Johannes Zschocke Matthias Baumgartner Eva Morava Marc Patterson Shamima Rahman Verena Peters Editors JIMD Repor ts Volume 19 JIMD Reports Volume 19 . Johannes Zschocke Editor-in-Chief Matthias Baumgartner Eva Morava (cid:129) (cid:129) Marc Patterson Shamima Rahman (cid:129) Editors Verena Peters Managing Editor JIMD Reports Volume 19 Editor-in-Chief Editor JohannesZschocke MarcPatterson DivisionofHumanGenetics DivisionofChildandAdolescent MedicalUniversityInnsbruck Neurology Innsbruck MayoClinic Austria Rochester Minnesota Editor USA MatthiasBaumgartner DivisionofMetabolismandChildren’sResearchCentre Editor UniversityChildren’sHospitalZurich ShamimaRahman Zurich ClinicalandMolecularGeneticsUnit Switzerland UCLInstituteofChildHealth London Editor UK EvaMorava TulaneUniversityMedicalSchool ManagingEditor NewOrleans VerenaPeters Louisiana CenterforChildandAdolescent USA Medicine HeidelbergUniversityHospital Heidelberg Germany ISSN2192-8304 ISSN2192-8312 (electronic) JIMDReports ISBN978-3-662-46189-1 ISBN978-3-662-46190-7 (eBook) DOI10.1007/978-3-662-46190-7 SpringerHeidelbergNewYorkDordrechtLondon #SSIEMandSpringer-VerlagBerlinHeidelberg2015 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpartofthematerialis concerned,specificallytherightsoftranslation,reprinting,reuseofillustrations,recitation,broadcasting,reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation,computersoftware,orbysimilarordissimilarmethodologynowknownorhereafterdeveloped. Theuseofgeneraldescriptivenames,registerednames,trademarks,servicemarks,etc.inthispublicationdoesnot imply,evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfromtherelevantprotectivelawsand regulationsandthereforefreeforgeneraluse. Thepublisher,theauthorsandtheeditorsaresafetoassumethattheadviceandinformationinthisbookarebelieved tobetrueandaccurateatthedateofpublication.Neitherthepublishernortheauthorsortheeditorsgiveawarranty, expressorimplied,withrespecttothematerialcontainedhereinorforanyerrorsoromissionsthatmayhavebeen made. Printedonacid-freepaper Springer-VerlagGmbHBerlinHeidelbergispartofSpringerScience+BusinessMedia(www.springer.com) Contents ADeNovoVariantinGalactose-1-PUridylyltransferase(GALT)Leading toClassicGalactosemia ................................................. 1 Thanh-Thanh(Claire)V.Tran,YingLiu,MichaelE.Zwick,DhanyaRamachandran, DavidJ.Cutler,XiaopingHuang,GerardT.Berry,andJudithL.Fridovich-Keil RefsumDiseasePresentingwithaLate-OnsetLeukodystrophy.................. 7 FlavieBompaire,Ve´roniqueMarcaud,EmmanuelleLeTrionnaire,Fre´de´ricSedel, andThierryLevade MakingtheWhiteMatterMatters:ProgressinUnderstandingCanavan’s DiseaseandTherapeuticInterventionsThroughEightDecades................. 11 SeeminS.Ahmed,andGuangpingGao DisorderedEatingandBodyEsteemAmongIndividualswithGlycogen StorageDisease....................................................... 23 TheresaB.Flanagan,JillA.Sutton,LaurieM.Brown,DavidA.Weinstein, andLisaJ.Merlo 1 OneYearExperienceofPheburane (SodiumPhenylbutyrate)Treatmentin aPatientwithArgininosuccinateLyaseDeficiency........................... 31 SemaKalkanUc¸ar,BurcuOzbaran,YaseminAtikAltinok,MelisKose,EbruCanda, MehtapKagnici,andMahmutCoker GrowthHormoneDeficiencyandLysinuricProteinIntolerance:CaseReport andReviewoftheLiterature............................................ 35 MainesEvelina,MorandiGrazia,OlivieriFrancesca,CamilotMarta,CavarzerePaolo, GaudinoRossella,AntoniazziFranco,andBordugoAndrea GeographicalandEthnicDistributionofMutationsoftheFumarylacetoacetate HydrolaseGeneinHereditaryTyrosinemiaType1 .......................... 