Liver Disorders in Inherited Metabolic Disorders
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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. -
Propionic Acidemia: an Extremely Rare Cause of Hemophagocytic Lymphohistiocytosis in an Infant
Case report Arch Argent Pediatr 2020;118(2):e174-e177 / e174 Propionic acidemia: an extremely rare cause of hemophagocytic lymphohistiocytosis in an infant Sultan Aydin Kökera, MD, Osman Yeşilbaşb, MD, Alper Kökerc, MD, and Esra Şevketoğlud, Assoc. Prof. ABSTRACT INTRODUCTION Hemophagocytic lymphohystiocytosis (HLH) may be primary Hemophagocytic lymphohistiocytosis (inherited/familial) or secondary to infections, malignancies, rheumatologic disorders, immune deficiency syndromes (HLH) is a life-threatening disorder in and metabolic diseases. Cases including lysinuric protein which there is uncontrolled proliferation of intolerance, multiple sulfatase deficiency, galactosemia, activated lymphocytes and histiocytes. The Gaucher disease, Pearson syndrome, and galactosialidosis have diagnosis of HLH is based on fulfilling at least previously been reported. It is unclear how the metabolites trigger HLH in metabolic diseases. A 2-month-old infant five of eight criteria (fever, splenomegaly, with lethargy, pallor, poor feeding, hepatosplenomegaly, bicytopenia, hypertriglyceridemia and/ fever and pancytopenia, was diagnosed with HLH and the or hypofibrinogenemia, hemophagocytosis, HLH-2004 treatment protocol was initiated. Analysis for low/absent natural killer cell activity, primary HLH gene mutations and metabolic screening tests were performed together; primary HLH gene mutations were hyperferritinemia, and high soluble interleukin- negative, but hyperammonemia and elevated methyl citrate 2-receptor levels). HLH includes both familial were detected. Propionic acidemia was diagnosed with tandem and reactive disease triggered by infection, mass spectrometry in neonatal dried blood spot. We report this immunologic disorder, malignancy, or drugs. case of HLH secondary to propionic acidemia. Both metabolic disorder screening tests and gene mutation analysis may be Clinical presentations of patients with primary performed simultaneously especially for early diagnosis in (familial) and secondary (reactive) HLH are infants presenting with HLH. -
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. -
Incidence of Inborn Errors of Metabolism by Expanded Newborn
Original Article Journal of Inborn Errors of Metabolism & Screening 2016, Volume 4: 1–8 Incidence of Inborn Errors of Metabolism ª The Author(s) 2016 DOI: 10.1177/2326409816669027 by Expanded Newborn Screening iem.sagepub.com in a Mexican Hospital Consuelo Cantu´-Reyna, MD1,2, Luis Manuel Zepeda, MD1,2, Rene´ Montemayor, MD3, Santiago Benavides, MD3, Hector´ Javier Gonza´lez, MD3, Mercedes Va´zquez-Cantu´,BS1,4, and Hector´ Cruz-Camino, BS1,5 Abstract Newborn screening for the detection of inborn errors of metabolism (IEM), endocrinopathies, hemoglobinopathies, and other disorders is a public health initiative aimed at identifying specific diseases in a timely manner. Mexico initiated newborn screening in 1973, but the national incidence of this group of diseases is unknown or uncertain due to the lack of large sample sizes of expanded newborn screening (ENS) programs and lack of related publications. The incidence of a specific group of IEM, endocrinopathies, hemoglobinopathies, and other disorders in newborns was obtained from a Mexican hospital. These newborns were part of a comprehensive ENS program at Ginequito (a private hospital in Mexico), from January 2012 to August 2014. The retrospective study included the examination of 10 000 newborns’ results obtained from the ENS program (comprising the possible detection of more than 50 screened disorders). The findings were the following: 34 newborns were confirmed with an IEM, endocrinopathies, hemoglobinopathies, or other disorders and 68 were identified as carriers. Consequently, the estimated global incidence for those disorders was 3.4 in 1000 newborns; and the carrier prevalence was 6.8 in 1000. Moreover, a 0.04% false-positive rate was unveiled as soon as diagnostic testing revealed negative results. -
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. -
