Inherited Metabolic Disease
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Hyperammonemia in Review: Pathophysiology, Diagnosis, and Treatment
Pediatr Nephrol DOI 10.1007/s00467-011-1838-5 EDUCATIONAL REVIEW Hyperammonemia in review: pathophysiology, diagnosis, and treatment Ari Auron & Patrick D. Brophy Received: 23 September 2010 /Revised: 9 January 2011 /Accepted: 12 January 2011 # IPNA 2011 Abstract Ammonia is an important source of nitrogen and is the breakdown and catabolism of dietary and bodily proteins, required for amino acid synthesis. It is also necessary for respectively. In healthy individuals, amino acids that are not normal acid-base balance. When present in high concentra- needed for protein synthesis are metabolized in various tions, ammonia is toxic. Endogenous ammonia intoxication chemical pathways, with the rest of the nitrogen waste being can occur when there is impaired capacity of the body to converted to urea. Ammonia is important for normal animal excrete nitrogenous waste, as seen with congenital enzymatic acid-base balance. During exercise, ammonia is produced in deficiencies. A variety of environmental causes and medica- skeletal muscle from deamination of adenosine monophos- tions may also lead to ammonia toxicity. Hyperammonemia phate and amino acid catabolism. In the brain, the latter refers to a clinical condition associated with elevated processes plus the activity of glutamate dehydrogenase ammonia levels manifested by a variety of symptoms and mediate ammonia production. After formation of ammonium signs, including significant central nervous system (CNS) from glutamine, α-ketoglutarate, a byproduct, may be abnormalities. Appropriate and timely management requires a degraded to produce two molecules of bicarbonate, which solid understanding of the fundamental pathophysiology, are then available to buffer acids produced by dietary sources. differential diagnosis, and treatment approaches available. -
Effect of Propionic Acid on Fatty Acid Oxidation and U Reagenesis
Pediat. Res. 10: 683- 686 (1976) Fatty degeneration propionic acid hyperammonemia propionic acidemia liver ureagenesls Effect of Propionic Acid on Fatty Acid Oxidation and U reagenesis ALLEN M. GLASGOW(23) AND H. PET ER C HASE UniversilY of Colorado Medical Celller, B. F. SlOlillsky LaboralOries , Denver, Colorado, USA Extract phosphate-buffered salin e, harvested with a brief treatment wi th tryps in- EDTA, washed twice with ph os ph ate-buffered saline, and Propionic acid significantly inhibited "CO z production from then suspended in ph os ph ate-buffe red saline (145 m M N a, 4.15 [I-"ejpalmitate at a concentration of 10 11 M in control fibroblasts m M K, 140 m M c/, 9.36 m M PO" pH 7.4) . I n mos t cases the cells and 100 11M in methyl malonic fibroblasts. This inhibition was we re incubated in 3 ml phosph ate-bu ffered sa lin e cont aining 0.5 similar to that produced by 4-pentenoic acid. Methylmalonic acid I1Ci ll-I4Cj palm it ate (19), final concentration approximately 3 11M also inhibited ' 'C0 2 production from [V 'ejpalmitate, but only at a added in 10 II I hexane. Increasing the amount of hexane to 100 II I concentration of I mM in control cells and 5 mM in methyl malonic did not impair palmit ate ox id ation. In two experiments (Fig. 3) the cells. fibroblasts were in cub ated in 3 ml calcium-free Krebs-Ringer Propionic acid (5 mM) also inhibited ureagenesis in rat liver phosphate buffer (2) co nt ain in g 5 g/ 100 ml essent iall y fatty ac id slices when ammonia was the substrate but not with aspartate and free bovine se rum albumin (20), I mM pa lm itate, and the same citrulline as substrates. -
Second-Tier DNA Confirmation of Newborn Screening Results
