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Ivanov IS, Azmanov DN, Ivanova MB, Chamova T, Pacheva IH, Panova MV, Song S, Morar B, Yordanova RV, Galabova FK, Sotkova IG, Linev AJ, Bitchev S, Shearwood AMJ, Kancheva D, Gabrikova D, Karcagi V, Guergueltcheva V, Geneva IE, Bozhinova V, Stoyanova VK, Kremensky I, Jordanova A, Savov A, Horvath R, Brown MA, Tournev I, Filipovska A, Kalaydjieva L. Founder p.Arg 446* mutation in the PDHX gene explains over half of cases with congenital lactic acidosis in Roma children. Mol Genet Metab 2014; 113:76-83. [PMID: 25087164 DOI: 10.1016/j.ymgme.2014.07.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/14/2014] [Accepted: 07/14/2014] [Indexed: 02/04/2023]
Abstract
Investigation of 31 of Roma patients with congenital lactic acidosis (CLA) from Bulgaria identified homozygosity for the R446* mutation in the PDHX gene as the most common cause of the disorder in this ethnic group. It accounted for around 60% of patients in the study and over 25% of all CLA cases referred to the National Genetic Laboratory in Bulgaria. The detection of a homozygous patient from Hungary and carriers among population controls from Romania and Slovakia suggests a wide spread of the mutation in the European Roma population. The clinical phenotype of the twenty R446* homozygotes was relatively homogeneous, with lactic acidosis crisis in the first days or months of life as the most common initial presentation (15/20 patients) and delayed psychomotor development and/or seizures in infancy as the leading manifestations in a smaller group (5/20 patients). The subsequent clinical picture was dominated by impaired physical growth and a very consistent pattern of static cerebral palsy-like encephalopathy with spasticity and severe to profound mental retardation seen in over 80% of cases. Most patients had a positive family history. We propose testing for the R446* mutation in PDHX as a rapid first screening in Roma infants with metabolic acidosis. It will facilitate and accelerate diagnosis in a large proportion of cases, allow early rehabilitation to alleviate the chronic clinical course, and prevent further affected births in high-risk families.
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Affiliation(s)
- Ivan S Ivanov
- Department of Pediatrics and Medical Genetics, Plovdiv Medical University, Bulgaria
| | - Dimitar N Azmanov
- Harry Perkins Institute of Medical Research and Centre for Medical Research, The University of Western Australia, Perth, Australia; Department of Diagnostic Genomics, PathWest, Perth, Australia
| | | | | | - Ilyana H Pacheva
- Department of Pediatrics and Medical Genetics, Plovdiv Medical University, Bulgaria
| | - Margarita V Panova
- Department of Pediatrics and Medical Genetics, Plovdiv Medical University, Bulgaria
| | - Sharon Song
- The University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, Brisbane, Australia
| | - Bharti Morar
- Harry Perkins Institute of Medical Research and Centre for Medical Research, The University of Western Australia, Perth, Australia
| | - Ralitsa V Yordanova
- Department of Pediatrics and Medical Genetics, Plovdiv Medical University, Bulgaria
| | - Fani K Galabova
- Department of Pediatrics and Medical Genetics, Plovdiv Medical University, Bulgaria
| | - Iglika G Sotkova
- Department of Pediatrics and Medical Genetics, Plovdiv Medical University, Bulgaria
| | - Alexandar J Linev
- Department of Pediatrics and Medical Genetics, Plovdiv Medical University, Bulgaria
| | - Stoyan Bitchev
- National Genetic Laboratory, Medical University-Sofia, Bulgaria
| | - Anne-Marie J Shearwood
- Harry Perkins Institute of Medical Research and Centre for Medical Research, The University of Western Australia, Perth, Australia
| | - Dalia Kancheva
- Molecular Neurogenomics Group, Department of Molecular Genetics, VIB, University of Antwerp, Belgium; Department of Medical Chemistry and Biochemistry, Molecular Medicine Centre, Medical University-Sofia, Bulgaria
| | - Dana Gabrikova
- Department of Biology, Faculty of Humanities and Natural Sciences, University of Presov, Slovakia
| | - Veronika Karcagi
- Department of Molecular Genetics and Diagnostics, NIEH, Budapest, Hungary
| | | | - Ina E Geneva
- Department of Pediatrics and Medical Genetics, Plovdiv Medical University, Bulgaria
| | | | - Vili K Stoyanova
- Department of Pediatrics and Medical Genetics, Plovdiv Medical University, Bulgaria
| | - Ivo Kremensky
- National Genetic Laboratory, Medical University-Sofia, Bulgaria
| | - Albena Jordanova
- Molecular Neurogenomics Group, Department of Molecular Genetics, VIB, University of Antwerp, Belgium; Department of Medical Chemistry and Biochemistry, Molecular Medicine Centre, Medical University-Sofia, Bulgaria
| | - Aleksey Savov
- National Genetic Laboratory, Medical University-Sofia, Bulgaria
| | - Rita Horvath
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Matthew A Brown
- The University of Queensland Diamantina Institute, Translational Research Institute, Princess Alexandra Hospital, Brisbane, Australia
| | - Ivailo Tournev
- Department of Neurology, Medical University-Sofia, Bulgaria; Department of Cognitive Science and Psychology, New Bulgarian University, Sofia, Bulgaria
| | - Aleksandra Filipovska
- Harry Perkins Institute of Medical Research and Centre for Medical Research, The University of Western Australia, Perth, Australia; School of Chemistry and Biochemistry, The University of Western Australia, Perth, Australia
| | - Luba Kalaydjieva
- Harry Perkins Institute of Medical Research and Centre for Medical Research, The University of Western Australia, Perth, Australia.
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