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He SJ, Li DJ, Lv WQ, Tang WH, Sun SW, Zhu YP, Liu Y, Wu J, Lu XX. Outcomes after HSCT for mucolipidosis II (I-cell disease) caused by novel compound heterozygous GNPTAB mutations. Front Pediatr 2023; 11:1199489. [PMID: 37484777 PMCID: PMC10359890 DOI: 10.3389/fped.2023.1199489] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/05/2023] [Indexed: 07/25/2023] Open
Abstract
Background Mucolipidosis type II (MLII), or I-cell disease, is a rare lysosomal storage disease (LSD) caused by variants in the GNPTAB gene. MLII patients exhibit clinical phenotypes in the prenatal or neonatal stage, such as marked dysmorphic features, cardiac involvement, respiratory symptoms, dysostosis multiplex, severe growth abnormalities, and mental and motor developmental abnormalities. The median age at diagnosis for MLII is 0.7 years, the median survival is 5.0 years, and the median age at death is 1.8 years. No cure for MLII exists. Methods Sanger sequencing of the GNPTAB gene identified the compound heterozygous mutations c.673C > T in exon 7 and c.1090C > T in exon 9, which were novel double heterozygous mutations first reported in China. For the first time, we describe our experience in the use of HSCT for MLII. Our patient underwent HSCT with cells from a 9/10 human leukocyte antigen (HLA)-matched unrelated donor at 12 months of age. Myeloid neutrophil and platelet engraftment occurred on Days 10 and 11, respectively. Results The patient's limb muscle tension was significantly reduced, and his gross and fine motor skills were improved four months after transplantation. DST(Developmental Screen Test) results showed that the patient's fine motor skills and mental development were improved compared with before HSCT. Conclusion MLII is a very severe lysosomal storage disease, to date, only 3 cases have been reported on the use of HSCT to treat MLII. Our data show that HSCT is a potential way to prolong the life of patients and improve their quality of life. Due to the lack of comparable data and time, the exact benefit remains unclear in MLII patients. Longer-term follow-up and in-depth prospective studies are indispensable.
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Affiliation(s)
- Si-jia He
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Dong-jun Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Wen-qiong Lv
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Wen-hao Tang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Shu-wen Sun
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yi-ping Zhu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ying Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Pediatrics, Prenatal Diagnosis Center of West China Second University Hospital, Chengdu, China
| | - Jin Wu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Pediatrics, Prenatal Diagnosis Center of West China Second University Hospital, Chengdu, China
| | - Xiao-xi Lu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
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Mao SJ, Zu YM, Dai YL, Zou CC. Case Report: Mucolipidosis II and III Alpha/Beta Caused by Pathogenic Variants in the GNPTAB Gene (Mucolipidosis). Front Pediatr 2022; 10:852701. [PMID: 35463894 PMCID: PMC9033252 DOI: 10.3389/fped.2022.852701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aimed to improve the cognition of mucolipidosis (ML) II and III alpha/beta by analyzing the clinical manifestations of two patients. METHODS The clinical, biochemical, and molecular data of two clinical cases associated with ML II and III alpha/beta were analyzed and compared with other case reports of ML II and III alpha/beta. RESULTS The first patient was a 14-month-old girl who was hospitalized because of abnormal postnatal coarse facial features. The child had no abnormal birth history, but developed multiple abnormalities such as psychomotor retardation, abnormal facial features, bilateral limb muscle hypotonia, and genital abnormalities. The X-ray of the spine revealed multiple bone malformations. Brain magnetic resonance imaging (MRI) showed delayed myelination. Genetic testing showed the presence of two compound heterozygous pathogenic variants (c.1364C>T and c.1284+1G>T) in the GNPTAB gene. The second patient was an 18-month-old boy who was hospitalized for recurrent respiratory tract infections. The patient was a high-risk preterm infant with postnatal psychomotor retardation, language development retardation, intellectual disability, and coarse facial features. X-ray showed multiple bone malformations. Craniocerebral ultrasound showed bilateral ventricle widening. Genetic testing showed the presence of two compound heterozygous pathogenic variants (c.1284+1G>T and c.483delT) in the same gene. CONCLUSIONS ML II and III alpha/beta are rare autosomal-recessive lysosomal storage diseases that are attributed to GNPTAB variants that cause N-acetylglucosamine-1-phosphotransferase deficiency, finally leading to multiple clinical signs and symptoms. A proper ML II and/or III alpha/beta diagnosis requires a combined analysis of a patient's clinical manifestations, imaging examination, enzymatic analysis, and genetic testing results. Ultimately, genetic counseling is essential for this disease.
