1
|
Zemniaçak ÂB, Ribeiro RT, Pinheiro CV, de Azevedo Cunha S, Tavares TQ, Castro ET, Leipnitz G, Wajner M, Amaral AU. In Vivo Intracerebral Administration of α-Ketoisocaproic Acid to Neonate Rats Disrupts Brain Redox Homeostasis and Promotes Neuronal Death, Glial Reactivity, and Myelination Injury. Mol Neurobiol 2024; 61:2496-2513. [PMID: 37910283 DOI: 10.1007/s12035-023-03718-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Abstract
Maple syrup urine disease (MSUD) is caused by severe deficiency of branched-chain α-keto acid dehydrogenase complex activity, resulting in tissue accumulation of branched-chain α-keto acids and amino acids, particularly α-ketoisocaproic acid (KIC) and leucine. Affected patients regularly manifest with acute episodes of encephalopathy including seizures, coma, and potentially fatal brain edema during the newborn period. The present work investigated the ex vivo effects of a single intracerebroventricular injection of KIC to neonate rats on redox homeostasis and neurochemical markers of neuronal viability (neuronal nuclear protein (NeuN)), astrogliosis (glial fibrillary acidic protein (GFAP)), and myelination (myelin basic protein (MBP) and 2',3'-cyclic-nucleotide 3'-phosphodiesterase (CNPase)) in the cerebral cortex and striatum. KIC significantly disturbed redox homeostasis in these brain structures 6 h after injection, as observed by increased 2',7'-dichlorofluorescein oxidation (reactive oxygen species generation), malondialdehyde levels (lipid oxidative damage), and carbonyl formation (protein oxidative damage), besides impairing the antioxidant defenses (diminished levels of reduced glutathione and altered glutathione peroxidase, glutathione reductase, and superoxide dismutase activities) in both cerebral structures. Noteworthy, the antioxidants N-acetylcysteine and melatonin attenuated or normalized most of the KIC-induced effects on redox homeostasis. Furthermore, a reduction of NeuN, MBP, and CNPase, and an increase of GFAP levels were observed at postnatal day 15, suggesting neuronal loss, myelination injury, and astrocyte reactivity, respectively. Our data indicate that disruption of redox homeostasis, associated with neural damage caused by acute intracerebral accumulation of KIC in the neonatal period may contribute to the neuropathology characteristic of MSUD patients.
Collapse
Affiliation(s)
- Ângela Beatris Zemniaçak
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Rafael Teixeira Ribeiro
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Camila Vieira Pinheiro
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Sâmela de Azevedo Cunha
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Tailine Quevedo Tavares
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ediandra Tissot Castro
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Guilhian Leipnitz
- Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 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, RS, Brazil
- 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
| | - 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, RS, Brazil.
- Programa de Pós-Graduação em Atenção Integral à Saúde, Universidade Regional Integrada do Alto Uruguai e das Missões, Avenida Sete de Setembro, 1621, Erechim, RS, 99709-910, Brazil.
| |
Collapse
|
2
|
Lemos IDS, Torres CA, Alano CG, Matiola RT, de Figueiredo Seldenreich R, Padilha APZ, De Pieri E, Effting PS, Machado-De-Ávila RA, Réus GZ, Leipnitz G, Streck EL. Memantine Improves Memory and Neurochemical Damage in a Model of Maple Syrup Urine Disease. Neurochem Res 2024; 49:758-770. [PMID: 38104040 DOI: 10.1007/s11064-023-04072-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 12/19/2023]
Abstract
Maple Syrup Urine Disease (MSUD) is a metabolic disease characterized by the accumulation of branched-chain amino acids (BCAA) in different tissues due to a deficit in the branched-chain alpha-ketoacid dehydrogenase complex. The most common symptoms are poor feeding, psychomotor delay, and neurological damage. However, dietary therapy is not effective. Studies have demonstrated that memantine improves neurological damage in neurodegenerative diseases, such as Alzheimer's and Parkinson's diseases. Therefore, we hypothesize that memantine, an NMDA receptor antagonist can ameliorate the effects elicited by BCAA in an MSUD animal model. For this, we organized the rats into four groups: control group (1), MSUD group (2), memantine group (3), and MSUD + memantine group (4). Animals were exposed to the MSUD model by the administration of BCAA (15.8 µL/g) (groups 2 and 4) or saline solution (0.9%) (groups 1 and 3) and treated with water or memantine (5 mg/kg) (groups 3 and 4). Our results showed that BCAA administration induced memory alterations, and changes in the levels of acetylcholine in the cerebral cortex. Furthermore, induction of oxidative damage and alterations in antioxidant enzyme activities along with an increase in pro-inflammatory cytokines were verified in the cerebral cortex. Thus, memantine treatment prevented the alterations in memory, acetylcholinesterase activity, 2',7'-Dichlorofluorescein oxidation, thiobarbituric acid reactive substances levels, sulfhydryl content, and inflammation. These findings suggest that memantine can improve the pathomechanisms observed in the MSUD model, and may improve oxidative stress, inflammation, and behavior alterations.
