1
|
Mütze U, Ottenberger A, Gleich F, Maier EM, Lindner M, Husain RA, Palm K, Beblo S, Freisinger P, Santer R, Thimm E, vom Dahl S, Weinhold N, Grohmann‐Held K, Haase C, Hennermann JB, Hörbe‐Blindt A, Kamrath C, Marquardt I, Marquardt T, Behne R, Haas D, Spiekerkoetter U, Hoffmann GF, Garbade SF, Grünert SC, Kölker S. Neurological outcome in long-chain hydroxy fatty acid oxidation disorders. Ann Clin Transl Neurol 2024; 11:883-898. [PMID: 38263760 PMCID: PMC11021608 DOI: 10.1002/acn3.52002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVE This study aims to elucidate the long-term benefit of newborn screening (NBS) for individuals with long-chain 3-hydroxy-acyl-CoA dehydrogenase (LCHAD) and mitochondrial trifunctional protein (MTP) deficiency, inherited metabolic diseases included in NBS programs worldwide. METHODS German national multicenter study of individuals with confirmed LCHAD/MTP deficiency identified by NBS between 1999 and 2020 or selective metabolic screening. Analyses focused on NBS results, confirmatory diagnostics, and long-term clinical outcomes. RESULTS Sixty-seven individuals with LCHAD/MTP deficiency were included in the study, thereof 54 identified by NBS. All screened individuals with LCHAD deficiency survived, but four with MTP deficiency (14.8%) died during the study period. Despite NBS and early treatment neonatal decompensations (28%), symptomatic disease course (94%), later metabolic decompensations (80%), cardiomyopathy (28%), myopathy (82%), hepatopathy (32%), retinopathy (17%), and/or neuropathy (22%) occurred. Hospitalization rates were high (up to a mean of 2.4 times/year). Disease courses in screened individuals with LCHAD and MTP deficiency were similar except for neuropathy, occurring earlier in individuals with MTP deficiency (median 3.9 vs. 11.4 years; p = 0.0447). Achievement of dietary goals decreased with age, from 75% in the first year of life to 12% at age 10, and consensus group recommendations on dietary management were often not achieved. INTERPRETATION While NBS and early treatment result in improved (neonatal) survival, they cannot reliably prevent long-term morbidity in screened individuals with LCHAD/MTP deficiency, highlighting the urgent need of better therapeutic strategies and the development of disease course-altering treatment.
Collapse
Affiliation(s)
- Ulrike Mütze
- Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic MedicineHeidelberg UniversityHeidelbergGermany
| | - Alina Ottenberger
- Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic MedicineHeidelberg UniversityHeidelbergGermany
| | - Florian Gleich
- Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic MedicineHeidelberg UniversityHeidelbergGermany
| | - Esther M. Maier
- Dr. von Hauner Children's Hospital, Ludwig‐Maximilians‐UniversityMunichGermany
| | - Martin Lindner
- Division of Pediatric NeurologyUniversity Children's Hospital FrankfurtFrankfurtGermany
| | - Ralf A. Husain
- Center for Inborn Metabolic Disorders, Department of NeuropediatricsJena University HospitalJenaGermany
| | - Katja Palm
- Division of Endocrinology, Diabetology and Metabolic MedicineUniversity Children's HospitalMagdeburgGermany
| | - Skadi Beblo
- Department of Women and Child Health, Hospital for Children and Adolescents, Center for Pediatric Research Leipzig (CPL)University Hospitals, University of LeipzigLeipzigGermany
| | - Peter Freisinger
- Children's Hospital Reutlingen, Klinikum am SteinenbergReutlingenGermany
| | - René Santer
- University Medical Center Hamburg‐Eppendorf, University Children's HospitalHamburgGermany
| | - Eva Thimm
- Department of General Pediatrics, Neonatology, and Pediatric CardiologyUniversity Children's Hospital, Heinrich Heine University DüsseldorfDüsseldorfGermany
| | - Stephan vom Dahl
- Department of Gastroenterology, Hepatology and Infectious DiseasesUniversity Hospital, Heinrich Heine University DüsseldorfDüsseldorfGermany
| | - Natalie Weinhold
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Center of Chronically Sick ChildrenCharité ‐ Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
| | - Karina Grohmann‐Held
- Department of Pediatrics and Adolescent MedicineUniversity Medicine GreifswaldGreifswaldGermany
| | - Claudia Haase
- Department of Pediatrics and Adolescent MedicineHelios Hospital ErfurtErfurtGermany
| | - Julia B. Hennermann
- Villa Metabolica, Center for Pediatric and Adolescent MedicineMainz University Medical CenterMainzGermany
| | | | - Clemens Kamrath
- Department of General Pediatrics and NeonatologyUniversity Hospital of Gießen and MarburgGießenGermany
| | - Iris Marquardt
- Department of Child NeurologyChildren's Hospital OldenburgOldenburgGermany
| | - Thorsten Marquardt
- Department of General Pediatrics, Metabolic DiseasesUniversity Children's Hospital MuensterMuensterGermany
| | - Robert Behne
- Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic MedicineHeidelberg UniversityHeidelbergGermany
| | - Dorothea Haas
- Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic MedicineHeidelberg UniversityHeidelbergGermany
| | - Ute Spiekerkoetter
- Department of General Pediatrics, Adolescent Medicine and NeonatologyMedical Center ‐ University of Freiburg, Faculty of MedicineFreiburgGermany
| | - Georg F. Hoffmann
- Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic MedicineHeidelberg UniversityHeidelbergGermany
| | - Sven F. Garbade
- Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic MedicineHeidelberg UniversityHeidelbergGermany
| | - Sarah C. Grünert
- Department of General Pediatrics, Adolescent Medicine and NeonatologyMedical Center ‐ University of Freiburg, Faculty of MedicineFreiburgGermany
| | - Stefan Kölker
- Medical Faculty of Heidelberg, Center for Child and Adolescent Medicine, Division of Child Neurology and Metabolic MedicineHeidelberg UniversityHeidelbergGermany
| |
Collapse
|
2
|
Souter V, Prigmore B, Becraft E, Repass E, Smart T, Sanapareddy N, Schweitzer M, Ortiz JB, Wang Y, Benn P. Reproductive Carrier Screening Results With Maternal Health Implications During Pregnancy. Obstet Gynecol 2023; 142:1208-1216. [PMID: 37562044 DOI: 10.1097/aog.0000000000005318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/22/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE To identify conditions on a reproductive carrier screening panel with the potential for carrier manifestations during pregnancy and review the implications for obstetric care. METHODS This was a retrospective cross-sectional study of consecutive samples from female patients aged 18-55 years submitted to a commercial laboratory for a 274-gene carrier screening panel (January 2020 to September 2022). A literature review was performed to identify genes on the panel with potential for pregnancy complications in carriers. Carrier expression and published recommendations for clinical management were reviewed. RESULTS We identified 12 genes with potential for carrier manifestations during pregnancy based on reports in the literature: nine with manifestations irrespective of the fetal genetic status ( ABCB11 , COL4A3 , COL4A4 , COL4A5 , DMD , F9 , F11 , GLA , and OTC ) and three ( CPT1A , CYP19A1 , and HADHA ) with manifestations only if the fetus is affected by the condition. Manifestations included cardiomyopathy, hemorrhage, gestational hypertensive disorders, cholestasis of pregnancy, acute fatty liver, hyperammonemic crisis, and maternal virilization. Published recommendations for carrier management were identified for 11 of the 12 genes. Of 91,637 tests performed during the study period, a pathogenic or likely pathogenic variant was identified in 2,139 (2.3%), giving a carrier frequency for any of the 12 genes of 1 in 43 (95% CI 1/41-45) 1,826 (2.0%) of the study population were identified as carriers for one of the nine genes with the potential for carrier manifestations irrespective of an affected or unaffected fetus. CONCLUSION Approximately 1 in 40 female patients were identified as carriers for a condition with potential for maternal manifestations in pregnancy, including some serious or even life-threatening complications. Obstetric care professionals should be aware of the possibility of pregnancy complications among carriers and the available recommendations for management. FUNDING SOURCE This study was funded by Natera, Inc.
Collapse
Affiliation(s)
- Vivienne Souter
- Natera, Inc., Austin, Texas; and the University of Connecticut Health Center, Farmington, Connecticut
| | | | | | | | | | | | | | | | | | | |
Collapse
|
3
|
Baydakova GV, Tsygankova PG, Pechatnikova NL, Bazhanova OA, Nazarenko YD, Zakharova EY. New Acylcarnitine Ratio as a Reliable Indicator of Long-Chain 3-Hydroxyacyl-CoA Dehydrogenase Deficiency. Int J Neonatal Screen 2023; 9:48. [PMID: 37754774 PMCID: PMC10531771 DOI: 10.3390/ijns9030048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023] Open
Abstract
Long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) and mitochondrial trifunctional protein (MTP) deficiencies are rare fatal disorders of fatty acid β-oxidation with no apparent genotype-phenotype correlation. The measurement of acylcarnitines by MS/MS is a current diagnostic workup in these disorders. Nevertheless, false-positive and false-negative results have been reported, highlighting a necessity for more sensitive and specific biomarkers. This study included 54 patients with LCHAD/MTP deficiency that has been confirmed by biochemical and molecular methods. The analysis of acylcarnitines in dried blood spots was performed using ESI-MS/MS. The established "HADHA ratio" = (C16OH + C18OH + C18:1OH)/C0 was significantly elevated in all 54 affected individuals in comparison to the control group. Apart from 54 LCHAD deficiency patients, the "HADHA ratio" was calculated in 19 patients with very-long-chain acyl-CoA dehydrogenase (VLCAD) deficiency. As VLCAD-deficient patients did not show increased "HADHA ratio", the results emphasized the high specificity of this new ratio. Therefore, the "HADHA ratio" was shown to be instrumental in improving the overall performance of MS/MS-based analysis of acylcarnitine levels in the diagnostics of LCHAD/MTP deficiencies. The ratio was demonstrated to increase the sensitivity and specificity of this method and reduce the chances of false-negative results.
Collapse
Affiliation(s)
- Galina V. Baydakova
- Research Centre for Medical Genetics, Moskvorechye Str., 1, 115522 Moscow, Russia
| | - Polina G. Tsygankova
- Research Centre for Medical Genetics, Moskvorechye Str., 1, 115522 Moscow, Russia
| | | | - Olga A. Bazhanova
- Research Centre for Medical Genetics, Moskvorechye Str., 1, 115522 Moscow, Russia
| | - Yana D. Nazarenko
- Research Centre for Medical Genetics, Moskvorechye Str., 1, 115522 Moscow, Russia
| | | |
Collapse
|
4
|
Averina OA, Permyakov OA, Emelianova MA, Grigoryeva OO, Gulyaev MV, Pavlova OS, Mariasina SS, Frolova OY, Kurkina MV, Baydakova GV, Zakharova EY, Marey MV, Tsarev DA, Tashlitsky VN, Popov VS, Lovat ML, Polshakov VI, Vyssokikh MY, Sergiev PV. Mitochondrial peptide Mtln contributes to oxidative metabolism in mice. Biochimie 2023; 204:136-139. [PMID: 36174793 DOI: 10.1016/j.biochi.2022.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/10/2022] [Accepted: 09/12/2022] [Indexed: 01/12/2023]
Abstract
Mitoregulin (Mtln) is a recently identified 56 amino acid long mitochondrial peptide conserved in vertebrates. Mtln is known to enhance function of respiratory complex I, which is likely mediated by modulation of lipid composition. To address an influence of Mtln gene on the metabolism we created knockout mice deficient in Mtln gene. In line with accumulation of triglycerides observed earlier on a model of Mtln knockout cell lines, we observed Mtln KO mice to develop obesity on a high fat diet. An increased weight gain could be attributed to enhanced fat accumulation according to the magnetic resonance live imaging. In addition, Mtln KO mice demonstrate elevated serum triglycerides and other oxidation substrates accompanied by an exhaustion of tricarboxylic acids cycle intermediates, suggesting suboptimal oxidation of respiration substrates by mitochondria lacking Mtln.
Collapse
Affiliation(s)
- Olga A Averina
- Institute of Functional Genomics, Lomonosov Moscow State University, 119992, Moscow, Russia; Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119992, Russia
| | - Oleg A Permyakov
- Institute of Functional Genomics, Lomonosov Moscow State University, 119992, Moscow, Russia
| | - Mariia A Emelianova
- Center for Life Sciences, Skolkovo Institute of Science and Technology, Skolkovo, Moscow Region, 143025, Russia
| | - Olga O Grigoryeva
- Institute of Functional Genomics, Lomonosov Moscow State University, 119992, Moscow, Russia
| | - Mikhail V Gulyaev
- Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, 119991, Russia
| | - Olga S Pavlova
- Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, 119991, Russia
| | - Sofia S Mariasina
- Institute of Functional Genomics, Lomonosov Moscow State University, 119992, Moscow, Russia
| | | | - Marina V Kurkina
- Research Centre for Medical Genetics (FSBI, RCMG), 115522, Moscow, Russia
| | - Galina V Baydakova
- Research Centre for Medical Genetics (FSBI, RCMG), 115522, Moscow, Russia
| | | | - Maria V Marey
- Research Center for Obstetrics, Gynecology and Perinatology, 117198, Moscow, Russia
| | | | - Vadim N Tashlitsky
- Department of Chemistry, Lomonosov Moscow State University, Moscow, 119991, Russia
| | - Vladimir S Popov
- Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, 119991, Russia
| | - Maxim L Lovat
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119992, Russia; Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, 119991, Russia; Institute of Mitoengineering MSU, 119992, Moscow, Russia
| | - Vladimir I Polshakov
- Faculty of Fundamental Medicine, Lomonosov Moscow State University, Moscow, 119991, Russia
| | - Mikhail Yu Vyssokikh
- Belozersky Institute of Physico-Chemical Biology, Lomonosov Moscow State University, Moscow, 119992, Russia; Research Center for Obstetrics, Gynecology and Perinatology, 117198, Moscow, Russia.
| | - Petr V Sergiev
- Institute of Functional Genomics, Lomonosov Moscow State University, 119992, Moscow, Russia; Center for Life Sciences, Skolkovo Institute of Science and Technology, Skolkovo, Moscow Region, 143025, Russia; Department of Chemistry, Lomonosov Moscow State University, Moscow, 119991, Russia.
| |
Collapse
|
5
|
Effectiveness of Robotic-Assisted Gait Training and Aquatic Physical Therapy in a Child With Long-Chain 3-Hydroxyacyl-CoA Dehydrogenase Deficiency: A Case Report. Pediatr Phys Ther 2022; 34:563-569. [PMID: 36044635 DOI: 10.1097/pep.0000000000000951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this case study is to describe the outpatient rehabilitation program for a 15-year-old girl with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD). SUMMARY OF KEY POINTS The child presented with sudden-onset muscle weakness and fatigue with resultant dependence for all mobility and self-care. After 12 months of therapy, which included aquatic interventions and robotic-assisted gait training, the patient demonstrated independence with transfers, ambulation with a rolling walker, and stair navigation. Functional mobility, gross motor skills, and participation in activities of daily living significantly improved per the Gross Motor Function Measure and the Pediatric Evaluation of Disability Inventory. STATEMENT OF CONCLUSION AND RECOMMENDATIONS FOR CLINICAL PRACTICE This is the first case in the literature to outline an outpatient physical therapy treatment plan to address mobility deficits secondary to exacerbation of LCHADD. This patient's rehabilitative course will hopefully add to future research and provide patients with guidelines for their recovery.