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Affiliation(s)
- Shao-Jia Mao
- Department of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yu-Mei Zu
- Department of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yang-Li Dai
- Department of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Chao-Chun Zou
- Department of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
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3
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Essawi ML, Fateen EM, Atia HA, Eissa NR, Aboul-Ezz EH, Ibrahim MM, Hassan HA, Temtamy SA. Quaternary diagnostics scheme for mucolipidosis II and detection of novel mutation in GNPTAB gene. J Genet Eng Biotechnol 2021; 19:111. [PMID: 34342781 PMCID: PMC8333150 DOI: 10.1186/s43141-021-00204-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/03/2021] [Indexed: 11/21/2022]
Abstract
Background Mucolipidosis II (ML II α/β) is an inherited lysosomal storage disorder caused by deficiency of GlcNAc-phosphotransferase enzyme and results in mis-targeting of multiple lysosomal enzymes. Affected patients are characterized by skeletal deformities and developmental delay. Homozygous or compound heterozygous mutations in GNPTAB gene are associated with the clinical presentation. This is the first study to characterize the underlying genetics of ML among a cohort of Egyptian patients. ML II diagnosis established by clinical assessment, biochemical evaluation of enzymes, electron microscopy examination of gingival inclusion bodies, and molecular study of GNPTAB gene using targeted next-generation sequencing panel in 8 patients form 8 unrelated Egyptian families. Results Sequencing revealed 3 mutations in GNPTAB gene; 1 novel frame-shift mutation in exon 19 (c.3488_3488delC) and 2 previously reported mutations (c.1759C>T in exon 13 and c.3503_3504delTC in exon 19). All patients were homozygous for their corresponding mutations and the parents were consanguineous. Conclusions According to the established quaternary diagnostic scheme, ML II was the final diagnosis in eight patients. The most common mutation was the frame shift c.3503_3504delTC mutation, found in 5 patients and associated with a severe phenotype.
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Affiliation(s)
- Mona L Essawi
- Department of Medical Molecular Genetics, Division of Human Genetics and Genome Research, Dokki, Cairo, 12311, Egypt.,National Research Centre, Cairo, Egypt
| | - Ekram M Fateen
- Department of Medical Molecular Genetics, Division of Human Genetics and Genome Research, Dokki, Cairo, 12311, Egypt.,National Research Centre, Cairo, Egypt
| | - Hanan A Atia
- Department of Pharmacology and Toxicology, College of Pharmacy, Hail University, Hail, Kingdom of Saudi Arabia.,Department of Biochemistry, Faculty of Pharmacy (Girls), Al Azhar University, Cairo, Egypt
| | - Noura R Eissa
- Department of Medical Molecular Genetics, Division of Human Genetics and Genome Research, Dokki, Cairo, 12311, Egypt. .,National Research Centre, Cairo, Egypt.
| | - Eman H Aboul-Ezz
- National Research Centre, Cairo, Egypt.,Division of Oral & Dental Research, Department of Basic Dental Sciences, Dokki, Cairo, 12311, Egypt
| | - Mona M Ibrahim
- National Research Centre, Cairo, Egypt.,Division of Human Genetics and Genome Research, Department of Biochemical Genetics, Dokki, Cairo, 12311, Egypt
| | - Heba A Hassan
- Department of Medical Molecular Genetics, Division of Human Genetics and Genome Research, Dokki, Cairo, 12311, Egypt.,National Research Centre, Cairo, Egypt
| | - Samia A Temtamy
- National Research Centre, Cairo, Egypt.,Division of Human Genetics and Genome Research, Department of Clinical Genetics, Dokki, Cairo, 12311, Egypt
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Graceffa V. Clinical Development of Cell Therapies to Halt Lysosomal Storage Diseases: Results and Lessons Learned. Curr Gene Ther 2021; 22:191-213. [PMID: 34323185 DOI: 10.2174/1566523221666210728141924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/31/2021] [Accepted: 06/13/2021] [Indexed: 11/22/2022]
Abstract
Although cross-correction was discovered more than 50 years ago, and held the promise of drastically improving disease management, still no cure exists for lysosomal storage diseases (LSDs). Cell therapies hold the potential to halt disease progression: either a subset of autologous cells can be ex vivo/ in vivo transfected with the functional gene or allogenic wild type stem cells can be transplanted. However, majority of cell-based attempts have been ineffective, due to the difficulties in reversing neuronal symptomatology, in finding appropriate gene transfection approaches, in inducing immune tolerance, reducing the risk of graft versus host disease (GVHD) when allogenic cells are used and that of immune response when engineered viruses are administered, coupled with a limited secretion and uptake of some enzymes. In the last decade, due to advances in our understanding of lysosomal biology and mechanisms of cross-correction, coupled with progresses in gene therapy, ongoing pre-clinical and clinical investigations have remarkably increased. Even gene editing approaches are currently under clinical experimentation. This review proposes to critically discuss and compare trends and advances in cell-based and gene therapy for LSDs. Systemic gene delivery and transplantation of allogenic stem cells will be initially discussed, whereas proposed brain targeting methods will be then critically outlined.
