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Willems AP, van der Ham M, Schiebergen-Bronkhorst BGM, van Aalderen M, de Barse MMJ, De Gruyter FE, van Hoek IN, Pras-Raves ML, de Sain-van der Velden MGM, Prinsen HCMT, Verhoeven-Duif NM, Jans JJM. A one-year pilot study comparing direct-infusion high resolution mass spectrometry based untargeted metabolomics to targeted diagnostic screening for inherited metabolic diseases. Front Mol Biosci 2023; 10:1283083. [PMID: 38028537 PMCID: PMC10657655 DOI: 10.3389/fmolb.2023.1283083] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background: Early diagnosis of inherited metabolic diseases (IMDs) is important because treatment may lead to reduced mortality and improved prognosis. Due to their diversity, it is a challenge to diagnose IMDs in time, effecting an emerging need for a comprehensive test to acquire an overview of metabolite status. Untargeted metabolomics has proven its clinical potential in diagnosing IMDs, but is not yet widely used in genetic metabolic laboratories. Methods: We assessed the potential role of plasma untargeted metabolomics in a clinical diagnostic setting by using direct infusion high resolution mass spectrometry (DI-HRMS) in parallel with traditional targeted metabolite assays. We compared quantitative data and qualitative performance of targeted versus untargeted metabolomics in patients suspected of an IMD (n = 793 samples) referred to our laboratory for 1 year. To compare results of both approaches, the untargeted data was limited to polar metabolites that were analyzed in targeted plasma assays. These include amino acid, (acyl)carnitine and creatine metabolites and are suitable for diagnosing IMDs across many of the disease groups described in the international classification of inherited metabolic disorders (ICIMD). Results: For the majority of metabolites, the concentrations as measured in targeted assays correlated strongly with the semi quantitative Z-scores determined with DI-HRMS. For 64/793 patients, targeted assays showed an abnormal metabolite profile possibly indicative of an IMD. In 55 of these patients, similar aberrations were found with DI-HRMS. The remaining 9 patients showed only marginally increased or decreased metabolite concentrations that, in retrospect, were most likely to be clinically irrelevant. Illustrating its potential, DI-HRMS detected additional patients with aberrant metabolites that were indicative of an IMD not detected by targeted plasma analysis, such as purine and pyrimidine disorders and a carnitine synthesis disorder. Conclusion: This one-year pilot study showed that DI-HRMS untargeted metabolomics can be used as a first-tier approach replacing targeted assays of amino acid, acylcarnitine and creatine metabolites with ample opportunities to expand. Using DI-HRMS untargeted metabolomics as a first-tier will open up possibilities to look for new biomarkers.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Judith J. M. Jans
- Section Metabolic Diagnostics, Department of Genetics, University Medical Center Utrecht, Utrecht, Netherlands
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2
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Rumping L, Pouwels PJW, Wolf NI, Rehmann H, Wamelink MMC, Waisfisz Q, Jans JJM, Prinsen HCMT, van de Kamp JM, van Hasselt PM. A second case of glutaminase hyperactivity: Expanding the phenotype with epilepsy. JIMD Rep 2023; 64:217-222. [PMID: 37151363 PMCID: PMC10159865 DOI: 10.1002/jmd2.12359] [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: 10/19/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 02/27/2023] Open
Abstract
Glutaminase (GLS) hyperactivity was first described in 2019 in a patient with profound developmental delay and infantile cataract. Here, we describe a 4-year-old boy with GLS hyperactivity due to a de novo heterozygous missense variant in GLS, detected by trio whole exome sequencing. This boy also exhibits developmental delay without dysmorphic features, but does not have cataract. Additionally, he suffers from epilepsy with tonic clonic seizures. In line with the findings in the previously described patient with GLS hyperactivity, in vivo 3 T magnetic resonance spectroscopy (MRS) of the brain revealed an increased glutamate/glutamine ratio. This increased ratio was also found in urine with UPLC-MS/MS, however, inconsistently. This case indicates that the phenotypic spectrum evoked by GLS hyperactivity may include epilepsy. Clarifying this phenotypic spectrum is of importance for the prognosis and identification of these patients. The combination of phenotyping, genetic testing, and metabolic diagnostics with brain MRS and in urine is essential to identify new patients with GLS hyperactivity and to further extend the phenotypic spectrum of this disease.
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Affiliation(s)
- Lynne Rumping
- Department of Human GeneticsAmsterdam UMCAmsterdamthe Netherlands
| | - Petra J. W. Pouwels
- Department of Radiology and Nuclear Medicine and Amsterdam NeuroscienceAmsterdam UMCAmsterdamthe Netherlands
| | - Nicole I. Wolf
- Department of Child Neurology, Amsterdam Leukodystrophy CenterEmma Children's Hospital, Amsterdam UMCAmsterdamthe Netherlands
- Amsterdam Neuroscience, Cellular and Molecular MechanismsVrije Universiteit AmsterdamAmsterdamthe Netherlands
| | - Holger Rehmann
- Department of Energy and BiotechnologyFlensburg University of Applied SciencesFlensburgGermany
| | - Mirjam M. C. Wamelink
- Department of Clinical Chemistry, Metabolic Unit, Amsterdam Gastroenterology Endocrinology MetabolismAmsterdam UMC location Vrije UniversiteitAmsterdamthe Netherlands
| | - Quinten Waisfisz
- Department of Human GeneticsAmsterdam UMCAmsterdamthe Netherlands
| | - Judith J. M. Jans
- Department of Genetics, Section Metabolic DiagnosticsUMC UtrechtUtrechtthe Netherlands
| | | | | | - Peter M. van Hasselt
- Department of Genetics, Section Metabolic DiagnosticsUMC UtrechtUtrechtthe Netherlands
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3
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Feenstra LR, Gehring R, van Geijswijk IM, König T, Prinsen HCMT, Vandemeulebroecke K, Lammens T, Krupa A, Teske E. Evaluation of PEG-L-asparaginase in asparagine suppression and anti-drug antibody development in healthy Beagle dogs: A multi-phase preclinical study. Vet J 2022; 286:105854. [PMID: 35781075 DOI: 10.1016/j.tvjl.2022.105854] [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: 01/13/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022]
Abstract
L-asparaginase is a frequently used drug in the treatment of canine malignant lymphoma. Since production and availability of native E. coli-derived L-asparaginase are limited, PEG-L-asparaginase (PEG-ASP) is an alternative. However, recommended doses and dosing intervals are mainly empirically determined. A multi-phase clinical dose-finding study with seven healthy Beagle dogs was conducted to find the minimum effective dose and, potentially, a dosing interval for PEG-ASP in dogs. Plasma concentrations of amino acids and PEG-ASP activity were measured at various time points after administration of different doses of PEG-ASP. Anti-PEG and anti-asparaginase antibody titres were measured. Administration of 10 IU/kg PEG-ASP resulted in asparagine depletion in all dogs, albeit for various durations: for 9 days in all dogs, 15 days in five dogs, 21 days in three dogs and 29 days in one dog. Asparagine suppression occurred at PEG-ASP plasma concentrations < 25 IU/L. Subsequent administrations of a second and third dose of 20 IU/kg and 40 IU/kg PEG-ASP resulted in asparagine suppression at < 9 days in five dogs, accompanied by the development of antibodies against PEG and L-asparaginase. Two dogs with prolonged asparagine suppression after the second and third administration did not develop antibodies. Marked individual variation in the mechanism and duration of response to PEG-ASP was noted. Antibody formation against PEG-ASP was frequently observed and sometimes occurred after one injection. This study suggests that PEG-ASP doses as high as the currently used dose of 40 IU/kg might not be needed in treatment of canine malignant lymphoma.
