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Forte G, Buonadonna AL, Pantaleo A, Fasano C, Capodiferro D, Grossi V, Sanese P, Cariola F, De Marco K, Lepore Signorile M, Manghisi A, Guglielmi AF, Simonetti S, Laforgia N, Disciglio V, Simone C. Classic Galactosemia: Clinical and Computational Characterization of a Novel GALT Missense Variant (p.A303D) and a Literature Review. Int J Mol Sci 2023; 24:17388. [PMID: 38139222 PMCID: PMC10744227 DOI: 10.3390/ijms242417388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/30/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
Classic galactosemia is an autosomal recessive inherited liver disorder of carbohydrate metabolism caused by deficient activity of galactose-1-phosphate uridylyltransferase (GALT). While a galactose-restricted diet is lifesaving, most patients still develop long-term complications. In this study, we report on a two-week-old female patient who is a compound heterozygote for a known pathogenic variant (p.K285N) and a novel missense variant (p.A303D) in the GALT gene. Segregation analysis showed that the patient inherited the p.K285N pathogenic variant from her father and the p.A303D variant from her mother. A bioinformatics analysis to predict the impact of the p.A303D missense variant on the structure and stability of the GALT protein revealed that it may be pathogenic. Based on this finding, we performed a literature review of all GALT missense variants identified in homozygous and compound heterozygous galactosemia patients carrying the p.K285N pathogenic variant to explore their molecular effects on the clinical phenotype of the disease. Our analysis revealed that these missense variants are responsible for a wide range of molecular defects. This study expands the clinical and mutational spectrum in classic galactosemia and reinforces the importance of understanding the molecular consequences of genetic variants to incorporate genetic analysis into clinical care.
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Affiliation(s)
- Giovanna Forte
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (G.F.); (A.L.B.); (A.P.); (C.F.); (V.G.); (P.S.); (F.C.); (K.D.M.); (M.L.S.); (A.M.); (A.F.G.)
| | - Antonia Lucia Buonadonna
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (G.F.); (A.L.B.); (A.P.); (C.F.); (V.G.); (P.S.); (F.C.); (K.D.M.); (M.L.S.); (A.M.); (A.F.G.)
| | - Antonino Pantaleo
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (G.F.); (A.L.B.); (A.P.); (C.F.); (V.G.); (P.S.); (F.C.); (K.D.M.); (M.L.S.); (A.M.); (A.F.G.)
| | - Candida Fasano
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (G.F.); (A.L.B.); (A.P.); (C.F.); (V.G.); (P.S.); (F.C.); (K.D.M.); (M.L.S.); (A.M.); (A.F.G.)
| | - Donatella Capodiferro
- Section of Neonatology and Neonatal Intensive Care Unit, Department of Interdisciplinary Medicine, “Aldo Moro” University of Bari, 70121 Bari, Italy; (D.C.); (N.L.)
| | - Valentina Grossi
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (G.F.); (A.L.B.); (A.P.); (C.F.); (V.G.); (P.S.); (F.C.); (K.D.M.); (M.L.S.); (A.M.); (A.F.G.)
| | - Paola Sanese
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (G.F.); (A.L.B.); (A.P.); (C.F.); (V.G.); (P.S.); (F.C.); (K.D.M.); (M.L.S.); (A.M.); (A.F.G.)
| | - Filomena Cariola
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (G.F.); (A.L.B.); (A.P.); (C.F.); (V.G.); (P.S.); (F.C.); (K.D.M.); (M.L.S.); (A.M.); (A.F.G.)
| | - Katia De Marco
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (G.F.); (A.L.B.); (A.P.); (C.F.); (V.G.); (P.S.); (F.C.); (K.D.M.); (M.L.S.); (A.M.); (A.F.G.)
| | - Martina Lepore Signorile
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (G.F.); (A.L.B.); (A.P.); (C.F.); (V.G.); (P.S.); (F.C.); (K.D.M.); (M.L.S.); (A.M.); (A.F.G.)
| | - Andrea Manghisi
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (G.F.); (A.L.B.); (A.P.); (C.F.); (V.G.); (P.S.); (F.C.); (K.D.M.); (M.L.S.); (A.M.); (A.F.G.)