43 FrancescaAngileri,AnneBergeron,Genevie`veMorrow,FrancineLettre,GeorgeGray, TimHutchin,SarahBall,andRobertM.Tanguay PathologicVariantsoftheMitochondrialPhosphateCarrierSLC25A3:TwoNew PatientsandExpansionoftheCardiomyopathy/SkeletalMyopathyPhenotype WithandWithoutLacticAcidosis........................................ 59 E.J.Bhoj,M.Li,R.Ahrens-Nicklas,L.C.Pyle,J.Wang,V.W.Zhang,C.Clarke, L.J.Wong, N.Sondheimer,C.Ficicioglu,andM.Yudkoff v vi Contents BaselineUrinaryGlucoseTetrasaccharideConcentrationsinPatientswith Infantile-andLate-OnsetPompeDiseaseIdentifiedbyNewbornScreening....... 67 Yin-HsiuChien,JenniferL.Goldstein,Wuh-LiangHwu,P.BrianSmith,Ni-ChungLee, Shu-ChuanChiang,AdviyeA.Tolun,HaoyueZhang,AmieE.Vaisnins, DavidS.Millington,PriyaS.Kishnani,andSarahP.Young DevelopmentalOutcomesofSchool-AgeChildrenwithDuarteGalactosemia: APilotStudy......................................................... 75 MaryEllenLynch,NancyL.Potter,ClaireD.Coles,andJudithL.Fridovich-Keil MolecularDiagnosisofHereditaryFructoseIntolerance:FounderMutation inaCommunityfromIndia............................................. 85 SunitaBijarnia-Mahay,SireeshaMovva,NeerjaGupta,DeepakSharma,RatnaD.Puri, UdhayaKotecha,RenuSaxena,MadhulikaKabra,NeelamMohan,andIshwarCVerma LeighSyndromeCausedbytheMT-ND5m.13513G>AMutation: ACasePresentingwithWPW-LikeConductionDefect,Cardiomyopathy, HypertensionandHyponatraemia........................................ 95 MarcusBrecht,MalcolmRichardson,AjayTaranath,ScottGrist,DavidThorburn, andDragoBratkovic DeepGenotypingoftheIDSGeneinColombianPatientswithHunterSyndrome.... 101 JohannaGalvis,JannetGonza´lez,AlfredoUribe,andHarvyVelasco ExpandingtheClinicalSpectrumofMitochondrialCitrateCarrier(SLC25A1) Deficiency:FacialDysmorphisminSiblingswithEpilepticEncephalopathyand CombinedD,L-2-HydroxyglutaricAciduria ............................... 111 PankajPrasun,SarahYoung,GajjaSalomons,AndreaWerneke,Yong-huiJiang, EduardStruys,MikellPaige,MariaLauraAvantaggiati,andMarieMcDonald AKoreanCaseofb-UreidopropionaseDeficiencyPresentingwithIntractable Seizure,GlobalDevelopmentalDelay,andMicrocephaly..................... 117 JunHwaLee,Andre´ B.P.vanKuilenburg,N.G.G.M.Abeling,ValeriaVasta, andSiHounHahn Erratumto:GrowthHormoneDeficiencyandLysinuricProteinIntolerance: CaseReportandReviewoftheLiterature ................................ 123 EvelinaMaines,GraziaMorandi,FrancescaOlivieri,MartaCamilot, PaoloCavarzere,RossellaGaudino,FrancoAntoniazzi,andAndreaBordugo JIMDReports DOI10.1007/8904_2014_349 RESEARCH REPORT A De Novo Variant in Galactose-1-P Uridylyltransferase GALT ( ) Leading to Classic Galactosemia Thanh-Thanh (Claire) V. Tran(cid:129)Ying Liu(cid:129) Michael E. Zwick(cid:129)Dhanya Ramachandran(cid:129) David J. Cutler(cid:129)Xiaoping Huang(cid:129)Gerard T. Berry(cid:129) Judith L. Fridovich-Keil Received:14June2014/Revised:27July2014/Accepted:31July2014/Publishedonline:15February2015 #SSIEMandSpringer-VerlagBerlinHeidelberg2014 Abstract Classic galactosemia (CG) is a potentially that GALT may have a higher new mutation rate than lethal genetic disease that results from profound previously believed. impairment of galactose-1-P uridylyltransferase (GALT), the middle enzyme in the Leloir pathway of galactose metabolism. Patients with CG carry pathogenic loss-of- Introduction function mutations in both of their GALT alleles; the parents of patients are considered obligate carriers. We Classic galactosemia (CG) is a potentially lethal genetic report here a first exception to that rule – a de novo disorder that affects close to 1/50,000 live births in the GALT variant in a patient