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Affiliation(s)
- Valeria Graceffa
- Cellular Health and Toxicology Research Group (CHAT), Institute of Technology Sligo, Ash Ln, Bellanode, Sligo, Ireland
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Arunkumar N, Vu DC, Khan S, Kobayashi H, Ngoc Can TB, Oguni T, Watanabe J, Tanaka M, Yamaguchi S, Taketani T, Ago Y, Ohnishi H, Saikia S, Álvarez JV, Tomatsu S. Diagnosis of Mucopolysaccharidoses and Mucolipidosis by Assaying Multiplex Enzymes and Glycosaminoglycans. Diagnostics (Basel) 2021; 11:1347. [PMID: 34441282 PMCID: PMC8394749 DOI: 10.3390/diagnostics11081347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/08/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022] Open
Abstract
Mucopolysaccharidoses (MPS) and mucolipidosis (ML II/III) are a group of lysosomal storage disorders (LSDs) that occur due to a dysfunction of the lysosomal hydrolases responsible for the catabolism of glycosaminoglycans (GAGs). However, ML is caused by a deficiency of the enzyme uridine-diphosphate N-acetylglucosamine:lysosomal-enzyme-N-acetylglucosamine-1-phosphotransferase (GlcNAc-1-phosphotransferase, EC2.7.8.17), which tags lysosomal enzymes with a mannose 6-phosphate (M6P) marker for transport to the lysosome. A timely diagnosis of MPS and ML can lead to appropriate therapeutic options for patients. To improve the accuracy of diagnosis for MPS and ML in a high-risk population, we propose a combination method based on known biomarkers, enzyme activities, and specific GAGs. We measured five lysosomal enzymes (α-L-iduronidase (MPS I), iduronate-2-sulfatase (MPS II), α-N-acetylglucosaminidase (MPS IIIB), N-acetylglucosamine-6-sulfatase (MPS IVA), and N-acetylglucosamine-4-sulfatase (MPS VI)) and five GAGs (two kinds of heparan sulfate (HS), dermatan sulfate (DS), and two kinds of keratan sulfate (KS)) in dried blood samples (DBS) to diagnose suspected MPS patients by five-plex enzyme and simultaneous five GAGs assays. We used liquid chromatography-tandem mass spectrometry (LC-MS/MS) for both assays. These combined assays were tested for 43 patients with suspected MPS and 103 normal control subjects. We diagnosed two MPS I, thirteen MPS II, one MPS IIIB, three MPS IVA, two MPS VI, and six ML patients with this combined method, where enzymes, GAGs, and clinical manifestations were compatible. The remaining 16 patients were not diagnosed with MPS or ML. The five-plex enzyme assay successfully identified MPS patients from controls. Patients with MPS I, MPS II, and MPS IIIB had significantly elevated HS and DS levels in DBS. Compared to age-matched controls, patients with ML and MPS had significantly elevated mono-sulfated KS and di-sulfated KS levels. The results indicated that the combination method could distinguish these affected patients with MPS or ML from healthy controls. Overall, this study has shown that this combined method is effective and can be implemented in larger populations, including newborn screening.
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Affiliation(s)
- Nivethitha Arunkumar
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA; (N.A.); (S.K.); (S.S.); (J.V.Á.)
- College of Health Sciences, University of Delaware, Newark, DE 19803, USA
| | - Dung Chi Vu
- Department of Endocrinology, Metabolism, and Genetics, Center for Rare Disease and Newborn Screening, National Children’s Hospital, Lathanh, Dongda, Hanoi 18/879, Vietnam; (D.C.V.); (T.B.N.C.)
| | - Shaukat Khan
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA; (N.A.); (S.K.); (S.S.); (J.V.Á.)
| | - Hironori Kobayashi
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo 693-8501, Japan; (H.K.); (S.Y.); (T.T.)
| | - Thi Bich Ngoc Can
- Department of Endocrinology, Metabolism, and Genetics, Center for Rare Disease and Newborn Screening, National Children’s Hospital, Lathanh, Dongda, Hanoi 18/879, Vietnam; (D.C.V.); (T.B.N.C.)
| | - Tsubasa Oguni
- Clinical Laboratory Division, Shimane University Hospital, Izumo 693-8501, Japan;
| | - Jun Watanabe
- Shimadzu Corporation, Kyoto 604-8442, Japan; (J.W.); (M.T.)
