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Burgac E, Kaplan İ, Köseci B, Kara E, Kor D, Bulut FD, Atmış A, Pişkin F, Tuğ Bozdoğan S, Urel Demir G, İncecik F, Önenli Mungan N. Early diagnostic clues of mucolipidosis type II: Significance of radiological findings. Am J Med Genet A 2024; 194:e63545. [PMID: 38264826 DOI: 10.1002/ajmg.a.63545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/11/2023] [Accepted: 01/15/2024] [Indexed: 01/25/2024]
Abstract
Mucolipidosis type-II (ML-II) is an ultra-rare disorder caused by deficiency of N-acetylglucosaminyl-1-phosphotransferase enzyme due to biallelic pathogenic variants in GNPTAB gene. There are a few known about the natural history of ML-II. In this study, we presented the natural course of 24 patients diagnosed with ML-II. Mean age at diagnosis was 9.3 ± 5.7 months. All patients had coarse face, developmental delay, and hypotonia. The mean survival time was 3.01 ± 1.4 years. The oldest patient was 6.5 years old. Twelve patients died due to lung infection and respiratory failure. We observed early and significant radiological findings of ML-II were different from typical dysostosis multiplex such as femoral cloaking, rickets-like changes, and talocalcaneal stippling. These are significant findings observed in the fetal or newborn period which is considered to be highly characteristic of ML-II and disappears in the first year. Cloaking, rickets-like changes, and stippling were not observed in patients older than three months of age and this suggests that these findings disappear within the first year. These radiological features can be used as important clues for diagnosis. We detected eight different pathogenic variants in GNPTAB gene, three of them were novel.
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Affiliation(s)
- Ezgi Burgac
- Pediatric Metabolism and Nutrition Department, Cukurova University, Adana, Turkey
| | - İrem Kaplan
- Pediatric Metabolism and Nutrition Department, Cukurova University, Adana, Turkey
| | - Burcu Köseci
- Pediatric Metabolism and Nutrition Department, Cukurova University, Adana, Turkey
| | - Esra Kara
- Pediatric Metabolism and Nutrition Department, Cukurova University, Adana, Turkey
| | - Deniz Kor
- Pediatric Metabolism and Nutrition Department, Cukurova University, Adana, Turkey
| | - Fatma Derya Bulut
- Pediatric Metabolism and Nutrition Department, Cukurova University, Adana, Turkey
| | - Anıl Atmış
- Pediatric Cardiology Department, Cukurova University, Adana, Turkey
| | | | | | - Gizem Urel Demir
- Pediatric Genetics Department, Hacettepe University, Ankara, Turkey
| | - Faruk İncecik
- Pediatric Neurology Department, Cukurova University, Adana, Turkey
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Bulut FD, Kor D, Kilavuz S, Cicek E, Koseci B, Kara E, Burgac E, Kaplan İ, Onenli Mungan N. Actions speak louder than words: Home visits and its effect on dietary adherence in patients with phenylketonuria. J Paediatr Child Health 2023; 59:1238-1243. [PMID: 37700622 DOI: 10.1111/jpc.16488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 09/14/2023]
Abstract
AIM Phenylketonuria (PKU) is an inherited metabolic disorder in which accumulation of phenylalanine (Phe) leads to poor neurological outcomes without treatment. Dietary therapy is the main treatment and nonadherence is associated with elevated blood Phe levels and correspondingly poor neuropsychiatric outcomes. This study aimed to examine the effect of home visits on blood Phe levels in PKU patients. METHODS Sixty-five paediatric PKU patients who were on low-phenylalanine diet were visited monthly at home for 6 months. At each visit, dietary education was provided, patients' height and weight were measured and blood samples were collected. RESULTS Twenty-eight (43.1%) patients had classic PKU and 37 (56.9%) had moderate PKU. Blood Phe levels decreased statistically significant at first, second, fifth, and sixth months compared with screening visit. Blood Phe levels in moderate PKU patients decreased significantly at the last visit unlike classic PKU patients. A significant decrease in blood Phe levels was observed in patients older than 10 years. Anthropometric parameters improved. CONCLUSIONS Dietary nonadherence is the main treatment failure in PKU. Home visits for education are a promising way to improve treatment outcomes by providing quality education, better assessment, and correction of mistakes but they should be ongoing and supported by different interventions that address patients' special needs.
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Affiliation(s)
- Fatma Derya Bulut
- Pediatric Metabolism and Nutrition Department, Çukurova University, Adana, Turkey
| | - Deniz Kor
- Pediatric Metabolism and Nutrition Department, Çukurova University, Adana, Turkey
| | - Sebile Kilavuz
- Pediatric Metabolism Department, Başakşehir Çam ve Sakura City Research and Education Hospital, İstanbul, Turkey
| | - Ebru Cicek
- Pediatric Metabolism and Nutrition Department, Çukurova University, Adana, Turkey
| | - Burcu Koseci
- Pediatric Metabolism and Nutrition Department, Çukurova University, Adana, Turkey
| | - Esra Kara
- Pediatric Metabolism and Nutrition Department, Çukurova University, Adana, Turkey
| | - Ezgi Burgac
- Pediatric Metabolism and Nutrition Department, Çukurova University, Adana, Turkey
| | - İrem Kaplan
- Pediatric Metabolism and Nutrition Department, Çukurova University, Adana, Turkey
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Bulut FD, Seydaoğlu G, Kor D, Kılavuz S, Boz A, Önenli Mungan N. Perspectives of adult patients with lysosomal storage diseases on the transition from pediatric to adult healthcare in Turkey. Arch Pediatr 2023; 30:450-454. [PMID: 37331832 DOI: 10.1016/j.arcped.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/13/2023] [Accepted: 04/29/2023] [Indexed: 06/20/2023]
Abstract
AIM In many countries, adult clinics specifically dedicated to adult patients with lysosomal storage diseases (LSDs) do not exist. In Turkey, these patients are managed either by pediatric metabolic specialists or adult physicians who do not specifically specialize in LSDs. In this study, we aimed to identify the unmet clinical needs of these adult patients and their suggestions. METHODS The focus group participants were 24 adult LSD patients. Interviews were conducted in person. RESULTS A total of 23 LSD patients and parents of a patient with mucopolysaccharidosis type-3b with intellectual deficit were interviewed, with 84.6% of patients diagnosed after the age of 18 years and 18% of patients diagnosed before the age of 18 years desiring management by adult physicians. Patients with particular physical characteristics or severe intellectual deficit declined the transition. Patients reported structural problems in the hospital and social problems associated with pediatric clinics. They made suggestions to facilitate the possible transition. CONCLUSION With improved care, more patients with LSDs survive into adulthood or receive the diagnosis in adulthood. Children with chronic diseases need to transition to the care of adult physicians when they reach adulthood. Thus, there is an increasing need for adult physicians to manage these patients. In this study, most LSD patients accepted a well-planned and organized transition. Problems were related to stigmatization and social isolation in the pediatric clinic or adult issues with which pediatricians are not familiar. There is a need for adult metabolic physicians. Thus, health authorities should adopt necessary regulations for training of physicians in this field.
