbo Zhao
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenhua Zhu
- Department of Neurology, Huashan Hospital Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Shanghai Medical College, Huashan Hospital, Fudan University, Shanghai, China
- *Correspondence: Wenhua Zhu
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Shanghai, China
- Qi Fang
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8
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Marques JS. The Clinical Management of Pompe Disease: A Pediatric Perspective. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9091404. [PMID: 36138713 PMCID: PMC9497581 DOI: 10.3390/children9091404] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 01/09/2023]
Abstract
Pompe disease (PD) is an inherited metabolic disorder caused by a deficiency of acid α-glucosidase (GAA), leading to lysosomal accumulation of glycogen, mainly in skeletal and cardiac muscles as well as the nervous system. Patients with PD develop cellular dysfunction and muscle damage. PD can be classified into two classic forms, namely infantile-onset PD (IOPD) and late-onset PD (LOPD). Delayed treatment, particularly in IOPD, would result in significant organ damage and early death. Nonetheless, early diagnosis and timely treatment are often hampered by the rarity of PD and its wide variety of, but overlapping, symptoms. This article reviews the common clinical presentations of PD and outlines the essentials of PD management. In particular, the implications of newborn screening (NBS) and clinical performance of enzyme replacement therapy (ERT) are highlighted.
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Affiliation(s)
- Jorge Sales Marques
- Conde S. Januário Hospital, Macau 999078, China;
- Hospital Cuf Trindade, 4000-541 Porto, Portugal
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9
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Saito Y, Nakamura K, Fukuda T, Sugie H, Hayashi S, Noguchi S, Nishino I. Muscle biochemical and pathological diagnosis in Pompe disease. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-329085. [PMID: 35470251 DOI: 10.1136/jnnp-2022-329085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/10/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Pompe disease is reportedly less prevalent in Japan than in neighbouring countries, raising a possibility that some patients may be overlooked. Therefore, all muscle biopsy samples received at our institute were screened for Pompe disease to determine the accuracy of the disease prevalence. METHODS The acid α-glucosidase (GAA) activity was assayed using 10 µm frozen muscle sections from 2408 muscle biopsies received between July 2015 and January 2018. Genetic analysis was performed for samples with decreased activity. The number of myopathologically diagnosed patients was retrospectively assessed. RESULTS The GAA activity was distributed similarly to previous results from dried blood spot screening. GAA activity measured using muscle sections corresponded to that measured using muscle blocks. Of 163 patients with GAA activity <3 nmol/hour/mg protein, 43 (26%) patients had homozygous pseudodeficiency alleles in GAA (p.G576S and p.E689K). In the retrospective analysis, the number of patients diagnosed with Pompe disease via muscle biopsies decreased to zero over time. DISCUSSION Muscle pathology is an accurate method to diagnose Pompe disease. It is unlikely that a significant number of patients with Pompe disease are overlooked. Pathological variants were rare, and the majority carried a pseudodeficiency allele, which further supports our conclusion.
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Affiliation(s)
- Yoshihiko Saito
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
| | | | - Tokiko Fukuda
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideo Sugie
- Faculty of Health and Medical Sciences, Tokoha University, Hamamatsu, Japan
| | - Shinichiro Hayashi
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Satoru Noguchi
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Ichizo Nishino
- Department of Neuromuscular Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
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10
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Amiñoso C, Solera J. Genetic analysis of 76 Spanish Pompe disease patients: Identification of 12 novel pathogenic GAA variants and functional characterization of splicing variants. Gene 2022; 808:145967. [PMID: 34530085 DOI: 10.1016/j.gene.2021.145967] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/14/2021] [Accepted: 09/09/2021] [Indexed: 11/04/2022]
Abstract
Glycogenosis type II (GSDII), or Pompe disease (MIM 232300), is an inherited autosomal recessive disorder caused by deficiency of the lysosomal acid-α-glucosidase. Mutations in the GAA gene alter normal enzyme production and lead to progressive buildup of intralysosomal glycogen, which plays an essential role in the severity and progression of the disease. We report here the study of 76 patients from Spain with either infantile or late onset form of Pompe disease. The analysis consisted in the molecular study of exons and intron flanking fragments of GAA gene. We have identified 55 different molecular pathogenic variants, 12 of them not previously described. In addition, we have determined a frequency of 84.37% for the c.-32-13T>G mutation in patients with the late-onset form of the disease. Functional characterization of some splice mutations showed deleterious mechanisms on the processing of mRNA.
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Affiliation(s)
- Cinthia Amiñoso
- Molecular Oncogenetics Section, INGEMM, Hospital La Paz, 28046 Madrid, Spain
| | - Jesús Solera
- Molecular Oncogenetics Section, INGEMM, Hospital La Paz, 28046 Madrid, Spain; Department of Biochemistry, Faculty of Medicine, Autonoma University of Madrid, 28046 Madrid, Spain.
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11
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Wencel M, Shaibani A, Goyal NA, Dimachkie MM, Trivedi J, Johnson NE, Gutmann L, Wicklund MP, Bandyopadhay S, Genge AL, Freimer ML, Goyal N, Pestronk A, Florence J, Karam C, Ralph JW, Rasheed Z, Hays M, Hopkins S, Mozaffar T. Investigating Late-Onset Pompe Prevalence in Neuromuscular Medicine Academic Practices: The IPaNeMA Study. Neurol Genet 2021; 7:e623. [PMID: 36299500 PMCID: PMC9595038 DOI: 10.1212/nxg.0000000000000623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/25/2021] [Accepted: 08/03/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVES We investigated the prevalence of late-onset Pompe disease (LOPD) in patients presenting to 13 academic, tertiary neuromuscular practices in the United States and Canada. METHODS All successive patients presenting with proximal muscle weakness or isolated hyperCKemia and/or neck muscle weakness to these 13 centers were invited to participate in the study. Whole blood was tested for acid alpha-glucosidase (GAA) assay through the fluorometric method, and all cases with enzyme levels of ≤10 pmoL/punch/h were reflexed to molecular testing for mutations in the GAA gene. Clinical and demographic information was abstracted from their clinical visit and, along with study data, entered into a purpose-built REDCap database, and analyzed at the University of California, Irvine. RESULTS GAA enzyme assay results were available on 906 of the 921 participants who consented for the study. LOPD was confirmed in 9 participants (1% prevalence). Another 9 (1%) were determined to have pseudodeficiency of GAA, whereas 19 (1.9%) were found to be heterozygous for a pathogenic GAA mutation (carriers). Of the definite LOPD participants, 8 (89%) were Caucasian and were heterozygous for the common leaky (IVS1) splice site mutation in the GAA gene (c -32-13T>G), with a second mutation that was previously confirmed to be pathogenic. DISCUSSION The prevalence of LOPD in undiagnosed patients meeting the criteria of proximal muscle weakness, high creatine kinase, and/or neck weakness in academic, tertiary neuromuscular practices in the United States and Canada is estimated to be 1%, with an equal prevalence rate of pseudodeficiency alleles. TRIAL REGISTRATION INFORMATION Clinical trial registration number: NCT02838368.
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12
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Niño MY, In't Groen SLM, de Faria DOS, Hoogeveen-Westerveld M, van den Hout HJMP, van der Ploeg AT, Bergsma AJ, Pijnappel WWMP. Broad variation in phenotypes for common GAA genotypes in Pompe disease. Hum Mutat 2021; 42:1461-1472. [PMID: 34405923 PMCID: PMC9292902 DOI: 10.1002/humu.24272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/30/2021] [Accepted: 08/15/2021] [Indexed: 11/09/2022]
Abstract
Patients with the common c.-32-13T > G/null GAA genotype have a broad variation in age at symptom onset, ranging from early childhood to late adulthood. Phenotypic variation for other common GAA genotypes remains largely unexplored. Here, we analyzed variation in age at symptom onset for the most common GAA genotypes using the updated and extended Pompe GAA variant database. Patients with the c.2647-7G > A/null genotype invariably presented symptoms at adulthood, while the c.-32-13T > G/null, c.546G > T/null, c.1076-22T > G/null, c.2238G > C/null, and c.2173C > T/null genotypes led to presentations from early childhood up to late adulthood. The c.1309C > T/null genotype was associated with onset at early to late childhood. Symptom onset shifted toward higher ages in homozygous patients. These findings indicate that a broad variation in symptom onset occurs for various common GAA genotypes, suggesting the presence of modifying factors. We identified three new compound heterozygous c.-32-13T > G/null patients who carried the genetic modifier c.510C > T and who showed symptom onset at childhood. While c.510C > T acted by lowering GAA enzyme activity, other putative genetic modifiers did not at the group level, suggesting that these act in trans on processes downstream of GAA enzyme activity.