Collapse
Affiliation(s)
- Isabela da Silva Lemos
- Programa de Pós-graduação em Ciências da Saúde, Laboratório de Doenças Neurometabólicas, Universidade do Extremo Sul Catarinense, Criciúma, SC, 88806-000, Brazil
| | - Carolina Antunes Torres
- Programa de Pós-graduação em Ciências da Saúde, Laboratório de Doenças Neurometabólicas, Universidade do Extremo Sul Catarinense, Criciúma, SC, 88806-000, Brazil
| | - Carolina Giassi Alano
- Programa de Pós-graduação em Ciências da Saúde, Laboratório de Doenças Neurometabólicas, Universidade do Extremo Sul Catarinense, Criciúma, SC, 88806-000, Brazil
| | - Rafaela Tezza Matiola
- Programa de Pós-graduação em Ciências da Saúde, Laboratório de Doenças Neurometabólicas, Universidade do Extremo Sul Catarinense, Criciúma, SC, 88806-000, Brazil
| | - Rejane de Figueiredo Seldenreich
- Programa de Pós-graduação em Ciências da Saúde, Laboratório de Doenças Neurometabólicas, Universidade do Extremo Sul Catarinense, Criciúma, SC, 88806-000, Brazil
| | - Alex Paulo Zeferino Padilha
- Programa de Pós-graduação em Ciências da Saúde, Laboratório de Psiquiatria Translacional, Universidade do Extremo Sul Catarinense, Criciúma, SC, 88806-000, Brazil
| | - Ellen De Pieri
- Programa de Pós-graduação em Ciências da Saúde, Laboratório de Fisiopatologia Experimental, Universidade do Extremo Sul Catarinense, Criciúma, SC, 88806-000, Brazil
| | - Pauline Souza Effting
- Programa de Pós-graduação em Ciências da Saúde, Laboratório de Doenças Neurometabólicas, Universidade do Extremo Sul Catarinense, Criciúma, SC, 88806-000, Brazil
| | - Ricardo Andrez Machado-De-Ávila
- Programa de Pós-graduação em Ciências da Saúde, Laboratório de Fisiopatologia Experimental, Universidade do Extremo Sul Catarinense, Criciúma, SC, 88806-000, Brazil
| | - Gislaine Zilli Réus
- Programa de Pós-graduação em Ciências da Saúde, Laboratório de Psiquiatria Translacional, Universidade do Extremo Sul Catarinense, Criciúma, SC, 88806-000, Brazil
| | - Guilhian Leipnitz
- Programa de Pós-graduação em Ciências Biológicas: Bioquímica, Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Anexo, Porto Alegre, RS, 90035-003, Brazil
- Programa de Pós-graduação em Ciências Biológicas: Fisiologia, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600-Anexo, Porto Alegre, RS, 90035-003, Brazil
| | - Emilio Luiz Streck
- Programa de Pós-graduação em Ciências da Saúde, Laboratório de Doenças Neurometabólicas, Universidade do Extremo Sul Catarinense, Criciúma, SC, 88806-000, Brazil.