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Affiliation(s)
- Fatma Derya Bulut
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey.
| | | | - Deniz Kor
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey
| | - Sebile Kılavuz
- Başakşehir Çam ve Sakura City Research and Education Hospital, Pediatric Metabolism Department, İstanbul, Turkey
| | - Aslı Boz
- Çukurova University, Biostatistics Department, Adana, Turkey
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Ozek G, Aksoylar S, Uçar SK, Canda E, Akcan M, Cartı O, Siviş ZO, Oymak Y, Yazıcı H, Bax B, Bulut FD, Yoldaş Çelik M, Erdem F, Çoker M, Kansoy S. Hematopoietic stem cell transplantation with reduced toxicity conditioning regimen in mitochondrial neurogastrointestinal encephalopathy syndrome. Pediatr Blood Cancer 2023; 70:e30334. [PMID: 37046411 DOI: 10.1002/pbc.30334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/05/2023] [Accepted: 03/13/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare autosomal recessive disorder due to mutations in the TYMP gene. Clinical findings are characterized by neurologic manifestations and severe gastrointestinal dysfunction. The syndrome is usually fatal, the most effective treatment appears to be hematopoietic stem cell transplantation (HSCT). PROCEDURE In this retrospective study, we evaluated HSCT that was performed using a reduced toxicity myeloablative conditioning regimen in patients with MNGIE at our center. RESULTS A total of six allogeneic transplant procedures were performed in four patients. Three patients had fully matched donors, and one patient had a haploidentical donor. Treosulfan-based myeloablative conditioning regimen was applied in five of six transplants. Bone marrow was used as a stem cell source. One patient is being followed up in the 4th year of posttransplant with full chimeric and without graft versus host disease (GVHD). One patient died of acute stage IV gastrointestinal system GVHD. Two patients underwent second transplantation due to engraftment failure, one of which was the patient who had a haploidentical transplant. CONCLUSIONS Treosulfan-based regimen is well tolerated, although engraftment failure with this conditioning regimen can be a significant problem. We share our haploidentical transplant experience, which will be the first reported case in the literature.
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Affiliation(s)
- Gülcihan Ozek
- Department of Pediatrics, Division of Pediatric Hemathology and Oncology, Ege University Medical Faculty, Izmir, Turkey
| | - Serap Aksoylar
- Department of Pediatrics, Division of Pediatric Hemathology and Oncology, Ege University Medical Faculty, Izmir, Turkey
| | - Sema Kalkan Uçar
- Department of Pediatrics, Division of Metabolism and Nutrition, Ege University Medical Faculty, Izmir, Turkey
| | - Ebru Canda
- Department of Pediatrics, Division of Metabolism and Nutrition, Ege University Medical Faculty, Izmir, Turkey
| | - Mediha Akcan
- Department of Pediatrics, Division of Pediatric Hemathology and Oncology, Ege University Medical Faculty, Izmir, Turkey
| | - Ozgür Cartı
- Department of Pediatrics, Division of Pediatric Hemathology and Oncology, Ege University Medical Faculty, Izmir, Turkey
| | - Zuhal Onder Siviş
- Department of Pediatrics, Division of Pediatric Hemathology and Oncology, Ege University Medical Faculty, Izmir, Turkey
| | - Yeşim Oymak
- Department of Pediatrics, Division of Pediatric Hemathology and Oncology, Ege University Medical Faculty, Izmir, Turkey
| | - Havva Yazıcı
- Department of Pediatrics, Division of Metabolism and Nutrition, Ege University Medical Faculty, Izmir, Turkey
| | - Bridget Bax
- Department of Cell Biology, Institute of Molecular and Clinical Sciences, St George's University of London, London, UK
| | - Fatma Derya Bulut
- Department of Pediatrics, Division of Metabolism and Nutrition, Çukurova University Medical Faculty, Adana, Turkey
| | - Merve Yoldaş Çelik
- Department of Pediatrics, Division of Metabolism and Nutrition, Ege University Medical Faculty, Izmir, Turkey
| | - Fehime Erdem
- Department of Pediatrics, Division of Metabolism and Nutrition, Ege University Medical Faculty, Izmir, Turkey
| | - Mahmut Çoker
- Department of Pediatrics, Division of Metabolism and Nutrition, Ege University Medical Faculty, Izmir, Turkey
| | - Savaş Kansoy
- Department of Pediatrics, Division of Pediatric Hemathology and Oncology, Ege University Medical Faculty, Izmir, Turkey
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Bulut FD, Kor D, Kılavuz S, Şeker Yılmaz B, Kaplan İ, Ekinci F, Burgaç E, Varol İ, Köşeci B, Tuğ Bozdoğan S, Kara E, Demir F, Deniz A, Temiz F, Önenli Mungan N. Expanding the phenotypic landscape of Gaucher disease type 3c with a novel entity - Transient neonatal cholestasis. Eur J Med Genet 2023; 66:104764. [PMID: 37061027 DOI: 10.1016/j.ejmg.2023.104764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 01/02/2023] [Accepted: 03/30/2023] [Indexed: 04/17/2023]
Abstract
Gaucher disease (GD) is the most frequent lysosomal storage disorder due to biallelic pathogenic variants in GBA gene. Only homozygous D409H variant has been associated with the cardiovascular phenotype which is also known as Gaucher disease type 3c. In this descriptive study, we presented phenotypic heterogeneity and a novel clinical finding among 13 patients with GD type 3c. Patients presented with varying degrees of cardiac valve and/or aortic calcifications (84,6%) and corneal opacities (76,9%) in addition to visceral (100%), hematological (92,3%), neurological (92,3%), and skeletal (30%) manifestations. Also, cervical dystonia (38,4%) and psychiatric disorders (46,1%) were not infrequent entities with respect to neurological involvement in GD type 3c. In this report, we highlight transient neonatal cholestasis (38,4%) as a novel finding in GD type 3c. Neonatal cholestasis is a finding associated with Gaucher type 2, but transient neonatal cholestasis has not been reported in GD patients, so far. The clinical features of GD type 3c are highly heterogeneous, from disease severity or age of onset to disease progression. Also, we concluded that phenotypic spectrum may be associated with age at onset of clinical symptoms. As, patients presenting in infancy or childhood had mainly visceral and hematological involvement and patients presenting in adolescence and adulthood had mainly cardiac, neurological involvement, and psychiatric behavioral disorders. Identifying the heterogeneous clinical course of these patients in this fatal disease, may lead a sufficient understanding of the pathophysiology which will enable targeted therapeutic interventions.
