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Shimizu M, Makiguchi M, Hishinuma E, Saito S, Hiratsuka M, Yamazaki H. Rare but impaired flavin-containing monooxygenase 3 (FMO3) variants reported in a recently updated Japanese mega-databank of genome resources. Drug Metab Pharmacokinet 2024; 55:100539. [PMID: 38280279 DOI: 10.1016/j.dmpk.2023.100539] [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: 08/23/2023] [Revised: 10/18/2023] [Accepted: 11/15/2023] [Indexed: 01/29/2024]
Abstract
Genetic variants of human flavin-containing monooxygenase 3 (FMO3) were investigated using an updated Japanese population panel containing 54,000 subjects (the previous panel contained 38,000 subjects). One stop codon mutation and six amino acid-substituted FMO3 variants were newly identified in the updated databank. Of these, two substituted variants (p.Thr329Ala and p.Arg492Trp) were previously identified in compound haplotypes with p.[(Glu158Lys; Glu308Gly)] and were associated with the metabolic disorder trimethylaminuria. Three recombinant FMO3 protein variants (p.Ser137Leu, p.Ala334Val, and p.Ile426Val) expressed in bacterial membranes had similar activities toward trimethylamine N-oxygenation (∼75-125 %) as wild-type FMO3 (117 min-1); however, the recombinant novel FMO3 variant Phe313Ile showed moderately decreased FMO3 catalytic activity (∼20 % of wild-type). Because of the known deleterious effects of FMO3 C-terminal stop codons, the novel truncated FMO3 Gly184Ter variant was suspected to be inactive. To easily identify the four impaired FMO3 variants (one stop codon mutation and three amino-acid substitutions) in the clinical setting, simple confirmation methods for these FMO3 variants are proposed using polymerase chain reaction/restriction fragment length polymorphism or allele-specific PCR methods. The updated whole-genome sequence data and kinetic analyses revealed that four of the seven single-nucleotide nonsense or missense FMO3 variants had moderately or severely impaired activity toward trimethylamine N-oxygenation.
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Affiliation(s)
| | | | - Eiji Hishinuma
- Advanced Research Center for Innovations in Next-Generation Medicine and Tohoku Medical Megabank Organization, Sendai, Japan
| | - Sakae Saito
- Advanced Research Center for Innovations in Next-Generation Medicine and Tohoku Medical Megabank Organization, Sendai, Japan
| | - Masahiro Hiratsuka
- Advanced Research Center for Innovations in Next-Generation Medicine and Tohoku Medical Megabank Organization, Sendai, Japan; Graduate School of Pharmaceutical Sciences, Tohoku University and Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan
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Zhao X, Zhao H, Chen R, Li J, Zhou J, Li N, Yan S, Liu C, Zhou P, Chen Y, Song L, Yan H. A Combined Measure of the Triglyceride Glucose Index and Trimethylamine N-Oxide in Risk Stratification of ST-Segment Elevation Myocardial Infarction Patients with High-Risk Plaque Features Defined by Optical Coherence Tomography: A Substudy of the OCTAMI Registry Study. Vasc Health Risk Manag 2024; 20:141-155. [PMID: 38567028 PMCID: PMC10986628 DOI: 10.2147/vhrm.s443742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/10/2024] [Indexed: 04/04/2024] Open
Abstract
Background and Aim An elevated triglyceride-glucose (TyG) level is associated with increased risk of mortality in patients with CAD. Trimethylamine N-oxide (TMAO) has mechanistic links to atherosclerotic coronary artery disease (CAD) pathogenesis and is correlated with adverse outcomes. However, the incremental prognostic value of TMAO and TyG in the cohort of optical coherence tomography (OCT)-defined high-risk ST-segment elevation myocardial infarction (STEMI) patients is unknown. Methods We studied 274 consecutive aged ≥18 years patients with evidence of STEMI and detected on pre-intervention OCT imaging of culprit lesions between March 2017 and March 2019. Outcomes There were 22 (22.68%), 27 (27.84%), 26 (26.80%), and 22 (22.68%) patients in groups A-D, respectively. The baseline characteristics according to the level of TMAO and TyG showed that patients with higher level in both indicators were more likely to have higher triglycerides (p < 0.001), fasting glucose (p < 0.001) and higher incidence of diabetes (p = 0.008). The group with TMAO > median and TyG ≤ median was associated with higher rates of MACEs significantly (p = 0.009) in fully adjusted analyses. During a median follow-up of 2.027 years, 20 (20.6%) patients experienced MACEs. To evaluate the diagnostic value of the TyG index combined with TMAO, the area under the receiver operating characteristic curve for predicting MACEs after full adjustment was 0.815 (95% confidence interval, 0.723-0.887; sensitivity, 85.00%; specificity, 72.73%; cut-off level, 0.577). Among the group of patients with TMAO > median and TyG ≤ median, there was a significantly higher incidence of MACEs (p=0.033). A similar tendency was found in the cohort with hyperlipidemia (p=0.016) and diabetes mellitus (p=0.036). Conclusion This study demonstrated the usefulness of combined measures of the TyG index and TMAO in enhancing risk stratification in STEMI patients with OCT-defined high-risk plaque characteristics. Trial Registration This study was registered at ClinicalTrials.gov as NCT03593928.