| |
Collapse
|
3
|
Feng J, Zhang X, Jiang M, Dai X, Li G, Liu Z. Effect of sevoflurane anesthesia to neonatal rat hippocampus by RNA-seq. Neurosci Lett 2023; 801:137141. [PMID: 36813076 DOI: 10.1016/j.neulet.2023.137141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/02/2023] [Accepted: 02/19/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Sevoflurane is an inhalational anesthetic for the induction and maintenance of general anesthesia in pediatric surgery. However, few studies have paid attention to the multiple organ toxicity and the mechanism behind it. METHODS Inhalation anesthesia neonatal rat model were realized by exposing to 3.5% sevoflurane. RNA-seq was performed to find out how inhalation anesthesia affects the lung, cerebral cortex, hippocampus, and heart. Validation of RNA-seq results by QPCR after animal model establishment. Tunel assay detects cell apoptosis in each group. CCK-8, cell apoptosis assay and western blot assay validation of the role of siRNA-Bckdhb in the action of sevoflurane on rat hippocampal neuronal cells. RESULTS There are significant differences between different groups, especially the hippocampus and cerebral cortex. Bckdhb was significantly up-regulated in the hippocampus with sevoflurane-treated. Pathway analysis revealed several abundant pathways related to DEGs, e.g., protein digestion and absorption and PI3K-Akt signaling pathway. A series of cellular and animal experiments showed that siRNA-Bckdhb can inhibit the reduction of cellular activity caused by sevoflurane. CONCLUSION Bckdhb interference experiments indicated that sevoflurane induces hippocampal neuronal cells apoptosis by regulating Bckdhb expression. Our study provided new insights into the molecular mechanism of sevoflurane-induced brain damage in pediatrics.
Collapse
Affiliation(s)
- Jinhua Feng
- Department of Pharmacy, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Xuesong Zhang
- Department of Anesthesiology, Zhongshan Wusong Hospital, Fudan University, Shanghai, China
| | - Menglu Jiang
- Department of Anesthesiology, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Xu Dai
- Department of Anesthesiology, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Guowei Li
- Department of Anesthesiology, Wuxi Fifth People's Hospital Affiliated to Jiangnan University, Wuxi, China.
| | - Zhenqing Liu
- Department of Anesthesiology, Wuxi 9th People's Hospital Affiliated to Soochow University, Wuxi, China.
| |
Collapse
|
4
|
Amaral AU, Wajner M. Pathophysiology of maple syrup urine disease: Focus on the neurotoxic role of the accumulated branched-chain amino acids and branched-chain α-keto acids. Neurochem Int 2022; 157:105360. [DOI: 10.1016/j.neuint.2022.105360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 12/21/2022]
|
5
|
Ribeiro BNDF, Marchiori E. Evaluation of neuroimaging findings in thalamic lesions: what can we think? Radiol Bras 2021; 54:341-347. [PMID: 34602671 PMCID: PMC8475170 DOI: 10.1590/0100-3984.2020.0129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 10/31/2020] [Indexed: 11/22/2022] Open
Abstract
The diseases that affect the thalamus are heterogeneous in their etiologies, including infectious, inflammatory, vascular, toxic-metabolic, and neoplastic causes. It is often difficult to make the clinical differentiation between different entities. Within this context, computed tomography and magnetic resonance imaging have come to be of fundamental importance for defining the etiology and planning the treatment. In this pictorial essay, we will illustrate the main causes of diseases affecting the thalamus, discussing the possible differential diagnoses, as well as the most relevant imaging aspects.