| | - Misa Tanaka
- Shimadzu Corporation, Kyoto 604-8442, Japan; (J.W.); (M.T.)
| | - Seiji Yamaguchi
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo 693-8501, Japan; (H.K.); (S.Y.); (T.T.)
| | - Takeshi Taketani
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo 693-8501, Japan; (H.K.); (S.Y.); (T.T.)
| | - Yasuhiko Ago
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu 501-1193, Japan; (Y.A.); (H.O.)
| | - Hidenori Ohnishi
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu 501-1193, Japan; (Y.A.); (H.O.)
| | - Sampurna Saikia
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA; (N.A.); (S.K.); (S.S.); (J.V.Á.)
- College of Health Sciences, University of Delaware, Newark, DE 19803, USA
| | - José V. Álvarez
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA; (N.A.); (S.K.); (S.S.); (J.V.Á.)
| | - Shunji Tomatsu
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE 19803, USA; (N.A.); (S.K.); (S.S.); (J.V.Á.)
- College of Health Sciences, University of Delaware, Newark, DE 19803, USA
- Department of Endocrinology, Metabolism, and Genetics, Center for Rare Disease and Newborn Screening, National Children’s Hospital, Lathanh, Dongda, Hanoi 18/879, Vietnam; (D.C.V.); (T.B.N.C.)
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu 501-1193, Japan; (Y.A.); (H.O.)
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Wongkittichote P, Upchurch GM, Dehner LP, Wood T, Granadillo JL. Placental pathology in an unsuspected case of mucolipidosis type II with secondary hyperparathyroidism in a premature infant. Mol Genet Metab Rep 2021; 27:100747. [PMID: 33854947 PMCID: PMC8025142 DOI: 10.1016/j.ymgmr.2021.100747] [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: 01/08/2021] [Revised: 03/14/2021] [Accepted: 03/14/2021] [Indexed: 11/06/2022] Open
Abstract
Mucolipidosis type II (MLII, MIM 252500) is a lysosomal storage disorders caused by defects in GNPTAB gene which encodes alpha and beta subunits of N-acetylglucosamine (GlcNAc)-1-phosphotransferase. Neonatal presentation includes coarse facial features, restricted postnatal growth, generalized hypotonia, gingival hypertrophy and multiple skeletal anomalies. Here we present a case of a 26-week gestational age preterm infant with MLII who did not exhibit the typical facial features at birth; however, the diagnosis was suggested from abnormal placental pathology showing trophoblastic lipidosis and initial skeletal abnormalities from chest radiograph revealing generalized diffuse severe bone demineralizing disease and multiple fractures. Biochemical testing revealed elevation of plasma lysosomal enzymes. Homozygous pathogenic variant, designated c.3505_3504del, was discovered from GNPTAB sequencing. Her course was complicated by respiratory distress, secondary hyperparathyroidism, abdominal distention and feeding difficulties. Urine mucopolysaccharides analysis revealed mild elevation of total and individual glycosaminoglycan species in a non-specific pattern. To our knowledge, our case is the most premature example of mucolipidosis type II that has ever been reported to date. This report highlights the importance of placental pathological studies in the diagnosis of lysosomal storage disorders.
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Affiliation(s)
- Parith Wongkittichote
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, United States of America
| | - Garland Michael Upchurch
- Department of Pathology and Immunology (Lauren V. Ackerman Laboratory of Surgical Pathology), Washington University School of Medicine, St Louis, MO, United States of America
| | - Louis P Dehner
- Department of Pathology and Immunology (Lauren V. Ackerman Laboratory of Surgical Pathology), Washington University School of Medicine, St Louis, MO, United States of America
| | - Timothy Wood
- Greenwood Genetic Center, Greenwood, SC, United States of America
| | - Jorge L Granadillo
- Division of Genetics and Genomic Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, United States of America
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7
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Majovska J, Nestrasil I, Paulson A, Nascene D, Jurickova K, Hlavata A, Lund T, Orchard PJ, Vaneckova M, Zeman J, Magner M, Dusek P. White matter alteration and cerebellar atrophy are hallmarks of brain MRI in alpha-mannosidosis. Mol Genet Metab 2021; 132:189-197. [PMID: 33317989 DOI: 10.1016/j.ymgme.2020.11.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Despite profound neurological symptomatology there are only few MRI studies focused on the brain abnormalities in alpha-mannosidosis (AM). Our aim was to characterize brain MRI findings in a large cohort of AM patients along with clinical manifestations. METHODS Twenty-two brain MRIs acquired in 13 untreated AM patients (8 M/5F; median age 17 years) were independently assessed by three experienced readers and compared to 16 controls. RESULTS Focal and/or diffuse hyperintense signals in the cerebral white matter were present in most (85%) patients. Cerebellar atrophy was common (62%), present from the age of 5 years. Progression was observed in two out of 6 patients with follow-up scans. Cortical atrophy (62%) and corpus callosum thinning (23%) were already present in a 13-month-old child. The presence of low T2 signal intensity in basal ganglia and thalami was excluded by the normalized signal intensity profiling. The enlargement of perivascular spaces in white matter (38%), widening of perioptic CSF spaces (62%), and enlargement of cisterna magna (85%) were also observed. Diploic space thickening (100%), mucosal thickening (69%) and sinus hypoplasia (54%) were the most frequent non-CNS abnormalities. CONCLUSION White matter changes and cerebellar atrophy are proposed to be the characteristic brain MRI features of AM. The previously reported decreased T2 signal intensity in basal ganglia and thalami was not detected in this quantitative study. Rather, this relative MR appearance seems to be related to the diffuse high T2 signal in the adjacent white matter and not the gray matter iron deposition that has been hypothesized.