| | - Anna Filomena Guglielmi
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (G.F.); (A.L.B.); (A.P.); (C.F.); (V.G.); (P.S.); (F.C.); (K.D.M.); (M.L.S.); (A.M.); (A.F.G.)
| | - Simonetta Simonetti
- Clinical Pathology and Neonatal Screening, Azienda Ospedaliera Universitaria Policlinico-Giovanni XXIII, 70124 Bari, Italy;
| | - Nicola Laforgia
- Section of Neonatology and Neonatal Intensive Care Unit, Department of Interdisciplinary Medicine, “Aldo Moro” University of Bari, 70121 Bari, Italy; (D.C.); (N.L.)
| | - Vittoria Disciglio
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (G.F.); (A.L.B.); (A.P.); (C.F.); (V.G.); (P.S.); (F.C.); (K.D.M.); (M.L.S.); (A.M.); (A.F.G.)
| | - Cristiano Simone
- Medical Genetics, National Institute of Gastroenterology-IRCCS “Saverio de Bellis” Research Hospital, 70013 Castellana Grotte, Italy; (G.F.); (A.L.B.); (A.P.); (C.F.); (V.G.); (P.S.); (F.C.); (K.D.M.); (M.L.S.); (A.M.); (A.F.G.)
- Medical Genetics, Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
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Çelik M, Akdeniz O, Ozbek MN, Kirbiyik O. Neonatal classic galactosemia-diagnosis, clinical profile and molecular characteristics in unscreened Turkish population. J Trop Pediatr 2022; 68:6827488. [PMID: 36375035 DOI: 10.1093/tropej/fmac098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Classic galactosemia (CG) is a rare hereditary disease that can cause serious morbidity and death if it is not diagnosed and treated in early periods of life. Clinical findings usually occur in the neonatal period after the neonate is fed with milk that contains galactose. Most patients are presented with jaundice, hepatomegaly, hypoglycemia and cataracts. OBJECTIVE We aimed to document the clinical, molecular characteristics, regional estimated incidence and time of diagnosis in newborn with CG. MATERIALS AND METHOD The data of 63 newborn with CG who were diagnosed and followed up between January 2011 and January 2018 were analyzed retrospectively. RESULTS During the study period, 63 (33 boys and 30 girls) newborns were diagnosed with CG. The median gestational age was 39 weeks (33-42). Major presenting symptoms were jaundice 90.5% and cataract 41.2%. The mean age at first symptom was 12 ± 7.4 days while the mean age at diagnosis was 18.9 ± 10.6 days. Nearly half of the patients (55.5%) were diagnosed later than the postnatal 15th day. Genetic analysis was performed on 56 patients and homozygous Q188R mutation was found in 92.8%. There were signs of sepsis in 33.3% of the cases. Six patients died due to sepsis. There was consanguinity in 84.1% of the parents and regional estimated incidence was calculated as 1 in 6103 live births. CONCLUSION Q188R mutation was found in 92.8% of our cases. The regional estimated incidence was found as 1 in 6103 live births. Our study strongly supports that galactosemia should be included in the national newborn screening program.
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Affiliation(s)
- Muhittin Çelik
- Division of Neonatology, Department of Pediatrics, Gaziantep University, Gaziantep 27410, Turkey.,Division of Neonatology, Department of Pediatrics, Diyarbakir Children's Diseases Hospital, 21100 Yenisehir, Diyarbakir, Turkey
| | - Osman Akdeniz
- Division of Pediatric Cardiology, Department of Pediatrics, Fırat University, Elazığ 21100, Turkey
| | - Mehmet Nuri Ozbek
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, Gazi Yaşargil Training and Research Hospital, Diyarbakir 21090, Turkey
| | - Ozgur Kirbiyik
- Department of Clinical Genetics. İzmir Health Sciences University, Tepecik Education and Research Hospital, Izmir 35210, Turkey
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Ohlsson A, Hunt M, Wedell A, von Döbeln U. Heterogeneity of disease-causing variants in the Swedish galactosemia population: Identification of 16 novel GALT variants. J Inherit Metab Dis 2019; 42:1008-1018. [PMID: 31194895 DOI: 10.1002/jimd.12136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 11/11/2022]
Abstract
The aim was to determine disease-causing variants in the GALT gene which codes for the enzyme galactose-1-phosphate uridylyltransferase. Loss of activity of this enzyme causes classical galactosemia-a life threatening, treatable disorder, included in the Swedish newborn screening program since 1967. A total of 66 patients with the disease are known in Sweden and 56 index patients were investigated. An additional two patients with Duarte galactosemia were included. The disease-causing variants were identified in all patients. As reported from other countries only a few variants frequently recur in severe disease. The two variants p.(Gln188Arg) (c.563A>G) and p.(Met142Lys) (c.425T>A) are present in several index patients whereas the remaining are found in one to three patients each. The most common variant, p.(Gln188Arg), has an allele frequency of 51% in the cohort. A total of 16 novel variants were found among the 33 different variants in the cohort. Two of these are synonymous variants affecting splicing, demonstrating the importance of the evaluation of synonymous variants at the cDNA level. Concise sentence: Galactosemia is a rare disease in Sweden and the disease-causing variants are heterogenous including two synonymous variants.
