Journal of Inherited Metabolic Disease最新文献

{"title":"Genetic aetiologies of acute liver failure","authors":"Robert Hegarty,&nbsp;Richard J. Thompson","doi":"10.1002/jimd.12733","DOIUrl":"10.1002/jimd.12733","url":null,"abstract":"<p>Acute liver failure (ALF) is a rare, rapidly evolving, clinical syndrome with devastating consequences where definitive treatment is by emergency liver transplantation. Establishing a diagnosis can be challenging and, historically, the cause of ALF was unidentified in up to half of children. However, recent technological and clinical advances in genomic medicine have led to an increasing proportion being diagnosed with monogenic aetiologies of ALF. The conditions encountered include a diverse group of inherited metabolic disorders each with prognostic and treatment implications. Often these disorders are clinically indistinguishable and may even mimic disorders of immune regulation or red cell disorders. Rapid genomic sequencing for children with ALF is, therefore, a key component in the diagnostic work up today. This review focuses on the monogenic aetiologies of ALF.</p>","PeriodicalId":16281,"journal":{"name":"Journal of Inherited Metabolic Disease","volume":"47 4","pages":"582-597"},"PeriodicalIF":4.2,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140158347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The continuously evolving phenotype of succinic semialdehyde dehydrogenase deficiency","authors":"Natalia Alexandra Julia-Palacios,&nbsp;Oya Kuseyri Hübschmann,&nbsp;Mireia Olivella,&nbsp;Roser Pons,&nbsp;Gabriella Horvath,&nbsp;Thomas Lücke,&nbsp;Cheuk-Wing Fung,&nbsp;Suet-Na Wong,&nbsp;Elisenda Cortès-Saladelafont,&nbsp;M. Mar Rovira-Remisa,&nbsp;Yılmaz Yıldız,&nbsp;Saadet Mercimek-Andrews,&nbsp;Birgit Assmann,&nbsp;Galina Stevanović,&nbsp;Filippo Manti,&nbsp;Heiko Brennenstuhl,&nbsp;Sabine Jung-Klawitter,&nbsp;Kathrin Jeltsch,&nbsp;H. Serap Sivri,&nbsp;Sven F. Garbade,&nbsp;Àngels García-Cazorla,&nbsp;Thomas Opladen","doi":"10.1002/jimd.12723","DOIUrl":"10.1002/jimd.12723","url":null,"abstract":"<p>The objective of the study is to evaluate the evolving phenotype and genetic spectrum of patients with succinic semialdehyde dehydrogenase deficiency (SSADHD) in long-term follow-up. Longitudinal clinical and biochemical data of 22 pediatric and 9 adult individuals with SSADHD from the patient registry of the International Working Group on Neurotransmitter related Disorders (iNTD) were studied with in silico analyses, pathogenicity scores and molecular modeling of <i>ALDH5A1</i> variants. Leading initial symptoms, with onset in infancy, were developmental delay and hypotonia. Year of birth and specific initial symptoms influenced the diagnostic delay. Clinical phenotype of 26 individuals (median 12 years, range 1.8–33.4 years) showed a diversifying course in follow-up: 77% behavioral problems, 76% coordination problems, 73% speech disorders, 58% epileptic seizures and 40% movement disorders. After ataxia, dystonia (19%), chorea (11%) and hypokinesia (15%) were the most frequent movement disorders. Involvement of the dentate nucleus in brain imaging was observed together with movement disorders or coordination problems. Short attention span (78.6%) and distractibility (71.4%) were the most frequently behavior traits mentioned by parents while impulsiveness, problems communicating wishes or needs and compulsive behavior were addressed as strongly interfering with family life. Treatment was mainly aimed to control epileptic seizures and psychiatric symptoms. Four new pathogenic variants were identified. In silico scoring system, protein activity and pathogenicity score revealed a high correlation. A genotype/phenotype correlation was not observed, even in siblings. This study presents the diversifying characteristics of disease phenotype during the disease course, highlighting movement disorders, widens the knowledge on the genotypic spectrum of SSADHD and emphasizes a reliable application of in silico approaches.