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Affiliation(s)
- Jitka Majovska
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Igor Nestrasil
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA; Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN, USA
| | - Amy Paulson
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - David Nascene
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Katarina Jurickova
- Center for Inherited Metabolic Disorders, Department of Paediatrics, National Institute of Children's Diseases and Faculty of Human Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Anna Hlavata
- Center for Inherited Metabolic Disorders, Department of Paediatrics, National Institute of Children's Diseases and Faculty of Human Medicine, Comenius University in Bratislava, Bratislava, Slovakia
| | - Troy Lund
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Paul J Orchard
- Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jiri Zeman
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Martin Magner
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Department of Pediatrics, First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic.
| | - Petr Dusek
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic.
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8
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Mucolipidoses Overview: Past, Present, and Future. Int J Mol Sci 2020; 21:ijms21186812. [PMID: 32957425 PMCID: PMC7555117 DOI: 10.3390/ijms21186812] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 12/12/2022] Open
Abstract
Mucolipidosis II and III (ML II/III) are caused by a deficiency of uridine-diphosphate N-acetylglucosamine: lysosomal-enzyme-N-acetylglucosamine-1-phosphotransferase (GlcNAc-1-phosphotransferase, EC2.7.8.17), which tags lysosomal enzymes with a mannose 6-phosphate (M6P) marker for transport to the lysosome. The process is performed by a sequential two-step process: first, GlcNAc-1-phosphotransferase catalyzes the transfer of GlcNAc-1-phosphate to the selected mannose residues on lysosomal enzymes in the cis-Golgi network. The second step removes GlcNAc from lysosomal enzymes by N-acetylglucosamine-1-phosphodiester α-N-acetylglucosaminidase (uncovering enzyme) and exposes the mannose 6-phosphate (M6P) residues in the trans-Golgi network, in which the enzymes are targeted to the lysosomes by M6Preceptors. A deficiency of GlcNAc-1-phosphotransferase causes the hypersecretion of lysosomal enzymes out of cells, resulting in a shortage of multiple lysosomal enzymes within lysosomes. Due to a lack of GlcNAc-1-phosphotransferase, the accumulation of cholesterol, phospholipids, glycosaminoglycans (GAGs), and other undegraded substrates occurs in the lysosomes. Clinically, ML II and ML III exhibit quite similar manifestations to mucopolysaccharidoses (MPSs), including specific skeletal deformities known as dysostosis multiplex and gingival hyperplasia. The life expectancy is less than 10 years in the severe type, and there is no definitive treatment for this disease. In this review, we have described the updated diagnosis and therapy on ML II/III.
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Alegra T, Sperb-Ludwig F, Guarany NR, Ribeiro EM, Lourenço CM, Kim CA, Valadares ER, Galera MF, Acosta AX, Horovitz DDG, Schwartz IVD. Clinical Characterization of Mucolipidoses II and III: A Multicenter Study. J Pediatr Genet 2019; 8:198-204. [PMID: 31687257 DOI: 10.1055/s-0039-1697605] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 08/15/2019] [Indexed: 10/26/2022]
Abstract
Mucolipidoses (MLs) II and III are rare lysosomal diseases caused by deficiency of GlcNAc-1-phosphotransferase, and clinical manifestations are multisystemic. Clinical and demographic data from 1983 to 2013 were obtained retrospectively. Twenty-seven patients were included (ML II = 15, ML III α/beta = 9, ML III gamma = 3). The median age at diagnosis was 2.7 years. The predominant clinical presentations were skeletal symptoms. The ML II patients showed physical and cognitive impairment, while the ML III α/beta patients have more somatic abnormalities and usually were delayed in early development as compared with ML III gamma patients. This is the most comprehensive study exploring characteristics of Brazilian patients with MLs II and III.