Collapse
Affiliation(s)
- Bruno Niemeyer de Freitas Ribeiro
- Department of Radiology, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, RJ, Brazil.,Department of Radiology, Hospital Casa de Portugal / 3D Diagnóstico por Imagem, Rio de Janeiro, RJ, Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| |
Collapse
|
6
|
Jiang HH, Guo Y, Shen X, Wang Y, Dai TT, Rong H, Cheng R, Zhao F. Neonatal maple syrup urine disease in China: two novel mutations in the BCKDHB gene and literature review. J Pediatr Endocrinol Metab 2021; 34:1147-1156. [PMID: 34187135 DOI: 10.1515/jpem-2020-0746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/31/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To report two novel mutations in the BCKDHB gene with Maple syrup urine disease (MSUD) and compare their data with 52 cases of MSUD reported in the available Chinese literature. METHODS Clinical data of a case of a newborn with MSUD was retrospectively studied. Literatures on MSUD in the local medical journals from January 1990 till December 2019 in China were reviewed. RESULTS Two novel BCKDHB mutations c.90_91insCTGGCGCGGGG (p.Phe35TrpfsTer41) and c.80_90del (p.Ala32PhefsTer48) were identified. We found a total of 52 cases of MSUD reports so far. A total of 49 cases had the symptom of poor feeding (94.2%), 50 cases showed poor responses to stimulation (96.2%), 21 cases had odor of maple syrup (40.3%), 29 cases had seizures (55.7%), and 13 cases had respiratory failure (25.0%). The average of the blood ammonia was 127.2 ± 75.0 μmol/L. A total of 18 cases reported the gene testing, among of them 9 cases of BCKDHA mutations, 6 cases of BCKDHB mutations, and 2 cases of DBT mutations. A total of 13 cases (25%) were treated with mechanical ventilation, 50 cases (96.2%) with protein-restricted diet and l-carnitine, 29 cases with thiamine, and only 2 cases were treated with blood purification. Finally, 19 patients (36.5%) were died, 21 cases (40.4%) were improved after treatments. CONCLUSIONS The clinical phenotype of neonatal MSUD in China belongs to the classical type currently. Suspected patients should have blood or urine branched-chain amino acid levels tested and brain MRI as early as possible to enable early diagnosis, thus improvement in prognosis.
Collapse
Affiliation(s)
- Hong-Hua Jiang
- Department of Pediatrics, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, Yangzhou, China.,Department of Neonatology, Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yan Guo
- Department of Neonatology, Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xian Shen
- Department of Neonatology, Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ying Wang
- Department of Nephrology, Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ting-Ting Dai
- Department of Nephrology, Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hui Rong
- Department of Neonatology, Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Rui Cheng
- Department of Neonatology, Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Fei Zhao
- Department of Nephrology, Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| |
Collapse
|
7
|
Wang HP, Wong LC, Hsu CJ, Hu SC, Chu YJ, Lee WT. Eye motor manifestations in children with neurometabolic disorders. J Formos Med Assoc 2021; 121:736-748. [PMID: 34561118 DOI: 10.1016/j.jfma.2021.09.003] [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] [Received: 04/02/2021] [Revised: 06/11/2021] [Accepted: 09/05/2021] [Indexed: 01/15/2023] Open
Abstract
Neurometabolic diseases are complex group of rare neurogenetic disorders, which are difficult to diagnose. Patients may have toxic metabolite accumulation, inadequate energy supply, or neurotransmitter deficiency, resulting in a variety of clinical manifestations and severity with enzyme activity or transporter function defects. Multiple organ involvement is frequently seen, among which neurological symptoms and signs are one of the most encountered problems. Ocular motor problems deserve special attention for it occurs in some inborn error of metabolism. Furthermore, some are early signs or characteristic findings of certain diseases, such as the gaze palsy in Niemann-Pick disease type C and Gaucher disease or oculogyric crisis in neurotransmitter diseases. Early recognition and intervention are important for better prognosis in treatable neurometabolic disorders. In addition, ways to evaluate and describe eye movement problems also help to demonstrate the severity or clinical progression for those diagnosed with certain neurometabolic diseases. However, the complexity of eye movement and ocular motor control renders our clinical observation, recording and even anatomic localization of abnormal eye movements. Clinicians are more likely to detect early signs and unravel problems by gaining awareness of abnormal eye movement. This study amied to approach neurometabolic diseases in children via eye motor manifestations.
Collapse
Affiliation(s)
- Hsin-Pei Wang
- Department of Pediatrics, National Taiwan University Hospital YunLin branch, Yun-Lin, Taiwan
| | - Lee-Chin Wong
- Department of Pediatrics, Cathy General Hospital, Taipei, Taiwan
| | - Chia-Jui Hsu
- Department of Pediatrics, National Taiwan University Hospital Hsinchu branch, Hsinchu, Taiwan
| | - Su-Ching Hu
- Department of Pediatrics, Cathy General Hospital, Taipei, Taiwan
| | - Yen-Ju Chu
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wang-Tso Lee
- Department of Pediatrics, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Brain and Mind Sciences, National Taiwan University College of Medicine, Taipei, Taiwan.