Collapse
|
6
|
Ambrose A, Sheehan M, Bahl S, Athey T, Ghai-Jain S, Chan A, Mercimek-Andrews S. Outcomes of mitochondrial long chain fatty acid oxidation and carnitine defects from a single center metabolic genetics clinic. Orphanet J Rare Dis 2022; 17:360. [PMID: 36109795 PMCID: PMC9479237 DOI: 10.1186/s13023-022-02512-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/04/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Mitochondrial long-chain fatty acid oxidation and carnitine metabolism defects are a group of inherited metabolic diseases. We performed a retrospective cohort study to report on the phenotypic and genotypic spectrum of mitochondrial long-chain fatty acid oxidation and carnitine metabolism defects as well as their treatment outcomes.
Methods
All patients with mitochondrial long-chain fatty acid oxidation and carnitine metabolism defects were included. We divided patients into two groups to compare outcomes of those treated symptomatically (SymX) and asymptomatically (AsymX). We reviewed patient charts for clinical features, biochemical investigations, molecular genetic investigations, cardiac assessments, neuroimaging, treatments, and outcomes.
Results
There were 38 patients including VLCAD (n = 5), LCHAD (n = 4), CACT (n = 3), MAD (n = 1), CPT-I (n = 13), CPT-II (n = 3) deficiencies and CTD (n = 9). Fourteen patients were diagnosed symptomatically (SymX), and 24 patients were diagnosed asymptomatically (AsymX). Twenty-eight variants in seven genes were identified in 36 patients (pathogenic/likely pathogenic n = 25; variant of unknown significance n = 3). Four of those variants were novel. All patients with LCHAD deficiency had the common variant (p.Glu474Gln) in HADHA and their phenotype was similar to the patients reported in the literature for this genotype. Only one patient with VLCAD deficiency had the common p.Val283Ala in ACADVL. The different genotypes in the SymX and AsymX groups for VLCAD deficiency presented with similar phenotypes. Eight patients were treated with carnitine supplementation [CTD (n = 6), CPT-II (n = 1), and MAD (n = 1) deficiencies]. Thirteen patients were treated with a long-chain fat restricted diet and MCT supplementation. A statistically significant association was found between rhabdomyolysis, and hypoglycemia in the SymX group compared to the AsymX group. A higher number of hospital admissions, longer duration of hospital admissions and higher CK levels were observed in the SymX group, even though the symptomatic group was only 37% of the study cohort.
Conclusion
Seven different mitochondrial long-chain fatty acid oxidation and carnitine metabolism defects were present in our study cohort. In our clinic, the prevalence of mitochondrial long-chain fatty acid oxidation and carnitine defects was 4.75%.
Collapse
|
7
|
Schwantje M, Fuchs SA, de Boer L, Bosch AM, Cuppen I, Dekkers E, Derks TGJ, Ferdinandusse S, Ijlst L, Houtkooper RH, Maase R, van der Pol WL, de Vries MC, Verschoof‐Puite RK, Wanders RJA, Williams M, Wijburg F, Visser G. Genetic, biochemical, and clinical spectrum of patients with mitochondrial trifunctional protein deficiency identified after the introduction of newborn screening in the Netherlands. J Inherit Metab Dis 2022; 45:804-818. [PMID: 35383965 PMCID: PMC9546250 DOI: 10.1002/jimd.12502] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/23/2022] [Accepted: 04/04/2022] [Indexed: 11/24/2022]
Abstract
Long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD) is included in many newborn screening (NBS) programs. Acylcarnitine-based NBS for LCHADD not only identifies LCHADD, but also the other deficiencies of the mitochondrial trifunctional protein (MTP), a multi-enzyme complex involved in long-chain fatty acid β-oxidation. Besides LCHAD, MTP harbors two additional enzyme activities: long-chain enoyl-CoA hydratase (LCEH) and long-chain ketoacyl-CoA thiolase (LCKAT). Deficiency of one or more MTP activities causes generalized MTP deficiency (MTPD), LCHADD, LCEH deficiency (not yet reported), or LCKAT deficiency (LCKATD). To gain insight in the outcomes of MTP-deficient patients diagnosed after the introduction of NBS for LCHADD in the Netherlands, a retrospective evaluation of genetic, biochemical, and clinical characteristics of MTP-deficient patients, identified since 2007, was carried out. Thirteen patients were identified: seven with LCHADD, five with MTPD, and one with LCKATD. All LCHADD patients (one missed by NBS, clinical diagnosis) and one MTPD patient (clinical diagnosis) were alive. Four MTPD patients and one LCKATD patient developed cardiomyopathy and died within 1 month and 13 months of life, respectively. Surviving patients did not develop symptomatic hypoglycemia, but experienced reversible cardiomyopathy and rhabdomyolysis. Five LCHADD patients developed subclinical neuropathy and/or retinopathy. In conclusion, patient outcomes were highly variable, stressing the need for accurate classification of and discrimination between the MTP deficiencies to improve insight in the yield of NBS for LCHADD. NBS allowed the prevention of symptomatic hypoglycemia, but current treatment options failed to treat cardiomyopathy and prevent long-term complications. Moreover, milder patients, who might benefit from NBS, were missed due to normal acylcarnitine profiles.
Collapse
Affiliation(s)
- Marit Schwantje
- Department of Metabolic DiseasesWilhelmina Children's Hospital, University Medical Center UtrechtUtrechtThe Netherlands
- Laboratory Genetic Metabolic Diseases, and Metabolism Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Sabine A. Fuchs
- Department of Metabolic DiseasesWilhelmina Children's Hospital, University Medical Center UtrechtUtrechtThe Netherlands
| | - Lonneke de Boer
- Department of Metabolic Diseases, Amalia Children's HospitalRadboud University Medical CentreNijmegenThe Netherlands
| | - Annet M. Bosch
- Department of Metabolic Diseases, Emma Children's Hospital, and Metabolism Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Inge Cuppen
- Department of Neurology and NeurosurgeryWilhelmina Children's Hospital, University Medical Center UtrechtUtrechtThe Netherlands
| | - Eugenie Dekkers
- National Institute for Public Health and the Environment (RIVM) Reference Laboratory for Pre‐ and Neonatal Screening, Center for Health Protection (R.M.) and Center for Population Screening (E.D)BilthovenThe Netherlands
| | - Terry G. J. Derks
- Department of Metabolic DiseasesBeatrix Children's Hospital, University Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Sacha Ferdinandusse
- Laboratory Genetic Metabolic Diseases, and Metabolism Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Lodewijk Ijlst
- Laboratory Genetic Metabolic Diseases, and Metabolism Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Riekelt H. Houtkooper
- Laboratory Genetic Metabolic Diseases, and Metabolism Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Rose Maase
- National Institute for Public Health and the Environment (RIVM) Reference Laboratory for Pre‐ and Neonatal Screening, Center for Health Protection (R.M.) and Center for Population Screening (E.D)BilthovenThe Netherlands
| | - W. Ludo van der Pol
- Department of Neurology and NeurosurgeryWilhelmina Children's Hospital, University Medical Center UtrechtUtrechtThe Netherlands
| | - Maaike C. de Vries
- Department of Metabolic Diseases, Amalia Children's HospitalRadboud University Medical CentreNijmegenThe Netherlands
| | - Rendelien K. Verschoof‐Puite
- Department for Vaccine Supply and Prevention ProgramsNational Institute for Public Health and the EnvironmentBilthovenThe Netherlands
| | - Ronald J. A. Wanders
- Laboratory Genetic Metabolic Diseases, and Metabolism Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Monique Williams
- Department of PediatricsCenter for Lysosomal and Metabolic Diseases, Erasmus MC, University Medical Center RotterdamRotterdamNetherlands
| | - Frits Wijburg
- Department of Metabolic Diseases, Emma Children's Hospital, and Metabolism Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Gepke Visser
- Department of Metabolic DiseasesWilhelmina Children's Hospital, University Medical Center UtrechtUtrechtThe Netherlands
- Laboratory Genetic Metabolic Diseases, and Metabolism Institute, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| |
Collapse
|
8
|
Veenvliet AR, Garrelfs MR, Udink ten Cate FE, Ferdinandusse S, Denis S, Fuchs SA, Schwantje M, Geurtzen R, van Wegberg AM, Huigen MC, Kluijtmans LA, Wanders RJ, Derks TG, de Boer L, Houtkooper RH, de Vries MC, van Karnebeek CD. Neonatal Long-Chain 3-Ketoacyl-CoA Thiolase deficiency: Clinical-biochemical phenotype, sodium-D,L-3-hydroxybutyrate treatment experience and cardiac evaluation using speckle echocardiography. Mol Genet Metab Rep 2022; 31:100873. [PMID: 35782614 PMCID: PMC9248206 DOI: 10.1016/j.ymgmr.2022.100873] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 04/16/2022] [Indexed: 02/08/2023] Open
Abstract
Isolated long-chain 3-keto-acyl CoA thiolase (LCKAT) deficiency is a rare long-chain fatty acid oxidation disorder caused by mutations in HADHB. LCKAT is part of a multi-enzyme complex called the mitochondrial trifunctional protein (MTP) which catalyzes the last three steps in the long-chain fatty acid oxidation. Until now, only three cases of isolated LCKAT deficiency have been described. All patients developed a severe cardiomyopathy and died before the age of 7 weeks. Here, we describe a newborn with isolated LCKAT deficiency, presenting with neonatal-onset cardiomyopathy, rhabdomyolysis, hypoglycemia and lactic acidosis. Bi-allelic 185G > A (p.Arg62His) and c1292T > C (p.Phe431Ser) mutations were found in HADHB. Enzymatic analysis in both lymphocytes and cultured fibroblasts revealed LCKAT deficiency with a normal long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD, also part of MTP) enzyme activity. Clinically, the patient showed recurrent cardiomyopathy, which was monitored by speckle tracking echocardiography. Subsequent treatment with special low-fat formula, low in long chain triglycerides (LCT) and supplemented with medium chain triglycerides (MCT) and ketone body therapy in (sodium-D,L-3-hydroxybutyrate) was well tolerated and resulted in improved carnitine profiles and cardiac function. Resveratrol, a natural polyphenol that has been shown to increase fatty acid oxidation, was also considered as a potential treatment option but showed no in vitro benefits in the patient's fibroblasts. Even though our patient deceased at the age of 13 months, early diagnosis and prompt initiation of dietary management with addition of sodium-D,L-3-hydroxybutyrate may have contributed to improved cardiac function and a much longer survival when compared to the previously reported cases of isolated LCKAT-deficiency.
Collapse
|
9
|
Shakerdi LA, McNulty J, Gillman B, McCarthy CM, Ivory J, Sheerin A, O'Byrne JJ, Donnelly JC, Treacy EP. Management of pregnancy in a patient with long‐chain 3‐hydroxyacyl
CoA
dehydrogenase deficiency. JIMD Rep 2022; 63:265-270. [PMID: 35822088 PMCID: PMC9259390 DOI: 10.1002/jmd2.12284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Abstract
Long‐chain 3‐hydroxyacyl‐CoA dehydrogenase deficiency (LCHADD) is a rare mitochondrial defect of β‐oxidation of long‐chain fatty acids. Patients may present with muscle pain, hypotonia, peripheral neuropathy, cardiomyopathy, recurrent rhabdomyolysis and sudden death. Dietary management of LCHADD aims at preventing prolonged fasting and decreasing energy production from long‐chain fatty acids compensated by an increase in medium‐chain triglyceride fat. Herein, we present medical and dietetic management of a successful pregnancy in a LCHADD female patient and the delivery of a healthy baby boy.
Collapse
Affiliation(s)
- Loai A. Shakerdi
- National Centre for Inherited Metabolic Disorders Mater Misericordiae University Hospital Dublin Ireland
| | - Jenny McNulty
- National Centre for Inherited Metabolic Disorders Children's Health Ireland (CHI) Dublin Ireland
| | - Barbara Gillman
- National Centre for Inherited Metabolic Disorders Mater Misericordiae University Hospital Dublin Ireland
| | | | - Jessica Ivory
- National Centre for Inherited Metabolic Disorders Mater Misericordiae University Hospital Dublin Ireland
| | - Alison Sheerin
- National Centre for Inherited Metabolic Disorders Mater Misericordiae University Hospital Dublin Ireland
| | - James J. O'Byrne
- National Centre for Inherited Metabolic Disorders Mater Misericordiae University Hospital Dublin Ireland
| | | | - Eileen P. Treacy
- National Centre for Inherited Metabolic Disorders Mater Misericordiae University Hospital Dublin Ireland
| |
Collapse
|
10
|
Morrison MA, Chung Y, Heneghan MA. Managing hepatic complications of pregnancy: practical strategies for clinicians. BMJ Open Gastroenterol 2022; 9:bmjgast-2021-000624. [PMID: 35292523 PMCID: PMC8928321 DOI: 10.1136/bmjgast-2021-000624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/12/2022] [Indexed: 12/17/2022] Open
Abstract
Liver disorders specific to pregnancy are rare but can have potentially serious consequences for mother and fetus. Pregnancy-related liver disorders are the most common cause of liver disease in otherwise healthy pregnant women and pose a challenge to physicians because of the need to take into account both maternal and fetal health. A good knowledge of these disorders is necessary as prompt diagnosis and appropriate management results in improved maternal and fetal outcomes. This review will focus on pregnancy-specific disorders and will aim to serve as a guide for physicians in their diagnosis, management and subsequent monitoring.