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Affiliation(s)
- Fatma Derya Bulut
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey.
| | - Deniz Kor
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey
| | - Sebile Kılavuz
- Başakşehir Çam ve Sakura City Research and Education Hospital, Pediatric Metabolism Department, İstanbul, Turkey
| | - Berna Şeker Yılmaz
- University College London, Genetics and Genomics Medicine, Institute of Child Health London, UK
| | - İrem Kaplan
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey
| | - Faruk Ekinci
- Çukurova University, Pediatric Intensive Care Department, Adana, Turkey
| | - Ezgi Burgaç
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey
| | - İlknur Varol
- İnönü University, Pediatric Gastroenterology and Hepatology Department, Malatya, Turkey
| | - Burcu Köşeci
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey
| | | | - Esra Kara
- Çukurova University, Pediatric Metabolism and Nutrition Department, Adana, Turkey
| | - Fadli Demir
- Çukurova University, Pediatric Cardiology Department, Adana, Turkey
| | - Ali Deniz
- Çukurova University, Pediatric Gastroenterology and Hepatology Department, Adana, Turkey
| | - Fatih Temiz
- Sütçü İmam University, Pediatric Endocrinology Department, Kahramanmaraş, Turkey
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Kalkan Uçar S, Yazıcı H, Canda E, Er E, Bulut FD, Eraslan C, Onay H, Bax BE, Çoker M. Clinical spectrum of early onset "Mediterranean" (homozygous p.P131L mutation) mitochondrial neurogastrointestinal encephalomyopathy. JIMD Rep 2022; 63:484-493. [PMID: 36101829 PMCID: PMC9458607 DOI: 10.1002/jmd2.12315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/17/2022] [Accepted: 06/23/2022] [Indexed: 11/25/2022] Open
Abstract
Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is an autosomal recessive mitochondrial disorder characterized by cumulative and progressive gastrointestinal and neurological findings. This retrospective observational study, aimed to explore the time of presentation, diagnosis and clinical follow-up of 13 patients with a confirmed MNGIE disease of Mediterranean origin. The mean age of symptom onset was 7 years (6 months-21 years) and the average diagnosis age was 15.4 years ±8.4. Four of 13 patients (30%) died before 30 years at the mean age of 19.7 years ±6.8. Cachexia and gastrointestinal symptoms were observed in all patients (100%). The mean body mass index standard deviation score at diagnosis was 4.8 ± 2.8. At least three subocclusive episodes were presented in patients who died in last year of their life. The main neurological symptom found in most patients was peripheral neuropathy (92%). Ten patients (77%) had leukoencephalopathy and the remaining three patients without were under 10 years of age. The new homozygous "Mediterranean" TYMP mutation, p.P131L (c.392 C > T) was associated with an early presentation and poor prognosis in nine patients (69%) from five separates families. Based on the observations from this Mediterranean MNGIE cohort, we propose that the unexplained abdominal pain combined with cachexia is an indicator of MNGIE. High-platelet counts and nerve conduction studies may be supportive laboratory findings and the frequent subocclusive episodes could be a negative prognostic factor for mortality. Finally, the homozygous p.P131L (c.392 C > T) mutation could be associated with rapid progressive disease with poor prognosis.
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Affiliation(s)
- Sema Kalkan Uçar
- Department of Pediatrics, Division of Metabolism and NutritionEge University Medical FacultyIzmirTurkey
| | - Havva Yazıcı
- Department of Pediatrics, Division of Metabolism and NutritionEge University Medical FacultyIzmirTurkey
| | - Ebru Canda
- Department of Pediatrics, Division of Metabolism and NutritionEge University Medical FacultyIzmirTurkey
| | - Esra Er
- Department of Pediatrics, Division of Metabolism and NutritionEge University Medical FacultyIzmirTurkey
| | - Fatma Derya Bulut
- Department of Pediatrics, Division of Metabolism and NutritionÇukurova University Medical FacultyAdanaTurkey
| | - Cenk Eraslan
- Department of Radiology, Division of NeuroradiologyEge University Medical FacultyBornovaTurkey
| | - Hüseyin Onay
- Department of GeneticsEge University Medical FacultyIzmirTurkey
| | - Bridget Elizabeth Bax
- Institute of Molecular and Clinical SciencesSt George's University of LondonLondonUK
| | - Mahmut Çoker
- Department of Pediatrics, Division of Metabolism and NutritionEge University Medical FacultyIzmirTurkey
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Bulut FD, Bozbulut NE, Özalp Ö, Dalgiç B, Mungan NÖ, Koç Uçar H, Biberoğlu G. Diagnostic value of plasma lysosphingolipids levels in a Niemann-Pick disease type C patient with transient neonatal cholestasis. J Pediatr Endocrinol Metab 2022; 35:681-685. [PMID: 35107903 DOI: 10.1515/jpem-2021-0580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/17/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Niemann-Pick disease type C (NPC) is a lysosomal storage disease due to impaired intracellular lipid trafficking caused by biallelic pathogenic variants in NPC1 or NPC2 genes. NPC is classified according to the age of onset of neurological manifestations. Cholestatic liver disease can be transient or lead to liver failure. Accompanying neurological findings can be observed at any age. In this report, an infant with a homozygous pathogenic variant in NPC1 gene whose diagnosis was eventually confirmed by specific biomarkers is described. CASE PRESENTATION A sixteen-day-old male was admitted to hospital with prolonged jaundice. He had mild hepatosplenomegaly, conjugated hyperbilirubinemia, elevated liver transaminases, and mild hypoalbuminemia. Cholestasis resolved spontaneously and patient was readmitted due to progressive hepatosplenomegaly without any neurologic findings when he was 8 months old. Molecular investigations detected homozygous c.1123A > C (p.Thr375Pro) pathogenic variant in NPC1 gene. NPC-specific lysosomal biomarkers such as Lysosphingomyelin and Lysosphingomyelin-509 were elevated, confirming the diagnosis. CONCLUSIONS The clinical features of NPC are highly heterogeneous, from disease severity or age of onset to disease progression. Patients presenting with transient neonatal cholestasis and should be regularly followed for neurodevelopmental status and visceromegaly. In the case of variants of unknown significance in NPC1 gene, lysosomal biomarkers play an important role when genetic analyses are inconclusive.
