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Demaret T, Bédard K, Soucy JF, Watkins D, Allard P, Levtova A, O'Brien A, Brunel-Guitton C, Rosenblatt DS, Mitchell GA. The MMACHC variant c.158T>C: Mild clinical and biochemical phenotypes and marked hydroxocobalamin response in cblC patients. Mol Genet Metab 2024; 142:108345. [PMID: 38387306 DOI: 10.1016/j.ymgme.2024.108345] [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: 12/20/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/24/2024]
Abstract
Mutations in MMACHC cause cobalamin C disease (cblC, OMIM 277400), the commonest inborn error of vitamin B12 metabolism. In cblC, deficient activation of cobalamin results in methylcobalamin and adenosylcobalamin deficiency, elevating methylmalonic acid (MMA) and total plasma homocysteine (tHcy). We retrospectively reviewed the medical files of seven cblC patients: three compound heterozygotes for the MMACHC (NM_015506.3) missense variant c.158T>C p.(Leu53Pro) in trans with the common pathogenic mutation c.271dupA (p.(Arg91Lysfs*14), "compounds"), and four c.271dupA homozygotes ("homozygotes"). Compounds receiving hydroxocobalamin intramuscular injection monotherapy had age-appropriate psychomotor performance and normal ophthalmological examinations. In contrast, c.271dupA homozygotes showed marked psychomotor retardation, retinopathy and feeding problems despite penta-therapy (hydroxocobalamin, betaine, folinic acid, l-carnitine and acetylsalicylic acid). Pretreatment levels of plasma and urine MMA and tHcy were higher in c.271dupA homozygotes than in compounds. Under treatment, levels of the compounds approached or entered the reference range but not those of c.271dupA homozygotes (tHcy: compounds 9.8-32.9 μM, homozygotes 41.6-106.8 (normal (N) < 14); plasma MMA: compounds 0.14-0.81 μM, homozygotes, 10.4-61 (N < 0.4); urine MMA: compounds 1.75-48 mmol/mol creatinine, homozygotes 143-493 (N < 10)). Patient skin fibroblasts all had low cobalamin uptake, but this was milder in compound cells. Also, the distribution pattern of cobalamin species was qualitatively different between cells from compounds and from homozygotes. Compared to the classic cblC phenotype presented by c.271dupA homozygous patients, c.[158T>C];[271dupA] compounds had mild clinical and biochemical phenotypes and responded strikingly to hydroxocobalamin monotherapy.
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Affiliation(s)
- Tanguy Demaret
- Medical Genetics Division, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada; Centre de Génétique Humaine, Institut de Pathologie et Génétique, Gosselies, Belgium
| | - Karine Bédard
- Medical Genetics Division, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada; Laboratoire de Diagnostic Moléculaire, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada; Département de Pathologie et Biologie Cellulaire, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Jean-François Soucy
- Medical Genetics Division, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - David Watkins
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada; Department of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Pierre Allard
- Medical Genetics Division, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada; Department of Biochemistry, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Alina Levtova
- Service de Médecine Génique, Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Alan O'Brien
- Service de Médecine Génique, Département de Médecine, Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Catherine Brunel-Guitton
- Medical Genetics Division, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada; Division of Biochemical Genetics, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - David S Rosenblatt
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada; Department of Medical Genetics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Grant A Mitchell
- Medical Genetics Division, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Québec, Canada.
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Sun M, Dai Y. Late-onset cobalamin C deficiency type in adult with cognitive and behavioral disturbances and significant cortical atrophy and cerebellar damage in the MRI: a case report. Front Neurol 2023; 14:1308289. [PMID: 38148982 PMCID: PMC10749923 DOI: 10.3389/fneur.2023.1308289] [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: 10/06/2023] [Accepted: 11/21/2023] [Indexed: 12/28/2023] Open
Abstract
Background Late-onset cobalamin C (cblC) deficiency is associated with a wide range of neurological and psychiatric symptoms, hematological manifestations, anorexia, renal failure, ocular abnormalities, dermatitis, and pancreatitis. However, the neuroimaging characteristics of late-onset cblC deficiency remain insufficiently documented. Common findings include diffuse white matter swelling, varying degrees of severe leukoaraiosis, hydrocephalus, corpus callosum atrophy, and symmetric bilateral basal ganglia lesions. In this report, we present a case of late-onset cblC deficiency in adults presenting with cerebellar ataxia as the primary symptom. The MRI findings revealed bilateral lateral cerebellar hemispheres exhibiting symmetric hyperintensity, primarily observed in diffusion-weighted imaging (DWI), which is a rarely reported imaging change in this context. Case presentation Our patient was a male who experienced symptoms starting at the age of 30 years, including unsteady walking, apparent cerebellar ataxia, and cognitive impairment upon nervous system examination. Brain magnetic resonance imaging (MRI) exhibited symmetric hyperintensity in the bilateral lateral cerebellar hemispheres, predominantly manifested in DWI, without any enhancement. Subsequently, significantly elevated blood total homocysteine and urinary methylmalonic acid levels were observed. Genetic analysis confirmed the presence of MMACHC compound heterozygous mutants c.482G > A and c.609G > A, thus confirming the diagnosis of cblC deficiency. These variants were classified as likely pathogenic following the guidelines of the American College of Medical Genetics and Genomics (ACMG) and were verified using Sanger sequencing. Following treatment, the patient experienced improvements in walking ability and cognition, a significant decrease in blood total homocysteine levels, and reversal of the imaging lesions. In conclusion Late-onset cblC deficiency presents with diverse clinical and imaging manifestations. Early diagnosis and treatment are crucial in achieving a favorable prognosis. This case serves as a reminder to clinicians not to overlook genetic metabolic disorders, particularly those causing multisite damage, in adult patients with undiagnosed neurological disorders, especially those affecting the cerebellum. Notably, methylmalonic acidemia should be considered within the spectrum of bilateral cerebellar lesions.