Collapse
Affiliation(s)
| | - Yooyun Chung
- Institute of Liver Studies, King's College Hospital, London, UK
| | | |
Collapse
|
11
|
Sacconi R, Bandello F, Querques G. CHOROIDAL NEOVASCULARIZATION ASSOCIATED WITH LONG-CHAIN 3-HYDROXYACYL-CoA DEHYDROGENASE DEFICIENCY. Retin Cases Brief Rep 2022; 16:99-101. [PMID: 31479012 DOI: 10.1097/icb.0000000000000923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report the first case describing choroidal neovascularization in long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency. METHODS Case report including multimodal imaging discussion. RESULTS A 21-year-old woman affected by LCHAD deficiency (confirmed by 1528 G>C homozygous mutation) was referred to our department for progressive visual decline in both eyes. Best-corrected visual acuities were 20/40 and 20/1,000 in the right and left eye, respectively. Ultra-widefield imaging, fluorescein angiography, structural optical coherence tomography, and optical coherence tomography angiography revealed the presence of macular and midperipheral chorioretinal atrophy complicated by a choroidal neovascularization in the left eye. CONCLUSION Ocular changes in LCHAD deficiency are long-term complications and severely affect the quality of life of patients. We report for the first time the evidence that choroidal neovascularization could complicate ocular changes accelerating the progressive vision impairment.
Collapse
Affiliation(s)
- Riccardo Sacconi
- Department of Ophthalmology, University Vita-Salute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | | |
Collapse
|
12
|
Kim C, Lee D, Lee J, Cho SY, Lee J. A Case of Mitochondrial Trifunctional Protein Deficiency with HADHB Variants Diagnosed Using Whole-Exome Sequencing. ANNALS OF CHILD NEUROLOGY 2021. [DOI: 10.26815/acn.2021.00416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
13
|
Li Y, He C, Li S, Wang J, Jiang L, Guo Y. Hypoparathyroidism, neutropenia and nephrotic syndrome in a patient with mitochondrial trifunctional protein deficiency: A case report and review of the literature. Eur J Med Genet 2021; 64:104344. [PMID: 34543737 DOI: 10.1016/j.ejmg.2021.104344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 07/20/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Mitochondrial trifunctional protein (TFP) deficiency is an autosomal recessive disorder that causes a clinical spectrum of diseases ranging from severe infantile cardiomyopathy to mild chronic progressive neuromyopathy, however, parathyroid glands, hematologic system and kidney damage are not the common presentations of this disease. METHODS We describe the clinical, biochemical and molecular features of the TFP deficiency patient at our institution. We also provide an extensive literature review of previous published cases with emphasis on the clinical/biochemical phenotype-genotype correlation of this disorder. RESULTS Our case is a complete TFP deficiency patient dominated presented with hypoparathyroidism, neutropenia and nephrotic syndrome, which caused by compound heterozygoues variants in HADHB gene. Based on the retrospective study of 157 cases, TFP patients presented with diverse clinical, biochemical and molecular features. The onset age is typically before early childhood. Neuromuscular system is more vulnerable involved. Severe form is generally characterized by multiorgan involvement. A notable feature of severe and intermediate form is respiratory failure. Neuropathy and rhabdomyolysis are the typical manifestations of mild form. Increased long-chain 3-OH-acylcarnitines (C16-OH, C18:1-OH) are the most common biochemical finding. The mortality of the present study is as high as 57.9%, which is linked with the onset age, phenotype, mutation type and muscular histology. Mutations in HADHB are more frequent in Asian descent with complete TFP deficiency and usually presented with atypical presentations. The type of mutation, rather than residual enzyme activity seem to be more related to the phenotype and prognosis. The most common HADHA variant is 1528G > C, no common HADHB variant were detected. CONCLUSIONS TFP deficiency is heterogeneous at both the molecular and phenotypic levels, generally a high mortality. Although there is no strict clinical/biochemical phenotype-genotype correlation, difference in ethnic and subunit mutations still have certain characteristics.
Collapse
Affiliation(s)
- Yi Li
- Department of Neurology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China
| | - ChuangFeng He
- Department of Neurology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China
| | - Shengrui Li
- Department of Neurology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China
| | - Juan Wang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, China; Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, China; Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Yi Guo
- Department of Neurology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, 400014, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, 400014, China; Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China.
| |
Collapse
|
14
|
Braun F, Hentschel A, Sickmann A, Marteau T, Hertel S, Förster F, Prokisch H, Wagner M, Wortmann S, Della Marina A, Kölbel H, Roos A, Schara-Schmidt U. Muscular and Molecular Pathology Associated with SPATA5 Deficiency in a Child with EHLMRS. Int J Mol Sci 2021; 22:ijms22157835. [PMID: 34360601 PMCID: PMC8345956 DOI: 10.3390/ijms22157835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/09/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022] Open
Abstract
Mutations in the SPATA5 gene are associated with epilepsy, hearing loss and mental retardation syndrome (EHLMRS). While SPATA5 is ubiquitously expressed and is attributed a role within mitochondrial morphogenesis during spermatogenesis, there is only limited knowledge about the associated muscular and molecular pathology. This study reports on a comprehensive workup of muscular pathology, including proteomic profiling and microscopic studies, performed on an 8-year-old girl with typical clinical presentation of EHLMRS, where exome analysis revealed two clinically relevant, compound-heterozygous variants in SPATA5. Proteomic profiling of a quadriceps biopsy showed the dysregulation of 82 proteins, out of which 15 were localized in the mitochondrion, while 19 were associated with diseases presenting with phenotypical overlap to EHLMRS. Histological staining of our patient’s muscle biopsy hints towards mitochondrial pathology, while the identification of dysregulated proteins attested to the vulnerability of the cell beyond the mitochondria. Through our study we provide insights into the molecular etiology of EHLMRS and provide further evidence for a muscle pathology associated with SPATA5 deficiency, including a pathological histochemical pattern accompanied by dysregulated protein expression.
Collapse
Affiliation(s)
- Frederik Braun
- Centre for Neuromuscular Disorders, Centre for Translational Neuro- and Behavioral Sciences, Department of Pediatric Neurology, University Duisburg-Essen, 45147 Essen, Germany; (T.M.); (S.H.); (F.F.); (A.D.M.); (H.K.); (A.R.); (U.S.-S.)
- Correspondence:
| | - Andreas Hentschel
- Leibniz-Institut für Analytische Wissenschaften—ISAS e.V., 44139 Dortmund, Germany; (A.H.); (A.S.)
| | - Albert Sickmann
- Leibniz-Institut für Analytische Wissenschaften—ISAS e.V., 44139 Dortmund, Germany; (A.H.); (A.S.)
| | - Theodore Marteau
- Centre for Neuromuscular Disorders, Centre for Translational Neuro- and Behavioral Sciences, Department of Pediatric Neurology, University Duisburg-Essen, 45147 Essen, Germany; (T.M.); (S.H.); (F.F.); (A.D.M.); (H.K.); (A.R.); (U.S.-S.)
| | - Swantje Hertel
- Centre for Neuromuscular Disorders, Centre for Translational Neuro- and Behavioral Sciences, Department of Pediatric Neurology, University Duisburg-Essen, 45147 Essen, Germany; (T.M.); (S.H.); (F.F.); (A.D.M.); (H.K.); (A.R.); (U.S.-S.)
| | - Fabian Förster
- Centre for Neuromuscular Disorders, Centre for Translational Neuro- and Behavioral Sciences, Department of Pediatric Neurology, University Duisburg-Essen, 45147 Essen, Germany; (T.M.); (S.H.); (F.F.); (A.D.M.); (H.K.); (A.R.); (U.S.-S.)
| | - Holger Prokisch
- Institute of Human Genetics, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (H.P.); (M.W.); (S.W.)
- Helmholtz Zentrum München—German Research Center for Environmental Health, Institute of Neurogenomics, 85764 Neuherberg, Germany
| | - Matias Wagner
- Institute of Human Genetics, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (H.P.); (M.W.); (S.W.)
- Helmholtz Zentrum München—German Research Center for Environmental Health, Institute of Neurogenomics, 85764 Neuherberg, Germany
| | - Saskia Wortmann
- Institute of Human Genetics, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany; (H.P.); (M.W.); (S.W.)
| | - Adela Della Marina
- Centre for Neuromuscular Disorders, Centre for Translational Neuro- and Behavioral Sciences, Department of Pediatric Neurology, University Duisburg-Essen, 45147 Essen, Germany; (T.M.); (S.H.); (F.F.); (A.D.M.); (H.K.); (A.R.); (U.S.-S.)
| | - Heike Kölbel
- Centre for Neuromuscular Disorders, Centre for Translational Neuro- and Behavioral Sciences, Department of Pediatric Neurology, University Duisburg-Essen, 45147 Essen, Germany; (T.M.); (S.H.); (F.F.); (A.D.M.); (H.K.); (A.R.); (U.S.-S.)
| | - Andreas Roos
- Centre for Neuromuscular Disorders, Centre for Translational Neuro- and Behavioral Sciences, Department of Pediatric Neurology, University Duisburg-Essen, 45147 Essen, Germany; (T.M.); (S.H.); (F.F.); (A.D.M.); (H.K.); (A.R.); (U.S.-S.)
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 5B2, Canada
| | - Ulrike Schara-Schmidt
- Centre for Neuromuscular Disorders, Centre for Translational Neuro- and Behavioral Sciences, Department of Pediatric Neurology, University Duisburg-Essen, 45147 Essen, Germany; (T.M.); (S.H.); (F.F.); (A.D.M.); (H.K.); (A.R.); (U.S.-S.)
| |
Collapse
|
15
|
Grünert SC, Eckenweiler M, Haas D, Lindner M, Tsiakas K, Santer R, Tucci S, Spiekerkoetter U. The spectrum of peripheral neuropathy in disorders of the mitochondrial trifunctional protein. J Inherit Metab Dis 2021; 44:893-902. [PMID: 33638202 DOI: 10.1002/jimd.12372] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 12/28/2022]
Abstract
Peripheral neuropathy is a known irreversible long-term complication of long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD) and mitochondrial trifunctional protein deficiency (MTPD), two inherited disorders of mitochondrial long-chain fatty acid oxidation. The underlying pathophysiology of neuropathy is still not fully understood. We report electrophysiological studies and neurological findings in a series of 8 LCHAD-deficient and 11 MTP-deficient patients. The median age at time of the study was 8.0 years (0.5-25 years). The overall prevalence of neuropathy was 58% with neuropathic symptoms being slightly more common in MTPD compared to LCHADD (70% vs 50%, respectively). Onset of neuropathy was significantly earlier in MTPD patients compared to LCHADD patients (median age at onset 4.7 vs 15.3 years, respectively, P = .047). In four patients, isolated peripheral neuropathy was the first and only presenting symptom, and in all four the diagnosis was missed by newborn screening. About half of the patients (45.5%) had a sensorimotor neuropathy, while 27.3% showed a pure motor form and another 27.3% an isolated sensory form. Despite early diagnosis by newborn screening and early initiation of therapy, peripheral neuropathy cannot be prevented in all patients with LCHADD/MTPD and has severe impact on the life of affected patients. Electrophysiology classifies LCHADD/MTPD neuropathy as axonal with secondary demyelination. A novel observation is that in patients with acute, fulminant onset of neuropathy, symptoms can be partly reversible. Further studies are needed to elucidate the underlying pathophysiology of axonal damage and possible therapeutic targets.
Collapse
Affiliation(s)
- Sarah C Grünert
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Matthias Eckenweiler
- Department of Neuropediatrics and Muscle Disorders, University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dorothea Haas
- Department of Neuropediatrics and Pediatric Metabolic Medicine, Center for Child and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Lindner
- Department of Pediatric Neurology, University Children's Hospital, Frankfurt/Main, Germany
| | | | - René Santer
- Department of Pediatrics, University Medical Center Eppendorf, Hamburg, Germany
| | - Sara Tucci
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Ute Spiekerkoetter
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| |
Collapse
|
16
|
Marsden D, Bedrosian CL, Vockley J. Impact of newborn screening on the reported incidence and clinical outcomes associated with medium- and long-chain fatty acid oxidation disorders. Genet Med 2021; 23:816-829. [PMID: 33495527 PMCID: PMC8105167 DOI: 10.1038/s41436-020-01070-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 02/07/2023] Open
Abstract
Fatty acid oxidation disorders (FAODs) are potentially fatal inherited disorders for which management focuses on early disease detection and dietary intervention to reduce the impact of metabolic crises and associated spectrum of clinical symptoms. They can be divided functionally into long-chain (LC-FAODs) and medium-chain disorders (almost exclusively deficiency of medium-chain acyl-coenzyme A dehydrogenase). Newborn screening (NBS) allows prompt identification and management. FAOD detection rates have increased following the addition of FAODs to NBS programs in the United States and many developed countries. NBS-identified neonates with FAODs may remain asymptomatic with dietary management. Evidence from numerous studies suggests that NBS-identified patients have improved outcomes compared with clinically diagnosed patients, including reduced rates of symptomatic manifestations, neurodevelopmental impairment, and death. The limitations of NBS include the potential for false-negative and false-positive results, and the need for confirmatory testing. Although NBS alone does not predict the consequences of disease, outcomes, or management needs, subsequent genetic analyses may have predictive value. Genotyping can provide valuable information on the nature and frequency of pathogenic variants involved with FAODs and their association with specific phenotypes. Long-term follow-up to fully understand the clinical spectrum of NBS-identified patients and the effect of different management strategies is needed.