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Affiliation(s)
- Fatma Derya Bulut
- Pediatric Metabolism Department, Adana City Research and Education Hospital, Adana, Turkey
| | - Neslihan Ekşi Bozbulut
- Pediatric Gastroenterology and Hepatology Department, Antakya Research and Education Hospital, Antakya, Hatay, Turkey
| | - Özge Özalp
- Genetics Department, Adana City Research and Education Hospital, Adana, Turkey
| | - Buket Dalgiç
- Pediatric Gastroenterology and Hepatology Department, Gazi University, Ankara, Turkey
| | | | - Habibe Koç Uçar
- Pediatric Neurology Department, Adana City Research and Education Hospital, Adana, Turkey
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Kor D, Bulut FD, Kılavuz S, Şeker Yılmaz B, Köşeci B, Kara E, Kaya Ö, Başaran S, Seydaoğlu G, Önenli Mungan N. Evaluation of bone health in patients with mucopolysaccharidosis. J Bone Miner Metab 2022; 40:498-507. [PMID: 35066680 DOI: 10.1007/s00774-021-01304-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/12/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This study aimed to evaluate the relationship between clinical findings, height and weight standard deviation scores, 25-hydroxyvitamin D3 (25(OH)D3) level, and dual-energy X-ray absorptiometry (DXA) results in patients diagnosed with mucopolysaccharidosis (MPS), where effective current treatments such as enzyme replacement therapy (ERT) can be accessed. MATERIALS AND METHODS 25(OH)D3 level was measured in 126 patients with MPS (17 with MPS I, 14 with MPS II, 18 with MPS III, 33 with MPS IVA, and 44 with MPS VI; 24-524 months). DXA was performed in 45 of these patients (8 with MPS I, 4 with MPS II, 4 with MPS III, 12 with MPS IVA, and 17 with MPS VI; 62-197 months; all patients were under 18 when DXA was performed) to assess bone mineral density (BMD) of the lumbar spine. RESULTS In total, 67.5% patients had a short stature, and 50% of them were underweight for their age. Of the patients, 13.5% were immobile, 28.6% had 25(OH)D3 deficiency, and 30.2% had an insufficient level of 25(OH)D3. BMD z score of 45 patients was - 2.5 ± 1.7. In 40% patients, it was < - 2. However, after correction for height-for-age z score (HAZ), HAZ-adjusted BMD z score was - 0.1 ± 0.9. In 2.2% patients, it was < - 2. CONCLUSION The low BMD z score prevalence reported with DXA was misleadingly higher in children with MPS and short stature. To prevent exposure to unnecessary antiresorptive treatments in these children, the effect of severe short stature and bone geometry on DXA measurements should be considered; further studies on bone health are warranted.
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Affiliation(s)
- Deniz Kor
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey.
| | - Fatma Derya Bulut
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Sebile Kılavuz
- Division of Pediatric Metabolism and Nutrition, Van Research and Training Hospital, Van, Turkey
| | - Berna Şeker Yılmaz
- Genetics and Genomic Medicine, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Burcu Köşeci
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Esra Kara
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Ömer Kaya
- Department of Radiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Sibel Başaran
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Gülşah Seydaoğlu
- Department of Biostatistics, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Neslihan Önenli Mungan
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey
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Kara E, Kor D, Bulut FD, Hergüner Ö, Ceylaner S, Köşeci B, Burgaç E, Mungan NÖ. Glycogen storage disease type XII; an ultra rare cause of hemolytic anemia and rhabdomyolysis: one new case report. J Pediatr Endocrinol Metab 2021; 34:1335-1339. [PMID: 34171939 DOI: 10.1515/jpem-2021-0258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/02/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Aldolase A deficiency also known as glycogen storage disease (GSD) XII, is an ultra rare autosomal recessively inherited GSD, associated with hemolytic anemia and rhabdomyolysis. CASE PRESENTATION Here, we first report a patient with dermatological findings, hemodialysis requirement for rhabdomyolysis, and a novel likely pathogenic c.971C>T (p.A324V) mutation in the ALDOA gene. CONCLUSIONS Episodes of rhabdomyolysis can be triggered by febrile illnesses and catabolic processes. Diagnosis should be confirmed by the mutation analysis of ALDOA gene. Treatment includes management of hemolytic anemia and administration of antipyretics during febrile episodes to avoid hemolysis and rhabdomyolysis.
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Affiliation(s)
- Esra Kara
- Department of Pediatric Metabolism and Nutrition, Çukurova University, Adana, Turkey
| | - Deniz Kor
- Department of Pediatric Metabolism and Nutrition, Çukurova University, Adana, Turkey
| | | | - Özlem Hergüner
- Department of Pediatric Neurology, Çukurova University, Adana, Turkey
| | | | - Burcu Köşeci
- Department of Pediatric Metabolism and Nutrition, Çukurova University, Adana, Turkey
| | - Ezgi Burgaç
- Department of Pediatric Metabolism and Nutrition, Çukurova University, Adana, Turkey
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Şeker Yılmaz B, Kor D, Bulut FD, Kılavuz S, Ceylaner S, Önenli Mungan HN. Clinical and molecular findings in 37 Turkish patients with isolated methylmalonic acidemia. Turk J Med Sci 2021; 51:1220-1228. [PMID: 33453710 PMCID: PMC8283478 DOI: 10.3906/sag-2001-72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/16/2021] [Indexed: 11/03/2022] Open
Abstract
Background/aim Isolated methylmalonic acidemia (MMA) is caused by complete or partial deficiency of the enzyme methylmalonyl- CoA mutase (mut0 or mut– enzymatic subtype), a defect of its cofactor adenosyl-cobalamin (cblA, cblB, or cblD-MMA), or deficiency of the enzyme methylmalonyl-CoA epimerase. While onset of the disease ranges from the neonatal period to adulthood, most cases present with lethargy, vomiting and ketoacidosis in the early infancy. Major secondary complications are; growth failure, developmental delay, interstitial nephritis with progressive renal failure, basal ganglia injury and cardiomyopathy. We aimed to demonstrate clinical and molecular findings based on long-term follow up in our patient cohort. Materials and methods The study includes 37 Turkish patients with isolated MMA who were followed up for long term complications 1 to 14 years. All patients were followed up regularly with clinical, biochemical and dietary monitoring to determine long term complications. Next Generation Sequencing technique was used for mutation screening in five disease-causing genes including; MUT, MMAA, MMAB, MMADHC, MCEE genes. Mutation screening identified 30 different types of mutations. Results While 28 of these mutations were previously reported, one novel MMAA mutation p.H382Pfs*24 (c.1145delA) and one novel MUT mutation IVS3+1G>T(c.752+1G>T) has been reported. The most common clinical complications were growth retardation, renal involvement, mental motor retardation and developmental delay. Furthermore, one of our patients developed cardiomyopathy, another one died because of hepatic failure and one presented with lactic acidosis after linezolid exposure. Conclusion We have detected two novel mutations, including one splice-site mutation in the MUT gene and one frame shift mutation in the MMAA gene in 37 Turkish patients. We confirm the genotype-phenotype correlation in the study population according to the long-term complications.