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Affiliation(s)
| | - Yingjie Dai
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China
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Du M, Wu S, Su C, Wang X, Li B, Lin Y, Yuan S, Chen Y, Zhu C, Wei H. Serum Vitamin B12 is a Promising Auxiliary Index for the Diagnosis of Methylmalonic Acidemia in Children: A Single Center Study in China. Clin Chim Acta 2023; 546:117409. [PMID: 37217112 DOI: 10.1016/j.cca.2023.117409] [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: 02/17/2023] [Revised: 04/25/2023] [Accepted: 05/19/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND AND AIMS Vitamin B12 (cobalamin, VitB12) is an essential coenzyme of methylmalonyl-CoA mutase and methionine synthase. Variations in VitB12 metabolism, absorption, transport, or intake may cause changes in methylmalonic acidemia (MMA) biomarkers. We aimed to investigate whether serum Vitamin B12 levels could be used in the early detection of MMA. MATERIALS AND METHODS We included 241 children with MMA and 241 healthy matched controls. We measured serum VitB12 levels by an enzyme immunoassay and investigated the relationship between abnormal VitB12 levels and hematologic parameters as potential risk factors for MMA symptoms. RESULTS Compared with controls, the serum levels of VitB12 were increased in the MMA group (p < 0.001). Serum VitB12 distinguished patients with MMA from healthy children (p < 0.001). Serum VitB12 combined with homocysteine and ammonia identified cblC and mut type MMA, respectively (p < 0.001). Homocysteine, folate, ammonia, NLR, and red blood cells contributed to serum VitB12 in cblC type MMA (p < 0.001); homocysteine, ammonia, and red blood cells, contributed in mut type MMA (p < 0.001); and elevated VitB12 was an independent predictor of MMA clinical onset (p < 0.001). CONCLUSION Serum VitB12 can be used as an early diagnostic biomarker for MMA in children.
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Affiliation(s)
- Mengmeng Du
- Children's Hospital Affiliated to Zhengzhou University, Department of Endocrinology, Genetics and Metabolism, Henan Children's Hospital, Zhengz- hou Children's Hospital, Zhengzhou, China; Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Third Affiliated Hospital and Institute of Neuroscience, Zhengzhou University, Zhengzhou, China.
| | - Shengnan Wu
- Children's Hospital Affiliated to Zhengzhou University, Department of Endocrinology, Genetics and Metabolism, Henan Children's Hospital, Zhengz- hou Children's Hospital, Zhengzhou, China.
| | - Chang Su
- Department of Endocrinology, Genetic and Metabolism, Beijing Children's Hospital, Capital Medical University, Beijing, China.
| | - Xiaohong Wang
- Children's Hospital Affiliated to Zhengzhou University, Department of Endocrinology, Genetics and Metabolism, Henan Children's Hospital, Zhengz- hou Children's Hospital, Zhengzhou, China.
| | - Bingbing Li
- Henan Key Laboratory of Child Brain Injury and Henan Pediatric Clinical Research Center, Third Affiliated Hospital and Institute of Neuroscience, Zhengzhou University, Zhengzhou, China.
| | - Yifan Lin
- Children's Hospital Affiliated to Zhengzhou University, Department of Endocrinology, Genetics and Metabolism, Henan Children's Hospital, Zhengz- hou Children's Hospital, Zhengzhou, China.
| | - Shuxian Yuan
- Children's Hospital Affiliated to Zhengzhou University, Department of Endocrinology, Genetics and Metabolism, Henan Children's Hospital, Zhengz- hou Children's Hospital, Zhengzhou, China.
| | - Yongxing Chen
- Children's Hospital Affiliated to Zhengzhou University, Department of Endocrinology, Genetics and Metabolism, Henan Children's Hospital, Zhengz- hou Children's Hospital, Zhengzhou, China.
| | - Changlian Zhu
- Children's Hospital Affiliated to Zhengzhou University, Department of Endocrinology, Genetics and Metabolism, Henan Children's Hospital, Zhengz- hou Children's Hospital, Zhengzhou, China; Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Sweden.
| | - Haiyan Wei
- Children's Hospital Affiliated to Zhengzhou University, Department of Endocrinology, Genetics and Metabolism, Henan Children's Hospital, Zhengz- hou Children's Hospital, Zhengzhou, China.
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Paz D, Pinales BE, Castellanos BS, Perez I, Gil CB, Madrigal LJ, Reyes-Nava NG, Castro VL, Sloan JL, Quintana AM. Abnormal chondrocyte development in a zebrafish model of cblC syndrome restored by an MMACHC cobalamin binding mutant. Differentiation 2023; 131:74-81. [PMID: 37167860 DOI: 10.1016/j.diff.2023.04.003] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 05/13/2023]
Abstract
Variants in the MMACHC gene cause combined methylmalonic acidemia and homocystinuria cblC type, the most common inborn error of intracellular cobalamin (vitamin B12) metabolism. cblC is associated with neurodevelopmental, hematological, ocular, and biochemical abnormalities. In a subset of patients, mild craniofacial dysmorphia has also been described. Mouse models of Mmachc deletion are embryonic lethal but cause severe craniofacial phenotypes such as facial clefts. MMACHC encodes an enzyme required for cobalamin processing and variants in this gene result in the accumulation of two metabolites: methylmalonic acid (MMA) and homocysteine (HC). Interestingly, other inborn errors of cobalamin metabolism, such as cblX syndrome, are associated with mild facial phenotypes. However, the presence and severity of MMA and HC accumulation in cblX syndrome is not consistent with the presence or absence of facial phenotypes. Thus, the mechanisms by which mutations in MMACHC cause craniofacial defects are yet to be completely elucidated. Here we have characterized the craniofacial phenotypes in a zebrafish model of cblC (hg13) and performed restoration experiments with either a wildtype or a cobalamin binding deficient MMACHC protein. Homozygous mutants did not display gross morphological defects in facial development but did have abnormal chondrocyte nuclear organization and an increase in the average number of neighboring cell contacts, both phenotypes were fully penetrant. Abnormal chondrocyte nuclear organization was not associated with defects in the localization of neural crest specific markers, sox10 (RFP transgene) or barx1. Both nuclear angles and the number of neighboring cell contacts were fully restored by wildtype MMACHC and a cobalamin binding deficient variant of the MMACHC protein. Collectively, these data suggest that mutation of MMACHC causes mild to moderate craniofacial phenotypes that are independent of cobalamin binding.