Second-tier DNA Confirmation of Newborn Screening by Targeted Next Generation Sequencing Edwin Naylor, Ph.D. MPH Andy Bhattacharjee , Ph.D. Erik Puffenberger, Ph.D.; Kevin Strauss, MD; Holmes Morton, MD Newborn Screening & Clinical Genomics 1961 1990’s 2010-2012 2 Robert Guthrie Development of develops simple automated MS/MS Newborn Screening screening across (NBS) several disorders Current de facto standard 2 Why Newborn Genomics? • Mendelian Diseases disproportionately affect Newborns - ~3500 genetic diseases with molecular basis - >10% of NICU admissions are genetic Clinical manifestation of Genetic diseases - Current NBS tests limited to 29+ diseases CHROMOSOMAL - 2nd tier DNA testing to validate biochemical results MULTI-FACTORIAL SINGLE GENE (MENDELIAN) • Advantage of NGS based DNA testing individuals # of Affected - Find causal variants (rare/novel) in gene(s) - A ‘universal’ NGS approach avoids repeated, serial BIRTH PUBERTY ADULT single gene testing Gelehrter TD, Collins FS, Ginsburg D. Principles of - Current Sanger sequencing is expensive ($3-10K) and Medical Genetics. 2nd ed. Baltimore, MD: Williams & slow (3 months to 1 year) Wilkins; 1998:1-42 NICU- Neonatal Intensive Care Unit NBS-Newborn Screening 3 NGS-Next Generation Sequencing Why Targeted (Exome) Sequencing for now? NGS Sequencing * Genomic DNA from Causal Mutations in Affected Individuals Exons/Target Regions Fold Test Menu Cost ($) Throughput Efficiency Whole Genome (Res.) 7,666* 1 1 Exome (Res) 1,200 15 95 Neonate Panel (Clinical) <1000 150 >1140 •Majority of known disease-causing mutations in exons •Exome = protein-encoding parts of genes •Targeted NGS is Cost & Throughput Efficient *Saunders et al., (2012) Rapid Whole Genome Sequencing for Genetic Disease Diagnosis in NICUs 4 Workflow for 2nd Tier Newborn Screening Sample 2h DNA Capture 92h Raw Data 10h Analysis 1h+ Isolation & Sequencing Management & Interpretation 8 samples, 105 Hrs, <$10,000 = Real Neonatal Genomics! 5 Workflow for 2nd Tier Newborn Screening Sample •High M.Wt. -
EXTENDED CARRIER SCREENING Peace of Mind for Planned Pregnancies
Focusing on Personalised Medicine EXTENDED CARRIER SCREENING Peace of Mind for Planned Pregnancies Extended carrier screening is an important tool for prospective parents to help them determine their risk of having a child affected with a heritable disease. In many cases, parents aren’t aware they are carriers and have no family history due to the rarity of some diseases in the general population. What is covered by the screening? Genomics For Life offers a comprehensive Extended Carrier Screening test, providing prospective parents with the information they require when planning their pregnancy. Extended Carrier Screening has been shown to detect carriers who would not have been considered candidates for traditional risk- based screening. With a simple mouth swab collection, we are able to test for over 419 genes associated with inherited diseases, including Fragile X Syndrome, Cystic Fibrosis and Spinal Muscular Atrophy. The assay has been developed in conjunction with clinical molecular geneticists, and includes genes listed in the NIH Genetic Test Registry. For a list of genes and disorders covered, please see the reverse of this brochure. If your gene of interest is not covered on our Extended Carrier Screening panel, please contact our friendly team to assist you in finding a gene test panel that suits your needs. Why have Extended Carrier Screening? Extended Carrier Screening prior to pregnancy enables couples to learn about their reproductive risk and consider a complete range of reproductive options, including whether or not to become pregnant, whether to use advanced reproductive technologies, such as preimplantation genetic diagnosis, or to use donor gametes. -
Birth Prevalence of Disorders Detectable Through Newborn Screening by Race/Ethnicity
©American College of Medical Genetics and Genomics ORIGINAL RESEARCH ARTICLE Birth prevalence of disorders detectable through newborn screening by race/ethnicity Lisa Feuchtbaum, DrPH, MPH1, Jennifer Carter, MPH2, Sunaina Dowray, MPH2, Robert J. Currier, PhD1 and Fred Lorey, PhD1 Purpose: The purpose of this study was to describe the birth prev- Conclusion: The California newborn screening data offer a alence of genetic disorders among different racial/ethnic groups unique opportunity to explore the birth prevalence of many through population-based newborn screening data. genetic dis orders across a wide spectrum of racial/ethnicity classifications. The data demonstrate that racial/ethnic subgroups Methods: Between 7 July 2005 and 6 July 2010 newborns in Cali- of the California newborn population have very different patterns fornia were screened for selected metabolic, endocrine, hemoglobin, of heritable disease expression. Determining the birth prevalence and cystic fibrosis disorders using a blood sample