Collapse
Affiliation(s)
| | | | - Jerry Vockley
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| |
Collapse
|
17
|
Rigaudière F, Delouvrier E, Le Gargasson JF, Milani P, Ogier de Baulny H, Schiff M. Long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency and progressive retinopathy: one case report followed by ERGs, VEPs, EOG over a 17-year period. Doc Ophthalmol 2021; 142:371-380. [PMID: 33392894 DOI: 10.1007/s10633-020-09802-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 10/27/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND LCHAD (long-chain 3-hydroxyacyl-CoA dehydrogenase) deficiency is a rare genetic disorder of mitochondrial long-chain fatty acid oxidation inherited as a recessive trait. Affected patients can present with hypoglycaemia, rhabdomyolysis and cardiomyopathy. About half of the patients may suffer from retinopathy. CASE REPORT A 19-year-old girl was diagnosed as suffering from LCHAD deficiency with recurrent rhabdomyolysis episodes at the age of 7 months by an inaugural coma with hypoglycaemia and hepatomegaly. Appropriate dietary management with carnitine supplementation was initiated. Retinopathy was diagnosed at age two. Ophthalmological assessments including visual acuity, visual field, OCT, flash ERGs, P-ERG, flash VEPs and EOG recordings were conducted over a 17-year period. RESULTS Visual acuity was decreased. Fundi showed a progressive retinopathy and chorioretinopathy. Photophobia was noticed 2 years before the decrease in photopic-ERG amplitude with normal scotopic-ERGs. Scotopic-ERG amplitude decreased 10 years after the decrease in photopic-ERG amplitude. No EOG light rise was observed. Flash VEPs remained normal. These results suggest that the cone system dysfunction occurs largely prior to the rod system dysfunction with a relative preservation of the macula function. COMMENTS This dysfunction of cones prior to the dysfunction of rods was not reported previously. This could be related to mitochondrial energy failure in cones as cones are greater consumers of ATP than rods. This hypothesis needs to be further confirmed as other long-chain fatty oxidation defective patients (VLCAD and CPT2 deficiencies) do not exhibit retinopathy.
Collapse
Affiliation(s)
- Florence Rigaudière
- Service de Physiologie Clinique, Exploration Fonctionnelle, Hôpital Lariboisière, AP-HP, Paris, France. .,Faculté de Médecine Paris-Diderot, Université de Paris, Paris, France.
| | | | - Jean-François Le Gargasson
- Service de Physiologie Clinique, Exploration Fonctionnelle, Hôpital Lariboisière, AP-HP, Paris, France.,Faculté de Médecine Paris-Diderot, Université de Paris, Paris, France
| | - Paolo Milani
- Service de Physiologie Clinique, Exploration Fonctionnelle, Hôpital Lariboisière, AP-HP, Paris, France
| | - Hélène Ogier de Baulny
- Faculté de Médecine Paris-Diderot, Université de Paris, Paris, France.,Reference Center for Inborn Errors of Metabolism, Robert Debré Hospital, AP-HP, Paris, France
| | - Manuel Schiff
- Reference Center for Inborn Errors of Metabolism, Robert Debré Hospital, AP-HP, Paris, France.,Reference Center for Inborn Errors of Metabolism, Faculté de Médecine Paris-Descartes, Necker University Hospital, AP-HP, Université de Paris, Paris, France.,Institut Imagine, Inserm UMRS_1163, Paris, France
| |
Collapse
|
18
|
Stinton C, Fraser H, Geppert J, Johnson R, Connock M, Johnson S, Clarke A, Taylor-Phillips S. Newborn Screening for Long-Chain 3-Hydroxyacyl-CoA Dehydrogenase and Mitochondrial Trifunctional Protein Deficiencies Using Acylcarnitines Measurement in Dried Blood Spots-A Systematic Review of Test Accuracy. Front Pediatr 2021; 9:606194. [PMID: 33816395 PMCID: PMC8017228 DOI: 10.3389/fped.2021.606194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/03/2021] [Indexed: 12/31/2022] Open
Abstract
Background: Long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) and mitochondrial trifunctional protein (MTP) deficiencies are rare autosomal recessive fatty acid β-oxidation disorders. Their clinical presentations are variable, and premature death is common. They are included in newborn blood spot screening programs in many countries around the world. The current process of screening, through the measurement of acylcarnitines (a metabolic by-product) in dried blood spots with tandem mass spectrometry, is subject to uncertainty regarding test accuracy. Methods: We conducted a systematic review of literature published up to 19th June 2018. We included studies that investigated newborn screening for LCHAD or MTP deficiencies by tandem mass spectrometry of acylcarnitines in dried blood spots. The reference standards were urine organic acids, blood acylcarnitine profiles, enzyme analysis in cultured fibroblasts or lymphocytes, mutation analysis, or at least 10-year follow-up. The outcomes of interest were sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Assessment of titles, abstracts, and full-text papers and quality appraisal were carried out independently by two reviewers. One reviewer extracted study data. This was checked by a second reviewer. Results: Ten studies provided data on test accuracy. LCHAD or MTP deficiencies were identified in 23 babies. No cases of LCHAD/MTP deficiencies were identified in four studies. PPV ranged from 0% (zero true positives and 28 false positives from 276,565 babies screened) to 100% (13 true positives and zero false positives from 2,037,824 babies screened). Sensitivity, specificity, and NPV could not be calculated as there was no systematic follow-up of babies who screened negative. Conclusions: Test accuracy estimates of screening for LCHAD and MTP deficiencies with tandem mass spectrometry measurement of acylcarnitines in dried blood were variable in terms of PPVs. Screening methods (including markers and thresholds) varied between studies, and sensitivity, specificity, and NPVs are unknown.
Collapse
Affiliation(s)
- Chris Stinton
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Hannah Fraser
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Julia Geppert
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Rebecca Johnson
- School of Nursing, Midwifery and Health, Coventry University, Coventry, United Kingdom
| | - Martin Connock
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Samantha Johnson
- Warwick Library, University of Warwick, Coventry, United Kingdom
| | - Aileen Clarke
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | | |
Collapse
|
19
|
Amaral AU, Wajner M. Recent Advances in the Pathophysiology of Fatty Acid Oxidation Defects: Secondary Alterations of Bioenergetics and Mitochondrial Calcium Homeostasis Caused by the Accumulating Fatty Acids. Front Genet 2020; 11:598976. [PMID: 33329744 PMCID: PMC7729159 DOI: 10.3389/fgene.2020.598976] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/03/2020] [Indexed: 12/18/2022] Open
Abstract
Deficiencies of medium-chain acyl-CoA dehydrogenase, mitochondrial trifunctional protein, isolated long-chain 3-hydroxyacyl-CoA dehydrogenase, and very long-chain acyl-CoA dehydrogenase activities are considered the most frequent fatty acid oxidation defects (FAOD). They are biochemically characterized by the accumulation of medium-chain, long-chain hydroxyl, and long-chain fatty acids and derivatives, respectively, in tissues and biological fluids of the affected patients. Clinical manifestations commonly include hypoglycemia, cardiomyopathy, and recurrent rhabdomyolysis. Although the pathogenesis of these diseases is still poorly understood, energy deprivation secondary to blockage of fatty acid degradation seems to play an important role. However, recent evidence indicates that the predominant fatty acids accumulating in these disorders disrupt mitochondrial functions and are involved in their pathophysiology, possibly explaining the lactic acidosis, mitochondrial morphological alterations, and altered mitochondrial biochemical parameters found in tissues and cultured fibroblasts from some affected patients and also in animal models of these diseases. In this review, we will update the present knowledge on disturbances of mitochondrial bioenergetics, calcium homeostasis, uncoupling of oxidative phosphorylation, and mitochondrial permeability transition induction provoked by the major fatty acids accumulating in prevalent FAOD. It is emphasized that further in vivo studies carried out in tissues from affected patients and from animal genetic models of these disorders are necessary to confirm the present evidence mostly achieved from in vitro experiments.
Collapse
Affiliation(s)
- Alexandre Umpierrez Amaral
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Departamento de Ciências Biológicas, Universidade Regional Integrada do Alto Uruguai e das Missões, Erechim, Brazil
| | - Moacir Wajner
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| |
Collapse
|
20
|
The Cost-Effectiveness of Expanding the UK Newborn Bloodspot Screening Programme to Include Five Additional Inborn Errors of Metabolism. Int J Neonatal Screen 2020; 6:ijns6040093. [PMID: 33233828 PMCID: PMC7711627 DOI: 10.3390/ijns6040093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/17/2022] Open
Abstract
Glutaric aciduria type 1, homocystinuria, isovaleric acidaemia, long-chain hydroxyacyl CoA dehydrogenase deficiency and maple syrup urine disease are all inborn errors of metabolism that can be detected through newborn bloodspot screening. This evaluation was undertaken in 2013 to provide evidence to the UK National Screening Committee for the cost-effectiveness of including these five conditions in the UK Newborn Bloodspot Screening Programme. A decision-tree model with lifetable estimates of outcomes was built with the model structure and parameterisation informed by a systematic review and expert clinical judgment. A National Health Service/Personal Social Services perspective was used, and lifetime costs and quality-adjusted life years (QALYs) were discounted at 1.5%. Uncertainty in the results was explored using expected value of perfect information analysis methods together with a sensitivity analysis using the screened incidence rate in the UK from 2014 to 2018. The model estimates that screening for all the conditions is more effective and cost saving when compared to not screening for each of the conditions, and the results were robust to the updated incidence rates. The key uncertainties included the sensitivity and specificity of the screening test and the estimated costs and QALYs.
Collapse
|
21
|
Dulz S, Atiskova Y, Engel P, Wildner J, Tsiakas K, Santer R. Retained visual function in a subset of patients with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD). Ophthalmic Genet 2020; 42:23-27. [PMID: 33107778 DOI: 10.1080/13816810.2020.1836658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Introduction: LCHADD causes retinopathy associated with low vision, visual field defects, nyctalopia and myopia. We report a retrospective long-term single-center study of 6 LCHADD patients trying to clarify if early diagnosis has an impact on the course and outcome of chorioretinal degeneration. Methods: Long-term follow-up of visual acuity and staging of chorioretinal degeneration by fundus photography, optical coherence tomography (OCT) and autofluorescence (AF) in all six patients. Three patients (2 m/1 f; age 8-14.8 years) were diagnosed by newborn screening, a single patient early within the first year of life and treated promptly while the other two (1 m/1 f; age 23-24 years) were diagnosed later after developing symptoms. All carried HADHA variants; five were homozygous for the common p.E510Q variant, in one from the symptomatically diagnosed group p.[E510Q]; [R291*] was detected. Results: All patients showed retinal alterations, but early diagnosis was associated with a milder phenotype and a longer preservation of visual function. Among symptomatic patients, only one showed mild retinal involvement at the time of diagnosis. Conclusion: Despite the small number our study suggests that early diagnosis does not prevent retinopathy but might contribute to a milder phenotype with retained good visual acuity over time. OCT and AF are reliable non-invasive diagnostic tools to estimate the progression of early-stage retinal changes in LCHADD patients.
Collapse
Affiliation(s)
- Simon Dulz
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf , Hamburg, Germany.,University Children's Hospital, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Yevgeniya Atiskova
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf , Hamburg, Germany.,University Children's Hospital, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Peter Engel
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf , Hamburg, Germany.,University Children's Hospital, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Jan Wildner
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf , Hamburg, Germany.,University Children's Hospital, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Konstantinos Tsiakas
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf , Hamburg, Germany.,University Children's Hospital, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| | - Rene Santer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf , Hamburg, Germany.,University Children's Hospital, University Medical Center Hamburg-Eppendorf , Hamburg, Germany
| |
Collapse
|
22
|
Rath W, Tsikouras P, Stelzl P. HELLP Syndrome or Acute Fatty Liver of Pregnancy: A Differential Diagnostic Challenge: Common Features and Differences. Geburtshilfe Frauenheilkd 2020; 80:499-507. [PMID: 32435066 PMCID: PMC7234826 DOI: 10.1055/a-1091-8630] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/15/2019] [Accepted: 01/08/2020] [Indexed: 12/17/2022] Open
Abstract
HELLP syndrome and the less common acute fatty liver of pregnancy (AFL) are unpredictable, life-threatening complications of pregnancy. The similarities in their clinical and laboratory presentations are often challenging for the obstetrician when making a differential diagnosis. Both diseases are characterised by microvesicular steatosis of varying degrees of severity. A specific risk profile does not exist for either of the entities. Genetic defects in mitochondrial fatty acid oxidation and multiple pregnancy are considered to be common predisposing factors. The diagnosis of AFL is based on a combination of clinical symptoms and laboratory findings. The Swansea criteria have been proposed as a diagnostic tool for orientation. HELLP syndrome is a laboratory diagnosis based on the triad of haemolysis, elevated aminotransferase levels and a platelet count < 100 G/l. Generalised malaise, nausea, vomiting and abdominal pain are common symptoms of both diseases, making early diagnosis difficult. Clinical differences include a lack of polydipsia/polyuria in HELLP syndrome, while jaundice is more common and more pronounced in AFL, there is a lower incidence of hypertension and proteinuria, and patients with AFL may develop encephalopathy with rapid progression to acute liver failure. In contrast, neurological symptoms such as severe headache and visual disturbances are more prominent in patients with HELLP syndrome. In terms of laboratory findings, AFL can be differentiated from HELLP syndrome by the presence of leucocytosis, hypoglycaemia, more pronounced hyperbilirubinemia, an initial lack of haemolysis and thrombocytopenia < 100 G/l, as well as lower antithrombin levels < 65% and prolonged prothrombin times. While HELLP syndrome has a fluctuating clinical course with rapid exacerbation within hours or transient remissions, AFL rapidly progresses to acute liver failure if the infant is not delivered immediately. The only causal treatment for both diseases is immediate delivery. Expectant management between 24 + 0 and 33 + 6 weeks of gestation is recommended for HELLP syndrome, but only in cases where the mother can be stabilised and there is no evidence of foetal compromise. The maternal mortality rate for HELLP syndrome in developed countries is approximately 1%, while the rate for AFL is 1.8 – 18%. Perinatal mortality rates are 7 – 20% and 15 – 20%, respectively. While data on the long-term impact of AFL on the health of mother and child is still insufficient, HELLP syndrome is associated with an increased risk of developing cardiovascular, metabolic and neurological diseases in later life.