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Affiliation(s)
- David Paz
- Department of Biological Sciences, Border Biomedical Research Center, The University of Texas at El Paso, El Paso, TX, 79968, USA
| | - Briana E Pinales
- Department of Biological Sciences, Border Biomedical Research Center, The University of Texas at El Paso, El Paso, TX, 79968, USA
| | - Barbara S Castellanos
- Department of Biological Sciences, Border Biomedical Research Center, The University of Texas at El Paso, El Paso, TX, 79968, USA
| | - Isaiah Perez
- Department of Biological Sciences, Border Biomedical Research Center, The University of Texas at El Paso, El Paso, TX, 79968, USA
| | - Claudia B Gil
- Department of Biological Sciences, Border Biomedical Research Center, The University of Texas at El Paso, El Paso, TX, 79968, USA
| | - Lourdes Jimenez Madrigal
- Department of Biological Sciences, Border Biomedical Research Center, The University of Texas at El Paso, El Paso, TX, 79968, USA
| | - Nayeli G Reyes-Nava
- Department of Biological Sciences, Border Biomedical Research Center, The University of Texas at El Paso, El Paso, TX, 79968, USA
| | - Victoria L Castro
- Department of Biological Sciences, Border Biomedical Research Center, The University of Texas at El Paso, El Paso, TX, 79968, USA
| | - Jennifer L Sloan
- Metabolic Medicine Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Anita M Quintana
- Department of Biological Sciences, Border Biomedical Research Center, The University of Texas at El Paso, El Paso, TX, 79968, USA.
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Sun S, Jin H, Rong Y, Song W, Li Q. Methylmalonic acid levels in serum, exosomes, and urine and its association with cblC type methylmalonic acidemia-induced cognitive impairment. Front Neurol 2022; 13:1090958. [PMID: 36582607 PMCID: PMC9792485 DOI: 10.3389/fneur.2022.1090958] [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: 11/06/2022] [Accepted: 11/28/2022] [Indexed: 12/14/2022] Open
Abstract
Background The cblC type methylmalonic acidemia is the most common methylmalonic acidemia (MMA) in China. The biochemical characteristics of this disease include elevated methylmalonic acid and homocysteine (HCY), increased propionylcarnitine (C3), decreased free carnitine (C0). In this study, we aimed to clarify the roles of these biomarkers in cblC-MMA induced cognitive impairment and evaluate the capacity of methylmalonic acid in different fluids or exosomes to distinguish cblC-MMA induced cognitive impairment. Methods 15 non-inherited hyperhomocysteinemia (HHcy) patients, 42 cblC-MMA patients and 57 age- and sex-matched healthy children were recruited in this study. The levels of HCY were detected by an automatic immune analyzer. The levels of acylcarnitines and methylmalonic acid were detected by tandem mass spectrometer. Results The main findings were all biomarkers as HCY, acylcarnitines and methylmalonic acid had capacities for distinguishing patients with cblC-MMA induced cognitive impairment from healthy children. The methylmalonic acid in different fluids or exosomes had good performances for distinguishing patients with cblC-MMA induced cognitive impairment from HHcy patients. The methylmalonic acid in serum exosomes and neuronal-derived exosomes were able to distinguishing cblC-MMA patients with cognitive impairment from patients without cognitive impairment. The methylmalonic acid in neuronal-derived exosomes might be helpful to evaluate the severity of cblC-MMA induced cognitive impairment. Discussion Methylmalonic acid levels in serum exosomes, especially in serum neuronal-derived exosomes, serve as potential biomarkers for distinguishing cblC-MMA induced cognitive impairment.