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Affiliation(s)
- Xiaoxiao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People’s Republic of China
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People’s Republic of China
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People’s Republic of China
| | - Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People’s Republic of China
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People’s Republic of China
| | - Nan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People’s Republic of China
| | - Shaodi Yan
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences, ShenZhen, People’s Republic of China
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People’s Republic of China
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People’s Republic of China
| | - Yi Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People’s Republic of China
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People’s Republic of China
| | - Hongbing Yan
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences, ShenZhen, People’s Republic of China
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Van Bergen NJ, Hock DH, Spencer L, Massey S, Stait T, Stark Z, Lunke S, Roesley A, Peters H, Lee JY, Le Fevre A, Heath O, Mignone C, Yang JYM, Ryan MM, D’Arcy C, Nash M, Smith S, Caruana NJ, Thorburn DR, Stroud DA, White SM, Christodoulou J, Brown NJ. Biallelic Variants in PYROXD2 Cause a Severe Infantile Metabolic Disorder Affecting Mitochondrial Function. Int J Mol Sci 2022; 23:ijms23020986. [PMID: 35055180 PMCID: PMC8777681 DOI: 10.3390/ijms23020986] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/11/2022] [Accepted: 01/13/2022] [Indexed: 12/04/2022] Open
Abstract
Pyridine Nucleotide-Disulfide Oxidoreductase Domain 2 (PYROXD2; previously called YueF) is a mitochondrial inner membrane/matrix-residing protein and is reported to regulate mitochondrial function. The clinical importance of PYROXD2 has been unclear, and little is known of the protein’s precise biological function. In the present paper, we report biallelic variants in PYROXD2 identified by genome sequencing in a patient with suspected mitochondrial disease. The child presented with acute neurological deterioration, unresponsive episodes, and extreme metabolic acidosis, and received rapid genomic testing. He died shortly after. Magnetic resonance imaging (MRI) brain imaging showed changes resembling Leigh syndrome, one of the more common childhood mitochondrial neurological diseases. Functional studies in patient fibroblasts showed a heightened sensitivity to mitochondrial metabolic stress and increased mitochondrial superoxide levels. Quantitative proteomic analysis demonstrated decreased levels of subunits of the mitochondrial respiratory chain complex I, and both the small and large subunits of the mitochondrial ribosome, suggesting a mitoribosomal defect. Our findings support the critical role of PYROXD2 in human cells, and suggest that the biallelic PYROXD2 variants are associated with mitochondrial dysfunction, and can plausibly explain the child’s clinical presentation.
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Affiliation(s)
- Nicole J. Van Bergen
- Brain and Mitochondrial Research Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (L.S.); (S.M.); (T.S.); (D.R.T.); (D.A.S.)
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia; (Z.S.); (S.L.); (J.Y.L.); (J.Y.-M.Y.); (S.M.W.)