Inherited Metabolic Disease
Inherited metabolic disease Dr Neil W Hopper SRH Areas for discussion • Introduction to IEMs • Presentation • Initial treatment and investigation of IEMs • Hypoglycaemia • Hyperammonaemia • Other presentations • Management of intercurrent illness • Chronic management Inherited Metabolic Diseases • Result from a block to an essential pathway in the body's metabolism. • Huge number of conditions • All rare – very rare (except for one – 1:500) • Presentation can be non-specific so index of suspicion important • Mostly AR inheritance – ask about consanguinity Incidence (W. Midlands) • Amino acid disorders (excluding phenylketonuria) — 18.7 per 100,000 • Phenylketonuria — 8.1 per 100,000 • Organic acidemias — 12.6 per 100,000 • Urea cycle diseases — 4.5 per 100,000 • Glycogen storage diseases — 6.8 per 100,000 • Lysosomal storage diseases — 19.3 per 100,000 • Peroxisomal disorders — 7.4 per 100,000 • Mitochondrial diseases — 20.3 per 100,000 Pathophysiological classification • Disorders that result in toxic accumulation – Disorders of protein metabolism (eg, amino acidopathies, organic acidopathies, urea cycle defects) – Disorders of carbohydrate intolerance – Lysosomal storage disorders • Disorders of energy production, utilization – Fatty acid oxidation defects – Disorders of carbohydrate utilization, production (ie, glycogen storage disorders, disorders of gluconeogenesis and glycogenolysis) – Mitochondrial disorders – Peroxisomal disorders IMD presentations • ? IMD presentations • Screening – MCAD, PKU • Progressive unexplained neonatal -
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. -
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. -
Amino Acid Disorders
471 Review Article on Inborn Errors of Metabolism Page 1 of 10 Amino acid disorders Ermal Aliu1, Shibani Kanungo2, Georgianne L. Arnold1 1Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; 2Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA Contributions: (I) Conception and design: S Kanungo, GL Arnold; (II) Administrative support: S Kanungo; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: E Aliu, GL Arnold; (V) Data analysis and interpretation: None; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Georgianne L. Arnold, MD. UPMC Children’s Hospital of Pittsburgh, 4401 Penn Avenue, Suite 1200, Pittsburgh, PA 15224, USA. Email: [email protected]. Abstract: Amino acids serve as key building blocks and as an energy source for cell repair, survival, regeneration and growth. Each amino acid has an amino group, a carboxylic acid, and a unique carbon structure. Human utilize 21 different amino acids; most of these can be synthesized endogenously, but 9 are “essential” in that they must be ingested in the diet. In addition to their role as building blocks of protein, amino acids are key energy source (ketogenic, glucogenic or both), are building blocks of Kreb’s (aka TCA) cycle intermediates and other metabolites, and recycled as needed. A metabolic defect in the metabolism of tyrosine (homogentisic acid oxidase deficiency) historically defined Archibald Garrod as key architect in linking biochemistry, genetics and medicine and creation of the term ‘Inborn Error of Metabolism’ (IEM). The key concept of a single gene defect leading to a single enzyme dysfunction, leading to “intoxication” with a precursor in the metabolic pathway was vital to linking genetics and metabolic disorders and developing screening and treatment approaches as described in other chapters in this issue. -
Fatal Propionic Acidemia: a Challenging Diagnosis
Issue: Ir Med J; Vol 112; No. 7; P980 Fatal Propionic Acidemia: A Challenging Diagnosis A. Fulmali, N. Goggin 1. Department of Paediatrics, NDDH, Barnstaple, UK 2. Department of Paediatrics, UHW, Waterford, Ireland Dear Sir, We present a two days old neonate with severe form of propionic acidemia with lethal outcome. Propionic acidemia is an AR disorder, presents in the early neonatal period with progressive encephalopathy and death can occur quickly. A term neonate admitted to NICU on day 2 with poor feeding, lethargy and dehydration. Parents are non- consanguineous and there was no significant family history. Prenatal care had been excellent. Delivery had