</p>","PeriodicalId":16281,"journal":{"name":"Journal of Inherited Metabolic Disease","volume":"47 3","pages":"447-462"},"PeriodicalIF":4.2,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jimd.12723","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140158349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatobiliary circulation and dominant urinary excretion of homogentisic acid in a mouse model of alkaptonuria","authors":"B. P. Norman,&nbsp;H. Sutherland,&nbsp;P. J. M. Wilson,&nbsp;D. A. Rutland,&nbsp;A. M. Milan,&nbsp;A. T. Hughes,&nbsp;A. S. Davison,&nbsp;M. Khedr,&nbsp;J. C. Jarvis,&nbsp;J. A. Gallagher,&nbsp;G. Bou-Gharios,&nbsp;L. R. Ranganath","doi":"10.1002/jimd.12728","DOIUrl":"10.1002/jimd.12728","url":null,"abstract":"<p>Altered activity of specific enzymes in phenylalanine-tyrosine (phe-tyr) metabolism results in incomplete breakdown of various metabolite substrates in this pathway. Increased biofluid concentration and tissue accumulation of the phe-tyr pathway metabolite homogentisic acid (HGA) is central to pathophysiology in the inherited disorder alkaptonuria (AKU). Accumulation of metabolites upstream of HGA, including tyrosine, occurs in patients on nitisinone, a licenced drug for AKU and hereditary tyrosinaemia type 1, which inhibits the enzyme responsible for HGA production. The aim of this study was to investigate the phe-tyr metabolite content of key biofluids and tissues in AKU mice on and off nitisinone to gain new insights into the biodistribution of metabolites in these altered metabolic states. The data show for the first time that HGA is present in bile in AKU (mean [±SD] = 1003[±410] μmol/L; nitisinone-treated AKU mean [±SD] = 45[±23] μmol/L). Biliary tyrosine, 3(4-hydroxyphenyl)pyruvic acid (HPPA) and 3(4-hydroxyphenyl)lactic acid (HPLA) are also increased on nitisinone. Urine was confirmed as the dominant elimination route of HGA in untreated AKU, but with indication of biliary excretion. These data provide new insights into pathways of phe-tyr metabolite biodistribution and metabolism, showing for the first time that hepatobiliary excretion contributes to the total pool of metabolites in this pathway. Our data suggest that biliary elimination of organic acids and other metabolites may play an underappreciated role in disorders of metabolism. We propose that our finding of approximately 3.8 times greater urinary HGA excretion in AKU mice compared with patients is one reason for the lack of extensive tissue ochronosis in the AKU mouse model.</p>","PeriodicalId":16281,"journal":{"name":"Journal of Inherited Metabolic Disease","volume":"47 4","pages":"664-673"},"PeriodicalIF":4.2,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jimd.12728","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140131748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Open-label, single-center, clinical study evaluating the safety, tolerability and clinical effects of pentosan polysulfate sodium in subjects with mucopolysaccharidosis I","authors":"Drago Bratkovic,&nbsp;Curtis Gravance,&nbsp;David Ketteridge,&nbsp;Ravi Krishnan,&nbsp;Divya Navuru,&nbsp;Michael Sheehan,&nbsp;Donna Skerrett,&nbsp;Michael Imperiale","doi":"10.1002/jimd.12715","DOIUrl":"10.1002/jimd.12715","url":null,"abstract":"<p>Lysosomal enzyme deficiency in mucopolysaccharidosis (MPS) I results in glycosaminoglycan (GAG) accumulation leading to pain and limited physical function. Disease-modifying treatments for MPS I, enzyme replacement, and hematopoietic stem cell therapy (HSCT), do not completely resolve MPS I symptoms, particularly skeletal manifestations. The GAG reduction, anti-inflammatory, analgesic, and tissue remodeling properties of pentosan polysulfate sodium (PPS) may provide disease-modifying treatment for musculoskeletal symptoms and joint inflammation in MPS I following ERT and/or HSCT. The safety and efficacy of PPS were evaluated in four subjects with MPS I aged 14–19 years, previously treated with ERT and/or HSCT. Subjects received doses of 0.75 mg/kg or 1.5 mg/kg PPS via subcutaneous injections weekly for 12 weeks, then every 2 weeks for up to 72 weeks. PPS was well tolerated at both doses with no serious adverse events. MPS I GAG fragment (UA-HNAc [1S]) levels decreased at 73 weeks. Cartilage degradation biomarkers serum C-telopeptide of crosslinked collagen (CTX) type I (CTX-I) and type II (CTX-II) and urine CTX-II decreased in all subjects through 73 weeks. PROMIS scores for pain interference, pain behavior, and fatigue decreased in all subjects through 73 weeks. Physical function, measured by walking distance and dominant hand function, improved at 49 and 73 weeks. Decreased GAG fragments and cartilage degradation biomarkers, and positive PROMIS outcomes support continued study of PPS as a potential disease-modifying treatment for MPS I with improved pain and function outcomes.