Collapse
Affiliation(s)
- Werner Rath
- Medizinische Fakultät, Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Panagiotis Tsikouras
- Democritus University of Thrace, Department of Obstetrics and Gynecology, Alexandroupolis, Greece
| | - Patrick Stelzl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| |
Collapse
|
23
|
Katarey D, Westbrook RH. Pregnancy-specific liver diseases. Best Pract Res Clin Obstet Gynaecol 2020; 68:12-22. [PMID: 32381461 DOI: 10.1016/j.bpobgyn.2020.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 12/17/2022]
Abstract
Liver disease presenting in pregnancy may be due to a pregnancy-specific liver disorder, due to previously unrecognised pre-existing liver disease, or de novo liver disorders coincidentally presenting in a pregnant woman. The pregnancy-specific liver diseases can span from mild disease with limited impact on maternal and foetal health to severe disorders that can result in significant morbidity and mortality for mother and foetus. Swift identification of these disorders is essential to allow timely and appropriate management via a multi-disciplinary approach. The pregnancy-specific conditions, including their presentation, investigations, and management are reviewed in this chapter in detail.
Collapse
Affiliation(s)
- Dev Katarey
- Royal Free Hospital, Pond Street, London, NW3 2QG, United Kingdom
| | | |
Collapse
|
24
|
Nadjar Y, Souvannanorath S, Maisonobe T, Brisset M, De Lonlay P, Schiff M, Viala K, Boutron A, Nicolas G, Laforêt P. Sensory neuronopathy as a major clinical feature of mitochondrial trifunctional protein deficiency in adults. Rev Neurol (Paris) 2020; 176:380-386. [PMID: 32253025 DOI: 10.1016/j.neurol.2019.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/22/2019] [Accepted: 11/07/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Mitochondrial trifunctional protein deficiency (MTPD) is a long-chain fatty acid oxidation disorder characterized by co-existence of rhabdomyolysis episodes and peripheral neuropathy. Two phenotypes are described: generalized mitochondrial trifunctional protein deficiency (gMTPD) and isolated long-chain-3-hydroxyacyl-CoA dehydrogenase deficiency (iLCHADD) that is always associated with the c.1528G>C mutation. Peripheral neuropathy of MTPD is commonly described in children as axonal, length-dependent and sensorimotor. OBJECTIVES To report clinical and electrophysiological features of four independent adult MTPD patients with peripheral neuropathy. RESULTS Onset of the disease was characterized in all patients by rhabdomyolysis episodes occurring during childhood preceded by severe hypoglycemic episodes in three patients. Peripheral nerve involvement manifesting as sensory ataxia appeared later, during adolescence or adulthood. In all cases, electroneuromyogram showed no length-dependent sensory potentials decrease characteristic of sensory neuronopathy ("ganglionopathy"). All patients harbored at least one c.1528G>C mutation. DISCUSSION We describe MTPD as a newly hereditary etiology of sensory neuronopathy in adults, specifically in patients with c.1528G>C mutation. MTPD should be screened for by performing plasma acylcarnitines in patients with chronic sensory neuronopathy and additional suggestive features such as exercise intolerance or retinopathy.
Collapse
Affiliation(s)
- Y Nadjar
- Département de neurologie, centre de référence des maladies lysosomales, UF neuro-génétique et métabolisme, groupe hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France.
| | - S Souvannanorath
- Centre de référence des maladies neuromusculaires, hôpital Henri-Mondor, Assistance publique-Hôpitaux de Pars, Créteil, France.
| | - T Maisonobe
- Département de neurophysiologie clinique, groupe hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France.
| | - M Brisset
- Département de neurologie, hôpital Raymond-Poincaré, Garches, France; Inserm U1179 Versailles Saint-Quentin-en-Yvelines university, 78180 Montigny-le-Bretonneux, France.
| | - P De Lonlay
- Reference center for inborn errors of metabolism, Necker-Enfants-Malades university hospital, AP-HP, Paris Descartes university, INSERM UMR_S1151, 75015 Paris, France.
| | - M Schiff
- Reference center for inborn errors of metabolism, Robert-Debré university hospital, AP-HP, Paris Diderot university, INSERM U1141, 75019 Paris, France.
| | - K Viala
- Département de neurophysiologie clinique, groupe hospitalier Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France.
| | - A Boutron
- Service de biochimie, hôpital de Bicêtre, CHU Paris - GH Paris-Sud, Paris, France.
| | - G Nicolas
- Département de neurologie, hôpital Raymond-Poincaré, Garches, France; Inserm U1179 Versailles Saint-Quentin-en-Yvelines university, 78180 Montigny-le-Bretonneux, France.
| | - P Laforêt
- Département de neurologie, hôpital Raymond-Poincaré, Garches, France; Inserm U1179 Versailles Saint-Quentin-en-Yvelines university, 78180 Montigny-le-Bretonneux, France.
| |
Collapse
|
25
|
|
26
|
Fraser H, Geppert J, Johnson R, Johnson S, Connock M, Clarke A, Taylor-Phillips S, Stinton C. Evaluation of earlier versus later dietary management in long-chain 3-hydroxyacyl-CoA dehydrogenase or mitochondrial trifunctional protein deficiency: a systematic review. Orphanet J Rare Dis 2019; 14:258. [PMID: 31730477 PMCID: PMC6858661 DOI: 10.1186/s13023-019-1226-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/09/2019] [Indexed: 12/11/2022] Open
Abstract
Background Mitochondrial trifunctional protein (MTP) and long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiencies are rare fatty acid β-oxidation disorders. Without dietary management the conditions are life-threatening. We conducted a systematic review to investigate whether pre-symptomatic dietary management following newborn screening provides better outcomes than treatment following symptomatic detection. Methods We searched Web of Science, Medline, Pre-Medline, Embase and the Cochrane Library up to 23rd April 2018. Two reviewers independently screened titles, abstracts and full texts for eligibility and quality appraised the studies. Data extraction was performed by one reviewer and checked by another. Results We included 13 articles out of 7483 unique records. The 13 articles reported on 11 patient groups, including 174 people with LCHAD deficiency, 18 people with MTP deficiency and 12 people with undifferentiated LCHAD/MTP deficiency. Study quality was moderate to weak in all studies. Included studies suggested fewer heart and liver problems in screen-detected patients, but inconsistent results for mortality. Follow up analyses compared long-term outcomes of (1) pre-symptomatically versus symptomatically treated patients, (2) screened versus unscreened patients, and (3) asymptomatic screen-detected, symptomatic screen-detected, and clinically diagnosed patients in each study. For follow up analyses 1 and 2, we found few statistically significant differences in the long-term outcomes. For follow up analysis 3 we found a significant difference for only one comparison, in the incidence of cardiomyopathy between the three groups. Conclusions There is some evidence that dietary management following screen-detection might be associated with a lower incidence of some LCHAD and MTP deficiency-related complications. However, the evidence base is limited by small study sizes, quality issues and risk of confounding. An internationally collaborative research effort is needed to fully examine the risks and the benefits to pre-emptive dietary management with particular attention paid to disease severity and treatment group.
Collapse
Affiliation(s)
- Hannah Fraser
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - Julia Geppert
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Rebecca Johnson
- Faculty of Health and Life Sciences, Coventry University, Coventry, CV1 5RW, UK
| | | | - Martin Connock
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Aileen Clarke
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | | | - Chris Stinton
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| |
Collapse
|
27
|
Fleming L, Oliver J, Potter M, Kam AJ. Vomiting and seizure following circumcision in an infant. Paediatr Child Health 2019; 24:146-147. [PMID: 31110452 DOI: 10.1093/pch/pxx202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Lindsay Fleming
- McMaster University Medical Centre, Department of Pediatrics, McMaster University, Hamilton, Ontario
| | - Joseph Oliver
- McMaster University Medical Centre, Department of Pediatrics, McMaster University, Hamilton, Ontario
| | - Murray Potter
- Health Science Centre, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario
| | - April J Kam
- Pediatric Emergency Medicine, McMaster University, Hamilton, Ontario
| |
Collapse
|
28
|
Abstract
Liver diseases during pregnancy pose a unique clinical challenge because they can affect the lives of both the mother and unborn child. Although severe liver disease is rare, pregnancy-related liver disease affects approximately 3% of pregnancies and can be fatal. Timely recognition and diagnosis are essential in order to institute appropriate management strategies. This article provides an overview of liver diseases during pregnancy and is divided into 2 sections: (1) liver diseases specific to pregnancy, and (2) preexisting or coincident liver diseases during pregnancy.
Collapse
Affiliation(s)
- Karen Ma
- Section of Gastroenterology, Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, 1725 West Harrison Street, Suite 207, Chicago, IL 60612, USA
| | - Daniel Berger
- Section of Gastroenterology, Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, 1725 West Harrison Street, Suite 207, Chicago, IL 60612, USA
| | - Nancy Reau
- Section of Hepatology, Division of Digestive Diseases, Department of Internal Medicine, Rush University Medical Center, 1725 West Harrison Street, Suite 319, Chicago, IL 60612, USA.
| |
Collapse
|
29
|
Diebold I, Schön U, Horvath R, Schwartz O, Holinski-Feder E, Kölbel H, Abicht A. HADHA and HADHB gene associated phenotypes - Identification of rare variants in a patient cohort by Next Generation Sequencing. Mol Cell Probes 2019; 44:14-20. [PMID: 30682426 DOI: 10.1016/j.mcp.2019.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/17/2019] [Accepted: 01/20/2019] [Indexed: 12/31/2022]
Abstract
The heterooctameric mitochondrial trifunctional protein (MTP), composed of four α- and β-subunits harbours three enzymes that each perform a different function in mitochondrial fatty acid β-oxidation. Pathogenic variants in the MTP genes (HADHA and HADHB) cause MTP deficiency, a rare autosomal recessive metabolic disorder characterized by phenotypic heterogeneity ranging from severe, early-onset, cardiac disease to milder, later-onset, myopathy and neuropathy. Since metabolic myopathies and neuropathies are a group of rare genetic disorders and their associated muscle symptoms may be subtle, the diagnosis is often delayed. Here we evaluated data of 161 patients with myopathy and 242 patients with neuropathy via next generation sequencing (NGS) and report the diagnostic yield in three patients of this cohort by the detection of disease-causing variants in the HADHA or HADHB gene. The mitigated phenotypes of this treatable disease were missed by the newborn screening, highlighting the importance of phenotype-based NGS analysis in patients with rare and clinically very variable disorders such as MTP deficiency.
Collapse
Affiliation(s)
| | | | - Rita Horvath
- Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK
| | - Oliver Schwartz
- Department of Neuropediatrics, University Children's Hospital Muenster, Muenster, Germany
| | | | - Heike Kölbel
- Department of Pediatric Neurology, Developmental Neurology and Social Pediatrics, University of Essen, Germany
| | - Angela Abicht
- Medical Genetics Center, Munich, Germany; Department of Neurology, Friedrich-Baur-Institute, Klinikum der Ludwig-Maximilians-University, Munich, Germany.
| |
Collapse
|
30
|
Cecatto C, Wajner A, Vargas CR, Wajner SM, Amaral AU, Wajner M. High vulnerability of the heart and liver to 3-hydroxypalmitic acid-induced disruption of mitochondrial functions in intact cell systems. J Cell Biochem 2018; 119:7678-7686. [PMID: 29923625 DOI: 10.1002/jcb.27115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 05/04/2018] [Indexed: 12/31/2022]
Abstract
Patients affected by long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency predominantly present severe liver and cardiac dysfunction, as well as neurological symptoms during metabolic crises, whose pathogenesis is still poorly known. In this study, we demonstrate for the first time that pathological concentrations of 3-hydroxypalmitic acid (3HPA), the long-chain hydroxyl fatty acid (LCHFA) that most accumulates in LCHAD deficiency, significantly decreased adenosine triphosphate-linked and uncoupled mitochondrial respiration in intact cell systems consisting of heart fibers, cardiomyocytes, and hepatocytes, but less intense in diced forebrain. 3HPA also significantly reduced mitochondrial Ca2+ retention capacity and membrane potential in Ca2+ -loaded mitochondria more markedly in the heart and the liver, with mild or no effects in the brain, supporting a higher susceptibility of the heart and the liver to the toxic effects of this fatty acid. It is postulated that disruption of mitochondrial energy and Ca2+ homeostasis caused by the accumulation of LCHFA may contribute toward the severe cardiac and hepatic clinical manifestations observed in the affected patients.
Collapse
Affiliation(s)
- Cristiane Cecatto
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alessandro Wajner
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carmen Regla Vargas
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Programa de Pós-Graduação em Ciências Farmacêuticas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Simone Magagnin Wajner
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alexandre Umpierrez Amaral
- Departamento de Ciências Biológicas, Universidade Regional Integrada do Alto Uruguai e das Missões, Erechim, Brazil
| | - Moacir Wajner
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.,Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
31
|
Cecatto C, Amaral AU, da Silva JC, Wajner A, Schimit MDOV, da Silva LHR, Wajner SM, Zanatta Â, Castilho RF, Wajner M. Metabolite accumulation in VLCAD deficiency markedly disrupts mitochondrial bioenergetics and Ca 2+ homeostasis in the heart. FEBS J 2018; 285:1437-1455. [PMID: 29476646 DOI: 10.1111/febs.14419] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 01/19/2018] [Accepted: 02/20/2018] [Indexed: 12/11/2022]
Abstract
We studied the effects of the major long-chain fatty acids accumulating in very long-chain acyl-CoA dehydrogenase (VLCAD) deficiency, namely cis-5-tetradecenoic acid (Cis-5) and myristic acid (Myr), on important mitochondrial functions in isolated mitochondria from cardiac fibers and cardiomyocytes of juvenile rats. Cis-5 and Myr at pathological concentrations markedly reduced mitochondrial membrane potential (ΔΨm ), matrix NAD(P)H pool, Ca2+ retention capacity, ADP- (state 3) and carbonyl cyanide 3-chlorophenyl hydrazine-stimulated (uncoupled) respiration, and ATP generation. By contrast, these fatty acids increased resting (state 4) respiration (uncoupling effect) with the involvement of the adenine nucleotide translocator because carboxyatractyloside significantly attenuated the increased state 4 respiration provoked by Cis-5 and Myr. Furthermore, the classical inhibitors of mitochondrial permeability transition (MPT) pore cyclosporin A plus ADP, as well as the Ca2+ uptake blocker ruthenium red, fully prevented the Cis-5- and Myr-induced decrease in ΔΨm in Ca2+ -loaded mitochondria, suggesting, respectively, the induction of MPT pore opening and the contribution of Ca2+ toward these effects. The findings of the present study indicate that the major long-chain fatty acids that accumulate in VLCAD deficiency disrupt mitochondrial bioenergetics and Ca2+ homeostasis, acting as uncouplers and metabolic inhibitors of oxidative phosphorylation, as well as inducers of MPT pore opening, in the heart at pathological relevant concentrations. It is therefore presumed that a disturbance of bioenergetics and Ca2+ homeostasis may contribute to the cardiac manifestations observed in VLCAD deficiency.