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Affiliation(s)
- Monica Y Niño
- Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Center for Lysosomal and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Stijn L M In't Groen
- Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Center for Lysosomal and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Douglas O S de Faria
- Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Center for Lysosomal and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Hannerieke J M P van den Hout
- Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Center for Lysosomal and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ans T van der Ploeg
- Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Center for Lysosomal and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Atze J Bergsma
- Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Center for Lysosomal and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - W W M Pim Pijnappel
- Department of Pediatrics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands.,Center for Lysosomal and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
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13
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Hernández-Arévalo P, Santotoribio JD, Delarosa-Rodríguez R, González-Meneses A, García-Morillo S, Jiménez-Arriscado P, Guerrero JM, Macher HC. Genotype-phenotype correlation of 17 cases of Pompe disease in Spanish patients and identification of 4 novel GAA variants. Orphanet J Rare Dis 2021; 16:233. [PMID: 34020684 PMCID: PMC8139113 DOI: 10.1186/s13023-021-01864-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/10/2021] [Indexed: 11/15/2022] Open
Abstract
Background Pompe disease (PD) is an autosomal recessive metabolic disorder caused by pathogenic variants in the acid -glucosidase gene (GAA) that produces defects in the lysosomal acid -1,4-glucosidase. We aimed to identify genetic variations and clinical features in Spanish subjects to establish genotypephenotype correlation. Methods A total of 2637 samples of patients who showed symptoms or susceptible signs of PD were enrolled in this observational study. Enzymatic activity was detected by fluorometric techniques and the genetic study was carried out using Next-Generation Sequencing. Results Fourteen different variants from 17 diagnosed patients were identified, seven males and nine females with LOPD (mean age 36.07, SD 20.57, range 764) and a 2-day-old boy with IOPD, four genetic variants had not been described in the literature previously, including a homozygous variant. In all of them -glucosidase activity was decreased. Muscle weakness, respiratory distress, exercise intolerance, hypotonia, dysphagia and myalgia were commonly observed in patients. Conclusions This study report four new genetic variants that contribute to the pathogenic variants spectrum of the GAA gene. We confirm that patients in Spain have a characteristic profile of a European population, with c.-32-13T>G being the most prevalent variant. Furthermore, it was confirmed that the c.236_246delCCACACAGTGC pathogenic variant in homozygosity is associated with early disease and a worse prognosis.
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Affiliation(s)
- Paula Hernández-Arévalo
- Fundación Pública Andaluza para la Gestión de la Investigación en Salud de Sevilla (FISEVI), Molecular Diagnosis and Rare Diseases Laboratory, Department of Clinical Biochemistry, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - José D Santotoribio
- Molecular Diagnosis and Rare Diseases Laboratory, Department of Clinical Biochemistry, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Rocío Delarosa-Rodríguez
- Fundación Pública Andaluza para la Gestión de la Investigación en Salud de Sevilla (FISEVI), Molecular Diagnosis and Rare Diseases Laboratory, Department of Clinical Biochemistry, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Antonio González-Meneses
- Dysmorphology Unit, Department of Pediatrics, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Salvador García-Morillo
- Collagenosis and Minority Diseases Unit, Experimental Cardiovascular Risk Unit, Department of Internal Medicine, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Pilar Jiménez-Arriscado
- Molecular Diagnosis and Rare Diseases Laboratory, Department of Clinical Biochemistry, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Juan M Guerrero
- Department of Clinical Biochemistry and Molecular Biology Hospital Universitario Virgen del Rocío, Institute of Biomedicine of Seville (Ibis),, Seville University, Seville, Spain
| | - Hada C Macher
- Molecular Diagnosis and Rare Diseases Laboratory, Department of Clinical Biochemistry, Hospital Universitario Virgen del Rocío, Seville, Spain.
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14
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Park KS. Carrier frequency and predicted genetic prevalence of Pompe disease based on a general population database. Mol Genet Metab Rep 2021; 27:100734. [PMID: 33717985 PMCID: PMC7933537 DOI: 10.1016/j.ymgmr.2021.100734] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 12/15/2022] Open
Abstract
Background The genetic prevalence of Pompe disease was estimated based on the proportion of individuals who have a causative genotype in a general population database. In addition, clinical severity for causative genotypes was assessed based on currently available locus-specific databases (LSDBs), which contain information on both genotype and clinical severity. Methods Genetic variants in the GAA gene in the Genome Aggregation Database (gnomAD) (v2.1.1) were analyzed in combination with LSDBs of ClinVar, ClinGen Evidence Repository, Pompe disease GAA variant database, and the Pompe Registry. Carrier frequency (CF) and predicted genetic prevalence (pGP) were estimated. Results Of 7 populations, East Asian and African showed higher proportions of pathogenic or likely pathogenic variants (PLPVs) associated with classic infantile-onset Pompe disease. Total CF and pGP in the overall population were 1.3% (1 in 77) and 1:23,232, respectively. The highest pGP was observed in the East Asian population at 1:12,125, followed by Non-Finnish European (1:13,756), Ashkenazi Jewish (1:22,851), African/African-American (1:26,560), Latino/Admixed American (1:57,620), South Asian (1:93,087), and Finnish (1:1,056,444). Conclusions Pompe disease has a higher pGP (1:23,232) than earlier accepted (1:40,000). The pGP for Pompe disease was expectedly wide by population and consistent with previous reports based on newborn screening programs (approximately 1:10,000-1:30,000).
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Affiliation(s)
- Kyung Sun Park
- Department of Laboratory Medicine, Kyung Hee University School of Medicine and Kyung Hee University Medical Center, Seoul, Republic of Korea
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15
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Lysosomal storage disorders: Novel and frequent pathogenic variants in a large cohort of Indian patients of Pompe, Fabry, Gaucher and Hurler disease. Clin Biochem 2020; 89:14-37. [PMID: 33301762 DOI: 10.1016/j.clinbiochem.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Diagnosis of lysosomal storage disorders (LSDs) remains challenging due to wide clinical, biochemical and molecular heterogeneity. The study applies a combined biochemical and genetic approach to diagnose symptomatic Indian patients of Pompe, Fabry, Gaucher and Hurler disease to generate a comprehensive dataset of pathogenic variants for these disorders. DESIGN & METHODS Symptomatic patients were biochemically diagnosed by fluorometric methods and molecular confirmation was carried out by gene sequencing. Genetic variants were analyzed according to the ACMG/AMP 2015 variant interpretation guidelines. RESULTS Amongst the 2181 suspected patients, 285 (13%) were biochemically diagnosed. Of these, 22.5% (64/285) diagnosed with Pompe disease harboured c.1933G>A, c.1A>G, c.1927G>A and c.2783G>C as common and 10 novel pathogenic variants while 7.4% (21/285) patients diagnosed with Fabry disease carried c.851T>C, c.902G>A, c.905A>C and c.1212_1234del as frequent disease-causing variants along with 7 novel pathogenic variants. As many as 48.4% (138/285) patients were diagnosed with Gaucher disease and had c.1448T>C as the most common pathogenic variant followed by c.1342G>C and c.754T>C with 7 previously unreported disease-causing variants and in the 21.7% (62/285) diagnosed cases of Hurler disease, c.1469T>C, c.754delC c.568_581del and c.1898C>T were identified as the most common causative variants along with 21 novel pathogenic variants. CONCLUSION This comprehensive data set of disease-causing frequent and novel pathogenic variants reported for the first time in such a large patient cohort for each of these four LSDs from the Indian sub-continent, along with their biochemical and clinical spectrum will contribute towards providing definitive diagnosis and treatment, identifying carrier status, as well as in counselling prenatal cases to reduce the morbidity and mortality associated with these disorders.
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Jia X, Shao L, Liu C, Chen T, Peng L, Cao Y, Zhang C, Yang X, Zhang G, Gao J, Fan G, Gu M, Du H, Xia Z. GAA compound heterozygous mutations associated with autophagic impairment cause cerebral infarction in Pompe disease. Aging (Albany NY) 2020; 12:4268-4282. [PMID: 32126021 PMCID: PMC7093195 DOI: 10.18632/aging.102879] [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: 11/05/2019] [Accepted: 02/04/2020] [Indexed: 12/13/2022]
Abstract
Clinical manifestations of the late-onset adult Pompe disease (glycogen storage disease type II) are heterogeneous. To identify genetic defects of a special patient population with cerebrovascular involvement as the main symptom, we performed whole-genome sequencing (WGS) analysis on a consanguineous Chinese family of total eight members including two Pompe siblings both had cerebral infarction. Two novel compound heterozygous variants were found in GAA gene: c.2238G>C in exon 16 and c.1388_1406del19 in exon 9 in the two patients. We verified the function of the two mutations in leading to defects in GAA protein expression and enzyme activity that are associated with autophagic impairment. We further performed a gut microbiome metagenomics analysis, found that the child’s gut microbiome metagenome is very similar to his mother. Our finding enriches the gene mutation spectrum of Pompe disease, and identified the association of the two new mutations with autophagy impairment. Our data also indicates that gut microbiome could be shared within Pompe patient and cohabiting family members, and the abnormal microbiome may affect the blood biochemical index. Our study also highlights the importance of deep DNA sequencing in potential clinical applications.