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Affiliation(s)
- Taciane Alegra
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernanda Sperb-Ludwig
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,BRAIN Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Nicole Ruas Guarany
- Occupational Therapy Faculty, Federal University of Pelotas, Pelotas, Brazil
| | | | - Charles M Lourenço
- Ribeirão Preto Clinics Hospital, Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Chong Ae Kim
- Genetics Unit, Instituto da Criança, School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Eugênia R Valadares
- Department of Complementary Propaedeutics, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Marcial Francis Galera
- Department of Pediatrics, School of Medicine, Federal University of Mato Grosso, Cuiabá, Brazil
| | - Angelina X Acosta
- Faculdade de Medicina, Departamento de Pediatria, Setor de Genética, Universidade Federal da Bahia, Salvador, Brazil
| | - Dafne Dain Gandelman Horovitz
- Department of Genetics, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fiocruz, Rio de Janeiro, Brazil
| | - Ida Vanessa Doederlein Schwartz
- Postgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Department of Genetics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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10
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Yu F, Jin JY, He JQ, Fan LL, Jiao ZJ, Wu PF, Tang JY, Xiang R. Compound heterozygous GNPTAB mutations cause mucolipidosis II or III alpha/beta in two Chinese families. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2019; 12:2981-2988. [PMID: 31934135 PMCID: PMC6949696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 06/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Mucolipidosis II and III alpha/beta (ML II & ML III alpha/beta) are rare autosomal recessive lysosomal storage disorders. ML II is clinically evident from birth with a progressive course and fatal outcome in childhood. The typical phenotypes of ML II include limited statural growth, craniofacial abnormality, skeletal malformation, intelligence developmental deficiency and visceral organ abnormality. ML III is milder than ML II. Mutations in GNPTAB cause the ML II/III. METHODS Two families with ML II/III (initially undiagnosed) were recruited. We applied whole-exome sequencing (WES) and filtered mutations by genes causing lysosomal storage diseases with skeletal involvement. Mutational analysis and co-segregation confirmation were then performed. RESULTS We presented two families with ML II or ML III alpha/beta. By WES, the compound heterozygosity of GNPTAB (c.2404C>T, p.Q802* and c.2590dup, p.E864Gfs*4) is identified in a family with ML II, and c.1364C>T, p.A455V and c.2715+1G>A are detected in a family with ML III alpha/beta. CONCLUSION We detected the causative mutations in two ML II/III families by WES and confirmed their diagnosis of the diseases. The present identification of mutations expands the spectrum of known GNPTAB mutations and it may contribute to novel approaches to genetic diagnosis and counseling for patients with ML II/III.
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Affiliation(s)
- Fang Yu
- Department of Orthopaedics, Xiangya Hospital of Central South UniversityChangsha, China
| | - Jie-Yuan Jin
- School of Life Sciences, Central South UniversityChangsha, China
| | - Ji-Qiang He
- Department of Orthopaedics, Xiangya Hospital of Central South UniversityChangsha, China
| | - Liang-Liang Fan
- School of Life Sciences, Central South UniversityChangsha, China
| | - Zi-Jun Jiao
- School of Life Sciences, Central South UniversityChangsha, China
| | - Pan-Feng Wu
- Department of Orthopaedics, Xiangya Hospital of Central South UniversityChangsha, China
| | - Ju-Yu Tang
- Department of Orthopaedics, Xiangya Hospital of Central South UniversityChangsha, China
| | - Rong Xiang
- Department of Orthopaedics, Xiangya Hospital of Central South UniversityChangsha, China
- School of Life Sciences, Central South UniversityChangsha, China
- Human Key Laboratory of Animal Models for Human Diseases, School of Life Sciences, Central South UniversityChangsha, China
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11
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Velho RV, Harms FL, Danyukova T, Ludwig NF, Friez MJ, Cathey SS, Filocamo M, Tappino B, Güneş N, Tüysüz B, Tylee KL, Brammeier KL, Heptinstall L, Oussoren E, van der Ploeg AT, Petersen C, Alves S, Saavedra GD, Schwartz IV, Muschol N, Kutsche K, Pohl S. The lysosomal storage disorders mucolipidosis type II, type III alpha/beta, and type III gamma: Update on GNPTAB and GNPTG mutations. Hum Mutat 2019; 40:842-864. [PMID: 30882951 DOI: 10.1002/humu.23748] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/19/2019] [Accepted: 03/14/2019] [Indexed: 01/04/2023]
Abstract
Mutations in the GNPTAB and GNPTG genes cause mucolipidosis (ML) type II, type III alpha/beta, and type III gamma, which are autosomal recessively inherited lysosomal storage disorders. GNPTAB and GNPTG encode the α/β-precursor and the γ-subunit of N-acetylglucosamine (GlcNAc)-1-phosphotransferase, respectively, the key enzyme for the generation of mannose 6-phosphate targeting signals on lysosomal enzymes. Defective GlcNAc-1-phosphotransferase results in missorting of lysosomal enzymes and accumulation of non-degradable macromolecules in lysosomes, strongly impairing cellular function. MLII-affected patients have coarse facial features, cessation of statural growth and neuromotor development, severe skeletal abnormalities, organomegaly, and cardiorespiratory insufficiency leading to death in early childhood. MLIII alpha/beta and MLIII gamma are attenuated forms of the disease. Since the identification of the GNPTAB and GNPTG genes, 564 individuals affected by MLII or MLIII have been described in the literature. In this report, we provide an overview on 258 and 50 mutations in GNPTAB and GNPTG, respectively, including 58 novel GNPTAB and seven novel GNPTG variants. Comprehensive functional studies of GNPTAB missense mutations did not only gain insights into the composition and function of the GlcNAc-1-phosphotransferase, but also helped to define genotype-phenotype correlations to predict the clinical outcome in patients.