</p>","PeriodicalId":16281,"journal":{"name":"Journal of Inherited Metabolic Disease","volume":"47 2","pages":"355-365"},"PeriodicalIF":4.2,"publicationDate":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140101782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of sapropterin before and during pregnancy: Final analysis of the Kuvan® Adult Maternal Paediatric European Registry (KAMPER) maternal and Phenylketonuria Developmental Outcomes and Safety (PKUDOS) PKU-MOMs sub-registries","authors":"François Feillet,&nbsp;Can Ficicioglu,&nbsp;Florian B. Lagler,&nbsp;Nicola Longo,&nbsp;Ania C. Muntau,&nbsp;Alberto Burlina,&nbsp;Friedrich K. Trefz,&nbsp;Francjan J. van Spronsen,&nbsp;Jean-Baptiste Arnoux,&nbsp;Kristin Lindstrom,&nbsp;Joshua Lilienstein,&nbsp;Gillian E. Clague,&nbsp;Richard Rowell,&nbsp;Barbara K. Burton,&nbsp;the KAMPER and PKUDOS investigators","doi":"10.1002/jimd.12724","DOIUrl":"10.1002/jimd.12724","url":null,"abstract":"<p>Infants born to mothers with phenylketonuria (PKU) may develop congenital abnormalities because of elevated phenylalanine (Phe) levels in the mother during pregnancy. Maintenance of blood Phe levels between 120 and 360 μmol/L reduces risks of birth defects. Sapropterin dihydrochloride helps maintain blood Phe control, but there is limited evidence on its risk–benefit ratio when used during pregnancy. Data from the maternal sub-registries—KAMPER (NCT01016392) and PKUDOS (NCT00778206; PKU-MOMs sub-registry)—were collected to assess the long-term safety and efficacy of sapropterin in pregnant women in a real-life setting. Pregnancy and infant outcomes, and the safety of sapropterin were assessed. Final data from 79 pregnancies in 57 women with PKU are reported. Sapropterin dose was fairly constant before and during pregnancy, with blood Phe levels maintained in the recommended target range during the majority (82%) of pregnancies. Most pregnancies were carried to term, and the majority of liveborn infants were reported as ‘normal’ at birth. Few adverse and serious adverse events were considered related to sapropterin, with these occurring in participants with high blood Phe levels. This report represents the largest population of pregnant women with PKU exposed to sapropterin. Results demonstrate that exposure to sapropterin during pregnancy was well-tolerated and facilitated maintenance of blood Phe levels within the target range, resulting in normal delivery. This critical real-world data may facilitate physicians and patients to make informed treatment decisions about using sapropterin in pregnant women with PKU and in women of childbearing age with PKU who are responsive to sapropterin.</p>","PeriodicalId":16281,"journal":{"name":"Journal of Inherited Metabolic Disease","volume":"47 4","pages":"636-650"},"PeriodicalIF":4.2,"publicationDate":"2024-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jimd.12724","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140021907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal volumetric analysis of gray matter atrophy in metachromatic leukodystrophy","authors":"Murtadha L. Al-Saady,&nbsp;Hristina Galabova,&nbsp;Daphne H. Schoenmakers,&nbsp;Shanice Beerepoot,&nbsp;Caroline Lindemans,&nbsp;Peter M. van Hasselt,&nbsp;Marjo S. van der Knaap,&nbsp;Nicole I. Wolf,&nbsp;Petra J. W. Pouwels","doi":"10.1002/jimd.12725","DOIUrl":"10.1002/jimd.12725","url":null,"abstract":"<p>Metachromatic leukodystrophy (MLD) is an inherited lysosomal storage disorder characterized by arylsulfatase A (ASA) deficiency, leading to sulfatide accumulation and myelin degeneration in the central nervous system. While primarily considered a white matter (WM) disease, gray matter (GM) is also affected in MLD, and hematopoietic stem cell transplantation (HSCT) may have limited effect on GM atrophy. We cross-sectionally and longitudinally studied GM volumes using volumetric MRI in a cohort of 36 (late-infantile, juvenile and adult type) MLD patients containing untreated and HSCT treated subjects. Cerebrum, cortical GM, (total) CSF, cerebellum, deep gray matter (DGM) (excluding thalamus) and thalamus volumes were analyzed. Longitudinal correlations with measures of cognitive and motor