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Affiliation(s)
- Xiaodong Jia
- Joint Laboratory for Translational Medicine Research, Liaocheng People's Hospital, Liaocheng 252000, Shandong, P.R. China
| | - Libin Shao
- BGI-Qingdao, BGI-Shenzhen, Qingdao 266555, P.R. China.,School of Biology and Biological Engineering, South China University of Technology, Guangzhou 510006, P.R. China
| | | | - Tuanzhi Chen
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Shandong First Medical University, Liaocheng 252000, Shandong, P.R. China
| | - Ling Peng
- BGI-Qingdao, BGI-Shenzhen, Qingdao 266555, P.R. China
| | - Yinguang Cao
- Department of Clinical laboratory, Liaocheng People's Hospital and Liaocheng Clinical School of Shandong First Medical University, Liaocheng 252000, Shandong, P.R. China
| | - Chuanchen Zhang
- Department of Radiology, Liaocheng People's Hospital and Liaocheng Clinical School of Shandong First Medical University, Liaocheng 252000, Shandong, P.R. China
| | - Xiafeng Yang
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Shandong First Medical University, Liaocheng 252000, Shandong, P.R. China
| | - Guifeng Zhang
- Shandong First Medical University, Taian 271016, Shandong, P.R. China
| | - Jianlu Gao
- Joint Laboratory for Translational Medicine Research, Liaocheng People's Hospital, Liaocheng 252000, Shandong, P.R. China.,Department of Ophthalmology, Liaocheng People's Hospital and Liaocheng Clinical School of Shandong First Medical University, Liaocheng 252000, Shandong, P.R. China.,School of Medicine Shandong University, Jinan 250012, Shandong, P.R. China
| | - Guangyi Fan
- BGI-Qingdao, BGI-Shenzhen, Qingdao 266555, P.R. China.,BGI-Shenzhen, Shenzhen 518083, P.R. China.,China National GeneBank, BGI-Shenzhen, Shenzhen 518120, P.R. China.,BGI-Fuyang, BGI-Shenzhen, Fuyang 236009, P.R. China
| | - Mingliang Gu
- Joint Laboratory for Translational Medicine Research, Liaocheng People's Hospital, Liaocheng 252000, Shandong, P.R. China
| | - Hongli Du
- School of Biology and Biological Engineering, South China University of Technology, Guangzhou 510006, P.R. China
| | - Zhangyong Xia
- Department of Neurology, Liaocheng People's Hospital and Liaocheng Clinical School of Shandong First Medical University, Liaocheng 252000, Shandong, P.R. China.,School of Medicine Shandong University, Jinan 250012, Shandong, P.R. China
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17
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Li J, Cui Y, Wang X, Wang Q, Wang H, Yan B. The Novel Compound Heterozygous Mutations of GAA Gene in Mainland Chinese Patient with Classic Infantile-Onset Pompe Disease. Int Heart J 2020; 61:178-182. [DOI: 10.1536/ihj.19-241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Jiaming Li
- Clinical Medical College, Jining Medical University
| | - Yinghua Cui
- Department of Cardiology, Affiliated Hospital of Jining Medical University
| | - Xin Wang
- Department of Cardiology, Affiliated Hospital of Jining Medical University
| | - Qinglei Wang
- Department of Cardiology, Affiliated Hospital of Jining Medical University
| | - Hongjun Wang
- Department of Ultrasound, Affiliated Hospital of Jining Medical University
| | - Bo Yan
- Central Laboratory, Affiliated Hospital of Jining Medical University
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18
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Gupta N, Kazi ZB, Nampoothiri S, Jagdeesh S, Kabra M, Puri RD, Muranjan M, Kalaivani M, Rehder C, Bali D, Verma IC, Kishnani PS. Clinical and Molecular Disease Spectrum and Outcomes in Patients with Infantile-Onset Pompe Disease. J Pediatr 2020; 216:44-50.e5. [PMID: 31606152 DOI: 10.1016/j.jpeds.2019.08.058] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 08/25/2019] [Accepted: 08/28/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To evaluate the clinical and molecular spectrum, and factors affecting clinical outcome of patients in India diagnosed with infantile-onset Pompe disease (IOPD). STUDY DESIGN In this multicenter, cross-sectional study, we evaluated the records of 77 patients with IOPD to analyze their clinical course, outcomes, and factors influencing the outcomes. RESULTS Of the 77 patients with IOPD, phenotype data were available in 59; 46 (78%) had the classic phenotype. Overall, 58 of 77 (75%) and 19 of 77 (25%) patients were symptomatic before and after age 6 months, respectively. Alpha-glucosidase gene variant analysis available for 48 patients (96 alleles) showed missense variants in 49 alleles. Cross-reactive immunologic material (CRIM) status could be determined or predicted in 44 of 48 patients. In total, 32 of 44 patients (72%) were CRIM-positive, and 12 of 44 patients (27%) were CRIM-negative. Thirty-nine cases received enzyme-replacement therapy (ERT), alglucosidase alfa, and 38 patients never received ERT. Median age at initiation of ERT was 6.5 months. Response to ERT was better in babies who had CRIM-positive, non-classic IOPD. CONCLUSIONS This study highlights the clinical spectrum of IOPD in India and provides an insight on various factors, such as undernutrition, feeding difficulties, and recurrent respiratory infection, as possible factors influencing clinical outcomes in these patients. The study also reiterates the importance of raising awareness among clinicians about the need for early diagnosis and timely treatment of IOPD.
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Affiliation(s)
- Neerja Gupta
- Division of Genetics, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
| | - Zoheb B Kazi
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Sheela Nampoothiri
- Department of Pediatric Genetics, Amrita Institute of Medical Sciences, Kerala, India
| | - Sujatha Jagdeesh
- Department of Clinical Genetics & Genetic Counselling, Mediscan Systems, Chennai, India
| | - Madhulika Kabra
- Division of Genetics, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ratna Dua Puri
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Mamta Muranjan
- Department of Pediatrics, King Edward Memorial Hospital, Mumbai, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Catherine Rehder
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Deeksha Bali
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Ishwar C Verma
- Institute of Medical Genetics and Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Priya S Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC
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19
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Nagura H, Hokugo J, Ueda K. Long-Term Observation of the Safety and Effectiveness of Enzyme Replacement Therapy in Japanese Patients with Pompe Disease: Results From the Post-marketing Surveillance. Neurol Ther 2019; 8:397-409. [PMID: 31559584 PMCID: PMC6858897 DOI: 10.1007/s40120-019-00157-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Alglucosidase alfa received marketing approval for the treatment of Pompe disease in Japan in 2007. We conducted a post-marketing surveillance study to monitor the long-term safety and efficacy of alglucosidase alfa therapy among Japanese patients with Pompe disease. METHODS The safety and efficacy outcomes were collected as real-world data for up to 9 years following the initiation of treatment with alglucosidase alfa, without any intervention to treatment strategies. The safety of the drug was assessed in 73 patients in terms of the rate of drug-related adverse events, infusion-associated reactions, and antibody titers. The efficacy was evaluated in 72 patients on the basis of subjective evaluation of their general condition after treatment, pulmonary function, 6-min walk test, and survival rate. RESULTS Drug-related adverse events were observed in 29 of 73 (39.7%) cases, and the cumulative adverse event rate during the 9 years of the study was 45.7%. Immunoglobulin G antibodies against alglucosidase alfa were positive in 59 of 61 cases in which the titers were not correlated with drug-related adverse events or infusion-associated reactions. After the final dosing, the treating physicians determined that the disease was at least stabilized in 62 of 72 cases (86.1%), while the results of the physical function tests suggested that disease progression was actually not stopped completely. Survival of infantile-onset cases was sustained for 9 years. CONCLUSION The drug was generally well tolerated, and treatment with alglucosidase alfa was able to suppress disease progression in the majority of Japanese patients with Pompe disease included in this study. FUNDING Sanofi.
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Affiliation(s)
- Hitoshi Nagura
- Sanofi Genzyme Medical Operations, Sanofi K.K., Tokyo, Japan.
| | | | - Kazuo Ueda
- Sanofi Genzyme Medical Operations, Sanofi K.K., Tokyo, Japan
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20
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Goina E, Musco L, Dardis A, Buratti E. Assessment of the functional impact on the pre-mRNA splicing process of 28 nucleotide variants associated with Pompe disease in GAA exon 2 and their recovery using antisense technology. Hum Mutat 2019; 40:2121-2130. [PMID: 31301153 DOI: 10.1002/humu.23867] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 12/11/2022]
Abstract
Glycogen storage disease II (GSDII), also called Pompe disease, is an autosomal recessive inherited disease caused by a defect in glycogen metabolism due to the deficiency of the enzyme acid alpha-glucosidase (GAA) responsible for its degradation. So far, more than 500 sequence variants of the GAA gene have been reported but their possible involvement on the pre-messenger RNA splicing mechanism has not been extensively studied. In this work, we have investigated, by an in vitro functional assay, all putative splicing variants within GAA exon 2 and flanking introns. Our results show that many variants falling in the canonical splice site or the exon can induce GAA exon 2 skipping. In these cases, therefore, therapeutic strategies aimed at restoring protein folding of partially active mutated GAA proteins might not be sufficient. Regarding this issue, we have tested the effect of antisense oligonucleotides (AMOs) that were previously shown capable of rescuing splicing misregulation caused by the common c.-32-13T>G variant associated with the childhood/adult phenotype of GSDII. Interestingly, our results show that these AMOs are also quite effective in rescuing the splicing impairment of several exonic splicing variants, thus widening the potential use of these effectors for GSDII treatment.