Collapse
Affiliation(s)
- Cristiane Cecatto
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alexandre Umpierrez Amaral
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Departamento de Ciências Biológicas, Universidade Regional Integrada do Alto Uruguai e das Missões, Erechim, Brazil
| | - Janaína Camacho da Silva
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Alessandro Wajner
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mariana de Oliveira Vargas Schimit
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas Henrique Rodrigues da Silva
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Simone Magagnin Wajner
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ângela Zanatta
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Roger Frigério Castilho
- Departamento de Patologia Clínica, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Brazil
| | - Moacir Wajner
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Brazil
| |
Collapse
|
32
|
Knottnerus SJG, Bleeker JC, Wüst RCI, Ferdinandusse S, IJlst L, Wijburg FA, Wanders RJA, Visser G, Houtkooper RH. Disorders of mitochondrial long-chain fatty acid oxidation and the carnitine shuttle. Rev Endocr Metab Disord 2018; 19:93-106. [PMID: 29926323 PMCID: PMC6208583 DOI: 10.1007/s11154-018-9448-1] [Citation(s) in RCA: 194] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mitochondrial fatty acid oxidation is an essential pathway for energy production, especially during prolonged fasting and sub-maximal exercise. Long-chain fatty acids are the most abundant fatty acids in the human diet and in body stores, and more than 15 enzymes are involved in long-chain fatty acid oxidation. Pathogenic mutations in genes encoding these enzymes result in a long-chain fatty acid oxidation disorder in which the energy homeostasis is compromised and long-chain acylcarnitines accumulate. Symptoms arise or exacerbate during catabolic situations, such as fasting, illness and (endurance) exercise. The clinical spectrum is very heterogeneous, ranging from hypoketotic hypoglycemia, liver dysfunction, rhabdomyolysis, cardiomyopathy and early demise. With the introduction of several of the long-chain fatty acid oxidation disorders (lcFAOD) in newborn screening panels, also asymptomatic individuals with a lcFAOD are identified. However, despite early diagnosis and dietary therapy, a significant number of patients still develop symptoms emphasizing the need for individualized treatment strategies. This review aims to function as a comprehensive reference for clinical and laboratory findings for clinicians who are confronted with pediatric and adult patients with a possible diagnosis of a lcFAOD.
Collapse
Affiliation(s)
- Suzan J G Knottnerus
- Dutch Fatty Acid Oxidation Expertise Center, Department of Metabolic Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584, EA, Utrecht, The Netherlands
- Dutch Fatty Acid Oxidation Expertise Center, Laboratory Genetic Metabolic Diseases, Departments of Clinical Chemistry and Pediatrics, Emma Children's Hospital, Academic Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Jeannette C Bleeker
- Dutch Fatty Acid Oxidation Expertise Center, Department of Metabolic Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584, EA, Utrecht, The Netherlands
- Dutch Fatty Acid Oxidation Expertise Center, Laboratory Genetic Metabolic Diseases, Departments of Clinical Chemistry and Pediatrics, Emma Children's Hospital, Academic Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Rob C I Wüst
- Dutch Fatty Acid Oxidation Expertise Center, Laboratory Genetic Metabolic Diseases, Departments of Clinical Chemistry and Pediatrics, Emma Children's Hospital, Academic Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Sacha Ferdinandusse
- Dutch Fatty Acid Oxidation Expertise Center, Laboratory Genetic Metabolic Diseases, Departments of Clinical Chemistry and Pediatrics, Emma Children's Hospital, Academic Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Lodewijk IJlst
- Dutch Fatty Acid Oxidation Expertise Center, Laboratory Genetic Metabolic Diseases, Departments of Clinical Chemistry and Pediatrics, Emma Children's Hospital, Academic Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Frits A Wijburg
- Dutch Fatty Acid Oxidation Expertise Center, Laboratory Genetic Metabolic Diseases, Departments of Clinical Chemistry and Pediatrics, Emma Children's Hospital, Academic Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Ronald J A Wanders
- Dutch Fatty Acid Oxidation Expertise Center, Laboratory Genetic Metabolic Diseases, Departments of Clinical Chemistry and Pediatrics, Emma Children's Hospital, Academic Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Gepke Visser
- Dutch Fatty Acid Oxidation Expertise Center, Department of Metabolic Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584, EA, Utrecht, The Netherlands.
- Dutch Fatty Acid Oxidation Expertise Center, Laboratory Genetic Metabolic Diseases, Departments of Clinical Chemistry and Pediatrics, Emma Children's Hospital, Academic Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| | - Riekelt H Houtkooper
- Dutch Fatty Acid Oxidation Expertise Center, Laboratory Genetic Metabolic Diseases, Departments of Clinical Chemistry and Pediatrics, Emma Children's Hospital, Academic Medical Center, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| |
Collapse
|
33
|
Hagenbuchner J, Scholl-Buergi S, Karall D, Ausserlechner MJ. Very long-/ and long Chain-3-Hydroxy Acyl CoA Dehydrogenase Deficiency correlates with deregulation of the mitochondrial fusion/fission machinery. Sci Rep 2018; 8:3254. [PMID: 29459657 PMCID: PMC5818531 DOI: 10.1038/s41598-018-21519-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 02/06/2018] [Indexed: 02/06/2023] Open
Abstract
Children diagnosed with Long-Chain-3-Hydroxy-Acyl-CoA-Dehydrogenase-Deficiency (LCHADD) or Very-Long-Chain-3-Hydroxy-Acyl-CoA-Dehydrogenase-Deficiency (VLCADD) frequently present with hypertrophic cardiomyopathy or muscle weakness which is caused by the accumulation of fatty acid metabolites due to inactivating mutations in the mitochondrial trifunctional protein. By analyzing mitochondrial morphology we uncovered that mutations within the HADHA or the ACADVL gene not only affect fatty acid oxidation, but also cause significant changes in the DNM1L/MFN2 ratio leading to the significant accumulation of truncated and punctate mitochondria in contrast to network-like mitochondrial morphology in controls. These striking morphological abnormalities correlate with changes in OXPHOS, an imbalance in ROS levels, reduced mitochondrial respiration, reduced growth rates and significantly increased glucose uptake per cell, suggesting that HADHA and ACADVL mutations shift cellular energy household into glycolysis. Experiments using the NOX2-specific inhibitor Phox-I2 suggest that NOX2 is activated by accumulating long-chain fatty acids and generates ROS, which in turn changes mitochondrial morphology and activity. We thereby provide novel insights into the cellular energy household of cells from LCHADD/VLCADD patients and demonstrate for the first time a connection between fatty acid metabolism, mitochondrial morphology and ROS in patients with these rare genetic disorders.
Collapse
Affiliation(s)
- Judith Hagenbuchner
- Department of Pediatrics II, Medical University Innsbruck, Innsbruck, Austria
| | | | - Daniela Karall
- Department of Pediatrics I, Medical University Innsbruck, Innsbruck, Austria.
| | | |
Collapse
|
34
|
Natarajan SK, Ibdah JA. Role of 3-Hydroxy Fatty Acid-Induced Hepatic Lipotoxicity in Acute Fatty Liver of Pregnancy. Int J Mol Sci 2018; 19:ijms19010322. [PMID: 29361796 PMCID: PMC5796265 DOI: 10.3390/ijms19010322] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Revised: 01/16/2018] [Accepted: 01/16/2018] [Indexed: 12/16/2022] Open
Abstract
Acute fatty liver of pregnancy (AFLP), a catastrophic illness for both the mother and the unborn offspring, develops in the last trimester of pregnancy with significant maternal and perinatal mortality. AFLP is also recognized as an obstetric and medical emergency. Maternal AFLP is highly associated with a fetal homozygous mutation (1528G>C) in the gene that encodes for mitochondrial long-chain hydroxy acyl-CoA dehydrogenase (LCHAD). The mutation in LCHAD results in the accumulation of 3-hydroxy fatty acids, such as 3-hydroxy myristic acid, 3-hydroxy palmitic acid and 3-hydroxy dicarboxylic acid in the placenta, which are then shunted to the maternal circulation leading to the development of acute liver injury observed in patients with AFLP. In this review, we will discuss the mechanistic role of increased 3-hydroxy fatty acid in causing lipotoxicity to the liver and in inducing oxidative stress, mitochondrial dysfunction and hepatocyte lipoapoptosis. Further, we also review the role of 3-hydroxy fatty acids in causing placental damage, pancreatic islet β-cell glucolipotoxicity, brain damage, and retinal epithelial cells lipoapoptosis in patients with LCHAD deficiency.
Collapse
Affiliation(s)
- Sathish Kumar Natarajan
- Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, NE 68583-0806, USA.
| | - Jamal A Ibdah
- Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, USA.
- Department of Medical Pharmacology and Physiology, University of Missouri, Columbia, MO 65212, USA.
- Harry S. Truman Memorial Veterans Medical Center, Columbia, MO 65201, USA.
| |
Collapse
|
35
|
Sturm V. Ophthalmologic Abnormalities in Long-Chain 3-Hydroxyacyl-Coa Dehydrogenase Deficiency: Presentation of a Long-Term Survivor. Eur J Ophthalmol 2018; 18:476-8. [DOI: 10.1177/112067210801800330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- V. Sturm
- Department of Ophthalmology, University Hospital of Zurich, Zurich - Switzerland
- Department of Ophthalmology, University Hospital of Hamburg, Hamburg - Germany
| |
Collapse
|
36
|
Bursle C, Weintraub R, Ward C, Justo R, Cardinal J, Coman D. Mitochondrial Trifunctional Protein Deficiency: Severe Cardiomyopathy and Cardiac Transplantation. JIMD Rep 2017; 40:91-95. [PMID: 29124685 PMCID: PMC6122028 DOI: 10.1007/8904_2017_68] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/17/2017] [Accepted: 10/19/2017] [Indexed: 12/14/2022] Open
Abstract
We describe mitochondrial trifunctional protein deficiency (MTPD) in two male siblings who presented with severe cardiomyopathy in infancy. The first sibling presented in severe cardiac failure at 6 months of age and succumbed soon after. The second sibling came to attention after newborn screening identified a possible fatty acid oxidation defect. Dietary therapy and carnitine supplementation commenced in the neonatal period. Despite this the second child required cardiac transplantation at 3 years of age after a sudden and rapid decline in cardiac function. The outcome has been excellent, with no apparent extra-cardiac manifestations of a fatty acid oxidation disorder at the age of 7. Pathogenic HADHA mutations were subsequently identified via genome wide exome sequencing. This is the first reported case of MTPD to undergo cardiac transplantation. We suggest that cardiac transplantation could be considered in the treatment of cardiomyopathy in MTPD.
Collapse
Affiliation(s)
- C Bursle
- Department of Metabolic Medicine, The Lady Cilento Children's Hospital, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - R Weintraub
- Department of Cardiology, The Royal Children's Hospital, Melbourne, VIC, Australia
- School of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - C Ward
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
- Department of Cardiology, The Lady Cilento Children's Hospital, Brisbane, QLD, Australia
| | - R Justo
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
- Department of Cardiology, The Lady Cilento Children's Hospital, Brisbane, QLD, Australia
| | - J Cardinal
- Cardinal Bioresearch, Brisbane, QLD, Australia
| | - D Coman
- Department of Metabolic Medicine, The Lady Cilento Children's Hospital, Brisbane, QLD, Australia.
- School of Medicine, University of Queensland, Brisbane, QLD, Australia.
- Department of Paediatrics, The Wesley Hospital, Brisbane, QLD, Australia.
- School of Medicine, Griffith University, Gold Coast, QLD, Australia.
| |
Collapse
|
37
|
Nedoszytko B, Siemińska A, Strapagiel D, Dąbrowski S, Słomka M, Sobalska-Kwapis M, Marciniak B, Wierzba J, Skokowski J, Fijałkowski M, Nowicki R, Kalinowski L. High prevalence of carriers of variant c.1528G>C of HADHA gene causing long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD) in the population of adult Kashubians from North Poland. PLoS One 2017; 12:e0187365. [PMID: 29095929 PMCID: PMC5667839 DOI: 10.1371/journal.pone.0187365] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/18/2017] [Indexed: 12/14/2022] Open
Abstract
Background/Objectives The mitochondrial β-oxidation of fatty acids is a complex catabolic pathway. One of the enzymes of this pathway is the heterooctameric mitochondrial trifunctional protein (MTP), composed of four α- and β-subunits. Mutations in MTP genes (HADHA and HADHB), both located on chromosome 2p23, cause MTP deficiency, a rare autosomal recessive metabolic disorder characterized by decreased activity of MTP. The most common MTP mutation is long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency caused by the c.1528G>C (rs137852769, p.Glu510Gln) substitution in exon 15 of the HADHA gene. Subjects/Methods We analyzed the frequency of genetic variants in the HADHA gene in the adults of Kashubian origin from North Poland and compared this data in other Polish provinces. Results We found a significantly higher frequency of HDHA c.1528G>C (rs137852769, p.Glu510Gln) carriers among Kashubians (1/57) compared to subjects from other regions of Poland (1/187). We found higher frequency of c.652G>C (rs71441018, pVal218Leu) polymorphism in the HADHA gene within population of Silesia, southern Poland (1/107) compared to other regions. Conclusion Our study indicate described high frequency of c.1528G>C variant of HADHA gene in Kashubian population, suggesting the founder effect. For the first time we have found high frequency of rs71441018 in the South Poland Silesian population.