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Affiliation(s)
- Berna Şeker Yılmaz
- Department of Pediatric Metabolism, University of Mersin, Faculty of Medicine, Mersin, Turkey,Genetics and Genomics Medicine Department, Institute of Child Health, University College London, London, UK
| | - Deniz Kor
- Department of Pediatric Metabolism, University Hospital Çukurova, Adana, Turkey
| | - Fatma Derya Bulut
- Department of Pediatric Metabolism, Adana City Research and Training Hospital, Adana, Turkey
| | - Sebile Kılavuz
- Department of Pediatric Metabolism, University Hospital Çukurova, Adana, Turkey
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Kılavuz S, Basaran S, Kor D, Bulut FD, Erdem S, Ballı HT, Dağkıran M, Bisgin A, Mungan HNÖ. Morquio A syndrome and effect of enzyme replacement therapy in different age groups of Turkish patients: a case series. Orphanet J Rare Dis 2021; 16:144. [PMID: 33752727 PMCID: PMC7983100 DOI: 10.1186/s13023-021-01761-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/25/2021] [Indexed: 12/28/2022] Open
Abstract
Background This case series includes longitudinal clinical data of ten patients with Morquio A syndrome from south and southeastern parts of Turkey, which were retrospectively collected from medical records. All patients received enzyme replacement therapy (ERT). Clinical data collected included physical appearance, anthropometric data, neurological and psychological examinations, cardiovascular evaluation, pulmonary function tests, eye and ear-nose-throat examinations, endurance in the 6-min walk test and/or 3-min stair climb test, joint range of motion, and skeletal investigations (X-rays, bone mineral density). Results At the time of ERT initiation, two patients were infants (1.8 and 2.1 years), five were children (3.4–7.1 years), and three were adults (16.5–39.5 years). Patients had up to 4 years follow-up. Most patients had classical Morquio A, based on genotypic and phenotypic data. Endurance was considerably reduced in all patients, but remained relatively stable or increased over time in most cases after treatment initiation. Length/height fell below normal growth curves, except in the two infants who started ERT at ≤ 2.1 years of age. All patients had skeletal and/or joint abnormalities when ERT was started. Follow-up data did not suggest improvements in skeletal abnormalities, except in one of the younger infants. Nine patients had corneal clouding, which resolved after treatment initiation in the two infants, but not in the other patients. Hepatomegaly was reported in seven patients and resolved with treatment in five of them. Other frequent findings at treatment initiation were coarse facial features (N = 9), hearing loss (N = 6), and cardiac abnormalities (N = 6). Cardiac disease deteriorated over time in three patients, but did not progress in the others. Conclusions Overall, this case series with Morquio A patients confirms clinical trial data showing long-term stabilization of endurance after treatment initiation across ages and suggest that very early initiation of ERT optimizes growth outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01761-0.
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Affiliation(s)
- Sebile Kılavuz
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Faculty of Medicine, Çukurova University,, Adana, Turkey
| | - Sibel Basaran
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Deniz Kor
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Faculty of Medicine, Çukurova University,, Adana, Turkey
| | - Fatma Derya Bulut
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Faculty of Medicine, Çukurova University,, Adana, Turkey
| | - Sevcan Erdem
- Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Hüseyin Tuğsan Ballı
- Department of Radiology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Muhammed Dağkıran
- Department of Ear, Nose and Throat Diseases, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Atil Bisgin
- Medical Genetics Department of Medical Faculty, Cukurova University AGENTEM (Adana Genetic Diseases Diagnosis and Treatment Center), Adana, Turkey
| | - Halise Neslihan Önenli Mungan
- Division of Pediatric Metabolism and Nutrition, Department of Pediatrics, Faculty of Medicine, Çukurova University, 01130, Sarıçam, Adana, Turkey.
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Bulut FD, Özdemir Dilek S, Kotan D, Mengen E, Gürbüz F, Yüksel B. Mutations Within the Transcription Factor PROP1 in a Cohort of Turkish Patients with Combined Pituitary Hormone Deficiency. J Clin Res Pediatr Endocrinol 2020; 12:261-268. [PMID: 31948187 PMCID: PMC7499144 DOI: 10.4274/jcrpe.galenos.2020.2019.0191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Mutations of the genes encoding transcription factors which play important roles in pituitary morphogenesis, differentiation and maturation may lead to combined pituitary hormone deficiency (CPHD). PROP1 gene mutations are reported as the most frequent genetic aetiology of CHPD. The aim of this study was to describe the phenotypes of Turkish CPHD patients and define the frequency of PROP1 mutations. METHODS Fifty-seven CPHD patients from 50 families were screened for PROP1 mutations. The patients were affected by growth hormone (GH) and additional anterior pituitary hormone deficiencies. RESULTS All patients had GH deficiency. In addition, 98.2% had central hypothyroidism, 45.6% had hypogonadotropic hypogonadism, 43.8% had adrenocorticotropic hormone deficiency and 7.1% had prolactin deficiency. Parental consanguinity rate was 50.9% and 14 cases were familial. Mean height standard deviation score (SDS) and weight SDS were -3.8±1.4 and -3.1±2.0, respectively. Of 53 patients with available pituitary imaging, 32 (60.4%) showed abnormalities. None had extra-pituitary abnormalities. Eight index patients had PROP1 gene mutations. Five sporadic patients were homozygous for c.301_302delAG (p.Leu102CysfsTer8) mutation, two siblings had exon 2 deletion, two siblings had complete gene deletion and two siblings were homozygous for the novel c.353A>G (p.Q118R) mutation. The frequency of the PROP1 mutations was 16% in our cohort. Mutation rate was significantly higher in familial cases compared to sporadic cases (42.8% vs 11.6%; p<0.01). CONCLUSION Phenotype of patients regarding hormonal deficiencies, pituitary morphology, presence of extra-pituitary findings, family history of CPHD and parental consanguinity are important for deciding which pituitary transcription factor deficiency should be investigated. PROP1 mutation frequencies vary in different populations and its prevalence is high in Turkish CPHD patients.