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Affiliation(s)
- Elisa Goina
- Molecular Pathology, International Institute for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Lorena Musco
- Molecular Pathology, International Institute for Genetic Engineering and Biotechnology, Trieste, Italy
| | - Andrea Dardis
- Regional Coordinator Centre for Rare Diseases, Academic Hospital Santa Maria della Misericordia, Udine, Italy
| | - Emanuele Buratti
- Molecular Pathology, International Institute for Genetic Engineering and Biotechnology, Trieste, Italy
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21
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Peruzzo P, Pavan E, Dardis A. Molecular genetics of Pompe disease: a comprehensive overview. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:278. [PMID: 31392190 PMCID: PMC6642931 DOI: 10.21037/atm.2019.04.13] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 04/03/2019] [Indexed: 12/27/2022]
Abstract
Pompe disease (PD) is an autosomal recessive lysosomal disorder caused by the deficient activity of acid alpha-glucosidase (GAA) enzyme due to mutations in the GAA gene. The enzymatic deficiency leads to the accumulation of glycogen within the lysosomes. Clinically, the disease has been classically classified in infantile and childhood/adult forms. The GAA gene has been localized to chromosome 17q25.2-q25.3 and to date, 582 mutations distributed throughout the whole gene have been reported (HGMD: http://www.hgmd.cf.ac.uk/ac/). All types of mutations have been described; missense variants are the most frequent type followed by small deletions. Most GAA mutations are private or found in a small number of families. However, an exception is represented by the c.-32-13T>G splice mutation that is very common in patients of Caucasian origin affected by the childhood/adult form of the disease, with an allelic frequency ranging from 40% to 70%. In this article, we review the spectrum of GAA mutations, their distribution in different populations, and their classification according to their impact on GAA splicing process, protein expression and activity. In addition, whenever possible, we discuss the phenotype/genotype correlation. The information collected in this review provides an overview of the molecular genetics of PD and can be used to facilitate diagnosis and genetic counseling of families affected by this disorder.
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Affiliation(s)
- Paolo Peruzzo
- Regional Coordinator Centre for Rare Diseases, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Eleonora Pavan
- Regional Coordinator Centre for Rare Diseases, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Andrea Dardis
- Regional Coordinator Centre for Rare Diseases, University Hospital Santa Maria della Misericordia, Udine, Italy
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22
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Alandy-Dy J, Wencel M, Hall K, Simon J, Chen Y, Valenti E, Yang J, Bali D, Lakatos A, Goyal N, Mozaffar T, Kimonis V. Variable clinical features and genotype-phenotype correlations in 18 patients with late-onset Pompe disease. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:276. [PMID: 31392188 DOI: 10.21037/atm.2019.06.48] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Pompe disease is a lysosomal storage disorder caused by the deficiency of enzyme acid alpha-glucosidase (GAA) which results in accumulation of glycogen, particularly in the skeletal, cardiac, and smooth muscles. The late-onset form with symptoms presenting in childhood through adulthood, is characterized by proximal muscle weakness, respiratory insufficiency, and unlike the infantile-onset form often with no cardiac involvement. Methods We report our experience with 18 adult patients (14 males/4 females) with Pompe disease, several of whom had unique findings and novel pathogenic variants. Patients ranged in ages from 22-74 years (mean 53.7 years) and were diagnosed at an age range of 11-65 years (mean 43.6 years), often after a history of progressive muscle disease of several years' duration. All 18 patients were treated with alglucosidase alfa (Lumizyme) and their response to treatment was monitored by measurements of their pulmonary function and muscle weakness, six-minute walk test (6MWT), and other functional studies. Results Genetic sequencing revealed that 16 out of 18 individuals had the common c.-32-13T>G splicing variant, and six patients, including two sibships had four novel pathogenic variants: c.1594G>A, c.2655_2656delCG, c.1951-1952delGGinsT, and c.1134C>G. A male with the c.1594G>A variant developed an intracerebral aneurysm at the age of 43 years treated with surgery. Two siblings with the c.2655_2656delCG developed very high antibody titers, one of whom developed a severe infusion reaction. Other clinical features included BiPAP requirement in twelve, tinnitus in seven, scoliosis in five, cardiomyopathy in three, one individual was diagnosed with a cerebral aneurysm who underwent successful Penumbra coil placement, and another individual was diagnosed with both Graves' disease and testicular cancer. Conclusions Our study illustrates significant variability in the range of clinical features, and the variable clinical response to enzyme replacement therapy. It also alerts us to the importance of careful monitoring and early management of complications. Possible genotype-phenotype associations with the novel mutations identified may emerge with larger studies.
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Affiliation(s)
- Jousef Alandy-Dy
- Division of Genetics, Department of Pediatrics, University of California- Irvine, Orange, CA, USA
| | - Marie Wencel
- Division of Genetics, Department of Pediatrics, University of California- Irvine, Orange, CA, USA.,Division of Neuromuscular Disease, Department of Neurology, University of California- Irvine, Orange, CA, USA
| | - Kathy Hall
- Division of Genetics, Department of Pediatrics, University of California- Irvine, Orange, CA, USA
| | - Julie Simon
- Division of Genetics, Department of Pediatrics, University of California- Irvine, Orange, CA, USA
| | - Yanjun Chen
- Biostatistics, Epidemiology & Research Design (BERD) Unit, UCI Institute for Clinical and Translational Science, California- Irvine, Irvine, CA, USA
| | - Erik Valenti
- Division of Genetics, Department of Pediatrics, University of California- Irvine, Orange, CA, USA.,Division of Neuromuscular Disease, Department of Neurology, University of California- Irvine, Orange, CA, USA
| | - Jade Yang
- Dietitian & Nutrition Services, University of California- Irvine, Orange, CA, USA
| | - Deeksha Bali
- Biochemical Genetics Laboratory, Duke University Health System, Durham, NC, USA
| | - Anita Lakatos
- Division of Genetics, Department of Pediatrics, University of California- Irvine, Orange, CA, USA
| | - Namita Goyal
- Division of Neuromuscular Disease, Department of Neurology, University of California- Irvine, Orange, CA, USA
| | - Tahseen Mozaffar
- Division of Neuromuscular Disease, Department of Neurology, University of California- Irvine, Orange, CA, USA
| | - Virginia Kimonis
- Division of Genetics, Department of Pediatrics, University of California- Irvine, Orange, CA, USA
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23
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Zhao Y, Wang Z, Lu J, Gu X, Huang Y, Qiu Z, Wei Y, Yan C. Characteristics of Pompe disease in China: a report from the Pompe registry. Orphanet J Rare Dis 2019; 14:78. [PMID: 30943998 PMCID: PMC6448270 DOI: 10.1186/s13023-019-1054-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/26/2019] [Indexed: 11/24/2022] Open
Abstract
Background Pompe disease is a rare, progressive, autosomal recessive lysosomal storage disorder caused by mutations in the acid α-glucosidase gene. This is the first report of Chinese patients from the global Pompe Registry. Chinese patients enrolled in the Registry (ClinicalTrials.gov, NCT00231400) between Jan 2013 and 2 Sep 2016 with late onset Pompe disease (LOPD; presentation after 12 months of age or presentation at ≤12 months without cardiomyopathy) were included. Data analyses were descriptive. Results Of the 59 Chinese patients included, 86.4% had never received enzyme replacement therapy (ERT). The age at symptom onset and diagnosis was 14.9 (12.35) and 22.1 (10.08) years, which is younger than previous reports of LOPD patients from the rest of the world (28.4 [18.86] and 34.9 [20.03], respectively). The most common diagnosis methods were enzyme assay (79.7%) and/or DNA analysis (61.0%). Of the 36 patients diagnosed using DNA analysis, 31 had standardized variant data and among these patients the most common mutations were c.2238G > C (n = 18, 58.1%) and c.2662G > T (n = 5, 16.1%). Chinese LOPD patients appeared to have worse lung function versus patients from the rest of the world, indicated by lower forced vital capacity (37.2 [14.00]% vs. 63.5 [26.71]%) and maximal expiratory and inspiratory pressure (27.9 [13.54] vs. 51.0 [38.66] cm H2O, and 29.4 [12.04] vs. 70.5 [52.78] cm H2O). Conclusions Compared with patients from the rest of the world, Chinese patients with LOPD appeared to have younger age at symptom onset and diagnosis, lower lung function, and the majority had not received ERT. The most common mutations were c.2238G > C and c.2662G > T. Electronic supplementary material The online version of this article (10.1186/s13023-019-1054-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yuying Zhao
- Shandong University Qilu Hospital, No.107 Wen Hua Xi Road, Jinan, Shandong Province, China
| | - Zhaoxia Wang
- Beijing University 1st hospital, No. 8 Xi Shi Ku Street, Beijing, China
| | - Jiahong Lu
- Fudan University Huashan hospital, No. 12 Middle Wulumuqi Road, Shanghai, China
| | - Xuefan Gu
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1665 Kong Jiang Road, Shanghai, China
| | - Yonglan Huang
- Guangzhou Women & Children's Medical Center, Xing Nan Avenue, Guangzhou, China
| | - Zhengqing Qiu
- Peking Union Medical College Hospital, No. 9 Dongdan Santiao, Beijing, China
| | - Yanping Wei
- Peking Union Medical College Hospital, No. 9 Dongdan Santiao, Beijing, China
| | - Chuanzhu Yan
- Shandong University Qilu Hospital, No.107 Wen Hua Xi Road, Jinan, Shandong Province, China.