Collapse
Affiliation(s)
- Bogusław Nedoszytko
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdańsk, Poland
- * E-mail: (BN); (DS)
| | - Alicja Siemińska
- Department of Pneumonology and Allergology, Medical University of Gdansk, Gdańsk, Poland
| | - Dominik Strapagiel
- Biobank Lab, Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
- BBMRI.pl Consortium, Wrocław, Poland
- * E-mail: (BN); (DS)
| | | | - Marcin Słomka
- Biobank Lab, Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
- BBMRI.pl Consortium, Wrocław, Poland
| | - Marta Sobalska-Kwapis
- Biobank Lab, Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
- BBMRI.pl Consortium, Wrocław, Poland
| | - Błażej Marciniak
- Biobank Lab, Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, Lodz, Poland
- BBMRI.pl Consortium, Wrocław, Poland
| | - Jolanta Wierzba
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Gdańsk, Poland
| | - Jarosław Skokowski
- BBMRI.pl Consortium, Wrocław, Poland
- Department of Oncological Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Marcin Fijałkowski
- I Department of Cardiology, Medical University of Gdansk, Gdańsk, Poland
| | - Roman Nowicki
- Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, Gdańsk, Poland
| | - Leszek Kalinowski
- BBMRI.pl Consortium, Wrocław, Poland
- Department of Medical Laboratory Diagnostic, Central Bank of Frozen Tissues and Genetic Specimens, Medical University of Gdansk, Gdańsk, Poland
| |
Collapse
|
38
|
Acute Fatty Liver Disease of Pregnancy: Updates in Pathogenesis, Diagnosis, and Management. Am J Gastroenterol 2017; 112:838-846. [PMID: 28291236 DOI: 10.1038/ajg.2017.54] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 02/03/2017] [Indexed: 12/11/2022]
Abstract
Acute fatty liver of pregnancy (AFLP) is an obstetric emergency characterized by maternal liver failure and may have complications for the mother and fetus, including death. This review examines recent literature on the epidemiology, pathogenesis, diagnosis, and treatment of acute fatty liver of pregnancy. Pathogenesis of this disease has been linked to defects in fatty acid metabolism during pregnancy, especially in the setting of fetal genetic defects in fatty acid oxidation. The value of screening all patients for these genetic defects remains to be determined. Distinguishing AFLP from other high-risk liver diseases of pregnancy that have overlap features, such as HELLP and preeclampsia, can be challenging. Although sensitive diagnostic tools such as the Swansea criteria have been developed, further work is needed to diagnose AFLP more quickly. Although survival rates have improved in the past 30 years, delay in diagnosis and treatment of AFLP has life-threatening consequences; an algorithmic approach to AFLP may be a valuable resource for clinicians. Future epidemiological and long-term studies will improve our prediction of women at risk for developing AFLP and determine the long-term consequences of this condition.
Collapse
|
39
|
Clinical and molecular investigation of 14 Japanese patients with complete TFP deficiency: a comparison with Caucasian cases. J Hum Genet 2017; 62:809-814. [DOI: 10.1038/jhg.2017.52] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 04/12/2017] [Accepted: 04/12/2017] [Indexed: 12/30/2022]
|
40
|
Abstract
Inborn errors of metabolism (IEMs) are genetic disorders that disrupt enzyme activity, cellular transport, or energy production. They are individually rare but collectively have an incidence of 1:1000. Most patients with IEMs are followed by a physician with expertise in biochemical genetics (metabolism) but may present outside this setting. Because IEMs can present acutely with life-threatening crises that require specific interventions, it is critical for the emergency medicine physicians, pediatricians, internists, critical care physicians, and biochemical geneticists to be familiar with the initial assessment and management of patients with these disorders. Appropriate early care can be lifesaving. This protocol is not designed to replace the expert consultation of a biochemical geneticist but rather to improve early care and increase the level of comfort of the acute care physician with initial management of fatty acid oxidation and carnitine disorders until specialty consultation is obtained.
Collapse
|
41
|
Huang Y, Powers C, Moore V, Schafer C, Ren M, Phoon CKL, James JF, Glukhov AV, Javadov S, Vaz FM, Jefferies JL, Strauss AW, Khuchua Z. The PPAR pan-agonist bezafibrate ameliorates cardiomyopathy in a mouse model of Barth syndrome. Orphanet J Rare Dis 2017; 12:49. [PMID: 28279226 PMCID: PMC5345250 DOI: 10.1186/s13023-017-0605-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/27/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The PGC-1α/PPAR axis has been proposed as a potential therapeutic target for several metabolic disorders. The aim was to evaluate the efficacy of the pan-PPAR agonist, bezafibrate, in tafazzin knockdown mice (TazKD), a mouse model of Barth syndrome that exhibits age-dependent dilated cardiomyopathy with left ventricular (LV) dysfunction. RESULTS The effect of bezafibrate on cardiac function was evaluated by echocardiography in TazKD mice with or without beta-adrenergic stress. Adrenergic stress by chronic isoproterenol infusion exacerbates the cardiac phenotype in TazKD mice, significantly depressing LV systolic function by 4.5 months of age. Bezafibrate intake over 2 months substantially ameliorates the development of LV systolic dysfunction in isoproterenol-stressed TazKD mice. Without beta-adrenergic stress, TazKD mice develop dilated cardiomyopathy by 7 months of age. Prolonged treatment with suprapharmacological dose of bezafibrate (0.5% in rodent diet) over a 4-month period effectively prevented LV dilation in mice isoproterenol treatment. Bezafibrate increased mitochondrial biogenesis, however also promoted oxidative stress in cardiomyocytes. Surprisingly, improvement of systolic function in bezafibrate-treated mice was accompanied with simultaneous reduction of cardiolipin content and increase of monolysocardiolipin levels in cardiac muscle. CONCLUSIONS Thus, we demonstrate that bezafibrate has a potent therapeutic effect on preventing cardiac dysfunction in a mouse model of Barth syndrome with obvious implications for treating the human disease. Additional studies are needed to assess the potential benefits of PPAR agonists in humans with Barth syndrome.
Collapse
Affiliation(s)
- Yan Huang
- The Heart Institute, Department of Pediatrics, the University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, 240 Albert Sabin Way, Cincinnati, OH, 45229-7020, USA
| | - Corey Powers
- The Heart Institute, Department of Pediatrics, the University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, 240 Albert Sabin Way, Cincinnati, OH, 45229-7020, USA
| | - Victoria Moore
- The Heart Institute, Department of Pediatrics, the University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, 240 Albert Sabin Way, Cincinnati, OH, 45229-7020, USA
| | - Caitlin Schafer
- The Heart Institute, Department of Pediatrics, the University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, 240 Albert Sabin Way, Cincinnati, OH, 45229-7020, USA
| | - Mindong Ren
- Departments of Anesthesiology and Cell Biology, New York University School of Medicine, New York, NY, USA
| | - Colin K L Phoon
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
| | - Jeanne F James
- The Heart Institute, Department of Pediatrics, the University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, 240 Albert Sabin Way, Cincinnati, OH, 45229-7020, USA
| | - Alexander V Glukhov
- Department of Biochemistry, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Sabzali Javadov
- Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
| | - Frédéric M Vaz
- Academic Medical Center, Department of Clinical Chemistry and Pediatrics, Laboratory of Genetic Metabolic Disease (F0-224), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - John L Jefferies
- The Heart Institute, Department of Pediatrics, the University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, 240 Albert Sabin Way, Cincinnati, OH, 45229-7020, USA
| | - Arnold W Strauss
- The Heart Institute, Department of Pediatrics, the University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, 240 Albert Sabin Way, Cincinnati, OH, 45229-7020, USA
| | - Zaza Khuchua
- The Heart Institute, Department of Pediatrics, the University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center, 240 Albert Sabin Way, Cincinnati, OH, 45229-7020, USA.
| |
Collapse
|
42
|
Fahnehjelm KT, Liu Y, Olsson D, Amrén U, Haglind CB, Holmström G, Halldin M, Andreasson S, Nordenström A. Most patients with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency develop pathological or subnormal retinal function. Acta Paediatr 2016; 105:1451-1460. [PMID: 27461099 DOI: 10.1111/apa.13536] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 07/25/2016] [Indexed: 12/27/2022]
Abstract
AIM There have been few studies on long-term electroretinographic findings in patients with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD). This study correlated long-term electroretinographic findings with age, metabolic control and clinical symptoms. METHODS We examined 12 Swedish patients with LCHADD. Visual acuity testing, fundus examinations, optical coherence tomography and electroretinography were performed. The results were correlated to age, the levels of 3-hydroxyacylcarnitine and acylcarnitine and clinical metabolic control. RESULTS Blindness or moderate visual impairment was found in two patients. Retinal pigmentation, atrophy and fibrosis were present in 11, seven and one of the patients, respectively, and optical coherence tomography showed retinal thinning in three of the six patients examined. Electroretinography was performed on 11 of the 12 patients. It was pathological, with reduced rod and cone responses, in five patients, subnormal in four and was related to poor clinical metabolic control and severe neonatal symptoms. Repeated electroretinographies revealed reduced function with increasing age. CONCLUSION More than 80% of the LCHADD patients developed pathological or subnormal retinal function. This was more pronounced in patients with neonatal symptoms, but ameliorated by strict dietary treatment. Annual ophthalmological follow-ups, with electroretinography every second or third year, are recommended.
Collapse
Affiliation(s)
- Kristina Teär Fahnehjelm
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- St Erik Eye Hospital; Stockholm Sweden
- Institute of Neuroscience and Physiology; Sahlgrenska Akademin; University of Gothenburg; Gothenburg Sweden
| | - Ying Liu
- Department of Clinical Neurophysiology; Karolinska University Hospital; Huddinge Sweden
- Department of Ophthalmology; The South Hospital; Stockholm Sweden
| | - David Olsson
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Department of Paediatrics; Karolinska University Hospital; Stockholm Sweden
| | - Urban Amrén
- Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
- St Erik Eye Hospital; Stockholm Sweden
| | - Charlotte Bieneck Haglind
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Department of Paediatrics; Karolinska University Hospital; Stockholm Sweden
| | - Gerd Holmström
- Department of Neuroscience/ophthalmology; Uppsala University Hospital; Uppsala Sweden
| | - Maria Halldin
- Department of Paediatric endocrinology; Uppsala University Children's Hospital; Uppsala Sweden
| | - Sten Andreasson
- Department of Ophthalmology; University of Lund; Lund Sweden
| | - Anna Nordenström
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Department of Paediatrics; Karolinska University Hospital; Stockholm Sweden
| |
Collapse
|
43
|
An Unusual Case of LCHAD Deficiency Presenting With a Clinical Picture of Hemophagocytic Lymphohistiocytosis: Secondary HLH or Coincidence? J Pediatr Hematol Oncol 2016; 38:661-662. [PMID: 27769081 DOI: 10.1097/mph.0000000000000626] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There are published reports stating that some of the congenital metabolic diseases, such as lysinuric protein intolerance, multiple sulphatase deficiency, galactosemia, Gaucher disease, Pearson syndrome, and galactosialidosis, might lead to secondary hemophagocytic lymphohistiocytosis (HLH). However, to date, to our knowledge, the long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency has never been investigated among patients with HLH. Here, we report on a patient who was referred to our institution for a differential diagnosis of pancytopenia, liver failure, and rhabdomyolysis. The patient was diagnosed with HLH. Further investigation revealed an underlying diagnosis of the LCHAD deficiency. Our case was reported to contribute to the literature, as well as the HLH clinic, emphasizing the consideration of LCHAD deficiency, especially in 1 to 6 months' old infants with laboratory findings of hypoglycemia, metabolic acidosis, and elevated creatine kinase.
Collapse
|
44
|
Boese EA, Jain N, Jia Y, Schlechter CL, Harding CO, Gao SS, Patel RC, Huang D, Weleber RG, Gillingham MB, Pennesi ME. Characterization of Chorioretinopathy Associated with Mitochondrial Trifunctional Protein Disorders: Long-Term Follow-up of 21 Cases. Ophthalmology 2016; 123:2183-95. [PMID: 27491397 PMCID: PMC5035590 DOI: 10.1016/j.ophtha.2016.06.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 06/11/2016] [Accepted: 06/16/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To assess long-term effects of genotype on chorioretinopathy severity in patients with mitochondrial trifunctional protein (MTP) disorders. DESIGN Retrospective case series. PARTICIPANTS Consecutive patients with MTP disorders evaluated at a single center from 1994 through 2015, including 18 patients with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD) and 3 patients with trifunctional protein deficiency (TFPD). METHODS Local records from all visits were reviewed. Every participant underwent a complete ophthalmic examination and was evaluated by a metabolic physician and dietitian. Nine patients underwent ancillary funduscopic imaging including optical coherence tomography (OCT) and OCT angiography. MAIN OUTCOME MEASURES The primary outcome measure was best-corrected visual acuity at the final visit. Secondary outcome measures included spherical equivalent refraction, visual fields, electroretinography B-wave amplitudes, and qualitative imaging findings. RESULTS Participants were followed up for a median of 5.6 years (range 0.3-20.2 years). The median age of LCHADD participants at initial and final visits was 2.3 and 11.9 years, whereas that for TFPD participants at initial and final visits was 4.7 and 15.5 years, respectively. Four long-term survivors older than 16 years were included (3 with LCHADD and 1 with TFPD). The LCHADD participants demonstrated a steady decline in visual acuity from an average of 0.23 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/34) at baseline to 0.42 logMAR (Snellen equivalent, 20/53) at the final visit, whereas TFPD patients maintained excellent acuity throughout follow-up. Participants with LCHADD, but not TFPD, showed an increasing myopia with a mean decrease in spherical equivalent refraction of 0.24 diopters per year. Visual fields showed sensitivity losses centrally associated with defects on OCT. Multimodal imaging demonstrated progressive atrophy of the outer retina in LCHADD, often preceded by the formation of outer retinal tubulations and choriocapillaris dropout. Electroretinography findings support the more severe clinical profile of LCHADD patients compared with TFPD patients; the function of both rods and cones are attenuated diffusely in LCHADD patients, but are within normal limits for TFPD patients. CONCLUSIONS Despite improved survival with early diagnosis, medical management, and dietary treatment, participants with the LCHADD subtype of MTP disorder continue to demonstrate visually disabling chorioretinopathy. Multimodal imaging is most consistent with choriocapillaris loss exceeding photoreceptor loss.