collected via heel of these disorders in California is a first step to understanding stick. The race and ethnicity of each newborn was self-reported by the short- and long-term medical and treatment needs faced by the mother at the time of specimen collection. affected communities, especially those groups that are impacted by Results: Of 2,282,138 newborns screened, the overall disorder detec- more severe disorders. tion rate was 1 in 500 births. The disorder with the highest prevalence Genet Med 2012:14(11):937–945 among all groups was primary congenital hypothyroidism (1 in 1,706 births). Birth prevalence for specific disorders varied widely among Key Words: birth prevalence; disorders; newborn screening; race different racial/ethnic groups. -
Clinical Issues in Neonatal Care
Linda Ikuta , MN, RN, CCNS, PHN , and Ksenia Zukowsky, PhD, APRN, NNP-BC ❍ Section Editors Clinical Issues in Neonatal Care 2.5 HOURS Continuing Education Deconstructing Black Swans An Introductory Approach to Inherited Metabolic Disorders in the Neonate Nicholas Ah Mew , MD ; Sarah Viall , MSN, PPCNP ; Brian Kirmse , MD ; Kimberly A. Chapman , MD, PhD ABSTRACT Background: Inherited metabolic disorders (IMDs) are individually rare but collectively common disorders that frequently require rapid or urgent therapy. Purpose: This article provides a generalized approach to IMDs, as well as some investigations and safe therapies that may be initiated pending the metabolic consult. Methods/Search Strategy: An overview of the research supporting management strategies is provided. In addition, the newborn metabolic screen is reviewed. Findings/Results: Caring for infants with IMDs can seem difficult because each of the types is rarely seen; however, collectively the management can be seen as similar. Implications for Practice: When an IMD is suspected, a metabolic specialist should be consulted for expert advice regarding appropriate laboratory investigations and management. Because rapid intervention of IMDs before the onset of symptoms may prevent future irreversible sequelae, each abnormal newborn screen must be addressed promptly. Implications for Research: Management can be difficult. Research in this area is limited and can be difficult without multisite coordination since sample sizes of any significance are difficult to achieve. Key Words: -
Amino Acid Disorders 105
AMINO ACID DISORDERS 105 Massaro, A. S. (1995). Trypanosomiasis. In Guide to Clinical tions in biological fluids relatively easy. These Neurology (J. P. Mohrand and J. C. Gautier, Eds.), pp. 663– analyzers separate amino acids either by ion-ex- 667. Churchill Livingstone, New York. Nussenzweig, V., Sonntag, R., Biancalana, A., et al. (1953). Ac¸a˜o change chromatography or by high-pressure liquid de corantes tri-fenil-metaˆnicos sobre o Trypanosoma cruzi in chromatography. The results are plotted as a graph vitro: Emprego da violeta de genciana na profilaxia da (Fig. 1). The concentration of each amino acid can transmissa˜o da mole´stia de chagas por transfusa˜o de sangue. then be calculated from the size of the corresponding O Hospital (Rio de Janeiro) 44, 731–744. peak on the graph. Pagano, M. A., Segura, M. J., DiLorenzo, G. A., et al. (1999). Cerebral tumor-like American trypanosomiasis in Most amino acid disorders can be diagnosed by acquired immunodeficiency syndrome. Ann. Neurol. 45, measuring the concentrations of amino acids in 403–406. blood plasma; however, some disorders of amino Rassi, A., Trancesi, J., and Tranchesi, B. (1982). Doenc¸ade acid transport are more easily recognized through the Chagas. In Doenc¸as Infecciosas e Parasita´rias (R. Veroesi, Ed.), analysis of urine amino acids. Therefore, screening 7th ed., pp. 674–712. Guanabara Koogan, Sa˜o Paulo, Brazil. Spina-Franc¸a, A., and Mattosinho-Franc¸a, L. C. (1988). for amino acid disorders is best done using both South American trypanosomiasis (Chagas’ disease). In blood and urine specimens. Occasionally, analysis of Handbook of Clinical Neurology (P. -
Genes Investigated