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24
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Kim MS, Song A, Im M, Huh J, Kang IS, Song J, Yang A, Kim J, Kwon EK, Choi EJ, Han SJ, Park HD, Cho SY, Jin DK. Clinical and molecular characterization of Korean children with infantile and late-onset Pompe disease: 10 years of experience with enzyme replacement therapy at a single center. KOREAN JOURNAL OF PEDIATRICS 2018; 62:224-234. [PMID: 30360039 PMCID: PMC6584236 DOI: 10.3345/kjp.2018.06968] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/22/2018] [Indexed: 11/27/2022]
Abstract
Purpose Pompe disease (PD) is an autosomal recessive disorder caused by a deficiency of acid alphaglucosidase resulting from pathogenic GAA variants. This study describes the clinical features, genotypes, changes before and after enzyme replacement therapy (ERT), and long-term outcomes in patients with infantile-onset PD (IOPD) and late-onset PD (LOPD) at a tertiary medical center. Methods The medical records of 5 Korean patients (2 male, 3 female patients) diagnosed with PD between 2002 and 2013 at Samsung Medical Center in Seoul, Republic of Korea were retrospectively reviewed for data, including clinical and genetic characteristics at diagnosis and clinical course after ERT. Results Common initial symptoms included hypotonia, cyanosis, and tachycardia in patients with IOPD and limb girdle weakness in patients with LOPD. Electrocardiography at diagnosis revealed hypertrophic cardiomyopathy in all patients with IOPD who showed a stable disease course during a median follow-up period of 10 years. Patients with LOPD showed improved hepatomegaly and liver transaminase level after ERT. Conclusion As ERT is effective for treatment of PD, early identification of this disease is very important. Thus, patients with IOPD should be considered candidates for clinical trials of new drugs in the future.
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Affiliation(s)
- Min-Sun Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ari Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Minji Im
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Huh
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - I-Seok Kang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinyoung Song
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Aram Yang
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | - Jinsup Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Eun-Kyung Kwon
- Department of Pediatrics, Samsung Medical Center, Seoul, Korea
| | - Eu-Jin Choi
- Department of Pediatrics, Samsung Medical Center, Seoul, Korea
| | - Sun-Ju Han
- Samsung Biomedical Research Institute, Seoul, Korea
| | - Hyung-Doo Park
- Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Yoon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Kyu Jin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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25
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Liu HX, Pu CQ, Shi Q, Zhang YT, Ban R. Identification of Seven Novel Mutations in the Acid Alpha-glucosidase Gene in Five Chinese Patients with Late-onset Pompe Disease. Chin Med J (Engl) 2018; 131:448-453. [PMID: 29451150 PMCID: PMC5830830 DOI: 10.4103/0366-6999.225056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Pompe disease is a rare lysosomal glycogen storage disorder linked to the acid alpha-glucosidase gene (GAA). A wide clinical and genetic variability exists between patients from different ethnic populations, and the genotype-phenotype correlations are still not well understood. The aim of this study was to report the clinicopathological and genetic characteristics of five Chinese patients with late-onset Pompe disease (LOPD) who carried novel GAA gene mutations. Methods: Clinical and pathological data of patients diagnosed with glycogen storage disease at our institution from April 1986 to August 2017 were collected, and next-generation sequencing of frozen muscle specimens was conducted. Results: Of the five patients included in the study, the median disease onset age was 13 years, with a median 5 years delay in diagnosis. The patients mainly manifested as progressive weakness in the proximal and axial muscles, while one patient developed respiratory insufficiency that required artificial ventilation. In muscle biopsies, vacuoles with variable sizes and shapes appeared inside muscle fibers, and they stained positive for both periodic acid-Schiff and acid phosphatase staining. Ten GAA gene mutations, including seven novel ones (c.796C>A, c.1057C>T, c.1201C>A, c.1780C>T, c.1799G>C, c.2051C>A, c.2235dupG), were identified by genetic tests. Conclusions: The seven novel GAA gene mutations revealed in this study broaden the genetic spectrum of LOPD and highlight the genetic heterogeneity in Chinese LOPD patients.
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Affiliation(s)
- Hua-Xu Liu
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Chuan-Qiang Pu
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Qiang Shi
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Yu-Tong Zhang
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Rui Ban
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853; School of Medicine, Nankai University, Tianjin 300071, China
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Remiche G, Lukacs Z, Kasper DC, Abramowicz M, Pandolfo M. Low Prevalence Estimates of Late-Onset Glycogen Storage Disease Type II in French-Speaking Belgium are not Due to Missed Diagnoses. J Neuromuscul Dis 2018; 5:471-480. [PMID: 30175981 DOI: 10.3233/jnd-180336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Late-onset glycogen storage disease type II is associated with variable muscle phenotypes. Epidemiological data suggest that its prevalence is lower in Belgium than in bordering countries like The Netherlands. OBJECTIVE We investigated whether such low estimated prevalence is due to missed diagnoses. METHODS We screened 100 patients with muscle phenotypes of undetermined origin using a dried blood spot test for alpha-acid glucosidase (GAA) activity. Patients with low activity at screening were re-tested by the same method and, if low activity was confirmed, GAA gene analysis was performed. RESULTS The screening test revealed lower than normal GAA activity in 15 patients, but in only two of them it was low enough to be considered in the disease range. Retesting confirmed lower than normal GAA activity in five patients, but in all of them it was above the disease range. A single patient carried a heterozygous known pathogenic GAA mutation, whose significance in this case remains undetermined. CONCLUSIONS We conclude that reported low prevalence estimates in Belgium are not likely to be due to an underdiagnosis bias. Lower prevalence compared to neighbouring The Netherlands may be due to different ethnic stratification of our patients. Diagnostic strategies should keep into account the expected prevalence of a disease in specific populations.
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Affiliation(s)
- Gauthier Remiche
- Department of Neurology, Centre de Référence Neuromusculaire, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium
| | - Zoltan Lukacs
- Newborn Screening and Metabolic Diagnostics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - David C Kasper
- ARCHIMED Life Science GmbH, Vienna, Austria. ARCHIMEDlife Laboratories, Leberstraße 20/2 1110 Vienna, Austria
| | - Marc Abramowicz
- Department of Medical Genetics, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium
| | - Massimo Pandolfo
- Department of Neurology, Centre de Référence Neuromusculaire, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium
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27
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Prevalence and ancestral origin of the c.1987delC GAA gene mutation causing Pompe disease in Central Mexico. Meta Gene 2018. [DOI: 10.1016/j.mgene.2017.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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28
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Xu L, Zhang L, Zhong L, Huang X, Li S, Cheng Y, Liang Y, Pei Y, Huang H, Tang W, Zhang C. A novel compound heterozygous GAA mutation in a Chinese family with juvenile onset form of Pompe disease with cardiomyopathy. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2017; 10:11995-12002. [PMID: 31966564 PMCID: PMC6966062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/03/2017] [Indexed: 06/10/2023]
Abstract
Pompe disease is an autosomal recessive disorder resulting from a deficiency of acid α-glucosidase (GAA). It is uncommon in the mainland of China, due to rare mutations in the GAA gene. The aim of this work was to elucidate the causative role of a novel compound heterozygous mutation of juvenile onset Pompe disease. In this study, clinical samples were obtained from two siblings with muscle weakness, recurrent airway infections, cardiomyopathy and respiratory insufficiency in a non-consanguineous Chinese family. The α-glucosidase activity in leukocytes of both children was low. Next-generation sequencing was performed on the 19 coding exons of GAA in both children, with confirmation by Sanger sequencing. Next-generation sequencing showed the same compound heterozygous GAA mutation (c.1216G>A p.Asp406Asn and c.1935C>A p.Asp645Glu) in both children. As this mutation is consistent with the clinical manifestations of juvenile onset Pompe disease and no other mutations were detected after scanning the gene sequence, we suggest that the Pompe disease phenotype is caused by compound heterozygosity for c.1216G>A and c.1935C>A. As c.1216G>A is not currently listed in the Pompe disease Mutation Database, this information about Pompe disease in a Chinese population is of particular interest.