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Affiliation(s)
- L R Feenstra
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, the Netherlands.
| | - R Gehring
- Institute for Risk Assessment Sciences, Division of Toxicology and Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - I M van Geijswijk
- Institute for Risk Assessment Sciences, Division of Toxicology and Pharmacology, Utrecht University, Utrecht, the Netherlands; Pharmacy Department, Faculty of Veterinary Medicine, Utrecht University, Utrecht, the Netherlands
| | - T König
- Diagnostics Development Department, medac GmbH, Wedel, Germany
| | - H C M T Prinsen
- Department of Genetics, section Metabolic Diagnostics, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - K Vandemeulebroecke
- Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - T Lammens
- Pediatric Hematology-Oncology and Stem Cell Transplantation, Ghent University Hospital, Ghent, Belgium; Cancer Research Institute Ghent (CRIG), Ghent, Belgium; Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
| | - A Krupa
- AniCura Veterinary Hospital Zeeuws-Vlaanderen, Terneuzen, the Netherlands
| | - E Teske
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 108, 3584 CM Utrecht, the Netherlands
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4
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Coene KLM, Timmer C, Goorden SMI, ten Hoedt AE, Kluijtmans LAJ, Janssen MCH, Rennings AJM, Prinsen HCMT, Wamelink MMC, Ruijter GJG, Körver‐Keularts IMLW, Heiner‐Fokkema MR, van Spronsen FJ, Hollak CE, Vaz FM, Bosch AM, Huigen MCDG. Monitoring phenylalanine concentrations in the follow-up of phenylketonuria patients: An inventory of pre-analytical and analytical variation. JIMD Rep 2021; 58:70-79. [PMID: 33728249 PMCID: PMC7932865 DOI: 10.1002/jmd2.12186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 02/01/2020] [Revised: 09/17/2020] [Accepted: 11/05/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Reliable measurement of phenylalanine (Phe) is a prerequisite for adequate follow-up of phenylketonuria (PKU) patients. However, previous studies have raised concerns on the intercomparability of plasma and dried blood spot (DBS) Phe results. In this study, we made an inventory of differences in (pre-)analytical methodology used for Phe determination across Dutch laboratories, and compared DBS and plasma results. METHODS Through an online questionnaire, we assessed (pre-)analytical Phe measurement procedures of seven Dutch metabolic laboratories. To investigate the difference between plasma and DBS Phe, participating laboratories received simultaneously collected plasma-DBS sets from 23 PKU patients. In parallel, 40 sample sets of DBS spotted from either venous blood or capillary fingerprick were analyzed. RESULTS Our data show that there is no consistency on standard operating procedures for Phe measurement. The association of DBS to plasma Phe concentration exhibits substantial inter-laboratory variation, ranging from a mean difference of -15.5% to +30.6% between plasma and DBS Phe concentrations. In addition, we found a mean difference of +5.8% in Phe concentration between capillary DBS and DBS prepared from venous blood. CONCLUSIONS The results of our study point to substantial (pre-)analytical variation in Phe measurements, implicating that bloodspot Phe results should be interpreted with caution, especially when no correction factor is applied. To minimize variation, we advocate pre-analytical standardization and analytical harmonization of Phe measurements, including consensus on application of a correction factor to adjust DBS Phe to plasma concentrations.
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Affiliation(s)
- Karlien L. M. Coene
- Translational Metabolic Laboratory, Department of Laboratory MedicineRadboud University Medical CentreNijmegenThe Netherlands
| | - Corrie Timmer
- Department Endocrinology and MetabolismAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Susan M. I. Goorden
- Laboratory Genetic Metabolic Diseases, Department of Clinical ChemistryAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Amber E. ten Hoedt
- Department of Paediatrics, Division of Metabolic DisordersAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Leo A. J. Kluijtmans
- Translational Metabolic Laboratory, Department of Laboratory MedicineRadboud University Medical CentreNijmegenThe Netherlands
| | - Mirian C. H. Janssen
- Department of Internal MedicineRadboud University Medical CentreNijmegenThe Netherlands
| | | | | | - Mirjam M. C. Wamelink
- Metabolic Laboratory, Department of Clinical ChemistryAmsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - George J. G. Ruijter
- Center for Lysosomal and Metabolic Diseases, Department of Clinical GeneticsErasmus MCRotterdamThe Netherlands
| | - Irene M. L. W. Körver‐Keularts
- Laboratory of Biochemical Genetics, Department of Clinical GeneticsMaastricht University Medical CentreMaastrichtThe Netherlands
| | - M. Rebecca Heiner‐Fokkema
- Laboratory of Metabolic DiseasesUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Francjan J. van Spronsen
- Division of Metabolic DiseasesBeatrix Children's Hospital, University Medical Centre GroningenGroningenThe Netherlands
| | - Carla E. Hollak
- Department Endocrinology and MetabolismAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Frédéric M. Vaz
- Laboratory Genetic Metabolic Diseases, Department of Clinical ChemistryAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Annet M. Bosch
- Department of Paediatrics, Division of Metabolic DisordersAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - Marleen C. D. G. Huigen
- Translational Metabolic Laboratory, Department of Laboratory MedicineRadboud University Medical CentreNijmegenThe Netherlands
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5
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Kerkhofs MHPM, Haijes HA, Willemsen AM, van Gassen KLI, van der Ham M, Gerrits J, de Sain-van der Velden MGM, Prinsen HCMT, van Deutekom HWM, van Hasselt PM, Verhoeven-Duif NM, Jans JJM. Cross-Omics: Integrating Genomics with Metabolomics in Clinical Diagnostics. Metabolites 2020; 10:metabo10050206. [PMID: 32443577 PMCID: PMC7281020 DOI: 10.3390/metabo10050206] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/03/2020] [Accepted: 05/15/2020] [Indexed: 11/16/2022] Open
Abstract
Next-generation sequencing and next-generation metabolic screening are, independently, increasingly applied in clinical diagnostics of inborn errors of metabolism (IEM). Integrated into a single bioinformatic method, these two –omics technologies can potentially further improve the diagnostic yield for IEM. Here, we present cross-omics: a method that uses untargeted metabolomics results of patient’s dried blood spots (DBSs), indicated by Z-scores and mapped onto human metabolic pathways, to prioritize potentially affected genes. We demonstrate the optimization of three parameters: (1) maximum distance to the primary reaction of the affected protein, (2) an extension stringency threshold reflecting in how many reactions a metabolite can participate, to be able to extend the metabolite set associated with a certain gene, and (3) a biochemical stringency threshold reflecting paired Z-score thresholds for untargeted metabolomics results. Patients with known IEMs were included. We performed untargeted metabolomics on 168 DBSs of 97 patients with 46 different disease-causing genes, and we simulated their whole-exome sequencing results in silico. We showed that for accurate prioritization of disease-causing genes in IEM, it is essential to take into account not only the primary reaction of the affected protein but a larger network of potentially affected metabolites, multiple steps away from the primary reaction.