been uneventful. No resuscitation required with good APGAR scores. Baby had poor suck, lethargy, hypotonia and had lost about 13% of the birth weight. Initial investigations showed hypoglycemia (2.3mmol/L), uremia (8.3mmol/L), hypernatremia (149 mmol/L), severe metabolic acidosis (pH 7.24, HCO3 9.5, BE -18.9) with high anion gap (41) and ketonuria (4+). Hematologic parameters, inflammatory markers and CSF examination were unremarkable. Baby received initial fluid resuscitation and commenced on IV antibiotics. Generalised seizures became eminent at 70 hours of age. Loading doses of phenobarbitone and phenytoin were given. Hepatomegaly of 4cm was spotted on day 4 of life. Very soon baby became encephalopathic requiring invasive ventilation. At this stage clinical features were concerning for metabolic disorder and hence was transferred to tertiary care centre where further investigations showed high ammonia level (1178 μg/dl) and urinary organic acids were suggestive of propionic acidemia. Specific treatment for hyperammonemia and propionic acidemia was started. -
Mitochondrial Involvement and Erythronic Acid As a Novel Biomarker in Transaldolase Deficiency Udo F.H
Mitochondrial involvement and erythronic acid as a novel biomarker in transaldolase deficiency Udo F.H. Engelke, Fokje S.M. Zijlstra, Fanny Mochel, Vassili Valayannopoulos, Daniel Rabier, Leo A.J. Kluijtmans, András Perl, Nanda M. Verhoeven-Duif, Pascale de Lonlay, Mirjam M.C. Wamelink, et al. To cite this version: Udo F.H. Engelke, Fokje S.M. Zijlstra, Fanny Mochel, Vassili Valayannopoulos, Daniel Rabier, et al.. Mitochondrial involvement and erythronic acid as a novel biomarker in transaldolase deficiency. Biochimica et Biophysica Acta - Molecular Basis of Disease, Elsevier, 2010, 1802 (11), pp.1028. 10.1016/j.bbadis.2010.06.007. hal-00623290 HAL Id: hal-00623290 https://hal.archives-ouvertes.fr/hal-00623290 Submitted on 14 Sep 2011 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. ÔØ ÅÒÙ×Ö ÔØ Mitochondrial involvement and erythronic acid as a novel biomarker in transaldolase deficiency Udo F.H. Engelke, Fokje S.M. Zijlstra, Fanny Mochel, Vassili Valayannopou- los, Daniel Rabier, Leo A.J. Kluijtmans, Andr´asPerl, Nanda M. Verhoeven- Duif, Pascale de Lonlay, Mirjam M.C. Wamelink, Cornelis Jakobs, Eva´ Morava, Ron A. Wevers PII: S0925-4439(10)00117-1 DOI: doi: 10.1016/j.bbadis.2010.06.007 Reference: BBADIS 63115 To appear in: BBA - Molecular Basis of Disease Received date: 23 April 2010 Revised date: 11 June 2010 Accepted date: 11 June 2010 Please cite this article as: Udo F.H. -
Centometabolic® COMBINING GENETIC and BIOCHEMICAL TESTING for the FAST and COMPREHENSIVE DIAGNOSTIC of METABOLIC DISORDERS
CentoMetabolic® COMBINING GENETIC AND BIOCHEMICAL TESTING FOR THE FAST AND COMPREHENSIVE DIAGNOSTIC OF METABOLIC DISORDERS GENE ASSOCIATED DISEASE(S) ABCA1 HDL deficiency, familial, 1; Tangier disease ABCB4 Cholestasis, progressive familial intrahepatic 3 ABCC2 Dubin-Johnson syndrome ABCD1 Adrenoleukodystrophy; Adrenomyeloneuropathy, adult ABCD4 Methylmalonic aciduria and homocystinuria, cblJ type ABCG5 Sitosterolemia 2 ABCG8 Sitosterolemia 1 ACAT1 Alpha-methylacetoacetic aciduria ADA Adenosine deaminase deficiency AGA Aspartylglucosaminuria AGL Glycogen storage disease IIIa; Glycogen storage disease IIIb AGPS Rhizomelic chondrodysplasia punctata, type 3 AGXT Hyperoxaluria, primary, type 1 ALAD Porphyria, acute hepatic ALAS2 Anemia, sideroblastic, 1; Protoporphyria, erythropoietic, X-linked ALDH4A1 Hyperprolinemia, type II ALDOA Glycogen storage disease XII ALDOB Fructose intolerance, hereditary ALG3 Congenital disorder of glycosylation, type Id ALPL Hypophosphatasia, adult; Hypophosphatasia, childhood; Hypophosphatasia, infantile; Odontohypophosphatasia ANTXR2 Hyaline fibromatosis syndrome APOA2 Hypercholesterolemia, familial, modifier of APOA5 Hyperchylomicronemia, late-onset APOB Hypercholesterolemia, familial, 2 APOC2 Hyperlipoproteinemia, type Ib APOE Sea-blue histiocyte disease; Hyperlipoproteinemia, type III ARG1 Argininemia ARSA Metachromatic leukodystrophy ARSB Mucopolysaccharidosis type VI (Maroteaux-Lamy) 1 GENE ASSOCIATED DISEASE(S) ASAH1 Farber lipogranulomatosis; Spinal muscular atrophy with progressive myoclonic epilepsy