| |
Collapse
|
8
|
Mohamed MM, Bakheet MA, Magdy RM, El-Abd HS, Alam-Eldeen MH, Abo-Haded HM. The clinico-radiological findings of MSUD in a group of Egyptian children: Contribution to early diagnosis and outcome. Mol Genet Genomic Med 2021; 9:e1790. [PMID: 34432377 PMCID: PMC8580081 DOI: 10.1002/mgg3.1790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/15/2021] [Accepted: 08/16/2021] [Indexed: 12/26/2022] Open
Abstract
Background Maple syrup urine disease (MSUD) is an autosomal recessive inborn error of amino acid metabolism, with unique clinico‐radiological findings. This study aims to show the benefit of using the clinico‐radiological findings for early diagnosis of children with MSUD, and confirming this diagnosis using the tandem mass spectrometry (MS/MS), in order to avoid deleterious outcome. Methods A prospective cohort study conducted in the period from August 2016 to December 2020. Twenty‐one children were included either by selective screening or by high‐risk screening. All children had clinical and neurodevelopmental evaluation, brain magnetic resonance imaging (MRI) assessment, and blood amino acids analysis at diagnosis. Patients were followed clinically. Results Most children had acute onsets neuro‐developmental symptoms, with wide range of brain parenchyma involvement on MRI (hyperintensity). Diagnosis of MSUD was confirmed by detecting high serum levels of leucine/isoleucine (mean value 2085.5 μmol/L) in all patients, and elevated levels of serum valine in (81%) of children. In addition, all children showed elevated leucine: alanine ratio, and leucine: phenylalanine ratio. Conclusions The characteristic clinico‐radiological features can help in the early diagnosis of MSUD children, thus preventing the delay in laboratory diagnosis and improving their outcomes.
Collapse
Affiliation(s)
- Montaser M Mohamed
- Pediatric Neurology Unit, Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Mohamed A Bakheet
- Pediatric Cardiology Unit, Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Rofaida M Magdy
- Metabolic and Genetic Unit, Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Heba S El-Abd
- Department of Medical Genetics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Hany M Abo-Haded
- Pediatric Cardiology Unit, Department of Pediatrics, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| |
Collapse
|
9
|
Chavan R, Kadam S, Bhalke A, Choudhary SL, Patil P. Evaluation of Neonatal Acute Metabolic Crisis in Maple Syrup Urine Disease with MR Diffusion and MR Spectroscopy: Case Series and Review of the Literature. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1726312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractMagnetic resonance imaging (MRI) findings of acute metabolic crisis in maple syrup urine disease (MSUD) in neonates were reviewed. This case cohort study included six MSUD neonates imaged during acute metabolic decompensation. Specific diffusion imaging and proton spectroscopic findings were reviewed. All patients revealed extensive intramyelinic cytotoxic edema typically involving myelinated white matter structures. Brainstem, cerebellar white matter and peduncles, midbrain, posterior limbs of internal capsules, central portions of periventricular, and perirolandic white matter regions showed typical MSUD edema. Gray matter structures such as dentate nucleus and thalamus were involved in all patients. Involvement of other deep nuclei was also noted in a few patients. None of the patients showed involvement of the superficial cortex. Reduction in N-acetyl aspartate, a prominent lactate peak, and a peak representing methyl groups of amino acids were characteristic findings seen on intermediate short echo time MR spectroscopy. Our case series outlines the importance of diffusion and spectroscopy MR techniques in the diagnosis of acute neonatal MSUD metabolic crisis.
Collapse
Affiliation(s)
- Rajendra Chavan
- Anushka MRI & CT Scan Centre, King Edward Memorial Hospital, Pune, Maharashtra, India
| | - Sandeep Kadam
- Department of Pediatrics, King Edward Memorial Hospital, Pune, Maharashtra, India
| | - Amit Bhalke
- Department of Radiodiagnosis, King Edward Memorial Hospital, Pune, Maharashtra, India
| | - Sohan Lal Choudhary
- Department of Radiodiagnosis, King Edward Memorial Hospital, Pune, Maharashtra, India
| | - Pushpak Patil
- Department of Radiodiagnosis, King Edward Memorial Hospital, Pune, Maharashtra, India
| |
Collapse
|
10
|
Li Y, Liu X, Duan CF, Song XF, Zhuang XH. Brain magnetic resonance imaging findings and radiologic review of maple syrup urine disease: Report of three cases. World J Clin Cases 2021; 9:1844-1852. [PMID: 33748233 PMCID: PMC7953394 DOI: 10.12998/wjcc.v9.i8.1844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 12/12/2020] [Accepted: 01/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Maple syrup urine disease (MSUD) is a rare autosomal-recessive disorder that affects branched-chain amino acid (BCAA) metabolism and is named after the distinctive sweet odor of affected infants’ urine. This disease is characterized by the accumulation of BCAAs and corresponding branched-chain ketoacids of leucine, isoleucine, and valine in the plasma, urine, and cerebrospinal fluid. However, the mechanisms of MSUD-induced brain damage remain poorly defined. The accumulation of BCAAs in the brain inhibits the activity of pyruvate dehydrogenase and α-ketoglutarate, disrupting the citric acid cycle and consequently impacting the synthesis of amino acids, causing cerebral edema and abnormal myelination.