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Affiliation(s)
- Marten H. P. M. Kerkhofs
- Section Metabolic Diagnostics, Department of Genetics, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands; (M.H.P.M.K.); (H.A.H.); (A.M.W.); (M.v.d.H.); (J.G.); (M.G.M.d.S.-v.d.V.); (H.C.M.T.P.); (N.M.V.-D.)
| | - Hanneke A. Haijes
- Section Metabolic Diagnostics, Department of Genetics, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands; (M.H.P.M.K.); (H.A.H.); (A.M.W.); (M.v.d.H.); (J.G.); (M.G.M.d.S.-v.d.V.); (H.C.M.T.P.); (N.M.V.-D.)
- Section Metabolic Diseases, Department of Child Health, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands;
| | - A. Marcel Willemsen
- Section Metabolic Diagnostics, Department of Genetics, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands; (M.H.P.M.K.); (H.A.H.); (A.M.W.); (M.v.d.H.); (J.G.); (M.G.M.d.S.-v.d.V.); (H.C.M.T.P.); (N.M.V.-D.)
| | - Koen L. I. van Gassen
- Section Genomic Diagnostics, Department of Genetics, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands; (K.L.I.v.G.); (H.W.M.v.D.)
| | - Maria van der Ham
- Section Metabolic Diagnostics, Department of Genetics, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands; (M.H.P.M.K.); (H.A.H.); (A.M.W.); (M.v.d.H.); (J.G.); (M.G.M.d.S.-v.d.V.); (H.C.M.T.P.); (N.M.V.-D.)
| | - Johan Gerrits
- Section Metabolic Diagnostics, Department of Genetics, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands; (M.H.P.M.K.); (H.A.H.); (A.M.W.); (M.v.d.H.); (J.G.); (M.G.M.d.S.-v.d.V.); (H.C.M.T.P.); (N.M.V.-D.)
| | - Monique G. M. de Sain-van der Velden
- Section Metabolic Diagnostics, Department of Genetics, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands; (M.H.P.M.K.); (H.A.H.); (A.M.W.); (M.v.d.H.); (J.G.); (M.G.M.d.S.-v.d.V.); (H.C.M.T.P.); (N.M.V.-D.)
| | - Hubertus C. M. T. Prinsen
- Section Metabolic Diagnostics, Department of Genetics, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands; (M.H.P.M.K.); (H.A.H.); (A.M.W.); (M.v.d.H.); (J.G.); (M.G.M.d.S.-v.d.V.); (H.C.M.T.P.); (N.M.V.-D.)
| | - Hanneke W. M. van Deutekom
- Section Genomic Diagnostics, Department of Genetics, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands; (K.L.I.v.G.); (H.W.M.v.D.)
| | - Peter M. van Hasselt
- Section Metabolic Diseases, Department of Child Health, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands;
| | - Nanda M. Verhoeven-Duif
- Section Metabolic Diagnostics, Department of Genetics, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands; (M.H.P.M.K.); (H.A.H.); (A.M.W.); (M.v.d.H.); (J.G.); (M.G.M.d.S.-v.d.V.); (H.C.M.T.P.); (N.M.V.-D.)
| | - Judith J. M. Jans
- Section Metabolic Diagnostics, Department of Genetics, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands; (M.H.P.M.K.); (H.A.H.); (A.M.W.); (M.v.d.H.); (J.G.); (M.G.M.d.S.-v.d.V.); (H.C.M.T.P.); (N.M.V.-D.)
- Correspondence:
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6
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van den Broek BTA, van Egmond-Ebbeling MB, Achterberg JA, Boelens JJ, Vlessert IC, Prinsen HCMT, van Doorn J, van Hasselt PM. Longitudinal Analysis of Ocular Disease in Children with Mucopolysaccharidosis I after Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2019; 26:928-935. [PMID: 31786241 DOI: 10.1016/j.bbmt.2019.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/14/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 02/07/2023]
Abstract
Corneal clouding, causing visual impairment, is seen in nearly all patients with mucopolysaccharidosis type 1 (MPS-1). Hematopoietic cell transplantation (HCT) is able to stabilize disease in many organs. Residual disease in several tissues is being increasingly recognized, however. Data on the effect of HCT on ocular disease in patients with MPS-1 are contradictory. With this study, we aim to clarify the long-term effects of HCT on ocular disease in these patients. Best corrected visual acuity (BCVA), refraction, intraocular pressure (IOP), and slit-lamp biomicroscopic and fundoscopic examinations, including corneal clouding, were collected prospectively from 24 patients with MPS-1 who underwent HCT successfully between 2003 and 2018 (92% with >95% chimerism and normal enzyme activity after HCT). The course of corneal clouding and BCVA after HCT were analyzed using a linear mixed model. Other parameters studied were clinical phenotype, age at time of transplantation, and hematologic enzyme activity after transplantation. Outcomes of additional ophthalmologic tests were described. In addition, IDUA and α-galactosidase A (AGAL) enzyme activity and glycosaminoglycan (GAG) concentration in tear fluid were determined. Corneal clouding stabilized in the first years after HCT but increased rapidly beyond 3 years (P < .0001). BCVA and IOP also worsened over time (P = .01 and P < .0001, respectively). IDUA activity in tear fluid remained very low (P < .0001). After initial stabilization in the cornea, ongoing ocular disease and low IDUA activity in tear fluid is seen in patients with MPS-1 despite treatment with HCT, unveiling a weak spot of current standard therapy. New therapies that overcome these shortcomings are needed to improve the late outcomes of patients.