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Affiliation(s)
- Renata Voltolini Velho
- Section Cell Biology of Rare Diseases, Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frederike L Harms
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tatyana Danyukova
- Section Cell Biology of Rare Diseases, Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nataniel F Ludwig
- Department of Genetics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Post-Graduation Program in Genetics and Molecular Biology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Mirella Filocamo
- Laboratorio di Genetica Molecolare e Biobanche, Istituto Giannina Gaslini, Genova, Italy
| | - Barbara Tappino
- Laboratorio di Genetica Molecolare e Biobanche, Istituto Giannina Gaslini, Genova, Italy
| | - Nilay Güneş
- Department of Pediatric Genetics, Istanbul University Cerrahpasa, Medicine School, Istanbul, Turkey
| | - Beyhan Tüysüz
- Department of Pediatric Genetics, Istanbul University Cerrahpasa, Medicine School, Istanbul, Turkey
| | - Karen L Tylee
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Saint Mary's Hospital, Manchester, UK
| | - Kathryn L Brammeier
- Willink Biochemical Genetics Unit, Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Saint Mary's Hospital, Manchester, UK
| | - Lesley Heptinstall
- Genomic Diagnostics Laboratory, Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Saint Mary's Hospital, Manchester, UK
| | - Esmee Oussoren
- Department of Pediatrics, Center for LyMannose phosphorylation in health and diseasesosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ans T van der Ploeg
- Department of Pediatrics, Center for LyMannose phosphorylation in health and diseasesosomal and Metabolic Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Christine Petersen
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra Alves
- Department of Human Genetics, INSA, National Health Institute Doutor Ricardo Jorge, Porto, Portugal
| | - Gloria Durán Saavedra
- División de Pediatría, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ida V Schwartz
- Department of Genetics, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Post-Graduation Program in Genetics and Molecular Biology, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Nicole Muschol
- International Center for Lysosomal Disorders, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kerstin Kutsche
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sandra Pohl
- Section Cell Biology of Rare Diseases, Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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12
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Wang Y, Ye J, Qiu WJ, Han LS, Gao XL, Liang LL, Gu XF, Zhang HW. Identification of predominant GNPTAB gene mutations in Eastern Chinese patients with mucolipidosis II/III and a prenatal diagnosis of mucolipidosis II. Acta Pharmacol Sin 2019; 40:279-287. [PMID: 29872134 DOI: 10.1038/s41401-018-0023-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/28/2018] [Indexed: 11/09/2022] Open
Abstract
Mucolipidosis II α/β, mucolipidosis III α/β, and mucolipidosis III γ are autosomal recessive disorders belonging to the family of lysosomal storage disorders caused by deficiency of the UDP-N-acetylglucosamine, a lysosomal enzyme N-acetylglucosamine-1-phosphotransferase (GlcNAc-phosphotransferase) localized in the Golgi apparatus, which is essential for normal processing and packaging of soluble lysosomal enzymes with initiating the first step of tagging lysosomal enzymes with mannose-6-phosphate (M6P). Mucolipidosis II and III are caused by mutations in the GNPTAB and GNPTG genes, and patients with these diseases are characterized by short stature, skeletal abnormalities, and developmental delay. In this study we report 38 patients with mucolipidosis II and III enrolled in Eastern China during the past 8 years. The diagnosis was made based on clinical characteristics and measurement of plasma lysosomal enzyme activity. Sanger sequencing of GNPTAB and/or GNPTG for all patients and real-time quantitative PCR were performed to confirm the diagnosis. In addition, 11 cases of prenatal mucolipidosis II were diagnosed based on measurement of the enzyme activity in amniotic fluid supernatant and genetic testing of cultured amniotic cells. Based on molecular genetic tests, 30 patients were diagnosed with mucolipidosis II α/β, 6 were diagnosed with III α/β and 2 were diagnosed with III γ. Thirty-seven different GNPTAB gene mutations were identified in 29 patients with mucolipidosis II α/β and six patients with III α/β. These mutations included 22 new