- Correspondence: (N.J.V.B.); (J.C.); (N.J.B.)
| | - Daniella H. Hock
- Department of Biochemistry and Pharmacology and Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC 3010, Australia; (D.H.H.); (N.J.C.)
| | - Lucy Spencer
- Brain and Mitochondrial Research Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (L.S.); (S.M.); (T.S.); (D.R.T.); (D.A.S.)
| | - Sean Massey
- Brain and Mitochondrial Research Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (L.S.); (S.M.); (T.S.); (D.R.T.); (D.A.S.)
| | - Tegan Stait
- Brain and Mitochondrial Research Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (L.S.); (S.M.); (T.S.); (D.R.T.); (D.A.S.)
| | - Zornitza Stark
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia; (Z.S.); (S.L.); (J.Y.L.); (J.Y.-M.Y.); (S.M.W.)
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (A.R.); (A.L.F.)
- Australian Genomics Health Alliance, Parkville, VIC 3052, Australia
| | - Sebastian Lunke
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia; (Z.S.); (S.L.); (J.Y.L.); (J.Y.-M.Y.); (S.M.W.)
- Department of Pathology, University of Melbourne, Parkville, VIC 3010, Australia
| | - Ain Roesley
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (A.R.); (A.L.F.)
| | - Heidi Peters
- Department of Metabolic Medicine, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (H.P.); (O.H.)
| | - Joy Yaplito Lee
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia; (Z.S.); (S.L.); (J.Y.L.); (J.Y.-M.Y.); (S.M.W.)
- Department of Metabolic Medicine, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (H.P.); (O.H.)
| | - Anna Le Fevre
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (A.R.); (A.L.F.)
| | - Oliver Heath
- Department of Metabolic Medicine, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (H.P.); (O.H.)
| | - Cristina Mignone
- Medical Imaging Department, Royal Children’s Hospital, Parkville, VIC 3052, Australia;
| | - Joseph Yuan-Mou Yang
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia; (Z.S.); (S.L.); (J.Y.L.); (J.Y.-M.Y.); (S.M.W.)
- Department of Neurosurgery, Neuroscience Advanced Clinical Imaging Service (NACIS), The Royal Children’s Hospital, Parkville, VIC 3052, Australia
- Developmental Imaging, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
- Neuroscience Research, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia
| | - Monique M. Ryan
- Neurology Department, Royal Children’s Hospital, Parkville, VIC 3052, Australia;
| | - Colleen D’Arcy
- Anatomical Pathology Department, Royal Children’s Hospital, Parkville, VIC 3052, Australia;
| | - Margot Nash
- General Medicine, Royal Children’s Hospital, Parkville, VIC 3052, Australia;
| | - Sile Smith
- Paediatric Intensive Care Unit, Royal Children’s Hospital, Parkville, VIC 3052, Australia;
| | - Nikeisha J. Caruana
- Department of Biochemistry and Pharmacology and Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC 3010, Australia; (D.H.H.); (N.J.C.)
- Institute for Health and Sport (iHeS), Victoria University, Footscray, VIC 3011, Australia
| | - David R. Thorburn
- Brain and Mitochondrial Research Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (L.S.); (S.M.); (T.S.); (D.R.T.); (D.A.S.)
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia; (Z.S.); (S.L.); (J.Y.L.); (J.Y.-M.Y.); (S.M.W.)
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (A.R.); (A.L.F.)
| | - David A. Stroud
- Brain and Mitochondrial Research Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (L.S.); (S.M.); (T.S.); (D.R.T.); (D.A.S.)
- Department of Biochemistry and Pharmacology and Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC 3010, Australia; (D.H.H.); (N.J.C.)
| | - Susan M. White
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia; (Z.S.); (S.L.); (J.Y.L.); (J.Y.-M.Y.); (S.M.W.)
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (A.R.); (A.L.F.)
| | - John Christodoulou
- Brain and Mitochondrial Research Group, Murdoch Children’s Research Institute, Royal Children’s Hospital, Parkville, VIC 3052, Australia; (L.S.); (S.M.); (T.S.); (D.R.T.); (D.A.S.)
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia; (Z.S.); (S.L.); (J.Y.L.); (J.Y.-M.Y.); (S.M.W.)
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (A.R.); (A.L.F.)
- Discipline of Child and Adolescent Health, University of Sydney, Camperdown, NSW 2006, Australia
- Correspondence: (N.J.V.B.); (J.C.); (N.J.B.)
| | - Natasha J. Brown
- Department of Paediatrics, University of Melbourne, Parkville, VIC 3010, Australia; (Z.S.); (S.L.); (J.Y.L.); (J.Y.-M.Y.); (S.M.W.)