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Affiliation(s)
- Fatma Derya Bulut
- Adana City Training and Research Hospital, Clinic of Pediatrics, Adana, Turkey,* Address for Correspondence: Adana City Training and Research Hospital, Clinic of Pediatrics, Adana, Turkey Phone: +90 532 743 27 18 E-mail:
| | - Semine Özdemir Dilek
- Çukurova University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Adana, Turkey
| | - Damla Kotan
- Çukurova University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Adana, Turkey
| | - Eda Mengen
- Ankara City Hospital, Children’s Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Fatih Gürbüz
- Çukurova University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Adana, Turkey
| | - Bilgin Yüksel
- Çukurova University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology, Adana, Turkey
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Kör D, Şeker-Yılmaz B, Bulut FD, Kılavuz S, Öktem M, Ceylaner S, Yıldızdaş D, Önenli-Mungan N. Clinical features of 27 Turkish Propionic acidemia patients with 12 novel mutations. Turk J Pediatr 2020; 61:330-336. [PMID: 31916709 DOI: 10.24953/turkjped.2019.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Kör D, Şeker-Yılmaz B, Bulut FD, Kılavuz S, Öktem M, Ceylaner S, Yıldızdaş D, Önenli-Mungan N. Clinical features of 27 Turkish Propionic acidemia patients with 12 novel mutations. Turk J Pediatr 2019; 61: 330-336. Propionic acidemia (PA) is an inherited metabolic disease caused by the deficiency of one of the four biotin-dependent enzymes propionyl-CoA carboxylase (PCC), and is characterized by coma and death in unrecognized patients, additionally late diagnosis leads to severe developmental delay and neurological sequels. Manifestations of PA over time can include growth impairment, intellectual disability, seizures, basal ganglia lesions, pancreatitis, and cardiomyopathy. Other rarely reported complications include optic atrophy, hearing loss, premature ovarian insufficiency, and chronic renal failure. Mutations in PCCA-PCCB genes cause the clinically heterogeneous disease of PA. In this study, we investigate the mutation spectrum of PCCAPCCB genes and phenotypic features of 27 Turkish patients with PA from the South and Southeast parts of Turkey. We report 12 novel PA mutations, five affecting the PCCA gene and 7 affecting the PCCB gene.
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Affiliation(s)
- Deniz Kör
- Divisions of Pediatric Metabolism and Nutrition, Adana, Turkey
| | - Berna Şeker-Yılmaz
- Department of Pediatric Metabolism, Mersin City Hospital, Mersin, Turkey
| | - Fatma Derya Bulut
- Department of Pediatric Metabolism, Adana City Hospital, Adana, Turkey
| | - Sebile Kılavuz
- Divisions of Pediatric Metabolism and Nutrition, Adana, Turkey
| | - Murat Öktem
- Düzen Biochemistry Laboratories, Ankara, Turkey
| | | | - Dinçer Yıldızdaş
- Divisions of Pediatric Intensive Care Unit, Çukurova University Faculty of Medicine, Adana, Turkey
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Abstract
BACKGROUND Lysosomal acid lipase deficiency (LAL-D), also known as cholesteryl ester storage disease or Wolman disease, is a multi-systemic autosomal recessive genetic disorder caused by mutations in the lysosomal acid lipase gene (LIPA). CASE A 14-year-old female patient was diagnosed as LAL-D with the findings of hepatomegaly, splenomegaly, elevated liver enzyme levels, and abnormal lipid profile. Her sister had similar laboratory and ultrasonographic findings. Both siblings had a homozygous c.894 G > A mutation in the LIPA gene, and their parents were heterozygous for this mutation. CONCLUSIONS This case is one of the similar reports in the literature regarding clinical, biochemical, and genetic findings. It is well-known that LAL-D has overlapping clinical manifestations, and early diagnosis is quite challenging. Therefore, most patients die in the first year of life. After the determination of novel mutations in LAL-D patients, it is thought that LAL-D can present with heterogeneous signs and symptoms.
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Affiliation(s)
- Berrak Bilginer Gürbüz
- Divisions of Pediatric Metabolism, Adana City Education and Training Hospital, Adana, Turkey
| | - İlker Güney
- Divisions ofMedical Genetics, Adana City Education and Training Hospital, Adana, Turkey
| | - Fatma Derya Bulut
- Divisions of Pediatric Metabolism, Adana City Education and Training Hospital, Adana, Turkey
| | - Okan Dilek
- Divisions of Radiology, Adana City Education and Training Hospital, Adana, Turkey
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Ciftci V, Kılavuz S, Bulut FD, Mungan HN, Bisgin A, Dogan MC. Congenital erythropoietic porphyria with erythrodontia: A case report. Int J Paediatr Dent 2019; 29:542-548. [PMID: 30706587 DOI: 10.1111/ipd.12473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 01/02/2019] [Accepted: 01/24/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND The causes for intrinsic tooth discoloration can be separated into two categories as systemic and local. Systemic causes are either genetic or drug-induced effects. The development of dentition can also be affected by a number of systemic factors and metabolic diseases such as porphyria. Congenital erythropoietic porphyria (CEP), also known as Gunther's disease, is a metabolic disease caused by a transformation in the gene that codifies uroporphyrinogen-3 synthesis, leading to porphyrin aggregation in urine, skin, bone, and dentin. CASE REPORT A 21-month-old girl with erythrodontia was referred to Paediatric Dentistry Department in September 2017. A physical examination revealed blisters on her face, nose, hands, and feet. Laboratory findings showed highly elevated urine total uroporphyrin and total coproporphyrin I and III levels. Next-generation sequencing multigene panel testing for porphyria demonstrated a homozygous c.10C>T (p.L4F) mutation in the UROS gene. For curative therapy, the patient was admitted to the allogeneic bone marrow transplantation program. CONCLUSION Congenital erythropoietic porphyria most commonly presents in the first few years of life. Manifestations can include reddish-colored urine, skin blistering, scarring, and erythrodontia. A timely diagnosis can prevent undesirable skin findings of the disease and death due to hematological involvement before a curative allogeneic bone marrow transplantation is performed.