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Affiliation(s)
- Shuqi Sun
- Department of Clinical Laboratory, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Hong Jin
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yu Rong
- Department of Rehabilitation, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Wenqi Song
- Department of Clinical Laboratory, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Qiliang Li
- Department of Clinical Laboratory, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China,*Correspondence: Qiliang Li
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Chen Z, Dong H, Liu Y, He R, Song J, Jin Y, Li M, Liu Y, Liu X, Yan H, Qi J, Wang F, Xiao H, Zheng H, Kang L, Li D, Zhang Y, Yang Y. Late-onset cblC deficiency around puberty: a retrospective study of the clinical characteristics, diagnosis, and treatment. Orphanet J Rare Dis 2022; 17:330. [PMID: 36056359 PMCID: PMC9438293 DOI: 10.1186/s13023-022-02471-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/13/2021] [Accepted: 08/13/2022] [Indexed: 11/12/2022] Open
Abstract
Background cblC deficiency is the most common type of methylmalonic aciduria in China. Late-onset patients present with various non-specific symptoms and are usually misdiagnosed. The purpose of this study is to investigate the clinical features of patients with late-onset cblC deficiency and explore diagnosis and management strategies around puberty. Results This study included 56 patients (35 males and 21 females) with late-onset cblC deficiency who were admitted to our clinic between 2002 and September 2021. The diagnosis was confirmed by metabolic and genetic tests. The clinical and biochemical features, disease triggers, outcome, and associated genetic variants were examined. The onset age ranged from 10 to 20 years (median age, 12 years). Fifteen patients (26.8%) presented with symptoms after infection or sports training. Further, 46 patients (82.1%) had neuropsychiatric diseases; 11 patients (19.6%), cardiovascular diseases; and 6 patients (10.7%), pulmonary hypertension. Renal damage was observed in 6 cases (10.7%). Genetic analysis revealed 21 variants of the MMACHC gene in the 56 patients. The top five common variants detected in 112 alleles were c.482G > A (36.6%), c.609G > A (16.1%), c.658_660delAAG (9.8%), c.80A > G (8.0%), and c.567dupT (6.3%). Thirty-nine patients carried the c.482G > A variant. Among 13 patients who exhibited spastic paraplegia as the main manifestation, 11 patients carried c.482G > A variants. Six patients who presented with psychotic disorders and spastic paraplegia had compound heterozygotic c.482G > A and other variants. All the patients showed improvement after metabolic treatment with cobalamin, l-carnitine, and betaine, and 30 school-aged patients returned to school. Two female patients got married and had healthy babies. Conclusions Patients with late-onset cblC deficiency present with a wide variety of neuropsychiatric symptoms and other presentations, including multiple organ damage. As a result, cb1C deficiency can easily be misdiagnosed as other conditions. Metabolic and genetic studies are important for accurate diagnosis, and metabolic treatment with cobalamin, l-carnitine, and betaine appears to be beneficial. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-022-02471-x.
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Affiliation(s)
- Zhehui Chen
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Hui Dong
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Yupeng Liu
- Department of Pediatrics, Peking University People's Hospital, Beijing, 100034, China
| | - Ruxuan He
- Department of Respiratory Medicine II, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing, 100045, China
| | - Jinqing Song
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Ying Jin
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Mengqiu Li
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Yi Liu
- Department of Clinical Laboratory, China-Japan Friendship Hospital, Beijing, 100029, China
| | - Xueqin Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Hui Yan
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Jianguang Qi
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Fang Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Huijie Xiao
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - Hong Zheng
- Department of Pediatrics, First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, 450000, China
| | - Lulu Kang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - Dongxiao Li
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, 450053, China
| | - Yao Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China.
| | - Yanling Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China.
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Pang L, Chen J, Yu H, Huang H, Jin B, Wang X, Li H. Case Report: A Rare Case of Thrombotic Microangiopathy Induced by Remethylation Disorders. Front Med (Lausanne) 2022; 9:837253. [PMID: 35308551 PMCID: PMC8924285 DOI: 10.3389/fmed.2022.837253] [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: 12/16/2021] [Accepted: 01/31/2022] [Indexed: 11/25/2022] Open
Abstract
In this research, we described a very rare case of thrombotic microangiopathy induced by remethylation disorders. A 16-year-old boy presented to the emergency department with 5 months of weakness and fatigue. He was diagnosed with thrombotic microangiopathy based on clinical manifestation and laboratory information, which showed microangiopathic hemolytic anemia, renal impairment, and thrombocytopenia. After a complex diagnostic workup, the metabolite screening parameters and sequencing results guided us toward the diagnosis of remethylation disorders. The patient was diagnosed with thrombotic microangiopathy induced by remethylation disorders (cblC).
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Affiliation(s)
- Lu Pang
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Jian Chen
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Haiyan Yu
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Haiming Huang
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Bo Jin
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Xin Wang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haixia Li
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
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Liu X, Xiao H, Yao Y, Wang S, Zhang H, Zhong X, Yang Y, Ding J, Wang F. Prominent renal complications associated with MMACHC pathogenic variant c.80A > G in Chinese children with cobalamin C deficiency. Front Pediatr 2022; 10:1057594. [PMID: 36704130 PMCID: PMC9871484 DOI: 10.3389/fped.2022.1057594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/14/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE CblC deficiency, the most common cobalamin metabolic abnormality, is caused by pathogenic variants in the MMACHC gene. The renal complications of this disease have been described only in a small number of cases. This study aimed to better delineate renal phenotype and genetic characteristics in Chinese children with cblC defect. METHODS Children with cblC deficiency who manifested as kidney damage were enrolled. Clinical, renal pathological, and genetic data were reviewed in detail. RESULTS Seven cases were enrolled. Ages at disease onset ranged from 9 months to 5 years. All patients presented with hematuria and proteinuria, and 2/7 cases presented with nephrotic syndrome. Renal dysfunction was observed in 4/7 cases. Renal biopsy was performed in 5/7 cases, and all of them had renal thrombotic microangiopathy. Macrocytic anemia was detected in all seven patients. Six out of seven cases had hypertension, and 2/7 cases presented with pulmonary hypertension. Two of them had a mild intellectual disability, and one suffered from epilepsy. Increased urine methylmalonic acid and plasma homocysteine were detected in seven cases, while two patients had normal levels of urine methylmalonic acid at the initial evaluation. After diagnosis, all seven cases were treated with hydroxocobalamin IM. Six cases were followed-up for 3-8 years. After treatments, anemia was the first to be recovered, followed by proteinuria. Renal function recovered after 1 year in two cases, whereas patient 2 progressed to stage 2 chronic kidney disease 13 years after onset. While a case presented with end-stage kidney disease because of late diagnosis, one case died 3 months after disease onset due to giving up treatment. Three MMACHC pathogenic variants c.80A > G (8/14), c.609G > A (4/14), and c.658_660delAAG (2/14) were detected in all seven children. CONCLUSION MMACHC variant c.80A > G may be associated with prominent renal complications in Chinese cblC patients. Macrocytic anemia and hyperhomocysteinemia are useful clues for patients with hematuria and proteinuria caused by cblC defect. The most frequent renal pathological manifestation is thrombotic microangiopathy. Early diagnosis and treatment resulted in improving renal and hematological signs.
