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Turki A, Stockler S, Sirrs S, Duddy K, Ho G, Elango R. Impact of hematopoietic stem cell transplantation in glycogen storage disease type Ib: A single-subject research design using 13C-glucose breath test. Mol Genet Metab Rep 2023; 34:100955. [PMID: 36632325 PMCID: PMC9826966 DOI: 10.1016/j.ymgmr.2023.100955] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 01/01/2023] [Indexed: 01/04/2023] Open
Abstract
Background Glycogen storage disease type Ib (GSD Ib) is an autosomal recessively inherited deficiency of the glucose-6-phosphate translocase (G6PT). Clinical features include a combination of a metabolic phenotype (fasting hypoglycemia, lactic acidosis, hepatomegaly) and a hematologic phenotype with neutropenia and neutrophil dysfunction. Dietary treatment involves provision of starches such as uncooked cornstarch (UCCS) and Glycosade® to provide prolonged enteral supply of glucose. Granulocyte colony-stimulating factor (G-CSF) is the treatment of choice for neutropenia. Because long-term stimulation of hematopoiesis with G-CSF causes serious complications such as splenomegaly, hypersplenism, and osteopenia; hematopoietic stem cell transplantation (HSCT) has been considered in some patients with GSD Ib to correct neutropenia and avoid G-CSF related adverse effects. Whether HSCT also has an effect on the metabolic phenotype and utilization of carbohydrate sources has not been determined. Objective Our objective was to measure the utilization of starch in a patient with GSD Ib before and after HSCT using the minimally invasive 13C-glucose breath test (13C-GBT). Design A case of GSD Ib (18y; female) underwent 13C-GBT four times: UCCS (pre-HSCT), UCCS (3, 5 months post-HSCT) and Glycosade® (6 months post-HSCT) with a dose of 80 g administered via nasogastric tube after a 4 h fast according to our patient's fasting tolerance. Breath samples were collected at baseline and every 30 min for 240 min. Rate of CO2 production was measured at 120 min using indirect calorimetry. Finger-prick blood glucose was measured using a glucometer hourly to test hypoglycemia (glucose <4 mmol/L). Biochemical and clinical data were obtained from the medical records as a post-hoc chart review. Results UCCS utilization was significantly higher in GSD Ib pre-HSCT, which reduced and stabilized 5 months post-HSCT. UCCS and Glycosade® utilizations were low and not different at 5 and 6 months post-HSCT. Blood glucose concentrations were not significantly different at any time point. Conclusions Findings show that HSCT stabilized UCCS utilization, as reflected by lower and stable glucose oxidation. The results also illustrate the application of 13C-GBT to examine glucose metabolism in response to various carbohydrate sources after other treatment modalities like HSCT in GSD Ib.
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Key Words
- 13C-GBT, 13C-glucose breath test
- 13C-glucose
- ALT, alanine aminotransferase
- AML, acute myeloid leukemia
- ANOVA, analysis of variance
- AST, aspartate aminotransferase
- AUC, area under the curve
- BIA, bioelectrical impedance analysis
- BMI, body mass index
- Breath test
- CF-IRMS, continuous flow isotope ratio mass spectrometer
- CGM, continuous glucose monitor
- CRP, C-reactive protein
- Cmax, maximum peak enrichment in 13CO2 oxidation
- ER, endoplasmic reticulum
- FFM, fat free mass
- FM, fat mass
- G-CSF, granulocyte colony-stimulating factor
- G6P, glucose-6-phosphate
- G6PT, glucose-6-phosphate translocase
- G6Pase-ß, glucose-6-phosphatase-β
- G6Pase-α, glucose-6-phosphatase-α
- GGT, gamma glutamyltransferase
- GSD I, glycogen storage disease type I
- GSD III, glycogen storage disease type III
- GSD Ia, glycogen storage disease type Ia
- GSD Ib, glycogen storage disease type Ib
- Glycogen storage disease type Ib
- Glycosade®
- HSCT/BMT, hematopoietic stem cell transplantation / bone marrow transplantation
- Hematopoietic stem cell transplantation
- IBD, inflammatory bowel disease
- IM, intramuscular
- NG, nasogastric
- TBW, total body water
- UCCS, uncooked cornstarch
- Uncooked cornstarch
- VCO2, rate of carbon dioxide production.
