Genetic variation and clinical phenotype analysis of hypermethioninemia caused by MAT1A gene mutation: Case report.

IF 1.3 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
Jialin Mu, Yulin Li, Meng Sun, Panpan Li, Jingyun Wang, Hui Zou
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引用次数: 0

Abstract

Rationale: The high clinical heterogeneity of hypermethioninemia caused by MAT1A gene defects has resulted in a paucity of studies examining the association between clinical phenotypes, biochemical characteristics, and gene mutations in this patient group. Furthermore, the indications for therapeutic interventions in patients remain unclear. The objective of this study is to provide a foundation for clinical diagnosis, genetic counseling, and follow-up management of hypermethioninemia caused by MAT1A gene defects.

Patient concerns: A retrospective analysis of children with hypermethioninemia at Jinan Maternal and Child Health Hospital from January 2016 to December 2023 was performed using tandem mass spectrometry (MS/MS). The screened and diagnosed children were tested for gene mutations using second-generation sequencing technology and confirmed using Sanger sequencing.

Diagnoses: Newborn MS/MS screening for diseases demonstrated an elevated methionine level, which was outside the reference range. Upon recalling the newborns, the methionine levels remained elevated, necessitating further refinement of genetic testing. Ultimately, genetic testing confirmed hypermethioninemia, which was attributed to a mutation in the MAT1A gene.

Interventions: The intervention for the patients in this study took the following forms: regular follow-up without treatment (n = 3), intake of methionine-free milk powder without any medication (n = 4), intake of methionine-free milk powder with some medication, and eventually liver transplantation (n = 1).

Outcomes: A total of 14 mutation types were detected, including 3 compound heterozygous mutation types (c.926G > T, c.37_38delCT, and c.316G > A) that have not been previously reported. One patient had monoheterozygous mutations, including the novel mutation c.550-1G > A. Eight cases were monitored over time, 7 of which demonstrated typical growth and development. One infant with growth retardation was fed a special formula lacking methionine. The patient underwent liver transplantation. Subsequent follow-up examinations showed methionine and homocysteine levels within normal limits and no further neurological manifestations.

Lessons: Compound heterozygous mutations c.874C > T and c.896G > A may result in higher levels of methionine, affecting the central nervous system. For newborns with initial methionine levels of >500 µmol/L, treatment with a low-Met diet is recommended. Liver transplantation may be beneficial for children with severe hypermethioninemia, particularly in preventing central nervous system damage.

MAT1A基因突变致高蛋氨酸血症的遗传变异及临床表型分析:1例报告。
理由:由MAT1A基因缺陷引起的高蛋氨酸血症的临床异质性很高,导致研究该患者组临床表型、生化特征和基因突变之间关系的研究缺乏。此外,患者治疗干预的适应症仍不清楚。本研究旨在为MAT1A基因缺陷所致高蛋氨酸血症的临床诊断、遗传咨询及随访管理提供依据。患者关注点:采用串联质谱法(MS/MS)对2016年1月至2023年12月在济南市妇幼保健院收治的高蛋氨酸血症患儿进行回顾性分析。筛查和诊断的儿童使用第二代测序技术检测基因突变,并使用Sanger测序进行确认。诊断:新生儿MS/MS疾病筛查显示蛋氨酸水平升高,超出参考范围。在召回新生儿后,蛋氨酸水平仍然升高,需要进一步改进基因检测。最终,基因检测证实了高蛋氨酸血症,这归因于MAT1A基因的突变。干预措施:本研究患者的干预方式为:定期随访,不进行治疗(n = 3),不服用任何药物,服用不含蛋氨酸的奶粉(n = 4),服用不含蛋氨酸的奶粉,并服用一些药物,最终进行肝移植(n = 1)。结果:共检测到14种突变型,其中3种复合杂合突变型(c.926G > T、c.37_38delCT、c.316G > A)未见报道。一名患者有单杂合突变,包括新的突变c.550-1G >a。对8例进行长期监测,其中7例表现出典型的生长发育。给一名发育迟缓的婴儿喂食一种不含蛋氨酸的特殊配方奶粉。病人接受了肝移植。随后的随访检查显示蛋氨酸和同型半胱氨酸水平在正常范围内,没有进一步的神经系统症状。经验:复合杂合突变c.874C > T和c.896G > A可能导致蛋氨酸水平升高,影响中枢神经系统。对于初始蛋氨酸水平为bb0 500µmol/L的新生儿,建议采用低蛋氨酸饮食治疗。肝移植可能对重度高蛋氨酸血症儿童有益,特别是在预防中枢神经系统损伤方面。
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来源期刊
Medicine
Medicine 医学-医学:内科
CiteScore
2.80
自引率
0.00%
发文量
4342
审稿时长
>12 weeks
期刊介绍: Medicine is now a fully open access journal, providing authors with a distinctive new service offering continuous publication of original research across a broad spectrum of medical scientific disciplines and sub-specialties. As an open access title, Medicine will continue to provide authors with an established, trusted platform for the publication of their work. To ensure the ongoing quality of Medicine’s content, the peer-review process will only accept content that is scientifically, technically and ethically sound, and in compliance with standard reporting guidelines.
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