- Victorian Clinical Genetics Services, Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia; (A.R.); (A.L.F.)
- Correspondence: (N.J.V.B.); (J.C.); (N.J.B.)
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Veyrat-Durebex C, Benz-de-Bretagne I, Clavier V, Bruno C, Andres CR, Antar C, Hennart B, Maillot F, Nadal-Desbarats L, Blasco H. Quality consideration for the validation of urine TMA and TMAO measurement by nuclear magnetic resonance spectroscopy in Fish Odor Syndrome. Anal Biochem 2021; 630:114330. [PMID: 34364856 DOI: 10.1016/j.ab.2021.114330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/09/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Trimethylaminuria, also known as Fish Odor Syndrome (FOS), is a condition characterized by the presence of high concentrations of trimethylamine (TMA) in urine, sweat and expired air of affected patients. Diagnosis of this benign but unpleasant disease is mainly based on clinical presentation and assessment of TMA and its metabolite, TMAO (trimethylamine-N-oxide), concentrations in urine of patients. MATERIAL AND METHODS We here described the validation of an analytical method for measurement of TMA and TMAO in urine using nuclear magnetic resonance (NMR) according to the specifications of the ISO 15189 norm. We used a fast validation protocol, based exactitude profile method, enabling to determine accuracy, intra and inter-day precision from a limited number of samples. RESULTS The linearity was established from 2.5 to 100 mg/L for TMA measurement and from 10 to 1000 mg/L for TMAO measurement, with good analytical performances i.e. accuracy, intra and inter-day precision. We also report a case diagnose for FOS from this method. CONCLUSIONS This method validation ensures the robustness of NMR in routine use for diagnosis of trimethylaminuria, as part of the reference center for inherited metabolic diseases at the Tours hospital.
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Affiliation(s)
- Charlotte Veyrat-Durebex
- Laboratoire de Biochimie et Biologie Moléculaire, CHRU de Tours, Tours, France; Unité INSERM U 1253, Université de Tours, Tours, France.
| | - Isabelle Benz-de-Bretagne
- Laboratoire de Biochimie et Biologie Moléculaire, CHRU de Tours, Tours, France; Unité INSERM U 1253, Université de Tours, Tours, France
| | - Victoria Clavier
- Laboratoire de Biochimie et Biologie Moléculaire, CHRU de Tours, Tours, France
| | - Clément Bruno
- Laboratoire de Biochimie et Biologie Moléculaire, CHRU de Tours, Tours, France; Unité INSERM U 1253, Université de Tours, Tours, France
| | - Christian R Andres
- Laboratoire de Biochimie et Biologie Moléculaire, CHRU de Tours, Tours, France; Unité INSERM U 1253, Université de Tours, Tours, France
| | - Catherine Antar
- Laboratoire de Biochimie et Biologie Moléculaire, CHRU de Tours, Tours, France; Unité INSERM U 1253, Université de Tours, Tours, France
| | | | | | | | - Hélène Blasco
- Laboratoire de Biochimie et Biologie Moléculaire, CHRU de Tours, Tours, France; Unité INSERM U 1253, Université de Tours, Tours, France.