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Affiliation(s)
- Volkan Ciftci
- Department of Pediatric Dentistry, Faculty of Dentistry, Cukurova University, Adana, Turkey
| | - Sebile Kılavuz
- Division of Pediatric Metabolism and Nutrition, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Fatma Derya Bulut
- Division of Pediatric Metabolism and Nutrition, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Halise Neslihan Mungan
- Division of Pediatric Metabolism and Nutrition, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Atil Bisgin
- Medical Genetics Department of Balcali Hospital and Clinics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Muharrem Cem Dogan
- Department of Pediatric Dentistry, Faculty of Dentistry, Cukurova University, Adana, Turkey
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Şeker-Yılmaz B, Kör D, Bulut FD, Yüksel B, Karabay-Bayazıt A, Topaloğlu AK, Ceylaner G, Önenli-Mungan N. Impaired glucose tolerance in Fanconi-Bickel syndrome: Eight patients with two novel mutations. Turk J Pediatr 2018; 59:434-441. [PMID: 29624224 DOI: 10.24953/turkjped.2017.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Şeker-Yılmaz B, Kör D, Bulut FD, Yüksel B, Karabay-Bayazıt A, Topaloğlu AK, Ceylaner G, Önenli-Mungan N. Impaired glucose tolerance in Fanconi-Bickel syndrome: Eight patients with two novel mutations. Turk J Pediatr 2017; 59: 434-441. Fanconi-Bickel syndrome (FBS) is a rare, autosomal recessive disorder of carbohydrate metabolism caused by defects in the facilitative glucose transporter 2 (GLUT2 or SLC2A2) gene. Prominent findings are failure to thrive, renal tubular acidosis, hypoglycemia and postprandial hyperglycemia even mimicking diabetes mellitus. Eight patients from 6 families with FBS were included in this study. c.482_483insC homozygous mutation was detected in six patients from four different families. Mutation analysis of SLC2A2 gene revealed two novel homozygous mutations; c.1069delGinsAATAA and c.575A > G. Standard oral glucose tolerance test with 1.75 g/kg oral glucose was performed in six of the patients who were older than 3-years of age. Impaired glucose tolerance was found in all patients as expected and two of them had overt diabetes. None of the antidiabetic medications were given to them in order to avoid significant hypoglycemia. Beside the conservative treatment, follow up with frequent oral glucose tolerance tests are planned. We report these cases of FBS, as GSD XI is rare, two novel mutations were detected and also to highlight the risk of diabetes mellitus; although there is not a consensus about the treatment.
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Affiliation(s)
| | - Deniz Kör
- Department of Pediatric Metabolism, Adana City Hospital, Adana
| | - Fatma Derya Bulut
- Departments Pediatric Metabolism, Balcali Hospital, Cukurova University, Adana
| | - Bilgin Yüksel
- Departments Pediatric Endocrinology, Balcali Hospital, Cukurova University, Adana
| | | | - Ali Kemal Topaloğlu
- Departments Pediatric Endocrinology, Balcali Hospital, Cukurova University, Adana
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Bulut FD, Kör D, Şeker-Yılmaz B, Hergüner Ö, Ceylaner S, Özkınay F, Kılavuz S, Önenli-Mungan N. Four Gaucher disease type II patients with three novel mutations: a single centre experience from Turkey. Metab Brain Dis 2018; 33:1223-1227. [PMID: 29656334 DOI: 10.1007/s11011-018-0236-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/06/2018] [Indexed: 12/29/2022]
Abstract
Gaucher disease is the most common lysosomal storage disorder due to glucosylceramidase enzyme deficiency. There are three subtypes of the disease. Neurological involvement accompanies visceral and haematological findings only in type II and type III Gaucher patients. Type II is the acute progressive neuronopathic form which is the most severe and rare subtype. Clinical findings are recognized prenatally or in the first months of life and followed by death within the first two years of age. Among our 81 Gaucher patients, we identified 4 (4,9%) type II patients in our metabolic centre. This rate is significantly higher than the rate reported in the literature (<1%). Three of the patients had novel mutations, one of them was a collodion baby and the other one was mistyped as type III due to its atypical presentation at the beginning and he was treated with ERT for 8 months. In this report, we present our type II Gaucher patients with three novel mutations and one perinatal lethal form with generalized ichthyosis which is a very rare disorder. Additionally, we would like to highlight the phenotypic heterogeneity not only between the subtypes, also even in the same type.
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Affiliation(s)
- Fatma Derya Bulut
- Department of Pediatrics, Division of Metabolism and Nutrition, Çukurova University Medical Faculty, Adana, Turkey.
| | - Deniz Kör
- Department of Pediatrics, Division of Metabolism and Nutrition, Çukurova University Medical Faculty, Adana, Turkey
| | | | - Özlem Hergüner
- Department of Pediatrics, Division of Pediatric Neurology, Çukurova University Medical Faculty, Adana, Turkey
| | | | - Ferda Özkınay
- Department of Genetics, Ege University Medical Faculty, İzmir, Turkey
| | - Sebile Kılavuz
- Department of Pediatrics, Division of Metabolism and Nutrition, Çukurova University Medical Faculty, Adana, Turkey
| | - Neslihan Önenli-Mungan
- Department of Pediatrics, Division of Metabolism and Nutrition, Çukurova University Medical Faculty, Adana, Turkey
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Cansever Övetti NH, Önenli Mungan HN, Yılmaz BŞ, Bulut FD. Hiperkarotenemi. Cukurova Medical Journal 2018. [DOI: 10.17826/cumj.342841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kılavuz S, Bulut FD, Kör D, Şeker Yılmaz B, Başaran S, Sarpel T, Önenli Mungan N. Demographic, Phenotypic and Genotypic Features of Alkaptonuria Patients: A Single Centre Experience. jpr 2018. [DOI: 10.4274/jpr.20982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bulut FD, Kör D, Şeker-Yılmaz B, Gül-Mert G, Kılavuz S, Önenli-Mungan N. Turkish case of ethylmalonic encephalopathy misdiagnosed as short chain acyl-CoA dehydrogenase deficiency. Metab Brain Dis 2018; 33:977-979. [PMID: 29159724 DOI: 10.1007/s11011-017-0152-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
Abstract
Ethylmalonic encephalopathy is a very rare autosomal recessively inherited inborn error of metabolism; characterized by encephalopathy, recurrent petechiae without bleeding diathesis, chronic diarrhea, and orthostatic acrocyanosis. Here, we describe a case of ethylmalonic encephalopathy with late onset neurologic symptoms and a confusing family history of two deceased brothers with the wrong suspicion of short chain acyl-CoA dehydrogenase deficiency.