with classic galactosemia. The United States (Pyhtila et al 2014). Patients with CG new variant, c.563A>C (p.Q188P), which introduces a demonstrateprofoundimpairmentofgalactose-1-phosphate missense substitution near the active site of the GALT uridylyltransferase (GALT), the second enzyme in the enzyme, was found in the compound heterozygous state Leloir pathway of galactose metabolism (Fridovich-Keil in a child with classic galactosemia, but not in either of and Walter 2008). Classic galactosemia is inherited as an her parents. Extensive genomic studies of DNA from the autosomal recessive trait. Patients carry loss-of-function child and both parents confirmed the expected degrees of mutations in both of their GALT alleles, and their parents relationship in the trio as well as inheritance of a are considered obligate heterozygotes for those same common c.563A>G (p.Q188R) GALT mutation from mutations. The carrier risk for a loss-of-function GALT the mother. This result demonstrates that not all patho- mutation in the general population is estimated using the genic GALT mutations are inherited and raises concern Hardy–Weinberg equation at about 1 in 112 people. Sequencing the GALT alleles in patients with classic galactosemia reveals striking allelic heterogeneity with >250 distinct causal or ostensibly causal variants and a Communicatedby:JohnHWalter,MDFRCPCH smallnumberofostensiblyneutralpolymorphismsreported Competinginterests:Nonedeclared as of January 2013 ((Calderon et al 2007), http://arup.utah. T.-T.(Claire)V.Tran edu/database/GALT/GALT_welcome.php). Most variants BiologyDepartment,EmoryCollege,EmoryUniversity,Atlanta, are coding missense substitutions, but some are small GA30322,USA : : : : insertions, deletions, or indels. Finally, some variants Y.Liu M.E.Zwick D.Ramachandran D.J.Cutler J.L.Fridovich-Keil(*) impact only noncoding sequence, and two are large DepartmentofHumanGenetics,EmoryUniversitySchoolof deletions that remove most or all of the GALT gene (e.g., Medicine,Rm.325.2WhiteheadBldg.,615MichaelSt, (Calderon et al 2007; Coffee et al 2006; Gort et al 2006; Atlanta,GA30322,USA Papachristoforouetal2014;Tyfieldetal1999),http://arup. e-mail:[email protected] : utah.edu/database/GALT/GALT_welcome.php). X.Huang G.T.Berry SomeGALTmutationsarecommon,especiallyincertain TheMantonCenterforOrphanDiseaseResearch,Divisionof GeneticsandGenomics,DepartmentofPediatrics,BostonChildren’s populations. For example, c.563A>G (p.Q188R) accounts Hospital,HarvardMedicalSchool,Boston,MA,USA for the vast majority of CG patient alleles in Northern 2 JIMDReports Europeand>60%ofCGpatientallelesintheUnitedStates (Tyfield et al 1999). The mutation c.855G>T (p.K285N) accounts for a majority of CG patient alleles in Eastern Europe (Lukac-Bajalo et al 2007). Finally, c.404C>T (p.S135L) accounts for a majority of CG patient alleles in parts of Africa (Henderson et al 2002). Other mutations, suchasc.584T>C(p.L195P),arelesscommon,accounting for only a small percentage of reported patient alleles, and yet others are “private” – reported only in one affected patient or family. The heterogeneity of CG patient alleles Fig. 1 The family described in this study. The child, FKT118, has identifiedtodaystandsasastrikingrecordofthemanynew biochemically confirmed classic galactosemia and a GALT genotype of c.563A>G (p.Q188R)/c.563A>C (p.Q188P). The mother, GALT variants that have arisen over the course of human FKT118P1, is a heterozygous carrier of the c.563A>G (p.Q188R) history,butuntilnowtherehavebeennoreportedexamples mutation.Thefather,FKT118P2,doesnotshowanyGALTmutations