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Heianza Y, Ma W, DiDonato JA, Sun Q, Rimm EB, Hu FB, Rexrode KM, Manson JE, Qi L. Long-Term Changes in Gut Microbial Metabolite Trimethylamine N-Oxide and Coronary Heart Disease Risk. J Am Coll Cardiol 2020; 75:763-772. [PMID: 32081286 DOI: 10.1016/j.jacc.2019.11.060] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/27/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND A gut-microbial metabolite, trimethylamine N-oxide (TMAO), has been associated with coronary atherosclerotic burden. No previous prospective study has addressed associations of long-term changes in TMAO with coronary heart disease (CHD) incidence. OBJECTIVES The purpose of this study was to investigate whether 10-year changes in plasma TMAO levels were significantly associated with CHD incidence. METHODS This prospective nested case-control study included 760 healthy women at baseline. Plasma TMAO levels were measured both at the first (1989 to 1990) and the second (2000 to 2002) blood collections; 10-year changes (Δ) in TMAO were calculated. Incident cases of CHD (n = 380) were identified after the second blood collection through 2016 and were matched to controls (n = 380). RESULTS Regardless of the initial TMAO levels, 10-year increases in TMAO from the first to second blood collection were significantly associated with an increased risk of CHD (relative risk [RR] in the top tertile: 1.58 [95% confidence interval (CI): 1.05 to 2.38]; RR per 1-SD increment: 1.33 [95% CI: 1.06 to 1.67]). Participants with elevated TMAO levels (the top tertile) at both time points showed the highest RR of 1.79 (95% CI: 1.08 to 2.96) for CHD as compared with those with consistently low TMAO levels. Further, we found that the ΔTMAO-CHD relationship was strengthened by unhealthy dietary patterns (assessed by the Alternate Healthy Eating Index) and was attenuated by healthy dietary patterns (p interaction = 0.008). CONCLUSIONS Long-term increases in TMAO were associated with higher CHD risk, and repeated assessment of TMAO over 10 years improved the identification of people with a higher risk of CHD. Diet may modify the associations of ΔTMAO with CHD risk.
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Affiliation(s)
- Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Wenjie Ma
- Clinical and Translational Epidemiology Unit and Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Joseph A DiDonato
- Department of Cardiovascular & Metabolic Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Qi Sun
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Frank B Hu
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Kathryn M Rexrode
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Women's Health, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - JoAnn E Manson
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
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Bouchemal N, Ouss L, Brassier A, Barbier V, Gobin S, Hubert L, de Lonlay P, Le Moyec L. Diagnosis and phenotypic assessment of trimethylaminuria, and its treatment with riboflavin: 1H NMR spectroscopy and genetic testing. Orphanet J Rare Dis 2019; 14:222. [PMID: 31533761 PMCID: PMC6751875 DOI: 10.1186/s13023-019-1174-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/13/2019] [Indexed: 11/10/2022] Open
Abstract
Background Trimethylaminuria (TMAU) is a metabolic disorder characterized by the excessive excretion of the malodorous compound trimethylamine (TMA). The diagnosis of TMAU is challenging because this disorder is situated at the boundary between biochemistry and psychiatry. Here, we used nuclear magnetic resonance spectroscopy to assess TMAU in 13 patients. We also sequenced the FMO3 gene in 11 of these patients. Treatment with vitamin B2 was prescribed. Results Two patients (aged 3 and 9 years at the initial consultation) had a particularly unpleasant body odor, as assessed by their parents and the attending physicians. The presence of high urine TMA levels confirmed the presence of a metabolic disorder. The two (unrelated) children carried compound heterozygous variants in the FMO3 gene. In both cases, vitamin B2 administration decreased TMA excretion and reduced body odor. The 11 adults complained of an unpleasant body odor, but the physicians did not confirm this. In all adult patients, the urine TMA level was within the normal range reported for control (non-affected) subjects, although two of the patients displayed an abnormally high proportion of oxidized TMA. Seven of the 9 tested adult patients had a hypomorphic variant of the FMO3 gene; the variant was found in the homozygous state, in the heterozygous state or combined with another hypomorphic variant. All 11 adults presented a particular psychological or psychiatric phenotype, with a subjective perception of unpleasant odor. Conclusions The results present the clinical and biochemical data of patients complaining of unpleasant body odor. Contrary to adult patients, the two children exhibited all criteria of recessively inherited trimethylaminuria, suspected by parents in infancy. B2 vitamin treatment dramatically improved the unpleasant body odor and the ratio of TMA/Cr vs TMAO/Cr in the urine in the children. Other patients presented a particular psychological or psychiatric phenotype.