CASE SUMMARY We report three neonates admitted to our hospital with the classic subtype of MSUD. All three patients, with a transient normal period, presented with poor feeding, vomiting, poor weight gain, and increasing lethargy after birth. Laboratory testing revealed metabolic acidosis. The serum tandem mass spectrometry amino acid profile showed elevated plasma levels of BCAAs (leucine, isoleucine, and valine). Brain magnetic resonance imaging (MRI) presented abnormal signals mainly involving the globus pallidus, thalamus, internal capsule, brainstem, and cerebellar white matter, which represent the typical myelinated areas in normal full-term neonates.
CONCLUSION In our patients, MRI showed typical features, in concordance with the available literature. Early detection and timely treatment are very helpful for the prognosis of MSUD patients. Therefore, we discuss the neuroimaging features of MSUD to enhance the knowledge of pediatricians about this disease.
Collapse
Affiliation(s)
- Yang Li
- Department of Radiology, Qingdao Women and Children’s Hospital, Qingdao 266011, Shandong Province, China
| | - Xia Liu
- Department of Ultrasound, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Chong-Feng Duan
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Xiu-Feng Song
- Department of Radiology, Qingdao Women and Children’s Hospital, Qingdao 266011, Shandong Province, China
| | - Xun-Hui Zhuang
- Department of Radiology, Qingdao Women and Children’s Hospital, Qingdao 266011, Shandong Province, China
| |
Collapse
|
11
|
Brain Branched-Chain Amino Acids in Maple Syrup Urine Disease: Implications for Neurological Disorders. Int J Mol Sci 2020; 21:ijms21207490. [PMID: 33050626 PMCID: PMC7590055 DOI: 10.3390/ijms21207490] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/02/2020] [Accepted: 10/09/2020] [Indexed: 12/16/2022] Open
Abstract
Maple syrup urine disease (MSUD) is an autosomal recessive disorder caused by decreased activity of the branched-chain α-ketoacid dehydrogenase complex (BCKDC), which catalyzes the irreversible catabolism of branched-chain amino acids (BCAAs). Current management of this BCAA dyshomeostasis consists of dietary restriction of BCAAs and liver transplantation, which aims to partially restore functional BCKDC activity in the periphery. These treatments improve the circulating levels of BCAAs and significantly increase survival rates in MSUD patients. However, significant cognitive and psychiatric morbidities remain. Specifically, patients are at a higher lifetime risk for cognitive impairments, mood and anxiety disorders (depression, anxiety, and panic disorder), and attention deficit disorder. Recent literature suggests that the neurological sequelae may be due to the brain-specific roles of BCAAs. This review will focus on the derangements of BCAAs observed in the brain of MSUD patients and will explore the potential mechanisms driving neurologic dysfunction. Finally, we will discuss recent evidence that implicates the relevance of BCAA metabolism in other neurological disorders. An understanding of the role of BCAAs in the central nervous system may facilitate future identification of novel therapeutic approaches in MSUD and a broad range of neurological disorders.