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Affiliation(s)
- Brigitte T A van den Broek
- Sylvia Toth Center for Multidisciplinary Follow-Up after Hematopoietic Cell Transplantation, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Section Metabolic Diseases, Department of Child Health, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Michelle B van Egmond-Ebbeling
- Sylvia Toth Center for Multidisciplinary Follow-Up after Hematopoietic Cell Transplantation, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Jens A Achterberg
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jaap Jan Boelens
- Sylvia Toth Center for Multidisciplinary Follow-Up after Hematopoietic Cell Transplantation, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Pediatric Blood and Marrow Transplantation Program, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Isa C Vlessert
- Section of Metabolic Diagnostics, Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hubertus C M T Prinsen
- Section of Metabolic Diagnostics, Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jaap van Doorn
- Section of Metabolic Diagnostics, Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter M van Hasselt
- Sylvia Toth Center for Multidisciplinary Follow-Up after Hematopoietic Cell Transplantation, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Section Metabolic Diseases, Department of Child Health, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
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7
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Haijes HA, de Sain-van der Velden MGM, Prinsen HCMT, Willems AP, van der Ham M, Gerrits J, Couse MH, Friedman JM, van Karnebeek CDM, Selby KA, van Hasselt PM, Verhoeven-Duif NM, Jans JJM. Aspartylglycosamine is a biomarker for NGLY1-CDDG, a congenital disorder of deglycosylation. Mol Genet Metab 2019; 127:368-372. [PMID: 31311714 DOI: 10.1016/j.ymgme.2019.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 05/13/2019] [Revised: 07/01/2019] [Accepted: 07/01/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND NGLY1-CDDG is a congenital disorder of deglycosylation caused by a defective peptide:N-glycanase (PNG). To date, all but one of the reported patients have been diagnosed through whole-exome or whole-genome sequencing, as no biochemical marker was available to identify this disease in patients. Recently, a potential urinary biomarker was reported, but the data presented suggest that this marker may be excreted intermittently. METHODS In this study, we performed untargeted direct-infusion high-resolution mass spectrometry metabolomics in seven dried blood spots (DBS) from four recently diagnosed NGLY1-CDDG patients, to test for small-molecule biomarkers, in order to identify a potential diagnostic marker. Results were compared to 125 DBS of healthy controls and to 238 DBS of patients with other diseases. RESULTS We identified aspartylglycosamine as the only significantly increased compound with a median Z-score of 4.8 (range: 3.8-8.5) in DBS of NGLY1-CDDG patients, compared to a median Z-score of -0.1 (range: -2.1-4.0) in DBS of healthy controls and patients with other diseases. DISCUSSION The increase of aspartylglycosamine can be explained by lack of function of PNG. PNG catalyzes the cleavage of the proximal N-acetylglucosamine residue of an N-glycan from the asparagine residue of a protein, a step in the degradation of misfolded glycoproteins. PNG deficiency results in a single N-acetylglucosamine residue left attached to the asparagine residue which results in free aspartylglycosamine when the glycoprotein is degraded. Thus, we here identified aspartylglycosamine as the first potential small-molecule biomarker in DBS for NGLY1-CDDG, making a biochemical diagnosis for NGLY1-CDDG potentially feasible.
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Affiliation(s)
- Hanneke A Haijes
- Section Metabolic Diagnostics, Department of Genetics, Utrecht University, University Medical Centre Utrecht, Lundlaan 6, 3584 EA Utrecht, the Netherlands; Section Metabolic Diseases, Department of Child Health, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, the Netherlands.
| | - Monique G M de Sain-van der Velden
- Section Metabolic Diagnostics, Department of Genetics, Utrecht University, University Medical Centre Utrecht, Lundlaan 6, 3584 EA Utrecht, the Netherlands
| | - Hubertus C M T Prinsen
- Section Metabolic Diagnostics, Department of Genetics, Utrecht University, University Medical Centre Utrecht, Lundlaan 6, 3584 EA Utrecht, the Netherlands
| | - Anke P Willems
- Section Metabolic Diagnostics, Department of Genetics, Utrecht University, University Medical Centre Utrecht, Lundlaan 6, 3584 EA Utrecht, the Netherlands
| | - Maria van der Ham
- Section Metabolic Diagnostics, Department of Genetics, Utrecht University, University Medical Centre Utrecht, Lundlaan 6, 3584 EA Utrecht, the Netherlands
| | - Johan Gerrits
- Section Metabolic Diagnostics, Department of Genetics, Utrecht University, University Medical Centre Utrecht, Lundlaan 6, 3584 EA Utrecht, the Netherlands
| | - Madeline H Couse
- Medical Genetics Research Unit,Children's and Women's Hospital, University of British Columbia Department of Medical Genetics, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
| | - Jan M Friedman
- Medical Genetics Research Unit,Children's and Women's Hospital, University of British Columbia Department of Medical Genetics, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
| | - Clara D M van Karnebeek
- Departments of Pediatrics and Clinical Genetics, Emma Children's Hospital, University of Amsterdam, Amsterdam University Medical Centers, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Department of Pediatrics, Children's and Women's Hospital, University of British Columbia, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada; Centre for Molecular Medicine and Therapeutics, BC Children's Research Institute, University of British Columbia, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
| | - Kathryn A Selby
- Department of Pediatrics, Children's and Women's Hospital, University of British Columbia, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
| | - Peter M van Hasselt
- Section Metabolic Diseases, Department of Child Health, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, the Netherlands
| | - Nanda M Verhoeven-Duif
- Section Metabolic Diagnostics, Department of Genetics, Utrecht University, University Medical Centre Utrecht, Lundlaan 6, 3584 EA Utrecht, the Netherlands
| | - Judith J M Jans
- Section Metabolic Diagnostics, Department of Genetics, Utrecht University, University Medical Centre Utrecht, Lundlaan 6, 3584 EA Utrecht, the Netherlands.
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Haijes HA, van der Ham M, Gerrits J, van Hasselt PM, Prinsen HCMT, de Sain-van der Velden MGM, Verhoeven-Duif NM, Jans JJM. Direct-infusion based metabolomics unveils biochemical profiles of inborn errors of metabolism in cerebrospinal fluid. Mol Genet Metab 2019; 127:51-57. [PMID: 30926434 DOI: 10.1016/j.ymgme.2019.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 01/11/2019] [Revised: 03/11/2019] [Accepted: 03/14/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND For inborn errors of metabolism (IEM), metabolomics is performed for three main purposes: 1) development of next generation metabolic screening platforms, 2) identification of new biomarkers in predefined patient cohorts and 3) for identification of new IEM. To date, plasma, urine and dried blood spots are used. We anticipate that cerebrospinal fluid (CSF) holds additional - valuable - information, especially for IEM with neurological involvement. To expand metabolomics to CSF, we here tested whether direct-infusion high-resolution mass spectrometry (DI-HRMS) based non-quantitative metabolomics could correctly capture the biochemical profile of patients with an IEM in CSF. METHODS Eleven patient samples, harboring eight different IEM, and thirty control samples were analyzed using DI-HRMS. First we assessed whether the biochemical profile of the control samples represented the expected profile in CSF. Next, each patient sample was assigned a 'most probable diagnosis' by an investigator blinded for the known diagnoses of the patients. RESULTS the biochemical profile identified using DI-HRMS in CSF samples resembled the known profile, with - among others - the highest median intensities for mass peaks annotated with glucose, lactic acid, citric acid and glutamine. Subsequent analysis of patient CSF profiles resulted in correct 'most probable diagnoses' for all eleven patients, including non-ketotic hyperglycinaemia, propionic aciduria, purine nucleoside phosphorylase deficiency, argininosuccinic aciduria, tyrosinaemia type I, hyperphenylalaninemia and hypermethioninaemia. CONCLUSION We here demonstrate that DI-HRMS based non-quantitative metabolomics accurately captures the biochemical profile of this set of patients in CSF, opening new ways for using metabolomics in CSF in the metabolic diagnostic laboratory.
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Affiliation(s)
- Hanneke A Haijes
- Section Metabolic Diagnostics, Department of Biomedical Genetics, Centre for Molecular Medicine, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands; Section Metabolic Diseases, Department of Child Health, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Maria van der Ham
- Section Metabolic Diagnostics, Department of Biomedical Genetics, Centre for Molecular Medicine, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Johan Gerrits
- Section Metabolic Diagnostics, Department of Biomedical Genetics, Centre for Molecular Medicine, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Peter M van Hasselt
- Section Metabolic Diseases, Department of Child Health, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Hubertus C M T Prinsen
- Section Metabolic Diagnostics, Department of Biomedical Genetics, Centre for Molecular Medicine, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Monique G M de Sain-van der Velden
- Section Metabolic Diagnostics, Department of Biomedical Genetics, Centre for Molecular Medicine, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Nanda M Verhoeven-Duif
- Section Metabolic Diagnostics, Department of Biomedical Genetics, Centre for Molecular Medicine, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Judith J M Jans
- Section Metabolic Diagnostics, Department of Biomedical Genetics, Centre for Molecular Medicine, University Medical Centre Utrecht, Utrecht University, Lundlaan 6, 3584 EA Utrecht, The Netherlands.