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Affiliation(s)
- Nadia Bouchemal
- CSPBAT, UMR 7244, CNRS, Université Paris 13, Sorbonne Paris Cité, Bobigny, France.
| | - Lisa Ouss
- Reference Centre for Metabolic Diseases, Necker-Enfants Malades Hospital, Imagine Institute, Université Paris-Descartes, APHP, Paris, France.,Service de Pédopsychiatrie, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Anaïs Brassier
- Reference Centre for Metabolic Diseases, Necker-Enfants Malades Hospital, Imagine Institute, Université Paris-Descartes, APHP, Paris, France
| | - Valérie Barbier
- Reference Centre for Metabolic Diseases, Necker-Enfants Malades Hospital, Imagine Institute, Université Paris-Descartes, APHP, Paris, France
| | - Stéphanie Gobin
- Unité de Génétique moléculaire, Necker-Enfants Malades Hospital, APHP, Paris, France
| | - Laurence Hubert
- Reference Centre for Metabolic Diseases, Necker-Enfants Malades Hospital, Imagine Institute, Université Paris-Descartes, APHP, Paris, France
| | - Pascale de Lonlay
- Reference Centre for Metabolic Diseases, Necker-Enfants Malades Hospital, Imagine Institute, Université Paris-Descartes, APHP, Paris, France
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Doyle S, O'Byrne JJ, Nesbitt M, Murphy DN, Abidin Z, Byrne N, Pastores G, Kirk R, Treacy EP. The genetic and biochemical basis of trimethylaminuria in an Irish cohort. JIMD Rep 2019; 47:35-40. [PMID: 31240165 PMCID: PMC6498825 DOI: 10.1002/jmd2.12028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 01/30/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Inherited trimethylaminuria (TMAU), a rare genetic disorder of hepatic metabolism of trimethylamine (TMA) causing excessive accumulation of malodorous trimethylamine (TMA), is a socially distressing disorder. Diagnosis is made by biochemical analysis of urine, with the calculation of flavin monooxygenase trimethylamine conversion capacity. Genetic testing, sequencing the entire coding region of the FMO3 gene has been recommended for affected individuals who convert less than 90% of the total TMA load to TMAO. METHODS Genetic analysis was undertaken for 13 Irish patients with TMAU of varying phenotypic severity (three severe, six moderate, and four mild). RESULTS A genetic diagnosis was made for seven patients, including for five of the nine moderate to severely affected cases. We noted the c.913G>T;p.(Glu305*) and c.458C>T;p.(Pro153Leu) mutations in this Irish population with severe TMAU which is consistent with our earlier findings in Australian and North American families of Irish and British descent.Three individuals were noted to be homozygous for the common variant haplotype c.472G>A;923A>G;p.(Glu158Lys);(Glu308Gly). We also identified three novel variants in this population, which are likely to be pathogenic: c.682G>A;p(Gly228Ser), c.694G>T:p(Asp232Tyr), and c.989G>A;p.(Gly330Glu). CONCLUSION Urinary biochemical analysis probably remains the first line diagnostic approach to classify the various types of TMAU. FMO3 gene analysis is likely only to be informative for certain presentations of TMAU.
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Affiliation(s)
- Samantha Doyle
- National Centre for Inherited Metabolic Disorders, The Mater Misericordiae University HospitalDublinIreland
- School of Medicine and Medical Sciences, University College DublinDublinIreland
| | - James J. O'Byrne
- National Centre for Inherited Metabolic Disorders, The Mater Misericordiae University HospitalDublinIreland
| | - Mandy Nesbitt
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS TrustSheffieldUK
| | - Daniel N. Murphy
- National Rare Diseases Office, The Mater Misericordiae University HospitalDublinIreland
| | - Zaza Abidin
- National Centre for Inherited Metabolic Disorders, The Mater Misericordiae University HospitalDublinIreland
- School of Medicine and Medical Sciences, University College DublinDublinIreland
| | - Niall Byrne
- National Centre for Inherited Metabolic Disorders, The Mater Misericordiae University HospitalDublinIreland
- School of Medicine and Medical Sciences, University College DublinDublinIreland
| | - Gregory Pastores
- National Centre for Inherited Metabolic Disorders, The Mater Misericordiae University HospitalDublinIreland
- School of Medicine and Medical Sciences, University College DublinDublinIreland
| | - Richard Kirk
- Sheffield Diagnostic Genetics Service, Sheffield Children's NHS TrustSheffieldUK
| | - Eileen P. Treacy
- National Centre for Inherited Metabolic Disorders, The Mater Misericordiae University HospitalDublinIreland
- School of Medicine and Medical Sciences, University College DublinDublinIreland
- Department of Paediatrics, Trinity College Dublin, The University of DublinDublinIreland
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