functioning were assessed. Cross-sectionally, juvenile and adult type patients (infantiles excluded based on limited numbers) were compared with controls at earliest scan, before possible treatment. Patients had lower cerebrum, cortical GM, DGM and thalamus volumes. Differences were most pronounced for adult type patients. Longitudinal analyses showed substantial and progressive atrophy of all regions and increase of CSF in untreated patients. Similar, albeit less pronounced, effects were seen in treated patients for cerebrum, cortical GM, CSF and thalamus volumes. Deterioration in motor performance (all patients) was related to atrophy, and increase of CSF, in all regions. Cognitive functioning (data available for treated patients) was related to cerebral, cortical GM and thalamus atrophy; and to CSF increase. Our findings illustrate the importance of recognizing GM pathology as a potentially substantial, clinically relevant part of MLD, apparently less amenable to treatment.</p>","PeriodicalId":16281,"journal":{"name":"Journal of Inherited Metabolic Disease","volume":"47 4","pages":"792-804"},"PeriodicalIF":4.2,"publicationDate":"2024-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jimd.12725","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140012741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nucleotide metabolism, leukodystrophies, and CNS pathology","authors":"Francesco Gavazzi,&nbsp;Carlos Dominguez Gonzalez,&nbsp;Kaley Arnold,&nbsp;Meghan Swantkowski,&nbsp;Lauren Charlton,&nbsp;Nicholson Modesti,&nbsp;Asif A. Dar,&nbsp;Adeline Vanderver,&nbsp;Mariko Bennett,&nbsp;Laura A. Adang","doi":"10.1002/jimd.12721","DOIUrl":"10.1002/jimd.12721","url":null,"abstract":"<p>The balance between a protective and a destructive immune response can be precarious, as exemplified by inborn errors in nucleotide metabolism. This class of inherited disorders, which mimics infection, can result in systemic injury and severe neurologic outcomes. The most common of these disorders is Aicardi Goutières syndrome (AGS). AGS results in a phenotype similar to “TORCH” infections (<i>Toxoplasma gondii</i>, Other [Zika virus (ZIKV), human immunodeficiency virus (HIV)], Rubella virus, human Cytomegalovirus [HCMV], and Herpesviruses), but with sustained inflammation and ongoing potential for complications. AGS was first described in the early 1980s as familial clusters of “TORCH” infections, with severe neurology impairment, microcephaly, and basal ganglia calcifications (Aicardi &amp; Goutières, <i>Ann Neurol</i>, 1984;15:49–54) and was associated with chronic cerebrospinal fluid (CSF) lymphocytosis and elevated type I interferon levels (Goutières et al., <i>Ann Neurol</i>, 1998;44:900–907). Since its first description, the clinical spectrum of AGS has dramatically expanded from the initial cohorts of children with severe impairment to including individuals with average intelligence and mild spastic paraparesis. This broad spectrum of potential clinical manifestations can result in a delayed diagnosis, which families cite as a major stressor. Additionally, a timely diagnosis is increasingly critical with emerging therapies targeting the interferon signaling pathway. Despite the many gains in understanding about AGS, there are still many gaps in our understanding of the cell-type drivers of pathology and characterization of modifying variables that influence clinical outcomes and achievement of timely diagnosis.</p>","PeriodicalId":16281,"journal":{"name":"Journal of Inherited Metabolic Disease","volume":"47 5","pages":"860-875"},"PeriodicalIF":4.2,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139990304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From skin lesions to tyrosinemia type II diagnosis","authors":"Inês S. F. da Silva,&nbsp;Inês Sopa,&nbsp;Daniel Gomes,&nbsp;Lígia Peixoto,&nbsp;Anabela Oliveira","doi":"10.1002/jimd.12720","DOIUrl":"10.1002/jimd.12720","url":null,"abstract":"","PeriodicalId":16281,"journal":{"name":"Journal of Inherited Metabolic Disease","volume":"47 5","pages":"1107-1108"},"PeriodicalIF":4.2,"publicationDate":"2024-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139972157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A phenylalanine-free recombinant nutritional protein for the dietary management of phenylketonuria","authors":"Yvonne Mücke,&nbsp;Natalia