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Affiliation(s)
- Annika Ohlsson
- Centre for Inherited Metabolic Diseases (CMMS), Karolinska University Hospital, Stockholm, Sweden
- Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden
| | - Mary Hunt
- The School of Biological and Health Sciences, Dublin Institute of Technology, Dublin, Ireland
| | - Anna Wedell
- Centre for Inherited Metabolic Diseases (CMMS), Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Ulrika von Döbeln
- Centre for Inherited Metabolic Diseases (CMMS), Karolinska University Hospital, Stockholm, Sweden
- Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden
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Teke Kisa P, Kose M, Unal O, Er E, Hismi BO, Bulbul FS, Kose E, Gunduz M, Canda E, Kucukcongar A, Arslan N. Clinical and molecular characteristics and time of diagnosis of patients with classical galactosemia in an unscreened population in Turkey. J Pediatr Endocrinol Metab 2019; 32:675-681. [PMID: 31194682 DOI: 10.1515/jpem-2018-0457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/30/2019] [Indexed: 12/23/2022]
Abstract
Classical galactosemia is an autosomal recessive inborn error of metabolism caused by biallelic pathogenic variants in the GALT gene. With the benefit of early diagnosis by newborn screening, the acute presentation of galactosemia can be prevented. In this study, we describe the clinical phenotypes, time of diagnosis and GALT genotypes of 76 galactosemia patients from Turkey, where the disease is not yet included in the newborn screening program. The median age at first symptom was 10 days (range 5-20), while the median age at diagnosis was 30 days (range 17-53). Nearly half of the patients (36 patients, 47.4%) were diagnosed later than age 1 month. Fifty-eight individuals were found to have 18 different pathogenic variants in their 116 mutant alleles. In our sample, Q188R variant has the highest frequency with 53%, the other half of the allele frequency of the patients showed 17 different genotypes. Despite presenting with typical clinical manifestations, classical galactosemia patients are diagnosed late in Turkey. Due to the geographical location of our country, different pathogenic GALT variants may be seen in Turkish patients. In the present study, a clear genotype-phenotype correlation could not be established in patients.
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Affiliation(s)
- Pelin Teke Kisa
- Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Melis Kose
- Division of Pediatric Metabolism and Nutrition, Dr. Behcet Uz Children's Training and Research Hospital, Izmir, Turkey
| | - Ozlem Unal
- Division of Pediatric Metabolism and Nutrition, Ankara Children's Training and Research Hospital, Ankara, Turkey
| | - Esra Er
- Division of Pediatric Metabolism and Nutrition, Ege University Faculty of Medicine, Izmir, Turkey
| | - Burcu Ozturk Hismi
- Division of Pediatric Metabolism and Nutrition, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Fatma Selda Bulbul
- Division of Pediatric Metabolism and Nutrition, Kirikkale University, Kirikkale, Turkey
| | - Engin Kose
- Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Mehmet Gunduz
- Division of Pediatric Metabolism and Nutrition, Ankara Children's Training and Research Hospital, Ankara, Turkey
| | - Ebru Canda
- Division of Pediatric Metabolism and Nutrition, Ege University Faculty of Medicine, Izmir, Turkey
| | - Aynur Kucukcongar
- Division of Pediatric Metabolism and Nutrition, Ankara Children's Training and Research Hospital, Ankara, Turkey
| | - Nur Arslan
- Department of Pediatrics, Division of Pediatric Metabolism and Nutrition, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
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