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Affiliation(s)
- Xiaoyu Liu
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Huijie Xiao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yong Yao
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Suxia Wang
- Laboratory of Electron Microscopy, Pathological Center, Peking University First Hospital, Beijing, China
| | - Hongwen Zhang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Xuhui Zhong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Yanling Yang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Jie Ding
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Fang Wang
- Department of Pediatrics, Peking University First Hospital, Beijing, China
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Zhang X, Chen Q, Song Y, Guo P, Wang Y, Luo S, Zhang Y, Zhou C, Li D, Chen Y, Wei H. Epimutation of MMACHC compound to a genetic mutation in cblC cases. Mol Genet Genomic Med 2021; 9:e1625. [PMID: 33982424 PMCID: PMC8222841 DOI: 10.1002/mgg3.1625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 01/05/2021] [Accepted: 02/10/2021] [Indexed: 12/22/2022] Open
Abstract
Background Methylmalonic aciduria (MMA) combined with homocystinuria, cobalamin(cbl)C deficiency type (OMIM 277400), is the most common autosomal recessive inherited disorder of intracellular cobalamin metabolism caused by mutations in the MMACHC gene (OMIM 609831), of which more than 100 mutations have been identified to date. In this study, we only identified a coding mutation in one allele at the MMACHC gene locus, and no large fragments deletion or duplication were found. Up to now, only three epimutation cblC cases were reported. We hypothesized whether the MMACHC was hypermethylated. Methods To address this hypothesis, the entire coding region and adjacent splice sites of the panel genes involved in metabolic diseases were sequenced using the Illumina HiSeq X platform, followed by confirmation via Sanger sequencing in their parents and brothers. Methylation analysis of the MMACHC was performed using an EpiTect Bisulfite Kit and methylation‐specific PCR (MSP) to investigate the role of epimutations in cblC disease. Results We identified a clearly pathogenic single heterozygous c.658_660del, p. (K220del) mutation, which was also identified in the mother. Analysis of the MMACHC indicated a heterozygous epimutation consisting of 34 hypermethylated CpG sites in a CpG island encompassing the promoter and first exon of the MMACHC, which was also identified in the father. Furthermore, we identified a single heterozygous c.*2C>T mutation in the sixth exon of the PRDX1 (OMIM 176763) in patients and their fathers, which was the only sequence variation that segregated with the MMACHC methylation. Neither c.658_660del and epimutation in MMACHC nor c.*2C>T in PRDX1 was discovered in her brother. Conclusion We report compound heterozygotes in MMACHC for a genetic mutation and an epimutation in cblC cases. To our best knowledge, this is the first report of two cblC cases from China caused by compound heterozygous mutations with a coding mutation in one allele and an epimutation in the other at the MMACHC locus.
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Affiliation(s)
- Xiaoman Zhang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Qiong Chen
- Department of Pediatric Endocrinology and Genetic Metabolism, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Yinsen Song
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Pengbo Guo
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Yanhong Wang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Shuying Luo
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Yaodong Zhang
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Chongchen Zhou
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Dongxiao Li
- Henan Key Laboratory of Children's Genetics and Metabolic Diseases, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Yongxing Chen
- Department of Pediatric Endocrinology and Genetic Metabolism, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
| | - Haiyan Wei
- Department of Pediatric Endocrinology and Genetic Metabolism, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Zhengzhou, China
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10
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Wilson A, Cruz V, Kronick JB. Development of infantile tremor syndrome after initiation of hydroxycobalamin treatment in an infant with a late diagnosis of cobalamin C disorder. JIMD Rep 2020; 55:22-25. [PMID: 32905057 PMCID: PMC7463060 DOI: 10.1002/jmd2.12145] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/14/2020] [Accepted: 05/22/2020] [Indexed: 12/29/2022] Open
Abstract
Combined methylmalonic aciduria and homocystinuria (cobalamin C deficiency, cblC) is a well-described disorder of vitamin B12 metabolism caused by mutations in the MMACHC gene with multisystemic manifestations. While there is no cure, combined treatment with intramuscular hydroxycobalamin and oral betaine may reduce the severity of symptoms and improve clinical outcome. We report a female patient diagnosed with late-onset cobalamin C deficiency at the age of 8 months who presented with developmental regression and severe dermatitis. She developed a movement disorder after initiation of hydroxycobalamin treatment. Similar movement disorders have been described in patients with nutritional vitamin B12 deficiencies following cobalamin supplementation but have not previously been reported in patients with cobalamin C disorder. The movement disorder in our patient gradually resolved with clonazepam treatment, despite no seizure activity detected on EEG. She was eventually weaned off the clonazepam and the abnormal movements have not recurred. The patient remains developmentally delayed but is showing no other symptoms related to cobalamin C deficiency. The patient has a younger affected sibling who was treated from birth and who is physically and developmentally entirely normal; she did not have abnormal movements after treatment with hydroxycobalamin was initiated. There is no clear consensus on the cause of movement disorders that develop following initiation of intramuscular vitamin B12 treatment.