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9
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Rumping L, Büttner B, Maier O, Rehmann H, Lequin M, Schlump JU, Schmitt B, Schiebergen-Bronkhorst B, Prinsen HCMT, Losa M, Fingerhut R, Lemke JR, Zwartkruis FJT, Houwen RHJ, Jans JJM, Verhoeven-Duif NM, van Hasselt PM, Jamra R. Identification of a Loss-of-Function Mutation in the Context of Glutaminase Deficiency and Neonatal Epileptic Encephalopathy. JAMA Neurol 2019; 76:342-350. [PMID: 30575854 PMCID: PMC6439720 DOI: 10.1001/jamaneurol.2018.2941] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/06/2018] [Indexed: 01/01/2023]
Abstract
Importance The identification and understanding of the monogenic causes of neurodevelopmental disorders are of high importance for personalized treatment and genetic counseling. Objective To identify and characterize novel genes for a specific neurodevelopmental disorder characterized by refractory seizures, respiratory failure, brain abnormalities, and death in the neonatal period; describe the outcome of glutaminase deficiency in humans; and understand the underlying pathological mechanisms. Design, Setting, and Participants We performed exome sequencing of cases of neurodevelopmental disorders without a clear genetic diagnosis, followed by genetic and bioinformatic evaluation of candidate variants and genes. Establishing pathogenicity of the variants was achieved by measuring metabolites in dried blood spots by a hydrophilic interaction liquid chromatography method coupled with tandem mass spectrometry. The participants are 2 families with a total of 4 children who each had lethal, therapy-refractory early neonatal seizures with status epilepticus and suppression bursts, respiratory insufficiency, simplified gyral structures, diffuse volume loss of the brain, and cerebral edema. Data analysis occurred from October 2017 to June 2018. Main Outcomes and Measures Early neonatal epileptic encephalopathy with glutaminase deficiency and lethal outcome. Results A total of 4 infants from 2 unrelated families, each of whom died less than 40 days after birth, were included. We identified a homozygous frameshift variant p.(Asp232Glufs*2) in GLS in the first family, as well as compound heterozygous variants p.(Gln81*) and p.(Arg272Lys) in GLS in the second family. The GLS gene encodes glutaminase (Enzyme Commission 3.5.1.2), which plays a major role in the conversion of glutamine into glutamate, the main excitatory neurotransmitter of the central nervous system. All 3 variants probably lead to a loss of function and thus glutaminase deficiency. Indeed, glutamine was increased in affected children (available z scores, 3.2 and 11.7). We theorize that the potential reduction of glutamate and the excess of glutamine were a probable cause of the described physiological and structural abnormalities of the central nervous system. Conclusions and Relevance We identified a novel autosomal recessive neurometabolic disorder of loss of function of glutaminase that leads to lethal early neonatal encephalopathy. This inborn error of metabolism underlines the importance of GLS for appropriate glutamine homeostasis and respiratory regulation, signal transduction, and survival.
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Affiliation(s)
- Lynne Rumping
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Pediatrics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Benjamin Büttner
- Institute of Human Genetics, University Medical Center Leipzig, Leipzig, Germany
| | - Oliver Maier
- Department of Neuropediatrics, Development and Rehabilitation, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Holger Rehmann
- Center for Molecular Medicine, Department of Molecular Cancer Research, University Medical Center Utrecht, Utrecht, the Netherlands
- Oncode Institute, Utrecht, the Netherlands
- Expertise Centre for Structural Biology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Maarten Lequin
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jan-Ulrich Schlump
- Division for Children and Adolescents, Evangelical Hospital Oberhausen, Oberhausen, Germany
| | - Bernhard Schmitt
- Department of Child Neurology, University Children's Hospital, Zurich, Switzerland
| | | | - Hubertus C. M. T. Prinsen
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Michele Losa
- Department of Pediatric Intensive Care and Neonatology, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Ralph Fingerhut
- Swiss Newborn Screening Laboratory and Children`s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Johannes R. Lemke
- Institute of Human Genetics, University Medical Center Leipzig, Leipzig, Germany
| | - Fried J. T. Zwartkruis
- Center for Molecular Medicine, Department of Molecular Cancer Research, University Medical Center Utrecht, Utrecht, the Netherlands
- Oncode Institute, Utrecht, the Netherlands
| | - Roderick H. J. Houwen
- Department of Pediatrics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Judith J. M. Jans
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nanda M. Verhoeven-Duif
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Peter M. van Hasselt
- Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Rami Jamra
- Institute of Human Genetics, University Medical Center Leipzig, Leipzig, Germany
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10
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Rumping L, Tessadori F, Pouwels PJW, Vringer E, Wijnen JP, Bhogal AA, Savelberg SMC, Duran KJ, Bakkers MJG, Ramos RJJ, Schellekens PAW, Kroes HY, Klomp DWJ, Black GCM, Taylor RL, Bakkers JPW, Prinsen HCMT, van der Knaap MS, Dansen TB, Rehmann H, Zwartkruis FJT, Houwen RHJ, van Haaften G, Verhoeven-Duif NM, Jans JJM, van Hasselt PM. GLS hyperactivity causes glutamate excess, infantile cataract and profound developmental delay. Hum Mol Genet 2018; 28:96-104. [DOI: 10.1093/hmg/ddy330] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/12/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
Loss-of-function mutations in glutaminase (GLS), the enzyme converting glutamine into glutamate, and the counteracting enzyme glutamine synthetase (GS) cause disturbed glutamate homeostasis and severe neonatal encephalopathy. We report a de novo Ser482Cys gain-of-function variant in GLS encoding GLS associated with profound developmental delay and infantile cataract. Functional analysis demonstrated that this variant causes hyperactivity and compensatory downregulation of GLS expression combined with upregulation of the counteracting enzyme GS, supporting pathogenicity. Ser482Cys-GLS likely improves the electrostatic environment of the GLS catalytic site, thereby intrinsically inducing hyperactivity. Alignment of +/−12.000 GLS protein sequences from >1000 genera revealed extreme conservation of Ser482 to the same degree as catalytic residues. Together with the hyperactivity, this indicates that Ser482 is evolutionarily preserved to achieve optimal—but submaximal—GLS activity. In line with GLS hyperactivity, increased glutamate and decreased glutamine concentrations were measured in urine and fibroblasts. In the brain (both grey and white matter), glutamate was also extremely high and glutamine was almost undetectable, demonstrated with magnetic resonance spectroscopic imaging at clinical field strength and subsequently supported at ultra-high field strength. Considering the neurotoxicity of glutamate when present in excess, the strikingly high glutamate concentrations measured in the brain provide an explanation for the developmental delay. Cataract, a known consequence of oxidative stress, was evoked in zebrafish expressing the hypermorphic Ser482Cys-GLS and could be alleviated by inhibition of GLS. The capacity to detoxify reactive oxygen species was reduced upon Ser482Cys-GLS expression, providing an explanation for cataract formation. In conclusion, we describe an inborn error of glutamate metabolism caused by a GLS hyperactivity variant, illustrating the importance of balanced GLS activity.