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Affiliation(s)
- Lingling Xu
- Department of Pediatric Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou, China
| | - Lidan Zhang
- Department of Pediatric Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou, China
| | - Liangying Zhong
- Department of Laboratory Medicine, The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou, China
| | - Xueqiong Huang
- Department of Pediatric Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou, China
| | - Suping Li
- Department of Pediatric Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou, China
| | - Yucai Cheng
- Department of Pediatric Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou, China
- Department of Pediatrics, The Seventh Affiliated Hospital of Sun Yat-sen UniversityShenzhen, China
| | - Yujian Liang
- Department of Pediatric Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou, China
| | - Yuxin Pei
- Department of Pediatric Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou, China
| | - Huimin Huang
- Department of Pediatric Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou, China
| | - Wen Tang
- Department of Pediatric Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou, China
| | - Cheng Zhang
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou, China
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Johnson K, Töpf A, Bertoli M, Phillips L, Claeys KG, Stojanovic VR, Perić S, Hahn A, Maddison P, Akay E, Bastian AE, Łusakowska A, Kostera-Pruszczyk A, Lek M, Xu L, MacArthur DG, Straub V. Identification of GAA variants through whole exome sequencing targeted to a cohort of 606 patients with unexplained limb-girdle muscle weakness. Orphanet J Rare Dis 2017; 12:173. [PMID: 29149851 PMCID: PMC5693551 DOI: 10.1186/s13023-017-0722-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/06/2017] [Indexed: 12/30/2022] Open
Abstract
Background Late-onset Pompe disease is a rare genetic neuromuscular disorder caused by a primary deficiency of α-glucosidase and the associated accumulation of glycogen in lysosomal vacuoles. The deficiency of α-glucosidase can often be detected using an inexpensive and readily accessible dried blood spot test when Pompe disease is suspected. Like several neuromuscular disorders, Pompe disease typically presents with progressive weakness of limb-girdle muscles and respiratory insufficiency. Due to the phenotypic heterogeneity of these disorders, however, it is often difficult for clinicians to reach a diagnosis for patients with Pompe disease. Six hundred and six patients from a European population were recruited onto our study. Inclusion criteria stipulated that index cases must present with limb-girdle weakness or elevated serum creatine kinase activity. Whole exome sequencing with at least 250 ng DNA was completed using an Illumina exome capture and a 38 Mb baited target. A panel of 169 candidate genes for limb-girdle weakness was analysed for disease-causing variants. Results A total of 35 variants within GAA were detected. Ten distinct variants in eight unrelated index cases (and four siblings not sequenced in our study) were considered disease-causing, with the patients presenting with heterogeneous phenotypes. The eight unrelated individuals were compound heterozygotes for two variants. Six patients carried the intronic splice site c.-13 T > G transversion and two of the six patients also carried the exonic p.Glu176ArgfsTer45 frameshift. Four of the ten variants were novel in their association with Pompe disease. Conclusions Here, we highlight the advantage of using whole exome sequencing as a tool for detecting, diagnosing and treating patients with rare, clinically variable genetic disorders.
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Affiliation(s)
- Katherine Johnson
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Ana Töpf
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Marta Bertoli
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Lauren Phillips
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK
| | - Kristl G Claeys
- Department of Neurology and Institute of Neuropathology, RWTH Aachen University Hospital, Aachen, Germany.,Department of Neurology, University Hospitals Leuven, Leuven, Belgium.,Laboratory for Muscle Diseases and Neuropathies, Research Group Experimental Neurology, Department of Neurosciences, KU Leuven (University of Leuven), Leuven, Belgium
| | | | - Stojan Perić
- Neurology Clinic CCS, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andreas Hahn
- Department of Child Neurology, Justus-Liebig University, Gießen, Germany
| | | | - Ela Akay
- Queen's Medical Centre, Nottingham, UK
| | - Alexandra E Bastian
- Clinical Hospital Colentina, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Anna Łusakowska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | | | - Monkol Lek
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA.,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Liwen Xu
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA.,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Daniel G MacArthur
- Analytic and Translational Genetics Unit, Massachusetts General Hospital, Boston, MA, USA.,Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, MA, USA
| | - Volker Straub
- John Walton Muscular Dystrophy Research Centre, Institute of Genetic Medicine, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, NE1 3BZ, UK.
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30
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Fukuhara Y, Fuji N, Yamazaki N, Hirakiyama A, Kamioka T, Seo JH, Mashima R, Kosuga M, Okuyama T. A molecular analysis of the GAA gene and clinical spectrum in 38 patients with Pompe disease in Japan. Mol Genet Metab Rep 2017; 14:3-9. [PMID: 29124014 PMCID: PMC5671405 DOI: 10.1016/j.ymgmr.2017.10.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 10/25/2017] [Indexed: 11/21/2022] Open
Abstract
Pompe disease is an autosomal recessive disorder caused by acid α-glucosidase (GAA) deficiency, which results in the accumulation of glycogen in lysosomes in multiple tissues, including cardiac, skeletal, and smooth muscle cells. Thus far, 558 sequence variants of the GAA gene have been published in the Pompe Disease Mutation Database, and some mutations appear with considerable frequency in particular ethnic groups, such as Caucasians, Taiwanese, Chinese, and Koreans. However, the GAA mutation pattern in Japanese patients remains poorly understood. We analyzed the relationship between the genetic and clinical features of 38 mostly Japanese patients with Pompe disease from 35 unrelated families. We identified 28 different GAA gene mutations, including 7 novel mutations, by a GAA gene analysis. c.546G > T (22.9%) and c.1857C > G (14.3%) were the most common mutations and accounted for 37.1% of the total mutant alleles. In the six patients with infantile-onset Pompe disease (IOPD), c.1857C > G was also the most common mutation. In addition, there were 13 homozygotes (5 with the c.546G > T) among the 35 families, which is the highest frequency reported thus far. Regarding the initial symptoms, cardiomegaly was the most common (3/6 = 50%) in IOPD patients, while muscle weakness was observed the most frequently in patients with late-onset Pompe disease (LOPD) (15/30 = 50%). Notably, all IOPD patients who showed respiratory distress at the time of onset require respiratory assistance at present (4/4 = 100%). Regarding the presenting symptoms, cardiomegaly (6/6 = 100%) and hepatomegaly (4/6 = 66.7%) were more commonly seen in IOPD, and muscle weakness (24/29 = 82.7%) was observed more frequently in LOPD. Respiratory assistance is required at present in 33.3% of IOPD patients and 50% of LOPD patients, and 20% of IOPD patients and 29.6% of LOPD patients are wheelchair users. These individual clinical courses may be influenced by the timing of the diagnosis and treatment; for example, in 2007, an ERT orphan drug for treatment of Pompe disease, Alglucosidase alfa, was made available in Japan, and there were 5 (5/6 = 83.3%) wheelchair users diagnosed from 2008 to 2009 (cases 32–38) and 4 (4/27 = 14.8%) from 2010 to 2015 (cases 1–31). These findings underscore the importance of the early diagnosis and treatment.
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Affiliation(s)
- Yasuyuki Fukuhara
- Division of Medical Genetics, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Naoko Fuji
- Department of Clinical Laboratory Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Narutoshi Yamazaki
- Division of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Asami Hirakiyama
- Department of Clinical Laboratory Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Tetsuharu Kamioka
- Center for Lysosomal Storage Diseases, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan.,Department of Clinical Laboratory Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Joo-Hyun Seo
- Center for Lysosomal Storage Diseases, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Ryuichi Mashima
- Department of Clinical Laboratory Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Motomichi Kosuga
- Division of Medical Genetics, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan.,Center for Lysosomal Storage Diseases, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan.,Department of Clinical Laboratory Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
| | - Torayuki Okuyama
- Center for Lysosomal Storage Diseases, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan.,Department of Clinical Laboratory Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan
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31
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Yang L, Li Z, Mei M, Fan X, Zhan G, Wang H, Huang G, Wang M, Tian W, Zhou W. Whole genome sequencing identifies a novel ALMS1 gene mutation in two Chinese siblings with Alström syndrome. BMC MEDICAL GENETICS 2017; 18:75. [PMID: 28724398 PMCID: PMC5518093 DOI: 10.1186/s12881-017-0418-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 05/06/2017] [Indexed: 12/11/2022]
Abstract
Background Alström syndrome is a rare multi-systemic disorder with a broad spectrum of symptoms. This syndrome is characterized by childhood retinal degeneration; sensorineural hearing loss; obesity; type 2 diabetes mellitus; cardiomyopathy; systemic fibrosis; and pulmonary, hepatic, and renal failure. Case presentation A Chinese quartet family with two siblings predominantly affected by cone-rod dystrophy and short stature were recruited. The craniofacial dysmorphism and on-set age-of-cone-rod dystrophy in the proband showed a minor intrafamilial variability. Whole genome sequencing was performed to provide the full spectrum of the two siblings’ genetic variations. In this study, we present the patients’ clinical features and our interpretation of the whole genome sequencing data. After examining the data, we focus on two compound heterozygous mutations, (c.3902C > A, p.S1301X; c.6436C > T, p.R2146X) in ALMS1, which are shared by two siblings. Conclusion We reported a novel ALMS1 mutation. Whole genome sequencing is a powerful tool to provide the full spectrum of genetic variations for heterogeneous disorders such as Alström syndrome. Electronic supplementary material The online version of this article (doi:10.1186/s12881-017-0418-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lin Yang
- Division of Endocrinology, Genetics and Metabolic Diseases, Children's Hospital of Fudan University, Shanghai, China.,Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, China
| | - Zixiu Li
- Department of Biostatistics and Computational Biology, Life Science, Fudan University, Shanghai, China
| | - Mei Mei
- Division of Respiration, Children's Hospital of Fudan University, Shanghai, China
| | | | - Guodong Zhan
- Department of Biostatistics and Computational Biology, Life Science, Fudan University, Shanghai, China
| | - Huijun Wang
- Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, China
| | - Guoying Huang
- Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, China
| | | | - Weidong Tian
- Department of Biostatistics and Computational Biology, Life Science, Fudan University, Shanghai, China
| | - Wenhao Zhou
- Key Laboratory of Birth Defects, Children's Hospital of Fudan University, Shanghai, China. .,Department of Biostatistics and Computational Biology, Life Science, Fudan University, Shanghai, China. .,Key Laboratory of Neonatal Diseases, Ministry of Health, Children's Hospital of Fudan University, Shanghai, China. .,Department of Neonates, Children's Hospital, Fudan University, 399 Wan Yuan Road, Shanghai, China, 201102.