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Affiliation(s)
- Fatma Derya Bulut
- Department of Pediatric Metabolism and Nutrition, Çukurova University, Adana, Turkey.
| | - Deniz Kör
- Adana Numune Teaching and Research Hospital, Adana, Turkey
| | | | - Gülen Gül-Mert
- Adana Numune Teaching and Research Hospital, Adana, Turkey
| | - Sebile Kılavuz
- Department of Pediatric Metabolism and Nutrition, Çukurova University, Adana, Turkey
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Doğruel D, Bulut FD, Yılmaz M, Önenli-Mungan N, Altıntaş DU. Coexistence of 2 rare autosomal recessively inherited disorders manifesting with immune deficiency; IL-12 receptor β1 and biotinidase deficiencies. Turk J Pediatr 2018; 60:584-587. [PMID: 30968642 DOI: 10.24953/turkjped.2018.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Doğruel D, Bulut FD, Yılmaz M, Önenli-Mungan N, Altıntaş DU. Coexistence of 2 rare autosomal recessively inherited disorders manifesting with immune deficiency; IL-12 receptor β1 and biotinidase deficiencies. Turk J Pediatr 2018; 60: 584-587. In this report, we described an infant with both partial biotinidase and IL-12Rβ1 deficiencies as these two entities are rare and unrelated inherited disorders. One-month-old girl was diagnosed as partial biotinidase deficiency with newborn screening programme. Mutation analysis revealed a compound heterozygous mutation BTD: c.1330G > C (p.Val444Leu) / c.196_197dupCATC (p.Leu69HisfsTer24). At the age of 6 months, a nodule on her left axilla with purulent discharge was noticed which was related to BCG vaccination. A mutational analysis revealed a homozygous c.783+1G > A mutation on IL-12Rβ1 gene. Interferon-gamma and anti-tuberculosis treatment were initiated together and the nodule with purulent discharge regressed dramatically. Here, we want to emphasize consideration of coexistence of two rare autosomal recessively inherited diseases in a patient due to the high rate of consanguinity in our country.
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Affiliation(s)
- Dilek Doğruel
- Division of Allergy and Immunology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Fatma Derya Bulut
- Metabolism and Nutrition, Department of Pediatrics, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Mustafa Yılmaz
- Division of Allergy and Immunology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Neslihan Önenli-Mungan
- Metabolism and Nutrition, Department of Pediatrics, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Derya Ufuk Altıntaş
- Division of Allergy and Immunology, Çukurova University Faculty of Medicine, Adana, Turkey
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Kör D, Yılmaz BŞ, Bulut FD, Ceylaner S, Mungan NÖ. Improved metabolic control in tetrahydrobiopterin (BH4), responsive phenylketonuria with sapropterin administered in two divided doses vs. a single daily dose. J Pediatr Endocrinol Metab 2017; 30:713-718. [PMID: 28593914 DOI: 10.1515/jpem-2016-0461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 04/06/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Phenylketonuria (PKU) often requires a lifelong phenylalanine (Phe)-restricted diet. Introduction of 6R-tetrahydrobiopterin (BH4) has made a huge difference in the diets of patients with PKU. BH4 is the co-factor of the enzyme phenylalanine hydroxylase (PAH) and improves PAH activity and, thus, Phe tolerance in the diet. A limited number of published studies suggest a pharmacodynamic profile of BH4 more suitable to be administered in divided daily doses. METHODS After a 72-h BH4 loading test, sapropterin was initiated in 50 responsive patients. This case-control study was conducted by administering the same daily dose of sapropterin in group 1 (n=24) as a customary single dose or in two divided doses in group 2 (n=26) over 1 year. RESULTS Mean daily consumption of Phe increased significantly after the first year of BH4 treatment in group 2 compared to group 1 (p<0.05). At the end of the first year of treatment with BH4, another dramatic difference observed between the two groups was the ability to transition to a Phe-free diet. Eight patients from group 2 and two from group 1 could quit dietary restriction. CONCLUSIONS When given in two divided daily doses, BH4 was more efficacious than a single daily dose in increasing daily Phe consumption, Phe tolerance and the ability to transition to a Phe-unrestricted diet at the end of the first year of treatment.
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Melek E, Bulut FD, Atmış B, Yılmaz BŞ, Bayazıt AK, Mungan NÖ. An ignored cause of red urine in children: rhabdomyolysis due to carnitine palmitoyltransferase II (CPT-II) deficiency. J Pediatr Endocrinol Metab 2017; 30:237-239. [PMID: 28085674 DOI: 10.1515/jpem-2016-0324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 11/17/2016] [Indexed: 11/15/2022]
Abstract
Carnitine palmitoyltransferase II (CPT-II) deficiency is an autosomal recessively inherited disorder involving the β-oxidation of long-chain fatty acids, which leads to rhabdomyolysis and subsequent acute renal failure. The clinical phenotype varies from a severe infantile form to a milder muscle form. Here, we report a 9-year-old boy referred to our hospital for the investigation of hematuria with a 2-day history of dark urine and malaise. As no erythrocytes in the microscopic examination of the urine and hemoglobinuria were present, myoglobinuria due to rhabdomyolysis was the most probable cause of dark urine. After excluding the other causes of rhabdomyolysis, with the help of metabolic investigations, the patient was suspected to have CPT-II deficiency, the most common cause of metabolic rhabdomyolysis. Our aim in presenting this case is to emphasize considering rhabdomyolysis in the differential diagnosis of dark urine in order to prevent recurrent rhabdomyolysis and renal injury.
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Kör D, Şeker Yilmaz B, Bulut FD, Önenli Mungan N, Ufuk Altıntaş D. A Desensitization Method to Maintain Enzyme Replacement Therapy in Mucopolysaccharidosis Type VI. J Investig Allergol Clin Immunol 2016; 26:130-2. [DOI: 10.18176/jiaci.0030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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