Collapse
|
12
|
Feng W, Jia J, Guan H, Tian Q. Case report: maple syrup urine disease with a novel DBT gene mutation. BMC Pediatr 2019; 19:494. [PMID: 31830945 PMCID: PMC6909553 DOI: 10.1186/s12887-019-1880-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maple syrup urine disease (MSUD) is a potentially life-threatening metabolic disorder caused by decreased activity of the branched-chain α-ketoacid dehydrogenase (BCKD) complex. Mutations in four genes (BCKDHA, BCKDHB, DLD and DBT) are associated with MSUD. Here, the presenting symptoms and clinical course of a case of MSUD with a novel DBT gene mutation are described. CASE PRESENTATION We describe an infant with MSUD with the DBT gene mutation who had drowsiness and poor appetite as well as abnormal findings upon head magnetic resonance imaging (MRI), plasma amino acid analysis and urine organic acid analysis. Genetic testing revealed that both parents had the heterozygous mutation c.1132C > T (p.378X) in chr1:100672078, and the patient had the homozygous mutations c.1132C > T (p.378X) in chr1:100672078. Once diagnosed with MSUD, the patient's disease was controlled with a diet of BCAA-free enteral formula and thiamine. CONCLUSION The mutation c.1132C > T (p.378X) is a novel DBT gene mutation that is associated with MSUD and always has mild clinical manifestations. After timely BCAA-free nutrition and supplementation with thiamine for the patient, the plasma levels of BCAAs reached a safe level, the abnormal range of the multiple intracranial abnormalities was significantly smaller than before, and the symptoms of drowsiness and poor appetite disappeared.
Collapse
Affiliation(s)
- Wei Feng
- Tianjin Medical University, Tianjin, China
| | - Jinfu Jia
- Tianjin Medical University, Tianjin, China
| | - Heyang Guan
- Chongqing Medical University, Chongqing, China
| | - Qing Tian
- Tianjin First Central Hospital, Tianjin, China.
| |
Collapse
|
13
|
Dhawan SR, Saini AG, Vyas S, Attri SV. Teaching NeuroImages: When MRI is a clue in episodic ataxia. Neurology 2019; 93:e2074-e2075. [PMID: 31767667 DOI: 10.1212/wnl.0000000000008563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Sumeet R Dhawan
- From the Pediatric Neurology Unit, Department of Pediatrics (S.R.D., A.G.S., S.V.A.), and Department of Radiodiagnosis (S.V.), Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arushi Gahlot Saini
- From the Pediatric Neurology Unit, Department of Pediatrics (S.R.D., A.G.S., S.V.A.), and Department of Radiodiagnosis (S.V.), Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Sameer Vyas
- From the Pediatric Neurology Unit, Department of Pediatrics (S.R.D., A.G.S., S.V.A.), and Department of Radiodiagnosis (S.V.), Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Savita Verma Attri
- From the Pediatric Neurology Unit, Department of Pediatrics (S.R.D., A.G.S., S.V.A.), and Department of Radiodiagnosis (S.V.), Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
14
|
Kaur U, Kumar I, Singh A, Kumar M, Chakrabarti SS. Cerebellar Dysfunction in an Elderly Male After a Brief Course of Metronidazole. Curr Drug Saf 2019; 14:163-166. [PMID: 30727914 DOI: 10.2174/1574886314666190206154735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/22/2019] [Accepted: 01/29/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Metronidazole, a widely used antibacterial and antiprotozoal drug, is often the drug of choice in amoebic liver abscess. The drug, otherwise safe, can cause serious central nervous disturbances in rare circumstances. CASE REPORT Here, we report a case of cerebellar dysfunction in the form of slurring of speech and episodes of falls, in an elderly male following a three-week course of metronidazole therapy. RESULTS AND CONCLUSION The patient manifested classic radiologic features of metronidazole neurotoxicity. Marked improvement in clinical symptoms was seen following drug discontinuation.