- tmax, time to reach maximum 13CO2 oxidation
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Affiliation(s)
- Abrar Turki
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sylvia Stockler
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Biochemical Genetics, BC Children's Hospital, Vancouver, British Columbia, Canada
- Correspondence author to: Sylvia Stockler, Division of Biochemical Genetics, 4500 Oak St, BC Children's Hospital, Vancouver, BC V6H 3N1, Canada.
| | - Sandra Sirrs
- Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Costal Health, Adult Metabolic Diseases Clinic, Vancouver, British Columbia, Canada
| | - Kathleen Duddy
- Division of Biochemical Genetics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Gloria Ho
- Division of Biochemical Genetics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Rajavel Elango
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Correspondence author to: Rajavel Elango, Rm170A, 950 West 28th Avenue, BC Children's Hospital Research Institute, Vancouver BC V5Z 4H4, Canada.
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Lee YM, Kim GY, Pan CJ, Mansfield BC, Chou JY. Minimal hepatic glucose-6-phosphatase-α activity required to sustain survival and prevent hepatocellular adenoma formation in murine glycogen storage disease type Ia. Mol Genet Metab Rep 2015; 3:28-32. [PMID: 26937391 PMCID: PMC4750588 DOI: 10.1016/j.ymgmr.2015.03.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 03/06/2015] [Accepted: 03/06/2015] [Indexed: 12/01/2022] Open
Abstract
Glycogen storage disease type Ia (GSD-Ia), characterized by impaired glucose homeostasis and chronic risk of hepatocellular adenoma (HCA), is caused by a deficiency in glucose-6-phosphatase-α (G6Pase-α or G6PC) activity. In a previous 70–90 week-study, we showed that a recombinant adeno-associated virus (rAAV) vector-mediated gene transfer that restores more than 3% of wild-type hepatic G6Pase-α activity in G6pc−/− mice corrects hepatic G6Pase-α deficiency with no evidence of HCA. We now examine the minimal hepatic G6Pase-α activity required to confer therapeutic efficacy. We show that rAAV-treated G6pc−/− mice expressing 0.2% of wild-type hepatic G6Pase-α activity suffered from frequent hypoglycemic seizures at age 63–65 weeks but mice expressing 0.5–1.3% of wild-type hepatic G6Pase-α activity (AAV-LL mice) sustain 4–6 h of fast and grow normally to age 75–90 weeks. Despite marked increases in hepatic glycogen accumulation, the AAV-LL mice display no evidence of hepatic abnormalities, hepatic steatosis, or HCA. Interprandial glucose homeostasis is maintained by the G6Pase-α/glucose-6-phosphate transporter (G6PT) complex, and G6PT-mediated microsomal G6P uptake is the rate-limiting step in endogenous glucose production. We show that hepatic G6PT activity is increased in AAV-LL mice. These findings are encouraging for clinical studies of G6Pase-α gene-based therapy for GSD-Ia. Establish the minimal hepatic G6Pase-α activity restoration required to provide a blood glucose level that enables GSD-Ia mice grow to old age (75–90 weeks). Establish the minimal hepatic G6Pase-α activity restoration required that enables GSD-Ia mice grow to old age (75-90 weeks). Define the lowest dose for G6Pase-α gene therapy that provides efficacy in mice, which informs a phase I/II clinical trial design in human GSD-Ia.
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Key Words
- AAV, adeno-associated virus
- BW, body weight
- ER, endoplasmic reticulum
- G6P, glucose-6-phosphate
- G6PC, glucose-6-phosphatase-α gene
- G6PT, glucose-6-phosphate transporter
- G6Pase-α, glucose-6-phosphatase-α
- GPE, G6PC promoter and enhancer
- GSD-Ia, glycogen storage disease type Ia
- Gene therapy
- Glucose homeostasis
- Glucose-6-phosphate transporter
- HCA, hepatocellular adenoma
- Recombinant adeno-associated virus vector
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Affiliation(s)
- Young Mok Lee
- Section on Cellular Differentiation, Program on Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, United States
| | - Goo-Young Kim
- Section on Cellular Differentiation, Program on Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, United States
| | - Chi-Jiunn Pan
- Section on Cellular Differentiation, Program on Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, United States
| | - Brian C Mansfield
- Section on Cellular Differentiation, Program on Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, United States; Foundation Fighting Blindness, Columbia, MD 21046, United States
| | - Janice Y Chou
- Section on Cellular Differentiation, Program on Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892, United States
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