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Affiliation(s)
- Ashley Wilson
- Division of Clinical & Metabolic GeneticsThe Hospital for Sick ChildrenTorontoCanada
| | - Vivian Cruz
- Division of Clinical & Metabolic GeneticsThe Hospital for Sick ChildrenTorontoCanada
| | - Jonathan B. Kronick
- Division of Clinical & Metabolic GeneticsThe Hospital for Sick ChildrenTorontoCanada
- Department of PediatricsThe University of TorontoTorontoCanada
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11
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Wang C, Liu Y, Cai F, Zhang X, Xu X, Li Y, Zou Q, Zheng J, Zhang Y, Guo W, Cai C, Shu J. Rapid screening of MMACHC gene mutations by high-resolution melting curve analysis. Mol Genet Genomic Med 2020; 8:e1221. [PMID: 32198913 PMCID: PMC7284048 DOI: 10.1002/mgg3.1221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 02/07/2020] [Accepted: 02/24/2020] [Indexed: 12/23/2022] Open
Abstract
Background Cobalamin (cbl) C is a treatable rare hereditary disorder of cbl metabolism with autosomal recessive inheritance. It is the most common organic acidemia, manifested as methylmalonic academia combined with homocysteinemia. Early screening and diagnosis are important. The mutation spectrum of the MMACHC gene causing cblC varies among populations. The mutation spectrum in Chinese population is notably different from that in other populations. Methods A PCR followed by high‐resolution melting curve analysis (PCR‐HRM) method covering all coding exons of MMACHC gene was designed to verify 14 pathogenic MMACHC gene variants found in patients with cblC, including all common mutations in Chinese patients with cblC. Result By PCR‐HRM analysis, 14 pathogenic variants of MMACHC showed distinctly different melting curves, which were consistent with Sanger sequencing. The homozygous type of the most common mutation c.609G > A (p.Trp203Ter) can also be analyzed by specially designed PCR‐HRM. Conclusion The established PCR‐HRM method for screening common pathogenic MMACHC variants in Chinese patients with cblC has the advantages of high accuracy, high throughput, low cost, and high speed. It is suitable for the large‐sample screening of suspected children with methylmalonic acidemia and carriers in population.
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Affiliation(s)
- Chao Wang
- Tianjin Pediatric Research InstituteTianjin Children’s HospitalTianjinChina
- Tianjin Key Laboratory of Prevention and Treatment of Birth DefectsTianjinChina
| | - Yang Liu
- Department of NeonatalogyTianjin Children’s HospitalThe Pediatric Clinical College in Tianjin Medical UniversityTianjinChina
| | - Fengying Cai
- Department of PhysiologyTianjin Medical CollegeTianjinChina
| | - Xinjie Zhang
- Tianjin Pediatric Research InstituteTianjin Children’s HospitalTianjinChina
- Tianjin Key Laboratory of Prevention and Treatment of Birth DefectsTianjinChina
| | - Xiaowei Xu
- Tianjin Pediatric Research InstituteTianjin Children’s HospitalTianjinChina
- Tianjin Key Laboratory of Prevention and Treatment of Birth DefectsTianjinChina
| | - Yani Li
- Department of Internal MedicineQuyang County People's HospitalBaodingChina
| | - Qianqian Zou
- Department of NeurosurgeryTianjin Children’s HospitalTianjinChina
| | - Jie Zheng
- Department of NeurosurgeryTianjin Children’s HospitalTianjinChina
| | - Yuqin Zhang
- Department of NeurologyTianjin Children’s HospitalTianjinChina
| | - Wei Guo
- Department of RespirationTianjin Children’s HospitalTianjinChina
| | - Chunquan Cai
- Department of NeurosurgeryTianjin Children’s HospitalTianjinChina
| | - Jianbo Shu
- Tianjin Pediatric Research InstituteTianjin Children’s HospitalTianjinChina
- Tianjin Key Laboratory of Prevention and Treatment of Birth DefectsTianjinChina
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12
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Pollini L, Tolve M, Nardecchia F, Galosi S, Carducci C, di Carlo E, Carducci C, Leuzzi V. Multiple sclerosis and intracellular cobalamin defect ( MMACHC/ PRDX1) comorbidity in a young male. Mol Genet Metab Rep 2020; 22:100560. [PMID: 32099815 DOI: 10.1016/j.ymgmr.2019.100560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 12/19/2019] [Accepted: 12/21/2019] [Indexed: 01/12/2023] Open
Abstract
Background Methylmalonic acidaemia with homocystinuria type C (cblC defect) is an inherited error of cobalamin metabolism. Cobalamin deficient processing results in high levels of methylmalonic acid and homocysteine. The latter is considered to be a risk factor for multiple sclerosis (MS). We report on the first case of a patient with comorbid cblC defect and MS. Case report This young male presented at the age of 14 with a relapsing-remitting neurological disorder associated with imaging alterations suggestive of MS. Treatment resulted in a partial clinical improvement with vanishing of white matter lesions. Later on, the emergence of unexpected clinical features led to a metabolic work-up, revealing a cobalamin intracellular defect. Genetic analysis disclosed a single variant in MMACHC (c.482G > A; p.Arg161Gln) and another splicing variant in PRDX1 (c.1-515G > T) that cause the silencing of the wild-type MMACHC allele, so confirming the diagnosis of cblC defect. Although cblC treatment was effective, when 17-year-old he experienced a relapse of neurological symptoms. Further imaging and laboratory studies eventually supported the diagnosis of MS. Discussion While the comorbid association of MS and cblC in our patient may remain anecdotic, we suggest measuring Hcy and MMA levels in young patients with a relapsing-remitting demyelinating disorder, in order not to miss a cblC defect, that requires a specific and effective treatment.