mutations (p.W44X, p.E279X, p.W416X, p.W463X, p.Q802X, p.Q882X, p.A34P, p.R334P, p.D408N, p.D534N, p.Y997C, p.D1018V, p.L1025S, p.L1033P, c.88_89delAC, c.890_891insT, c.1150_1151insTTA, c.1523delG, c.2473_2474insA, c.2980_2983delGCCT, c.3094delA, and deletion of exon 9). Four new GNPTG gene mutations were identified (c.13delC, p.Y81X, p.G126R and c.609+1delG) in two mucolipidosis III γ patients. Among the 11 cases of prenatal diagnosis, four were mucolipidosis II fetuses, three were heterozygous, and the remaining four were normal fetuses. This study expands the mutation spectrum of the GNPTAB and GNPTG genes and contributes to specific knowledge of mucolipidosis II/III in a population from Eastern China.
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13
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Oussoren E, van Eerd D, Murphy E, Lachmann R, van der Meijden JC, Hoefsloot LH, Verdijk R, Ruijter GJG, Maas M, Hollak CEM, Langendonk JG, van der Ploeg AT, Langeveld M. Mucolipidosis type III, a series of adult patients. J Inherit Metab Dis 2018; 41:839-848. [PMID: 29704188 PMCID: PMC6133174 DOI: 10.1007/s10545-018-0186-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/04/2018] [Accepted: 04/10/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Mucolipidosis type III α/β or γ (MLIII) are rare autosomal recessive diseases, in which reduced activity of the enzyme UDP-N-acetyl glucosamine-1-phosphotransferase (GlcNAc-PTase) leads to intra-lysosomal accumulation of different substrates. Publications on the natural history of MLIII, especially the milder forms, are scarce. This study provides a detailed description of the disease characteristics and its natural course in adult patients with MLIII. METHODS In this retrospective chart study, the clinical, biochemical and molecular findings in adult patients with a confirmed diagnosis of MLIII from three treatment centres were collected. RESULTS Thirteen patients with MLIII were included in this study. Four patients (31%) were initially misdiagnosed with a type of mucopolysaccharidosis (MPS). Four patients (31%) had mild cognitive impairment. Six patients (46%) needed help with activities of daily living (ADL) or were wheelchair-dependent. All patients had dysostosis multiplex and progressive secondary osteoarthritis, characterised by cartilage destruction and bone lesions in multiple joints. All patients underwent multiple orthopaedic surgical interventions as early as the second or third decades of life, of which total hip replacement (THR) was the most common procedure (61% of patients). Carpal tunnel syndrome (CTS) was found in 12 patients (92%) and in eight patients (61%), CTS release was performed. CONCLUSIONS Severe skeletal abnormalities, resulting from abnormal bone development and severe progressive osteoarthritis, are the hallmark of MLIII, necessitating surgical orthopaedic interventions early in life. Future therapies for this disease should focus on improving cartilage and bone quality, preventing skeletal complications and improving mobility.
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Affiliation(s)
- Esmee Oussoren
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC—Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - David van Eerd
- Department of Internal Medicine, Center for Lysosomal and Metabolic Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Elaine Murphy
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Robin Lachmann
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Jan C. van der Meijden
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC—Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Lies H. Hoefsloot
- Department of Clinical Genetics, Center for Lysosomal and Metabolic Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Rob Verdijk
- Department of Pathology, Erasmus MC, Rotterdam, The Netherlands
| | - George J. G. Ruijter
- Department of Clinical Genetics, Center for Lysosomal and Metabolic Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Mario Maas
- Department of Radiology and Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Carla E. M. Hollak
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Janneke G. Langendonk
- Department of Internal Medicine, Center for Lysosomal and Metabolic Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Ans T. van der Ploeg
- Department of Pediatrics, Center for Lysosomal and Metabolic Diseases, Erasmus MC—Sophia Children’s Hospital, P.O. Box 2060, 3000 CB Rotterdam, The Netherlands
| | - Mirjam Langeveld
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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