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Affiliation(s)
- Lynne Rumping
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
- Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
- Department of Pediatrics, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
| | - Federico Tessadori
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
- Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
- Hubrecht Institute-KNAW, University Medical Center Utrecht, Utrecht University, Utrecht CT, The Netherlands
| | - Petra J W Pouwels
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam HV, The Netherlands
| | - Esmee Vringer
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
| | - Jannie P Wijnen
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
| | - Alex A Bhogal
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
| | - Sanne M C Savelberg
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
| | - Karen J Duran
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
| | - Mark J G Bakkers
- Department of Microbiology and Immunobiology, Harvard Medical School, Boston MA, USA
| | - Rúben J J Ramos
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
- Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
| | - Peter A W Schellekens
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
| | - Hester Y Kroes
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
| | - Dennis W J Klomp
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
| | - Graeme C M Black
- Division of Evolution and Genomic Sciences, The University of Manchester, Manchester M139WL, UK
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester M139WL, UK
| | - Rachel L Taylor
- Division of Evolution and Genomic Sciences, The University of Manchester, Manchester M139WL, UK
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester M139WL, UK
| | - Jeroen P W Bakkers
- Hubrecht Institute-KNAW, University Medical Center Utrecht, Utrecht University, Utrecht CT, The Netherlands
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
| | - Hubertus C M T Prinsen
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
| | - Marjo S van der Knaap
- Department of Child Neurology, VU University Medical Center, Amsterdam HV, The Netherlands
| | - Tobias B Dansen
- Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
- Molecular Cancer Research, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
| | - Holger Rehmann
- Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
- Molecular Cancer Research, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
| | - Fried J T Zwartkruis
- Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
- Molecular Cancer Research, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
| | - Roderick H J Houwen
- Department of Pediatrics, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
| | - Gijs van Haaften
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
- Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
| | - Nanda M Verhoeven-Duif
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
- Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
| | - Judith J M Jans
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
- Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
| | - Peter M van Hasselt
- Department of Pediatrics, University Medical Center Utrecht, Utrecht University, Utrecht CX, The Netherlands
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11
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de Sain-van der Velden MGM, Kuper WFE, Kuijper MA, van Kats LAT, Prinsen HCMT, Balemans ACJ, Visser G, van Gassen KLI, van Hasselt PM. Beneficial Effect of BH 4 Treatment in a 15-Year-Old Boy with Biallelic Mutations in DNAJC12. JIMD Rep 2018; 42:99-103. [PMID: 29380259 DOI: 10.1007/8904_2017_86] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 10/10/2017] [Revised: 11/30/2017] [Accepted: 12/12/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Biallelic mutations in DNAJC12 were recently identified as a BH4-responsive cause of hyperphenylalaninemia (HPA). Outcome was only favorable when treatment was initiated early in life. We report on a 15-year-old boy with HPA due to a homozygous deletion in DNAJC12 in whom - despite his advanced age - treatment was initiated. CASE A boy with developmental delay, an extrapyramidal movement disorder, and persistently elevated plasma phenylalanine levels was diagnosed with DNAJC12 deficiency at the age of 15 years. Diagnosis was made upon exome reanalysis revealing a homozygous 6.9 kb deletion in DNAJC12 which had not been detected by the standard exome analysis pipeline. Treatment with the BH4 analog sapropterin dihydrochloride (10 mg/kg/day) was initiated and evoked a 50% reduction of the plasma phenylalanine levels. More strikingly, a marked improvement in daily functioning and improved exercise tolerance was noted. Additionally, gait analysis before and after treatment initiation revealed a partial normalization of his movement disorder. CONCLUSION Patients with hyperphenylalaninemia due to DNAJC12 deficiency may benefit from treatment with a BH4 analog - even when introduced at a later age.
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Affiliation(s)
| | - Willemijn F E Kuper
- Department of Metabolic Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marie-Anne Kuijper
- Centre of Excellence for Rehabilitation Medicine Utrecht, Rehabilitation Centre De Hoogstraat, Utrecht, The Netherlands
| | - Lenneke A T van Kats
- Centre of Excellence for Rehabilitation Medicine Utrecht, Rehabilitation Centre De Hoogstraat, Utrecht, The Netherlands
| | - Hubertus C M T Prinsen
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Astrid C J Balemans
- Centre of Excellence for Rehabilitation Medicine Utrecht, Rehabilitation Centre De Hoogstraat, Utrecht, The Netherlands.,Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Gepke Visser
- Department of Metabolic Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Koen L I van Gassen
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Peter M van Hasselt
- Department of Metabolic Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
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12
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Massafra V, Milona A, Vos HR, Ramos RJJ, Gerrits J, Willemsen ECL, Ramos Pittol JM, Ijssennagger N, Houweling M, Prinsen HCMT, Verhoeven-Duif NM, Burgering BMT, van Mil SWC. Farnesoid X Receptor Activation Promotes Hepatic Amino Acid Catabolism and Ammonium Clearance in Mice. Gastroenterology 2017; 152:1462-1476.e10. [PMID: 28130067 DOI: 10.1053/j.gastro.2017.01.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 03/29/2016] [Revised: 01/09/2017] [Accepted: 01/17/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS The nuclear receptor subfamily 1 group H member 4 (NR1H4 or farnesoid X receptor [FXR]) regulates bile acid synthesis, transport, and catabolism. FXR also regulates postprandial lipid and glucose metabolism. We performed quantitative proteomic analyses of liver tissues from mice to evaluate these functions and investigate whether FXR regulates amino acid metabolism. METHODS To study the role of FXR in mouse liver, we used mice with a disruption of Nr1h4 (FXR-knockout mice) and compared them with floxed control mice. Mice were gavaged with the FXR agonist obeticholic acid or vehicle for 11 days. Proteome analyses, as well as targeted metabolomics and chromatin immunoprecipitation, were performed on the livers of these mice. Primary rat hepatocytes were used to validate the role of FXR in amino acid catabolism by gene expression and metabolomics studies. Finally, control mice and mice with liver-specific disruption of Nr1h4 (liver FXR-knockout mice) were re-fed with a high-protein diet after 6 hours fasting and gavaged a 15NH4Cl tracer. Gene expression and the metabolome were studied in the livers and plasma from these mice. RESULTS In livers of control mice and primary rat hepatocytes, activation of FXR with obeticholic acid increased expression of proteins that regulate amino acid degradation, ureagenesis, and glutamine synthesis. We found FXR to bind to regulatory sites of genes encoding these proteins in control livers. Liver tissues from FXR-knockout mice had reduced expression of urea cycle proteins, and accumulated precursors of ureagenesis, compared with control mice. In liver FXR-knockout mice on a high-protein diet, the plasma concentration of newly formed urea was significantly decreased compared with controls. In addition, liver FXR-knockout mice had reduced hepatic expression of enzymes that regulate ammonium detoxification compared with controls. In contrast, obeticholic acid increased expression of genes encoding enzymes involved in ureagenesis compared with vehicle in C57Bl/6 mice. CONCLUSIONS In livers of mice, FXR regulates amino acid catabolism and detoxification of ammonium via ureagenesis and glutamine synthesis. Failure of the urea cycle and hyperammonemia are common in patients with acute and chronic liver diseases; compounds that activate FXR might promote ammonium clearance in these patients.