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13
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Higashimoto T, Kim AY, Ogawa JT, Sloan JL, Almuqbil MA, Carlson JM, Manoli I, Venditti CP, Gunay-Aygun M, Wang T. High-dose hydroxocobalamin achieves biochemical correction and improvement of neuropsychiatric deficits in adults with late onset cobalamin C deficiency. JIMD Rep 2019; 51:17-24. [PMID: 32071835 PMCID: PMC7012733 DOI: 10.1002/jmd2.12087] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 08/25/2019] [Revised: 10/24/2019] [Accepted: 11/14/2019] [Indexed: 12/18/2022] Open
Abstract
Cobalamin C (cblC) deficiency is the most common inborn error of intracellular cobalamin metabolism caused by pathogenic variant(s) in MMACHC and manifests with methylmalonic acidemia, hyperhomocysteinemia, and hypomethioninemia with a variable age of presentation. Individuals with late‐onset cblC may be asymptomatic until manifesting neuropsychiatric symptoms, thromboembolic events, and renal disease. Although hydroxocobalamin provides a foundation for therapy, optimal dose regimen for adult patients has not been systematically evaluated. We report three adult siblings with late‐onset cblC disease, and their biochemical and clinical responses to high‐dose hydroxocobalamin. The 28‐year‐old proband presented with severe psychosis, progressive neurological deterioration, and deep venous thrombosis complicated by a pulmonary embolism. MRI studies identified lesions in the spinal cord, periventricular white matter, and basal ganglia. Serum homocysteine and methylmalonic acid levels were markedly elevated. Hydroxocobalamin at standard dose (1 mg/day) initially resulted in partial metabolic correction. A regimen of high‐dose hydroxocobalamin (25 mg/day) together with betaine and folic acid resulted in rapid and sustainable biochemical correction, resolution of psychosis, improvement of neurological functions, and amelioration of brain and spinal cord lesions. Two siblings who did not manifest neuropsychiatric symptoms or thromboembolism achieved a satisfactory metabolic control with the same high‐dose regimen. Hydroxocobalamin injection was then spaced out to 25 mg weekly with good and sustainable metabolic control. All three patients are compound heterozygotes for c.271dupA p.Arg91LysfsX14 and c.389A > G p.Tyr130Cys. This study highlights the importance of evaluating intracellular cobalamin metabolism in adults with neuropsychiatric manifestations and/or thromboembolic events, and demonstrates that high‐dose hydroxocobalamin achieves rapid and sustainable metabolic control and improvement in neuropsychiatric outcomes in adults with late‐onset cblC disease.
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Affiliation(s)
- Tomoyasu Higashimoto
- Department of Genetic Medicine and Pediatrics Johns Hopkins University Baltimore Maryland
| | - Alexander Y Kim
- Department of Genetic Medicine and Pediatrics Johns Hopkins University Baltimore Maryland
| | - Jessica T Ogawa
- Department of Genetic Medicine and Pediatrics Johns Hopkins University Baltimore Maryland
| | - Jennifer L Sloan
- Medical Genomics and Metabolic Genetics Branch National Institute of Human Genome Research, National Institutes of Health Bethesda Maryland
| | - Mohammed A Almuqbil
- Department of Genetic Medicine and Pediatrics Johns Hopkins University Baltimore Maryland.,Division of Pediatric Neurology King Saud bin Abdulaziz University for Health Sciences Riyadh Saudi Arabia.,King Abdullah International Medical Research Center King Abdullah Specialist Children's Hospital - Ministry of National Guard Riyadh Saudi Arabia
| | - Julia M Carlson
- Department of Neurology Johns Hopkins University Baltimore Maryland
| | - Irini Manoli
- Medical Genomics and Metabolic Genetics Branch National Institute of Human Genome Research, National Institutes of Health Bethesda Maryland
| | - Charles P Venditti
- Medical Genomics and Metabolic Genetics Branch National Institute of Human Genome Research, National Institutes of Health Bethesda Maryland
| | - Meral Gunay-Aygun
- Department of Genetic Medicine and Pediatrics Johns Hopkins University Baltimore Maryland
| | - Tao Wang
- Department of Genetic Medicine and Pediatrics Johns Hopkins University Baltimore Maryland
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14
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Hu S, Mei S, Liu N, Kong X. Molecular genetic characterization of cblC defects in 126 pedigrees and prenatal genetic diagnosis of pedigrees with combined methylmalonic aciduria and homocystinuria. BMC Med Genet 2018; 19:154. [PMID: 30157807 PMCID: PMC6116561 DOI: 10.1186/s12881-018-0666-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 08/15/2018] [Indexed: 11/21/2022]
Abstract
Background We sought to analyse MMACHC variants among 126 pedigrees with cobalamin (cbl) C deficiency and combined methylmalonic aciduria and homocystinuria by Sanger sequencing, characterize the spectrum of MMACHC gene variants, and perform prenatal genetic diagnosis by chorionic villus sampling among these pedigrees. Methods Peripheral blood was collected from 126 probands and their parents who visited the Genetic Counseling Clinic at our hospital between January 2014 and December 2017, and DNA was extracted from the blood. Then, we amplified the coding sequence and splicing regions of the MMACHC gene by PCR, and the PCR products were further sequenced to detect the variants in each pedigree. In 62 families, pregnant women were subjected to chorionic villus sampling for prenatal genetic diagnosis. Results In total, 31 distinct variants were detected in the 126 pedigrees, and the most frequent variants were c.609G > A (p.Trp203Ter), c.658_660delAAG (p.Lys220del), c.567dupT (p.Ile190Tyrfs*13) and c.80A > G (p.Gln27Arg). Two of these variants have not been previously reported in the literature. One variant [c.463_465delGGG (p.Gly155del)] is a small-scale deletion, and the other variant [c.637G>T(p.Glu213Ter)] is a nonsense mutation. Among the 62 pedigrees who received a prenatal diagnosis, 16 foetuses were normal, 34 foetuses were carriers of heterozygous variants, and the remaining 12 foetuses harboured compound heterozygous variants or homozygous variants. Couples whose foetuses were normal or carriers continued the pregnancy, whereas couples whose foetuses harboured compound heterozygous variants or homozygous variants decided to terminate the pregnancy. The follow-up results were consistent with the prenatal diagnosis. Conclusions Two novel MMACHC variants were identified, and prenatal genetic diagnosis is an accurate and convenient method that helps avoid the delivery of combined methylmalonic aciduria and homocystinuria patients. Electronic supplementary material The online version of this article (10.1186/s12881-018-0666-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shuang Hu
- The Center for Genetics and Prenatal Diagnosis, The First Affiliated Hospital of Zhengzhou University, Jianshe Road, Zhengzhou, 450052, China
| | - Shiyue Mei
- The Center for Genetics and Prenatal Diagnosis, The First Affiliated Hospital of Zhengzhou University, Jianshe Road, Zhengzhou, 450052, China
| | - Ning Liu
- The Center for Genetics and Prenatal Diagnosis, The First Affiliated Hospital of Zhengzhou University, Jianshe Road, Zhengzhou, 450052, China
| | - Xiangdong Kong
- The Center for Genetics and Prenatal Diagnosis, The First Affiliated Hospital of Zhengzhou University, Jianshe Road, Zhengzhou, 450052, China.
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15
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Shi C, Shang D, Sun S, Mao C, Qin J, Luo H, Shao M, Chen Z, Liu Y, Liu X, Song B, Xu Y. MMACHC gene mutation in familial hypogonadism with neurological symptoms. Gene 2015; 574:380-4. [PMID: 26283149 DOI: 10.1016/j.gene.2015.08.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 03/17/2015] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 10/23/2022]
Abstract
Recent studies have convincingly documented that hypogonadism is a component of various hereditary disorders and is often recognized as an important clinical feature in combination with various neurological symptoms, yet, the causative genes in a few related families are still unknown. High-throughput sequencing has become an efficient method to identify causative genes in related complex hereditary disorders. In this study, we performed exome sequencing in a family presenting hypergonadotropic hypogonadism with neurological presentations of mental retardation, epilepsy, ataxia, and leukodystrophy. After bioinformatic analysis and Sanger sequencing validation, we identified compound heterozygous mutations: c.482G>A (p.R161Q) and c.609G>A (p.W203X) in MMACHC gene in this pedigree. MMACHC was previously confirmed to be responsible for methylmalonic aciduria (MMA) combined with homocystinuria, cblC type (cblC disease), a hereditary vitamin B12 metabolic disorder. Biochemical and gas chromatography-mass spectrometry (GC-MS) examinations in this pedigree further supported the cblC disease diagnosis. These results indicated that hypergonadotropic hypogonadism may be a novel clinical manifestation of cblC disease, but more reports on additional patients are needed to support this hypothesis.
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Affiliation(s)
- Changhe Shi
- Department of Neurology, The first affiliated Hospital of Zhengzhou University, Zhengzhou University. 1 Jian-she East Road, Zhengzhou 450000, Henan, China
| | - Dandan Shang
- Department of Neurology, The first affiliated Hospital of Zhengzhou University, Zhengzhou University. 1 Jian-she East Road, Zhengzhou 450000, Henan, China
| | - Shilei Sun
- Department of Neurology, The first affiliated Hospital of Zhengzhou University, Zhengzhou University. 1 Jian-she East Road, Zhengzhou 450000, Henan, China
| | - Chengyuan Mao
- Department of Neurology, The first affiliated Hospital of Zhengzhou University, Zhengzhou University. 1 Jian-she East Road, Zhengzhou 450000, Henan, China
| | - Jie Qin
- Department of Neurology, The first affiliated Hospital of Zhengzhou University, Zhengzhou University. 1 Jian-she East Road, Zhengzhou 450000, Henan, China
| | - Haiyang Luo
- Department of Neurology, The first affiliated Hospital of Zhengzhou University, Zhengzhou University. 1 Jian-she East Road, Zhengzhou 450000, Henan, China
| | - Mingwei Shao
- Department of Endocrinology, The first affiliated Hospital of Zhengzhou University, Zhengzhou University. 1 Jian-she East Road, Zhengzhou 450000, Henan, China
| | - Zhengguang Chen
- Department of Ultrasound, The first affiliated Hospital of Zhengzhou University, Zhengzhou University. 1 Jian-she East Road, Zhengzhou 450000, Henan, China
| | - Yutao Liu
- Department of Neurology, The first affiliated Hospital of Zhengzhou University, Zhengzhou University. 1 Jian-she East Road, Zhengzhou 450000, Henan, China
| | - Xinjing Liu
- Department of Neurology, The first affiliated Hospital of Zhengzhou University, Zhengzhou University. 1 Jian-she East Road, Zhengzhou 450000, Henan, China
| | - Bo Song
- Department of Neurology, The first affiliated Hospital of Zhengzhou University, Zhengzhou University. 1 Jian-she East Road, Zhengzhou 450000, Henan, China
| | - Yuming Xu
- Department of Neurology, The first affiliated Hospital of Zhengzhou University, Zhengzhou University. 1 Jian-she East Road, Zhengzhou 450000, Henan, China.
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