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32
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Guimarães MJ, Winck JC, Conde B, Mineiro A, Raposo M, Moita J, Marinho A, Silva JM, Pires N, André S, Loureiro C. Prevalence of late-onset pompe disease in Portuguese patients with diaphragmatic paralysis - DIPPER study. REVISTA PORTUGUESA DE PNEUMOLOGIA 2017; 23:208-215. [PMID: 28499810 DOI: 10.1016/j.rppnen.2017.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 01/24/2017] [Accepted: 02/15/2017] [Indexed: 11/28/2022] Open
Abstract
Pompe disease is a rare autosomal recessive neuromuscular disorder caused by acid α-glucosidase enzyme (GAA) deficiency and divided into two distinct variants, infantile- and late-onset. The late-onset variant is characterized by a spectrum of phenotypic variation that may range from asymptomatic, to reduced muscle strength and/or diaphragmatic paralysis. Since muscle strength loss is characteristic of several different conditions, which may also cause diaphragmatic paralysis, a protocol was created to search for the diagnosis of Pompe disease and exclude other possible causes. METHODS We collected a sample size of 18 patients (10 females, 8 males) with a median age of 60 years and diagnosis of diaphragmatic paralysis of unknown etiology, followed in the Pulmonology outpatient consultation of 9 centers in Portugal, over a 24-month study period. We evaluated data from patient's clinical and demographic characteristics as well as complementary diagnostic tests including blood tests, imaging, neurophysiologic and respiratory function evaluation. All patients were evaluated for GAA activity with DBS (dried blood test) or serum quantification and positive results confirmed by serum quantification and sequencing. RESULTS Three patients were diagnosed with Pompe's disease and recommended for enzyme replacement therapy. The prevalence of Pompe, a rare disease, in our diaphragmatic paralysis patient sample was 16.8%. CONCLUSION We conclude that DBS test for GAA activity should be recommended for all patients with diaphragmatic paralysis which, despite looking at all the most common causes, remains of unknown etiology; this would improve both the timing and accuracy of diagnosis for Pompe disease in this patient population. Accurate diagnosis will lead to improved care for this rare, progressively debilitating but treatable neuromuscular disease.
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Affiliation(s)
- M J Guimarães
- Hospital Guimarães, Centro Hospitalar do Alto Ave, Guimarães, Portugal.
| | - J C Winck
- Universidade do Porto, Porto, Portugal
| | - B Conde
- Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - A Mineiro
- Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - M Raposo
- Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - J Moita
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - A Marinho
- Centro Hospitalar de São João, Porto, Portugal
| | - J M Silva
- Hospital Sousa Martins, Unidade Local de Saúde da Guarda, Guarda, Portugal
| | - N Pires
- Hospital de Santa Maria Maior, Barcelos, Portugal
| | - S André
- Centro Hospitalar do Porto, Porto, Portugal
| | - C Loureiro
- Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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33
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Chen X, Liu T, Huang M, Wu J, Zhu J, Guo Y, Xu X, Li F, Wang J, Fu L. Clinical and Molecular Characterization of Infantile-Onset Pompe Disease in Mainland Chinese Patients: Identification of Two Common Mutations. Genet Test Mol Biomarkers 2017; 21:391-396. [PMID: 28394184 DOI: 10.1089/gtmb.2016.0424] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS We sought to understand the clinical course and molecular defects of infantile-onset Pompe disease (IOPD) among mainland Chinese patients. MATERIALS AND METHODS Twenty-five Chinese patients with IOPD were enrolled and clinical data were retrospectively reviewed. The entire coding region of the GAA gene was amplified by polymerase chain reaction and analyzed by direct sequencing. RESULTS The median age at symptom onset was 3.4 months (range: 1.0-7.1 months) and 4.9 months (range: 2.7-8.3 months) at diagnosis. Only one patient received enzyme replacement therapy (ERT) and this child survived beyond the age of 2 years. Of the 24 patients not receiving ERT, all, but one patient, died at a median age of 8.3 months (range: 4.0-12.2 months). Thirteen novel and two common GAA mutations were identified in this study. The allelic frequency of c.2662G > T (p.Glu888X) was 23.1% in northern Chinese patients and 4.2% in southern Chinese patients, whereas the allelic frequency of c.1935C > A (p.Asp645Glu) was 20.8% in southern and 3.8% in northern Chinese patients. CONCLUSIONS We identified the most common mutations in southern and northern Chinese patients with IOPD.
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Affiliation(s)
- Xi Chen
- 1 Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Tingliang Liu
- 1 Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Meirong Huang
- 1 Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Jinjin Wu
- 1 Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Junxue Zhu
- 1 Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Ying Guo
- 1 Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Xinyi Xu
- 1 Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Fen Li
- 1 Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai, China
| | - Jian Wang
- 2 Research Division of Birth Defects, Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine , Shanghai, China
| | - Lijun Fu
- 1 Department of Cardiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine , Shanghai, China .,3 Research Division of Cardiovascular Disease, Institute of Pediatric Translational Medicine, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine , Shanghai, China
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Lee JH, Shin JH, Park HJ, Kim SZ, Jeon YM, Kim HK, Kim DS, Choi YC. Targeted population screening of late onset Pompe disease in unspecified myopathy patients for Korean population. Neuromuscul Disord 2017; 27:550-556. [PMID: 28433475 DOI: 10.1016/j.nmd.2017.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/26/2017] [Accepted: 03/08/2017] [Indexed: 11/16/2022]
Abstract
We performed targeted population screening of late onset Pompe disease (LOPD) in unspecified myopathy patients, because early diagnosis is difficult due to its heterogeneous clinical features. We prospectively enrolled 90 unrelated myopathic patients who had one or more signs out of five LOPD-like clinical findings (proximal weakness, axial weakness, lingual weakness, respiratory difficulty, idiopathic hyperCKemia). Acid alpha glucosidase activity was evaluated with dried blood spot and mixed leukocyte simultaneously. For a final diagnosis of LOPD, 16 patients with decreased enzyme activity were genotyped by GAA molecular analysis. We found two patients with LOPD (2.2%), and the remaining 14 patients had at least one G576S or E689K mutation, known as the pseudodeficiency allele. Acid alpha glucosidase activity of LOPD patients was significantly lower than that of patients with at least one pseudodeficiency allele (p = 0.017). This study is the first LOPD screening study for targeted Korean population, and more generally, an Asian population. Our findings suggest that for diagnosis of LOPD in Asian population, modified cutoff value of acid alpha glucosidase activity with dry blood spot considering that of patients having heterozygote pathogenic variants or pseudodeficiency alleles may reduce time and cost requirements and increase the comfort of patients.
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Affiliation(s)
- Jung Hwan Lee
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin-Hong Shin
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Hyung Jun Park
- Department of Neurology, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Sook Za Kim
- Kim Sook Za's Children Hospital, Cheongju, South Korea
| | - Young Mi Jeon
- Kim Sook Za's Children Hospital, Cheongju, South Korea
| | - Hye Kyoung Kim
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Dae-Seong Kim
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Young-Chul Choi
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine, Seoul, South Korea.