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Affiliation(s)
- Vittoria Massafra
- Center for Molecular Medicine, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Alexandra Milona
- Center for Molecular Medicine, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Harmjan R Vos
- Center for Molecular Medicine, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Rúben J J Ramos
- Department of Genetics, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Johan Gerrits
- Center for Molecular Medicine, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands; Department of Genetics, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Ellen C L Willemsen
- Center for Molecular Medicine, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - José M Ramos Pittol
- Center for Molecular Medicine, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Noortje Ijssennagger
- Center for Molecular Medicine, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Martin Houweling
- Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
| | | | - Nanda M Verhoeven-Duif
- Center for Molecular Medicine, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands; Department of Genetics, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Boudewijn M T Burgering
- Center for Molecular Medicine, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Saskia W C van Mil
- Center for Molecular Medicine, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands.
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13
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Prinsen HCMT, Schiebergen-Bronkhorst BGM, Roeleveld MW, Jans JJM, de Sain-van der Velden MGM, Visser G, van Hasselt PM, Verhoeven-Duif NM. Rapid quantification of underivatized amino acids in plasma by hydrophilic interaction liquid chromatography (HILIC) coupled with tandem mass-spectrometry. J Inherit Metab Dis 2016; 39:651-660. [PMID: 27099181 PMCID: PMC4987396 DOI: 10.1007/s10545-016-9935-z] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/30/2016] [Accepted: 04/04/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND Amino acidopathies are a class of inborn errors of metabolism (IEM) that can be diagnosed by analysis of amino acids (AA) in plasma. Current strategies for AA analysis include cation exchange HPLC with post-column ninhydrin derivatization, GC-MS, and LC-MS/MS-related methods. Major drawbacks of the current methods are time-consuming procedures, derivative problems, problems with retention, and MS-sensitivity. The use of hydrophilic interaction liquid chromatography (HILIC) columns is an ideal separation mode for hydrophilic compounds like AA. Here we report a HILIC-method for analysis of 36 underivatized AA in plasma to detect defects in AA metabolism that overcomes the major drawbacks of other methods. METHODS A rapid, sensitive, and specific method was developed for the analysis of AA in plasma without derivatization using HILIC coupled with tandem mass-spectrometry (Xevo TQ, Waters). RESULTS Excellent separation of 36 AA (24 quantitative/12 qualitative) in plasma was achieved on an Acquity BEH Amide column (2.1×100 mm, 1.7 μm) in a single MS run of 18 min. Plasma of patients with a known IEM in AA metabolism was analyzed and all patients were correctly identified. CONCLUSION The reported method analyzes 36 AA in plasma within 18 min and provides baseline separation of isomeric AA such as leucine and isoleucine. No separation was obtained for isoleucine and allo-isoleucine. The method is applicable to study defects in AA metabolism in plasma.
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Affiliation(s)
- Hubertus C M T Prinsen
- Section Metabolic Diagnostics, Department of Genetics, University Medical Center (UMC) Utrecht, KC.02.069.1, Lundlaan 6, 3584 EA, Utrecht, The Netherlands.
| | - B G M Schiebergen-Bronkhorst
- Section Metabolic Diagnostics, Department of Genetics, University Medical Center (UMC) Utrecht, KC.02.069.1, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - M W Roeleveld
- Section Metabolic Diagnostics, Department of Genetics, University Medical Center (UMC) Utrecht, KC.02.069.1, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - J J M Jans
- Section Metabolic Diagnostics, Department of Genetics, University Medical Center (UMC) Utrecht, KC.02.069.1, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - M G M de Sain-van der Velden
- Section Metabolic Diagnostics, Department of Genetics, University Medical Center (UMC) Utrecht, KC.02.069.1, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - G Visser
- Department of Metabolic Diseases, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
| | - P M van Hasselt
- Department of Metabolic Diseases, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
| | - N M Verhoeven-Duif
- Section Metabolic Diagnostics, Department of Genetics, University Medical Center (UMC) Utrecht, KC.02.069.1, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
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de Sain-van der Velden MGM, van der Ham M, Jans JJ, Visser G, Prinsen HCMT, Verhoeven-Duif NM, van Gassen KLI, van Hasselt PM. A New Approach for Fast Metabolic Diagnostics in CMAMMA. JIMD Rep 2016; 30:15-22. [PMID: 26915364 PMCID: PMC5110436 DOI: 10.1007/8904_2016_531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 12/09/2015] [Accepted: 12/17/2015] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The presence of increased urinary concentrations of both methylmalonic acid (MMA) and malonic acid (MA) is assumed to differentiate combined malonic and methylmalonic aciduria (CMAMMA), due to mutations in the ACSF3 gene, from other causes of methylmalonic aciduria (classic MMAemia). Detection of MA in urine, however, is challenging since excretion of MA can be easily missed. The objective of the study was to develop a method for quantification of MA in plasma to allow differentiation between CMAMMA and classic MMAemia. METHODS Compound heterozygosity for mutations in the ACSF3 gene was detected in two female siblings using diagnostic exome sequencing. Urine (MMA and MA) was analyzed with GC/MS, while plasma was analyzed with UPLC-MS/MS. MA/MMA ratios were calculated. RESULTS Both patients had a severe psychiatric presentation (at the age of 6 years and 5.5 years, respectively) after a viral infection. MA excretion in the patients was only just above the highest control value in several samples. MA concentrations in plasma from the two patients were clearly above the highest value observed in control subjects. However, MA concentrations in plasma from patients with classic MMAemia were also elevated. Additional, calculation of MA/MMA ratio in plasma allowed to fully differentiate between CMAMMA and classic MMAemia. CONCLUSIONS Calculating the MA/MMA ratio in plasma allows differentiation between CMAMMA and classic MMAemia. The full clinical spectrum of CMAMMA remains to be delineated.
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Affiliation(s)
| | - Maria van der Ham
- Department of Medical Genetics, UMC Utrecht, 85090, 3508AB, Utrecht, The Netherlands
| | - Judith J Jans
- Department of Medical Genetics, UMC Utrecht, 85090, 3508AB, Utrecht, The Netherlands
| | - Gepke Visser
- Department of Pediatric Gastroenterology and Metabolic Diseases, University Medical Centre (UMC) Utrecht, Utrecht, The Netherlands
| | | | | | - Koen L I van Gassen
- Department of Medical Genetics, UMC Utrecht, 85090, 3508AB, Utrecht, The Netherlands
| | - Peter M van Hasselt
- Department of Pediatric Gastroenterology and Metabolic Diseases, University Medical Centre (UMC) Utrecht, Utrecht, The Netherlands
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De Sain-Van der Velden MGM, Jans JJ, Figee M, Engelen M, Prinsen HCMT, Verhoeven-Duif NM, van Kuilenburg ABP, Visser G, Vinkers CH. [Metabolic diseases in psychiatry]. Tijdschr Psychiatr 2016; 58:402-406. [PMID: 27213640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Metabolic diseases can be associated with psychiatric symptoms. We present two case histories that demonstrate the importance of correctly diagnosing a metabolic disease as being the cause of psychiatric symptoms. We also discuss which symptoms or signals may indicate a metabolic disease.