Collapse
Affiliation(s)
- Erin A Boese
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Nieraj Jain
- Department of Ophthalmology, Emory University, Atlanta, Georgia
| | - Yali Jia
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Catie L Schlechter
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Cary O Harding
- Molecular & Medical Genetics, Oregon Health & Science University, Portland, Oregon
| | - Simon S Gao
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Rachel C Patel
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Richard G Weleber
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
| | - Melanie B Gillingham
- Molecular & Medical Genetics, Oregon Health & Science University, Portland, Oregon
| | - Mark E Pennesi
- Casey Eye Institute, Oregon Health & Science University, Portland, Oregon.
| |
Collapse
|
45
|
Cecatto C, Godoy KDS, da Silva JC, Amaral AU, Wajner M. Disturbance of mitochondrial functions provoked by the major long-chain 3-hydroxylated fatty acids accumulating in MTP and LCHAD deficiencies in skeletal muscle. Toxicol In Vitro 2016; 36:1-9. [PMID: 27371118 DOI: 10.1016/j.tiv.2016.06.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/10/2016] [Accepted: 06/24/2016] [Indexed: 12/19/2022]
Abstract
The pathogenesis of the muscular symptoms and recurrent rhabdomyolysis that are commonly manifested in patients with mitochondrial trifunctional protein (MTP) and long-chain 3-hydroxy-acyl-CoA dehydrogenase (LCHAD) deficiencies is still unknown. In this study we investigated the effects of the major long-chain monocarboxylic 3-hydroxylated fatty acids (LCHFA) accumulating in these disorders, namely 3-hydroxytetradecanoic (3HTA) and 3-hydroxypalmitic (3HPA) acids, on important mitochondrial functions in rat skeletal muscle mitochondria. 3HTA and 3HPA markedly increased resting (state 4) and decreased ADP-stimulated (state 3) and CCCP-stimulated (uncoupled) respiration. 3HPA provoked similar effects in permeabilized skeletal muscle fibers, validating the results obtained in purified mitochondria. Furthermore, 3HTA and 3HPA markedly diminished mitochondrial membrane potential, NAD(P)H content and Ca(2+) retention capacity in Ca(2+)-loaded mitochondria. Mitochondrial permeability transition (mPT) induction probably underlie these effects since they were totally prevented by cyclosporin A and ADP. In contrast, the dicarboxylic analogue of 3HTA did not alter the tested parameters. Our data strongly indicate that 3HTA and 3HPA behave as metabolic inhibitors, uncouplers of oxidative phosphorylation and mPT inducers in skeletal muscle. It is proposed that these pathomechanisms disrupting mitochondrial homeostasis may be involved in the muscle alterations characteristic of MTP and LCHAD deficiencies.
Collapse
Affiliation(s)
- Cristiane Cecatto
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Kálita Dos Santos Godoy
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Janaína Camacho da Silva
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Alexandre Umpierrez Amaral
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Moacir Wajner
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil; Serviço de Genética Médica, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
| |
Collapse
|
46
|
van Eerd DCD, Brussé IA, Adriaens VFR, Mankowski RT, Praet SFE, Michels M, Langeveld M. Management of an LCHADD Patient During Pregnancy and High Intensity Exercise. JIMD Rep 2016; 32:95-100. [PMID: 27334895 DOI: 10.1007/8904_2016_561] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/14/2016] [Accepted: 03/21/2016] [Indexed: 12/12/2022] Open
Abstract
In this report we describe a female Long-Chain 3-Hydroxyacyl-CoA Dehydrogenase Deficiency (LCHADD) patient who suffered from severe exercise intolerance. At age 34, the patient became pregnant for the first time. After an uneventful first 32 weeks of pregnancy she developed sinus tachycardia (resting heart rate 120-134 bpm) and lactate and creatinine kinase levels increased (3.3 mmol/L and 264 U/L, respectively). Increasing MCT supplementation (dose and frequency of administration) lowered heart rate and improved biochemical parameters. At 34 weeks the heart rate rose again and it was decided to deliver the child by caesarean section. Postpartum both mother and child did well.Prior to pregnancy, she performed exercise tests with different doses of medium chain triglycerides (MCTs) to establish a safe and effective exercise program (baseline test, second test with 10 g MCTs and third test with 20 g of MCTs). In the MCT supplemented tests the maximal power output was 23% (second test) and 26% (third test) higher, while cardiac output at maximal power output was the same in all three tests (~15.8 L/min).In conclusion, this is the first report of pregnancy in an LCHADD patient, with favourable outcome for both mother and child. Moreover, in the same patient, MCT supplementation improved cardiac performance and metabolic parameters during high intensity exercise. Using impedance cardiography, we got a clear indication that this benefit was due to improved muscle energy generation at high intensity exercise, since at the same cardiac output a higher power output could be generated.
Collapse
Affiliation(s)
- D C D van Eerd
- Center for Lysosomal and Metabolic Disease, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - I A Brussé
- Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - V F R Adriaens
- Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - R T Mankowski
- Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S F E Praet
- Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Michels
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Langeveld
- Center for Lysosomal and Metabolic Disease, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| |
Collapse
|
47
|
Llorca-Cardeñosa A, Català-Mora J, García-Cazorla A, Meavilla S, Castejón-Ponce E. Long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency: A case report. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2016; 91:236-239. [PMID: 26896063 DOI: 10.1016/j.oftal.2016.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 12/31/2015] [Accepted: 01/04/2016] [Indexed: 06/05/2023]
Abstract
CLINICAL CASE A five-year-old patient, with a diagnosis of long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency, was referred for an ophthalmological examination. He had a history of acute metabolic crises precipitated by intercurrent infections,as well as rhabdomyolysis. The fundoscopic examination revealed a peripapillary chorioretinal atrophy and a diffuse granular appearance of the macular retinal pigment epithelium. Best corrected visual acuity was 6/6 in both eyes, and he had a normal electroretinography test. DISCUSSION We perform a review of the literature and recent findings in relation to this disease through the description of a clinical case in order to improve the knowledge of this uncommon disorder.
Collapse
Affiliation(s)
- A Llorca-Cardeñosa
- Máster en Oftalmología Pediátrica, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España.
| | - J Català-Mora
- Sección de Retina y Vítreo, Departamento de Oftalmología Pediátrica, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - A García-Cazorla
- Departamento de Neuropediatría, Unidad de Enfermedades Metabólicas, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - S Meavilla
- Sección de Gastroenterología, Hepatología y Nutrición Infantil, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - E Castejón-Ponce
- Sección de Gastroenterología, Hepatología y Nutrición Infantil, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| |
Collapse
|
48
|
Immonen T, Turanlahti M, Paganus A, Keskinen P, Tyni T, Lapatto R. Earlier diagnosis and strict diets improve the survival rate and clinical course of long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency. Acta Paediatr 2016; 105:549-54. [PMID: 26676313 DOI: 10.1111/apa.13313] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/14/2015] [Accepted: 12/11/2015] [Indexed: 12/14/2022]
Abstract
AIM Long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD) is a severe metabolic disease that, without treatment, often leads to premature death or serious handicap. The aim of this study was to evaluate the clinical course of LCHADD with the homozygous 1528G>C (E510Q) mutation when patients underwent strict dietary treatment. METHODS From 1997 to 2010, 16 patients with LCHADD were diagnosed in Finland. They were followed up, and data were prospectively collected as they emerged. Clinical data before diagnosis were retrospectively collected from hospital records. This cohort was compared with an earlier cohort of patients diagnosed from 1976 to 1996. RESULTS The disease presented from birth to five months of age with failure to thrive, hypotonia, hepatomegaly, metabolic acidosis, cardiomyopathy and hypoketotic hypoglycaemia. In this cohort, the therapeutic delay was 0-30 days and the survival rate at the end of the study was 62.5% compared with 10-year survival rate of 14.3% for the earlier cohort. The survivors were in good overall condition, but some of them had developed mild retinopathy or mild neuropathy. CONCLUSION Earlier diagnosis and stricter dietary regimes improved the survival rates and clinical course of patients with LCHADD in Finland. However, improvements in therapy are still needed to prevent the development of long-term complications, such as retinopathy and neuropathy.
Collapse
Affiliation(s)
- Tuuli Immonen
- Children's Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Maila Turanlahti
- Children's Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Aila Paganus
- Children's Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Päivi Keskinen
- Pediatric Research Centre; University of Tampere; Tampere University Hospital; Tampere Finland
| | - Tiina Tyni
- Children's Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| | - Risto Lapatto
- Children's Hospital; University of Helsinki and Helsinki University Hospital; Helsinki Finland
| |
Collapse
|
49
|
De Biase I, Viau KS, Liu A, Yuzyuk T, Botto LD, Pasquali M, Longo N. Diagnosis, Treatment, and Clinical Outcome of Patients with Mitochondrial Trifunctional Protein/Long-Chain 3-Hydroxy Acyl-CoA Dehydrogenase Deficiency. JIMD Rep 2016; 31:63-71. [PMID: 27117294 DOI: 10.1007/8904_2016_558] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/15/2016] [Accepted: 03/16/2016] [Indexed: 12/02/2022] Open
Abstract
Deficiency of the mitochondrial trifunctional protein (TFP) and long-chain 3-Hydroxy Acyl-CoA dehydrogenase (LCHAD) impairs long-chain fatty acid oxidation and presents with hypoglycemia, cardiac, liver, eye, and muscle involvement. Without treatment, both conditions can be life-threatening. These diseases are identified by newborn screening (NBS), but the impact of early treatment on long-term clinical outcome is unknown. Moreover, there is lack of consensus on treatment, particularly on the use of carnitine supplementation. Here, we report clinical and biochemical data in five patients with TFP/LCHAD deficiency, three of whom were diagnosed by newborn screening. All patients had signs and symptoms related to their metabolic disorder, including hypoglycemia, elevated creatine kinase (CK), and rhabdomyolysis, and experienced episodes of metabolic decompensation triggered by illness. Treatment was started shortly after diagnosis in all patients and consisted of a diet low in long-chain fats supplemented with medium chain triglycerides (MCT), essential fatty acids, and low-dose carnitine (25 mg/kg/day). Patients had growth restriction early in life that resolved after 2 years of age. All patients but the youngest (2 years old) developed pigmentary retinopathy. Long-chain hydroxylated acylcarnitines did not change significantly with age, but increased during acute illnesses. Free carnitine levels were maintained within the normal range and did not correlate with long-chain hydroxylated acylcarnitines. These results show that patients with LCHAD deficiency can have normal growth and development with appropriate treatment. Low-dose carnitine supplements prevented carnitine deficiency and did not result in increased long-chain hydroxylated acylcarnitines or any specific toxicity.
Collapse
Affiliation(s)
- Irene De Biase
- Department of Pathology, University of Utah, Salt Lake City, UT, 84108, USA. .,ARUP Laboratories, 500 Chipeta Way, Salt Lake City, UT, 84108, USA. .,ARUP Institute of Clinical and Experimental Pathology, Salt Lake City, UT, USA.
| | - Krista S Viau
- Department of Pediatrics, University of Utah, Salt Lake City, UT, 84108, USA
| | - Aiping Liu
- ARUP Institute of Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Tatiana Yuzyuk
- Department of Pathology, University of Utah, Salt Lake City, UT, 84108, USA.,ARUP Laboratories, 500 Chipeta Way, Salt Lake City, UT, 84108, USA.,ARUP Institute of Clinical and Experimental Pathology, Salt Lake City, UT, USA
| | - Lorenzo D Botto
- Department of Pediatrics, University of Utah, Salt Lake City, UT, 84108, USA
| | - Marzia Pasquali
- Department of Pathology, University of Utah, Salt Lake City, UT, 84108, USA.,ARUP Laboratories, 500 Chipeta Way, Salt Lake City, UT, 84108, USA.,ARUP Institute of Clinical and Experimental Pathology, Salt Lake City, UT, USA.,Department of Pediatrics, University of Utah, Salt Lake City, UT, 84108, USA
| | - Nicola Longo
- Department of Pathology, University of Utah, Salt Lake City, UT, 84108, USA.,ARUP Laboratories, 500 Chipeta Way, Salt Lake City, UT, 84108, USA.,ARUP Institute of Clinical and Experimental Pathology, Salt Lake City, UT, USA.,Department of Pediatrics, University of Utah, Salt Lake City, UT, 84108, USA
| |
Collapse
|
50
|
Altered Energetics of Exercise Explain Risk of Rhabdomyolysis in Very Long-Chain Acyl-CoA Dehydrogenase Deficiency. PLoS One 2016; 11:e0147818. [PMID: 26881790 PMCID: PMC4755596 DOI: 10.1371/journal.pone.0147818] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/09/2016] [Indexed: 12/31/2022] Open
Abstract
Rhabdomyolysis is common in very long-chain acyl-CoA dehydrogenase deficiency (VLCADD) and other metabolic myopathies, but its pathogenic basis is poorly understood. Here, we show that prolonged bicycling exercise against a standardized moderate workload in VLCADD patients is associated with threefold bigger changes in phosphocreatine (PCr) and inorganic phosphate (Pi) concentrations in quadriceps muscle and twofold lower changes in plasma acetyl-carnitine levels than in healthy subjects. This result is consistent with the hypothesis that muscle ATP homeostasis during exercise is compromised in VLCADD. However, the measured rates of PCr and Pi recovery post-exercise showed that the mitochondrial capacity for ATP synthesis in VLCADD muscle was normal. Mathematical modeling of oxidative ATP metabolism in muscle composed of three different fiber types indicated that the observed altered energy balance during submaximal exercise in VLCADD patients may be explained by a slow-to-fast shift in quadriceps fiber-type composition corresponding to 30% of the slow-twitch fiber-type pool in healthy quadriceps muscle. This study demonstrates for the first time that quadriceps energy balance during exercise in VLCADD patients is altered but not because of failing mitochondrial function. Our findings provide new clues to understanding the risk of rhabdomyolysis following exercise in human VLCADD.
Collapse
|