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Bekircan-Kurt CE, Güneş HN, Yildiz FG, Saka E, Tan E, Erdem-Özdamar S. New mutations and genotype-phenotype correlation in late-onset Pompe patients. Acta Neurol Belg 2017; 117:269-275. [PMID: 28032299 DOI: 10.1007/s13760-016-0738-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 12/14/2016] [Indexed: 11/29/2022]
Abstract
Pompe disease is a glycogen storage disease caused by acid alfa-glucosidase deficiency. Here, we report clinical properties, genetic features of our late-onset Pompe patients. Seven patients were followed during the last 10 years in our institute. The clinical and laboratory findings were reviewed. Neuropsychological evaluation was performed in four patients. Myotonic discharges of paraspinal muscles and denervation potentials were seen in all patients at the diagnosis and were disappeared during follow-up in two. Only one patient, whose MRI showed cerebral atrophy, had attention and executive dysfunction. Compound heterozygous patients with IVS 1-13T>G have a milder disease. One patient who has homozygous IVS 1-13T>G mutation had more severe disease. Two of our patients who had very severe and fatal disease course carry double mutations on both alleles (c.547-39T>G and c.858+5ins7) that previously scored as "unknown" in Erasmus Pompe Center database. Lastly, we found new mutations (c.1209 C>A, 2737dupG) in two patients carrying IVS 1-13T>G in the other allele. Systemic involvements are very rare in late-onset Pompe patients. Similarly, Pompe disease does not cause cognitive impairment in adult population. Homozygous IVS 1-13T>G mutation and c.547-39T>G mutation which are previously noted as "unknown" pathogenicities cause a more severe disease.
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Affiliation(s)
- Can Ebru Bekircan-Kurt
- Neurology Department, School of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey.
- Neuromuscular Diseases Research Laboratory, School of Medicine, Hacettepe University, Ankara, Turkey.
| | | | - F Gokcem Yildiz
- Neurology Department, School of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Esen Saka
- Neurology Department, School of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Ersin Tan
- Neurology Department, School of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey
- Neuromuscular Diseases Research Laboratory, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Sevim Erdem-Özdamar
- Neurology Department, School of Medicine, Hacettepe University, Sihhiye, Ankara, Turkey
- Neuromuscular Diseases Research Laboratory, School of Medicine, Hacettepe University, Ankara, Turkey
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Chu YP, Sheng B, Lau KK, Chan HF, Kam GYW, Lee HHC, Mak CM. Clinical manifestation of late onset Pompe disease patients in Hong Kong. Neuromuscul Disord 2016; 26:873-879. [PMID: 27692865 DOI: 10.1016/j.nmd.2016.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 08/21/2016] [Accepted: 09/05/2016] [Indexed: 02/02/2023]
Abstract
Late onset Pompe disease is a rare inherited metabolic disease with diverse clinical manifestation. However, there is a lack of local data in Hong Kong. We aimed at performing an in-depth review of natural history of all patients in Hong Kong. Eleven patients were diagnosed to have the disease in Hong Kong from 2000 to 2013. All case records were reviewed and face-to-face interviews were conducted to complete a questionnaire regarding the clinical manifestation and diagnosis of the disease. The estimated birth incidence was 1/300,000. The age of diagnosis ranged from 9 to 44 years; all patients were ethnic Chinese. The median ages of first symptoms and first medical attention were 20.5(6-44) and 29(9-44) years respectively. The most common initial complaint was decreased exercise tolerance. Two patients' first complaint was difficulty with getting up from lying position and failure to perform sit up. The mean time from first medical attention to diagnosis was 1.3 years but one patient was diagnosed 8 years later. Half of the patients sought medical attention due to progressive shortness of breath and all of them developed type 2 respiratory failure requiring ventilator support during the first admission. Two patients became chair-bound and seven patients required assisted ventilation. Late onset Pompe disease tends to have an earlier and more aggressive clinical presentation in Chinese and lower birth incidence was found in Hong Kong.
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Affiliation(s)
- Yim Pui Chu
- Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong.
| | - Bun Sheng
- Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong
| | - Kwok Kwong Lau
- Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong
| | - Hiu Fai Chan
- Department of Medicine & Geriatrics, Queen Elizabeth Hospital, Hong Kong
| | - Grace Yee Wai Kam
- Department of Medicine & Geriatrics, United Christian Hospital, Hong Kong
| | | | - Chloe Miu Mak
- Department of Pathology, Princess Margaret Hospital, Hong Kong
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Lévesque S, Auray-Blais C, Gravel E, Boutin M, Dempsey-Nunez L, Jacques PE, Chenier S, Larue S, Rioux MF, Al-Hertani W, Nadeau A, Mathieu J, Maranda B, Désilets V, Waters PJ, Keutzer J, Austin S, Kishnani P. Diagnosis of late-onset Pompe disease and other muscle disorders by next-generation sequencing. Orphanet J Rare Dis 2016; 11:8. [PMID: 26809617 PMCID: PMC4727295 DOI: 10.1186/s13023-016-0390-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 01/17/2016] [Indexed: 11/16/2022] Open
Abstract
Background Late-onset Pompe disease (LOPD) is a rare treatable lysosomal storage disorder characterized by progressive lysosomal glycogen accumulation and muscle weakness, with often a limb-girdle pattern. Despite published guidelines, testing for LOPD is often overlooked or delayed in adults, owing to its low frequency compared to other muscle disorders with similar muscle patterns. Next-generation sequencing has the capability to test concurrently for several muscle disorders. This could potentially lead to increased diagnosis of LOPD, disorders with non-specific muscle weakness or atypical patients. Methods We developed a gene panel to further study its clinical utility in a cohort of patients with suspected muscle disorders. We designed a gene panel to analyze the coding sequences and splice site junctions of GAA causing LOPD, along with 77 other genes causing muscle disorders with overlapping phenotypes. Results At a median coverage of ~200X (sequences per base), all GAA exons were successfully covered with >20X and only 0.3 % of exons across all genes were <20X. The panel showed an excellent sensitivity (100 %) and specificity (98 %) across all selected genes, using known variations in Pompe patients and controls. We determined its clinical utility by analyzing 34 patients with suspected muscle disorders of undetermined etiology and various muscle patterns, who were referred or followed in neuromuscular and genetics clinics. A putative diagnosis was found in up to 32 % of patients. The gene panel was instrumental in reaching a diagnosis in atypical patients, including one LOPD case. Acid alpha-glucosidase activity was used to confirm the molecular results in all patients. Conclusion This work highlights the high clinical utility of gene panels in patients with suspected muscle disorders and its potential to facilitate the diagnosis of patients showing non-specific muscle weakness or atypical phenotypes. We propose that gene panels should be used as a first-tier test in patients with suspected muscle disorders of undetermined etiology, which could further increase overall diagnosis of muscle conditions, and potentially reduce diagnostic delay. Further studies are necessary to determine the impact of first-tier gene panels on diagnostic delay and on treatment outcome for LOPD. Electronic supplementary material The online version of this article (doi:10.1186/s13023-016-0390-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sébastien Lévesque
- Department of Pediatrics, Division of Medical Genetics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, and Centre Hospitalier Universitaire de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada.
| | - Christiane Auray-Blais
- Department of Pediatrics, Division of Medical Genetics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, and Centre Hospitalier Universitaire de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - Elaine Gravel
- Department of Pediatrics, Division of Medical Genetics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, and Centre Hospitalier Universitaire de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - Michel Boutin
- Department of Pediatrics, Division of Medical Genetics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, and Centre Hospitalier Universitaire de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - Laura Dempsey-Nunez
- Department of Pediatrics, Division of Medical Genetics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, and Centre Hospitalier Universitaire de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - Pierre-Etienne Jacques
- Departments of Biology and Computer Science, Faculty of Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Sébastien Chenier
- Department of Pediatrics, Division of Medical Genetics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, and Centre Hospitalier Universitaire de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - Sandrine Larue
- Department of Neurology, Notre-Dame Hospital, Université de Montréal, Montreal, QC, Canada
| | - Marie-France Rioux
- Department of Neurology, Université de Sherbrooke, and Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Walla Al-Hertani
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, and Alberta Children's Hospital, Calgary, AB, Canada
| | - Amelie Nadeau
- Department of Pediatrics, Division of Pediatric Neurology, Université de Sherbrooke, and Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean Mathieu
- Neuromuscular Clinic, Centre de réadaptation en déficience physique de Jonquière, Saguenay, QC, Canada
| | - Bruno Maranda
- Department of Pediatrics, Division of Medical Genetics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, and Centre Hospitalier Universitaire de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - Valérie Désilets
- Department of Pediatrics, Division of Medical Genetics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, and Centre Hospitalier Universitaire de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - Paula J Waters
- Department of Pediatrics, Division of Medical Genetics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, and Centre Hospitalier Universitaire de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada
| | - Joan Keutzer
- Genzyme Corporation, a Sanofi Company, Cambridge, MA, USA
| | - Stephanie Austin
- Department of Pediatrics, Division of Medical Genetics, Duke University Medical Center, Durham, NC, USA
| | - Priya Kishnani
- Department of Pediatrics, Division of Medical Genetics, Duke University Medical Center, Durham, NC, USA
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