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Rymen D, Winter J, Van Hasselt PM, Jaeken J, Kasapkara C, Gokçay G, Haijes H, Goyens P, Tokatli A, Thiel C, Bartsch O, Hecht J, Krawitz P, Prinsen HCMT, Mildenberger E, Matthijs G, Kornak U. Key features and clinical variability of COG6-CDG. Mol Genet Metab 2015; 116:163-70. [PMID: 26260076 DOI: 10.1016/j.ymgme.2015.07.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [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: 05/09/2015] [Revised: 07/09/2015] [Accepted: 07/09/2015] [Indexed: 11/26/2022]
Abstract
The conserved oligomeric Golgi (COG) complex consists of eight subunits and plays a crucial role in Golgi trafficking and positioning of glycosylation enzymes. Mutations in all COG subunits, except subunit 3, have been detected in patients with congenital disorders of glycosylation (CDG) of variable severity. So far, 3 families with a total of 10 individuals with biallelic COG6 mutations have been described, showing a broad clinical spectrum. Here we present 7 additional patients with 4 novel COG6 mutations. In spite of clinical variability, we delineate the core features of COG6-CDG i.e. liver involvement (9/10), microcephaly (8/10), developmental disability (8/10), recurrent infections (7/10), early lethality (6/10), and hypohidrosis predisposing for hyperthermia (6/10) and hyperkeratosis (4/10) as ectodermal signs. Regarding all COG6-related disorders a genotype-phenotype correlation can be discerned ranging from deep intronic mutations found in Shaheen syndrome as the mildest form to loss-of-function mutations leading to early lethal CDG phenotypes. A comparison with other COG deficiencies suggests ectodermal changes to be a hallmark of COG6-related disorders. Our findings aid clinical differentiation of this complex group of disorders and imply subtle functional differences between the COG complex subunits.
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Affiliation(s)
- Daisy Rymen
- Center for Human Genetics, University of Leuven, Leuven, Belgium; Center for Metabolic Diseases, University Hospital Gasthuisberg, Leuven, Belgium
| | - Julia Winter
- Neonatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Peter M Van Hasselt
- Department of Metabolic Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jaak Jaeken
- Center for Metabolic Diseases, University Hospital Gasthuisberg, Leuven, Belgium
| | - Cigdem Kasapkara
- Department of Pediatric Metabolism and Nutrition, Dr. Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey
| | - Gulden Gokçay
- Department of Pediatric Nutrition and Metabolism, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hanneke Haijes
- Department of Metabolic Diseases, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Philippe Goyens
- University Children's Hospital Queen Fabiola, Brussels, Belgium
| | - Aysegul Tokatli
- Division of Metabolism and Nutrition, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Christian Thiel
- Center for Child and Adolescent Medicine, Heidelberg, Germany
| | - Oliver Bartsch
- Institute of Human Genetics, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Jochen Hecht
- Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Peter Krawitz
- Institute of Medical Genetics and Human Genetics, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Hubertus C M T Prinsen
- Department of Medical Genetics, UMC Utrecht, Section Metabolic Diagnostics, Utrecht, The Netherlands
| | - Eva Mildenberger
- Neonatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Gert Matthijs
- Center for Human Genetics, University of Leuven, Leuven, Belgium
| | - Uwe Kornak
- Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitaetsmedizin Berlin, Berlin, Germany; Institute of Medical Genetics and Human Genetics, Charité-Universitaetsmedizin Berlin, Berlin, Germany; Max Planck Institute for Molecular Genetics, Berlin, Germany.
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Haijes H, Prinsen HCMT, Thiel C, Koerner C, Verhoeven-Duif NM, van Hasselt PM. Expanding the clinical phenotype of COG6 deficiency. J Med Genet 2014; 51:425. [DOI: 10.1136/jmedgenet-2014-102329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Bendadi F, de Koning TJ, Visser G, Prinsen HCMT, de Sain MGM, Verhoeven-Duif N, Sinnema G, van Spronsen FJ, van Hasselt PM. Impaired cognitive functioning in patients with tyrosinemia type I receiving nitisinone. J Pediatr 2014; 164:398-401. [PMID: 24238861 DOI: 10.1016/j.jpeds.2013.10.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [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: 02/03/2012] [Revised: 07/08/2013] [Accepted: 10/01/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine cognitive functioning in patients with tyrosinemia type I treated with nitisinone and a protein-restricted diet. STUDY DESIGN We performed a cross-sectional study to establish cognitive functioning in children with tyrosinemia type I compared with their unaffected siblings. Intelligence was measured using age-appropriate Wechsler Scales. To assess cognitive development over time, we retrieved sequential IQ scores in a single-center subset of patients. We also evaluated whether plasma phenylalanine and tyrosine levels during treatment was correlated with cognitive development. RESULTS Average total IQ score in 10 patients with tyrosinemia type I receiving nitisinone was significantly lower compared with their unaffected siblings (71 ± 13 vs 91 ± 13; P = .008). Both verbal and performance IQ subscores differed (77 ± 14 vs 95 ± 11; P < .05 and 70 ± 11 vs 87 ± 15; P < .05, respectively). Repeated IQ measurements in a single-center subset of 5 patients revealed a decline in average IQ score over time, from 96 ± 15 to 69 ± 11 (P < .001). No significant association was found between IQ score and either plasma tyrosine or phenylalanine concentration. CONCLUSION Patients with tyrosinemia type I treated with nitisinone are at risk for impaired cognitive function despite a protein-restricted diet.
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Affiliation(s)
- Fatiha Bendadi
- Department of Metabolic Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tom J de Koning
- Department of Metabolic Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gepke Visser
- Department of Metabolic Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hubertus C M T Prinsen
- Department of Medical Genetics, Section Metabolic Diagnostics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Monique G M de Sain
- Department of Medical Genetics, Section Metabolic Diagnostics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nanda Verhoeven-Duif
- Department of Medical Genetics, Section Metabolic Diagnostics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gerben Sinnema
- Department of Pediatric Psychology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Francjan J van Spronsen
- Division of Metabolic Diseases, Beatrix Children's Hospital, University Medical Center of Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter M van Hasselt
- Department of Metabolic Diseases, University Medical Center Utrecht, Utrecht, The Netherlands.
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Twickler TB, Prinsen HCMT, de Vries WR, Koppeschaar HPF, de Sain-Van Der Velden MGM. Analysis of the separate secretion of very low-density lipoprotein (VLDL)-1 and VLDL-2 by the liver will be a principal factor in resolving the proatherogenic lipoprotein profile in hypopituitarism. J Clin Endocrinol Metab 2002; 87:1907; author reply 1907. [PMID: 11932341 DOI: 10.1210/jcem.87.4.8370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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