of de novo GALT variants identified in a living patient or inhisDNA.Thebiologicalrelationshipsillustratedwereconfirmedby family. We report here the first such case. extensive marker analysis. The couple also has another unaffected biologicalchild(notillustrated)whohasnotbeengenotyped Methods GALT Genotyping of DNA from Both Parents Study Volunteers DNAs from parental saliva samples collected using Ora- gene kits were also genotyped by dideoxy sequencing of The volunteers in this study were a child with classic the relevant GALT locus using the following primers: galactosemia and both of her parents (Fig. 1). All three hGALT-F4(2): 50-AAGCTTTGGTTCTGGGGAGT-30 and participated following appropriate informed consent/assent hGALT-R3: 50-GTGTCTGGTAGGGCCATGTT-30. Initial in Emory IRB Protocol # 00024933 (PI: JL Fridovich- studies revealed that the mother, designated FKT118P1, Keil). The child was also a consented volunteer in a was a carrier of the c.563A>G (p.Q188R) missense research study of galactosemia conducted out of Boston mutationand that thefather,designated FKT118P2,carried Children’sHospital(IRBProtocol#NS09-07-0369(PI:GT neithermutation.Concernedthattheremayhavebeensome Berry)). mistake, we collected an independent saliva sample from FKT118P2 and repeated the test; again we found neither GALT Genotyping of DNA from the Child GALT mutation. DNA samples isolated from independent blood draws from Affymetrix6.0MicroarrayAnalysisofGenomicMarkersin the child were assessed by dideoxy sequencing of the the Trio full GALT locus first in a clinical genetics laboratory (at Boston Children’sHospital) andsubsequentlyinaresearch To confirm the biological relationships among the three laboratory(atEmoryUniversity).Intheresearchlaboratory study volunteers, we subjected each DNA sample to the GALT gene was PCR amplified as a single ~6 kb genotyping using the Affymetrix Genome-Wide Human amplicon using the primers 50-AGTACCAGGGGAG- SNP Array 6.0 that tests more than 900,000 single GAATTAATTTGAATTTT-30 and 50-ATTCAGT- nucleotide polymorphisms (SNPs) scattered across the CACTGTCCAGCCTTAGTGTGATTT-30 as described genome (http://www.affymetrix.com/catalog/131533/ previously (Boutron et al 2012), and the relevant region AFFY/Genome-Wide-Human-SNP-Array-6.0#1_1). was sequenced using the following custom primers: Briefly, to be considered for downstream analyses, each hGALT-F4(2): 50-AAGCTTTGGTTCTGGGGAGT-30 (30 array was required to pass the Affymetrix recommended end anneals to position 1324), hGALT-F03(1): 50- quality control (QC) parameters – namely >86% call rate, CCCTGGTCGG ATGTAACG-30 (30 end anneals to posi- >0.4 contrast QC, and gender concordance. Genotype tion 1164), and hGALT-R3: 50-GTGTCTGGTAGGGC- calling was performed using Birdseed algorithm (version CATGTT-30 (30 end anneals to position 2111). Both the 2),asimplementedintheAffymetrixPowerToolssoftware clinical and research labs identified the same two muta- (APT 1.12.0). Estimations of alleles that are identical by tions: the common c.563A>G (p.Q188R) missense muta- state(IBS)fromgenotypecallswereperformedusinganin- tion and also a novel c.563A>C (p.Q188P) missense house script (D.J.C). In comparison with the parents, the mutation, each found in the patient in the compound proband had approximately 73% of genotypes that were heterozygous state. IBSatbothalleles(IBS2),27%atoneallele(IBS1)and0% JIMDReports 3 Table1 Percentageof>900,000markerlociinthetriointerrogatedusingtheAffymetrixGenome-WideHumanSNPArray6.0showing0,1,or 2alleleswithidentitybystate(IBS) LevelofIBS 0of2alleleswithIBS 1of2alleleswithIBS 