BabyNEXTTM EXTENDED Investigated genes and associated diseases Gene Disease OMIM OMIM Condition RUSP gene Disease ABCC8 Familial hyperinsulinism 600509 256450 Metabolic disorder - ABCC8-related Inborn error of amino acid metabolism ABCD1 Adrenoleukodystrophy 300371 300100 Miscellaneous RUSP multisystem (C) * diseases ABCD4 Methylmalonic aciduria and 603214 614857 Metabolic disorder - homocystinuria, cblJ type Inborn error of amino acid metabolism ACAD8 Isobutyryl-CoA 604773 611283 Metabolic Disorder - RUSP dehydrogenase deficiency Inborn error of (S) ** organic acid metabolism ACAD9 acyl-CoA dehydrogenase-9 611103 611126 Metabolic Disorder - (ACAD9) deficiency Inborn error of fatty acid metabolism ACADM Acyl-CoA dehydrogenase, 607008 201450 Metabolic Disorder - RUSP medium chain, deficiency of Inborn error of fatty (C) acid metabolism ACADS Acyl-CoA dehydrogenase, 606885 201470 Metabolic Disorder - RUSP short-chain, deficiency of Inborn error of fatty (S) acid metabolism ACADSB 2-methylbutyrylglycinuria 600301 610006 Metabolic Disorder - RUSP Inborn error of (S) organic acid metabolism ACADVL very long-chain acyl-CoA 609575 201475 Metabolic Disorder - RUSP dehydrogenase deficiency Inborn error of fatty (C) acid metabolism ACAT1 Alpha-methylacetoacetic 607809 203750 Metabolic Disorder - RUSP aciduria Inborn error of (C) organic acid metabolism ACSF3 Combined malonic and 614245 614265 Metabolic Disorder - methylmalonic aciduria Inborn error of organic acid metabolism 1 ADA Severe combined 608958 102700 Primary RUSP immunodeficiency due -
Summary Current Practices Report
18/10/2011 EU Tender “Evaluation of population newborn screening practices for rare disorders in Member States of the European Union” Short Executive Summary of the Report on the practices of newborn screening for rare disorders implemented in Member States of the European Union, Candidate, Potential Candidate and EFTA Countries Authors: Peter Burgard1, Martina Cornel2, Francesco Di Filippo4, Gisela Haege1, Georg F. Hoffmann1, Martin Lindner1, J. Gerard Loeber3, Tessel Rigter2, Kathrin Rupp1, 4 Domenica Taruscio4,Luciano Vittozzi , Stephanie Weinreich2 1 Department of Pediatrics , University Hospital - Heidelberg (DE) 2 VU University Medical Centre - Amsterdam (NL) 3 RIVM - Bilthoven (NL) 4 National Centre for Rare Diseases - Rome (IT) The opinions expressed in this document are those of the Contractor only and do not represent the official position of the Executive Agency for Health and Consumers. This work is funded by the European Union with a grant of Euro 399755 (Contract number 2009 62 06 of the Executive Agency for Health and Consumers) 1 18/10/2011 Abbreviations 3hmg 3-Hydroxy-3-methylglutaric aciduria 3mcc 3-Methylcrotonyl-CoA carboxylase deficiency/3-Methylglutacon aciduria/2-methyl-3-OH- butyric aciduria AAD Disorders of amino acid metabolism arg Argininemia asa Argininosuccinic aciduria bio Biotinidase deficiency bkt Beta-ketothiolase deficiency btha S, beta 0-thalassemia cah Congenital adrenal hyperplasia cf Cystic fibrosis ch Primary congenital hypothyroidism citI Citrullinemia type I citII Citrullinemia type II cpt I Carnitin -
Argininosuccinate Lyase Deficiency
©American College of Medical Genetics and Genomics GENETEST REVIEW Argininosuccinate lyase deficiency Sandesh C.S. Nagamani, MD1, Ayelet Erez, MD, PhD1 and Brendan Lee, MD, PhD1,2 The urea cycle consists of six consecutive enzymatic reactions that citrulline together with elevated argininosuccinic acid in the plasma convert waste nitrogen into urea. Deficiencies of any of these enzymes or urine. Molecular genetic testing of ASL and assay of ASL enzyme of the cycle result in urea cycle disorders (UCDs), a group of inborn activity are helpful when the biochemical findings are equivocal. errors of hepatic metabolism that often result in life-threatening However, there is no correlation between the genotype or enzyme hyperammonemia. Argininosuccinate lyase (ASL) catalyzes the activity and clinical outcome. Treatment of acute metabolic decom- fourth reaction in this cycle, resulting in the breakdown of arginino- pensations with hyperammonemia involves discontinuing oral pro- succinic acid to arginine and fumarate. ASL deficiency (ASLD) is the tein intake, supplementing oral intake with intravenous lipids and/ second most common UCD, with a prevalence of ~1 in 70,000 live or glucose, and use of intravenous arginine and nitrogen-scavenging births. ASLD can manifest as either a severe neonatal-onset form therapy. Dietary restriction of protein and dietary supplementation with hyperammonemia within the first few days after birth or as a with arginine are the mainstays in long-term management. Ortho- late-onset form with episodic hyperammonemia and/or long-term topic liver transplantation (OLT) is best considered only in patients complications that include liver dysfunction, neurocognitive deficits, with recurrent hyperammonemia or metabolic decompensations and hypertension. -