Jablonka,&nbsp;Nicole Rimann,&nbsp;Hiu Man Grisch-Chan,&nbsp;Bernhard Hoffmann,&nbsp;Stefan Schillberg,&nbsp;Beat Thöny,&nbsp;Stefan Rasche","doi":"10.1002/jimd.12719","DOIUrl":"10.1002/jimd.12719","url":null,"abstract":"<p>Phenylketonuria (PKU) is a congenital metabolic disorder that causes the systemic elevation of phenylalanine (Phe), which is neurotoxic and teratogenic. PKU is currently incurable, and management involves lifelong adherence to an unpalatable protein-restricted diet based on Phe-free amino acid mixtures. Seeking a palatable dietary alternative, we identified a <i>Bacillus subtilis</i> protein (GSP16O) with a well-balanced but low-Phe amino acid profile. We optimized the sequence and expressed a modified Phe-free version (GSP105) in <i>Pseudomonas fluorescens</i>, achieving yields of 20 g/L. The purified GSP105 protein has a neutral taste and smell, is highly soluble, and remains stable up to 80°C. Homozygous <i>enu2</i> mice, a model of human PKU, were fed with diets containing either GSP105 or normal protein. The GSP105 diet led to normalization of blood Phe levels and brain monoamine neurotransmitter metabolites, and prevented maternal PKU. The GSP105 diet thus provides an alternative and efficacious dietary management strategy for PKU.</p>","PeriodicalId":16281,"journal":{"name":"Journal of Inherited Metabolic Disease","volume":"47 4","pages":"651-663"},"PeriodicalIF":4.2,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jimd.12719","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139931492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of citrulline substitution on clinical outcome after liver transplantation in carbamoyl phosphate synthetase 1 and ornithine transcarbamylase deficiency","authors":"Denise Aldrian,&nbsp;Birgit Waldner,&nbsp;Georg F. Vogel,&nbsp;Areeg H. El-Gharbawy,&nbsp;Patrick McKiernan,&nbsp;Jerard Vockley,&nbsp;Yuval E. Landau,&nbsp;Fuad Al Mutairi,&nbsp;Karolina M. Stepien,&nbsp;Anne Mei-Kwun Kwok,&nbsp;Yılmaz Yıldız,&nbsp;Tomas Honzik,&nbsp;Silvie Kelifova,&nbsp;Carolyn Ellaway,&nbsp;Allan M. Lund,&nbsp;Mari Mori,&nbsp;Sarah C. Grünert,&nbsp;Sabine Scholl-Bürgi,&nbsp;Thomas Zöggeler,&nbsp;Rupert Oberhuber,&nbsp;Stefan Schneeberger,&nbsp;Thomas Müller,&nbsp;Daniela Karall","doi":"10.1002/jimd.12717","DOIUrl":"10.1002/jimd.12717","url":null,"abstract":"<p>Carbamoyl phosphate synthetase 1 (CPS1) and ornithine transcarbamylase (OTC) deficiencies are rare urea cycle disorders, which can lead to life-threatening hyperammonemia. Liver transplantation (LT) provides a cure and offers an alternative to medical treatment and life-long dietary restrictions with permanent impending risk of hyperammonemia. Nevertheless, in most patients, metabolic aberrations persist after LT, especially low plasma citrulline levels, with questionable clinical impact. So far, little is known about these alterations and there is no consensus, whether <span>l</span>-citrulline substitution after LT improves patients' symptoms and outcomes. In this multicentre, retrospective, observational study of 24 patients who underwent LT for CPS1 (<i>n</i> = 11) or OTC (<i>n</i> = 13) deficiency, 25% did not receive <span>l</span>-citrulline or arginine substitution. Correlation analysis revealed no correlation between substitution dosage and citrulline levels (CPS1, <i>p</i> = 0.8 and OTC, <i>p</i> = 1). Arginine levels after liver transplantation were normal after LT independent of citrulline substitution. Native liver survival had no impact on mental impairment (<i>p</i> = 0.67). Regression analysis showed no correlation between <span>l</span>-citrulline substitution and failure to thrive (<i>p</i> = 0.611) or neurological outcome (<i>p</i> = 0.701). Peak ammonia had a significant effect on mental impairment (<i>p</i> = 0.017). Peak plasma ammonia levels correlate with mental impairment after LT in CPS1 and OTC deficiency. Growth and intellectual impairment after LT are not significantly associated with <span>l</span>-citrulline substitution.</p>","PeriodicalId":16281,"journal":{"name":"Journal of Inherited Metabolic Disease","volume":"47 2","pages":"220-229"},"PeriodicalIF":4.2,"publicationDate":"2024-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jimd.12717","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139905833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}