Collapse
Affiliation(s)
- Upinder Kaur
- Department of Pharmacology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India
| | - Ishan Kumar
- Department of Radiodiagnosis & Imaging, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India
| | - Anup Singh
- Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India
| | - Mukesh Kumar
- Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India
| | - Sankha Shubhra Chakrabarti
- Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India
| |
Collapse
|
15
|
Kontzialis M, Huisman TAGM. Toxic-Metabolic Neurologic Disorders in Children: A Neuroimaging Review. J Neuroimaging 2018; 28:587-595. [PMID: 30066477 DOI: 10.1111/jon.12551] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 12/19/2022] Open
Abstract
There are multiple causes of neurotoxicity in children including medications, extrinsic toxins and insults, illicit drugs, built up of toxic metabolites due to genetic or acquired disorders, and metabolic abnormalities. The review is centered on causes of neurotoxicity affecting the pediatric brain and producing typical and easily recognized imaging manifestations. Early identification of common and less common imaging findings may point toward the correct direction, and may facilitate early diagnosis and institution of appropriate treatment to reverse or at least limit the injury to the developing brain. Two common imaging patterns of neurotoxicity in children are the posterior reversible encephalopathy syndrome and acute toxic leukoencephalopathy that are usually related to chemotherapy and immunosuppression for common pediatric malignancies. Another well-described imaging pattern of injury in children involves reversible splenial lesions with or without associated white matter abnormalities. Multiple additional extrinsic causes of neurotoxicity are presented including radiation and chemoradiation, various medications and treatment regimens, poisoning, illicit drug use or accidental exposure, and the respective characteristic neuroimaging findings are highlighted. Intrinsic neurotoxicity may occur in the setting of inborn errors of metabolism or acquired progressive organ failure leading to build up of toxic metabolites. Additional intrinsic causes of neurotoxicity include metabolic derangements and characteristic imaging findings in all instances are reviewed. The goal of the article is to enhance familiarity of neurologists and neuroradiologists with the imaging appearance of common and less common toxic insults to the pediatric brain.
Collapse
Affiliation(s)
- Marinos Kontzialis
- Section of Neuroradiology, Department of Radiology, Rush University Medical Center, Chicago, IL
| | - Thierry A G M Huisman
- Pediatric Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
16
|
Liu G, Ma D, Hu P, Wang W, Luo C, Wang Y, Sun Y, Zhang J, Jiang T, Xu Z. A Novel Whole Gene Deletion of BCKDHB by Alu-Mediated Non-allelic Recombination in a Chinese Patient With Maple Syrup Urine Disease. Front Genet 2018; 9:145. [PMID: 29740478 PMCID: PMC5928131 DOI: 10.3389/fgene.2018.00145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/09/2018] [Indexed: 11/13/2022] Open
Abstract
Maple syrup urine disease (MSUD) is an autosomal recessive inherited metabolic disorder caused by mutations in the BCKDHA, BCKDHB, DBT, and DLD genes. Among the wide range of disease-causing mutations in BCKDHB, only one large deletion has been associated with MSUD. Compound heterozygous mutations in BCKDHB were identified in a Chinese patient with typical MSUD using next-generation sequencing, quantitative PCR, and array comparative genomic hybridization. One allele presented a missense mutation (c.391G > A), while the other allele had a large deletion; both were inherited from the patient’s unaffected parents. The deletion breakpoints were characterized using long-range PCR and sequencing. A novel 383,556 bp deletion (chr6: g.80811266_81194921del) was determined, which encompassed the entire BCKDHB gene. The junction site of the deletion was localized within a homologous sequence in two AluYa5 elements. Hence, Alu-mediated non-allelic homologous recombination is speculated as the mutational event underlying the large deletion. In summary, this study reports a recombination mechanism in the BCKDHB gene causing a whole gene deletion in a newborn with MSUD.
Collapse
Affiliation(s)
- Gang Liu
- State Key Laboratory of Reproductive Medicine, Department of Prenatal Diagnosis, The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Dingyuan Ma
- State Key Laboratory of Reproductive Medicine, Department of Prenatal Diagnosis, The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Ping Hu
- State Key Laboratory of Reproductive Medicine, Department of Prenatal Diagnosis, The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Wen Wang
- Reproductive Genetic Center, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chunyu Luo
- State Key Laboratory of Reproductive Medicine, Department of Prenatal Diagnosis, The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Yan Wang
- State Key Laboratory of Reproductive Medicine, Department of Prenatal Diagnosis, The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Yun Sun
- State Key Laboratory of Reproductive Medicine, Department of Prenatal Diagnosis, The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Jingjing Zhang
- State Key Laboratory of Reproductive Medicine, Department of Prenatal Diagnosis, The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Tao Jiang
- State Key Laboratory of Reproductive Medicine, Department of Prenatal Diagnosis, The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| | - Zhengfeng Xu
- State Key Laboratory of Reproductive Medicine, Department of Prenatal Diagnosis, The Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, China
| |
Collapse
|