Metabolomic Analysis Reveals That the Drosophila Gene Lysine Influences Diverse Aspects of Metabolism
Genetics: Early Online, published on October 6, 2017 as 10.1534/genetics.117.300201 Metabolomic analysis reveals that the Drosophila gene lysine influences diverse aspects of metabolism Samantha L. St. Clair*‡, Hongde Li*‡, Usman Ashraf†, Jonathan A. Karty†, and Jason M. *§ Tennessen * Department of Biology, Indiana University, Bloomington, IN 47405, USA † Department of Chemistry, Indiana University, Bloomington, IN, 47405, USA. ‡ These authors contributed equally to this work. § Correspondence: [email protected] Keywords: Drosophila, metabolomics, lysine, LKRSDH, familial hyperlysinemia 1 Copyright 2017. ABSTRACT The fruit fly Drosophila melanogaster has emerged as a powerful model for investigating the molecular mechanisms that regulate animal metabolism. A major limitation of these studies, however, is that many metabolic assays are tedious, dedicated to analyzing a single molecule, and rely on indirect measurements. As a result, Drosophila geneticists commonly use candidate gene approaches, which, while important, bias studies towards known metabolic regulators. In an effort to expand the scope of Drosophila metabolic studies, we used the classic mutant lysine (lys) to demonstrate how a modern metabolomics approach can be used to conduct forward genetic studies. Using an inexpensive and well-established gas chromatography-mass spectrometry (GC-MS)-based method, we genetically mapped and molecularly characterized lys by using free lysine levels as a phenotypic readout. Our efforts revealed that lys encodes the Drosophila homolog of Lysine Ketoglutarate Reductase/Saccharopine Dehydrogenase (LKRSDH), which is required for the enzymatic degradation of lysine. Furthermore, this approach also allowed us to simultaneously survey a large swath of intermediate metabolism, thus demonstrating that Drosophila lysine catabolism is complex and capable of influencing seemingly unrelated metabolic pathways. -
What Disorders Are Screened for by the Newborn Screen?
What disorders are screened for by the newborn screen? Endocrine Disorders The endocrine system is important to regulate the hormones in our bodies. Hormones are special signals sent to various parts of the body. They control many things such as growth and development. The goal of newborn screening is to identify these babies early so that treatment can be started to keep them healthy. To learn more about these specific disorders please click on the name of the disorder below: English: Congenital Adrenal Hyperplasia Esapnol Hiperplasia Suprarrenal Congenital - - http://www.newbornscreening.info/Parents/otherdisorders/CAH.html - http://www.newbornscreening.info/spanish/parent/Other_disorder/CAH.html - Congenital Hypothyroidism (Hipotiroidismo Congénito) - http://www.newbornscreening.info/Parents/otherdisorders/CH.html - http://www.newbornscreening.info/spanish/parent/Other_disorder/CH.html Hematologic Conditions Hemoglobin is a special part of our red blood cells. It is important for carrying oxygen to the parts of the body where it is needed. When people have problems with their hemoglobin they can have intense pain, and they often get sick more than other children. Over time, the lack of oxygen to the body can cause damage to the organs. The goal of newborn screening is to identify babies with these conditions so that they can get early treatment to help keep them healthy. To learn more about these specific disorders click here (XXX). - Sickle Cell Anemia (Anemia de Célula Falciforme) - http://www.newbornscreening.info/Parents/otherdisorders/SCD.html - http://www.newbornscreening.info/spanish/parent/Other_disorder/SCD.html - SC Disease (See Previous Link) - Sickle Beta Thalassemia (See Previous Link) Enzyme Deficiencies Enzymes are special proteins in our body that allow for chemical reactions to take place.