2of2alleleswithIBS Expectedforparentandoffspring 0.0010 0.2692 0.7307 ObservedforFKT118P1andFKT118 0.0002 0.2665 0.7333 ObservedforFKT118P2andFKT118 0.0002 0.2686 0.7311 with IBS0 value, thus confirming the familial relationship Dideoxy Sequencing Reveals a Novel GALT Variant in a (see Table 1). Child with Classic Galactosemia Initial GALT genotyping was performed in 2008 in a Results clinical genetics lab (Emory Genetics Laboratory) using allele-specific primer extension (Luminex; http://www. Case Report premierbiosoft.com/primerplex/allele-specific-primer- extension.html)todetectthepresenceorabsenceofapanel Theproband(FKT118,Fig.1)isa6-year-oldgirlwhowas ofcommon mutations.Theresultdemonstrated presenceof bornatgestationalage34weeksanddiagnosedwithclassic c.563A>G (p.Q188R) and absence of the wild-type allele galactosemia as an infant in follow-up to an abnormal atthatlocus;noothermutationsincludedinthepanelwere newborn screening result. On day 1 of life, she was detected. The genotype was therefore reported, to the supplementedwithaproprietaryformulacontaininglactose sensitivity of the assay, as c.563A>G (p.Q188R)/ because of a poor sucking reflex. In the first week of life, c.563A>G (p.Q188R). Of note, c.563A>C (p.Q188P) she manifested poor feeding, emesis, loose stools, and was not one of the common GALT mutations included in jaundice. The serum total bilirubin concentration was the panel. 23 mg%. The newborn screening test for galactosemia Yearslaterafreshbloodsamplewascollected(atBoston was positive and the infant was switched to a soy-based Children’sHospital)andsubjectedtoGALTgenotypingvia formula on day 5 of life. Seizures occurred at 3 years of full gene dideoxy sequencing. Two mutations were age, including grand mal seizures. There is a history of detected, c.563A>G (p.Q188R) and c.563A>C language delay and a speech defect. Magnetic resonance (p.Q188P), each in the compound heterozygous state. With imaging (MRI) of the brain conducted at 5 years of age permission, this result was shared with our research lab at revealed areas of patchy subcortical white matter signal Emory University that repeated the dideoxy sequencing on increases possibly related to non-suppressed perivascular an archived DNA sample from the child; the c.563A>G spaces. On physical examination at age five, the proband (p.Q188R)/c.563A>C (p.Q188P) result was confirmed had scars on her face due to a seizure-induced fall. There (Fig. 2). A search of the galactosemia literature and GALT was diffuse hypotonia. There were no discernible peaks of mutation database (http://arup.utah.edu/database/GALT/ galactitol on magnetic resonance spectroscopy (MRS). The GALT_welcome.php) revealed no prior reports of the erythrocyte GALT enzyme activity was undetectable, and c.563A>C (p.Q188P) mutation. the galactose-1-phosphate level was 3.67 mg% while on a lactose-restricted diet (reference range <1 mg%). The Dideoxy Sequencing of Parental GALT Loci Coupled with urinary galactitol excretion was 178 mmol/mmol creatinine ComprehensiveGenomicSNPAnalysisoftheTrioReveals (reference range 2–36). By early childhood the serum that c.563A>C (p.Q188P) is a De Novo Variant in this follicle stimulating hormone (FSH) level was elevated and Family the anti-M€ullerian hormone level was undetectable. A DEXA scan of bone density did not reveal any region with In response to a parental request for GALT genotyping to a Z score that was below two standard deviations of the determine which side of the family was at risk for carrying reference mean. which GALT mutation, parental saliva samples were