短链酰基辅酶A脱氢酶在大鼠心脏发育中的表达及其与心肌肥厚的关系

 目的：研究大鼠心脏发育过程中短链酰基辅酶A脱氢酶(short-chain acyl-CoA dehydrogenase, SCAD)的表达变化规律,并探讨其与高血压大鼠心肌肥厚的关系。方法：观察不同时期Wistar大鼠和不同周龄自发性高血压大鼠心肌组织的SCAD蛋白表达及酶活性变化,检测大鼠的血清和心肌游离脂肪酸含量。结果：与胚胎期19 d Wistar大鼠组比较,出生后1 d、2周、6周及16周龄Wistar大鼠组心肌的SCAD蛋白表达及酶活性增加,血清和心肌游离脂肪酸含量明显减少,二者之间呈负相关,其中,从2周龄Wistar大鼠组开始差异有统计学意义。与周龄匹配的WKY大鼠组比较,2周龄自发性高血压大鼠组收缩压尚未升高,6周龄及16周龄自发性高血压大鼠组收缩压显著增高;各时点自发性高血压大鼠组的左室重量指数均明显增高,提示自发性高血压大鼠在血压升高之前,已经发生了明显的心肌肥厚。与周龄匹配的WKY大鼠组比较,2周、6周及16周龄自发性高血压大鼠组心肌的SCAD蛋白表达及酶活性明显下降,血清和心肌游离脂肪酸含量明显增加,呈显著负相关。结论：(1)SCAD蛋白表达随大鼠心脏的生长发育逐渐上调,可能与心脏对脂肪酸的利用增加密切相关。(2)SCAD的蛋白表达及其酶活性显著下降, 可能是导致自发性高血压大鼠肥厚心肌能量代谢“胚胎型再演”的分子基础。     

短链酰基辅酶A脱氢酶在大鼠生理性和病理性心肌肥大中的作用

 目的：研究短链酰基辅酶A脱氢酶(short-chain acyl-CoA dehydrogenase, SCAD)在大鼠生理性和病理性心肌肥大中的变化,探讨其与心肌肥大之间的关系。方法：以自发性高血压大鼠作为病理性心肌肥大模型,游泳运动训练性大鼠作为生理性心肌肥大模型。检测大鼠的血压、左室重量指数、血清和心肌游离脂肪酸含量、SCAD mRNA、蛋白表达及其酶活性的变化,采用超声心动图观察心脏的结构及功能。结果：与对照组比较,运动组大鼠出现了明显的离心性肥大,心肌收缩功能增强;而高血压组大鼠呈现出明显的向心性肥大,心肌收缩功能减退。与对照组比较,运动组和高血压组大鼠的左室重量指数均明显增高,但两组间比较无显著差异,二者发生了相同程度的心肌肥大。与对照组比较,运动组大鼠左心室SCAD mRNA和蛋白表达均明显上调,酶活性增高,血清和心肌游离脂肪酸含量明显减少;而自发性高血压大鼠左心室SCAD mRNA和蛋白表达均明显下调,酶活性下降,血清和心肌游离脂肪酸含量明显增多。结论：SCAD在生理性和病理性心肌肥大中呈现出不一致的变化趋势,可能作为区别2种不同心肌肥大的分子标志物以及病理性心肌肥大的潜在治疗靶点。     

Maternal medium-chain acyl-CoA dehydrogenase deficiency identified by newborn screening

Prior to the advent of expanded newborn screening, sudden and unexplained death was often the first and only symptom of medium-chain acyl-CoA dehydrogenase deficiency (MCADD). With the use of tandem mass spectrometry, infants can now be identified and treated before a life threatening metabolic decompensation occurs. Newborn screening has also been shown to detect previously undiagnosed maternal inborn errors of metabolism. We have now diagnosed two women with MCADD following the identification of low free carnitine in their newborns. While one of the women reported prior symptoms of fasting intolerance, neither had a history of metabolic decompensation or other symptoms consistent with a fatty acid oxidation disorder. These cases illustrate the importance of including urine organic acid analysis and an acylcarnitine profile as part of the confirmatory testing algorithm for mothers when low free carnitine is identified in their infants.     

尿素酶预处理-气相色谱-质谱法诊断琥珀酸半醛脱氢酶缺陷病

本文探讨琥珀酸半醛脱氢酶(succinic semialdehyde dehydrogenase,SSADH)缺陷病各尿液标志物的气相色谱-质谱法(Gas Chromatography-Mass Spectrometry,GC-MS)分析特征。收集SSADH患儿的尿液标本,经去尿素、加内标(正十七酸)、除蛋白、真空干燥处理,残余物进行三甲基硅烷化衍生后进样行GC-MS法分析。尿液中可检测到明显的4-羟基丁酸、2,4-二羟基丁酸、3,4-二羟基丁酸和4,5-二羟基己酸信号。在TIC图上,其绝对保留时间(相对保留时间)分别是6．32min(0．434),7．80min(0．536),7．94min(0．546),8．80min,8．90min(0．605,0．612)。在质谱图上,其特征离子(m／z,TMS)分别是M-15(233,2),M-15(321,3),M-15(321,3),M-15(349,3)。GC-MS法分离鉴定尿液代谢成分,可作为诊断该病的一种可靠手段。     

Molecular,biochemical, and clinical characterization of mitochondrial acetoacetyl-coenzyme A thiolase deficiency in two further patients

The molecular basis of mitochondrial acetoacetyl-CoA thiolase (T2) deficiency was studied in two patients (GK11 and GK16). Fibroblasts from each patient had detectable immunoreactive T2 polypeptide (CRM). In pulse-chase experiments, fibroblasts from GK11 had two types of CRM: one (type I CRM) disappeared after a 24-hr chase and migrated more slowly than that of the normal control; the other (type II CRM) was detected with a small amount even after a 72-hr chase and had normalelectrophoretic mobility. GK16's fibroblasts had a CRM (type III) which was also detectable even after a 72-hr chase and showed a slower mobility than type I CRM. By analyzing amplified cDNA and genomic fragments, we showed that both patients are genetic compounds; GK11 for the mutations N158D and T297M, and GK16 for the mutations A301P and IVS8 ( + 1). Expression analyses confirmed that mutant T2 subunits with N158D, T297M, and A301P correspond to type I, II, and III CRM, respectively. Among them, only the mutant T2 polypeptide with T297M appeared to have a detectable residual activity, in spite of its instability. Cotransfection of two cDNAs containing N158D and T297M suggested that heterotetramer formation reduces residual activity in GK11 cells.© 1995 wiley-Liss, Inc.     

新生儿遗传代谢病的筛查诊断及治疗进展

遗传代谢病在新生儿早期症状大多无特异性,由于累及的部位和病情轻重差异大所以极易造成误诊.孕妇在产前应对胎儿进行遗传代谢疾病的筛查诊断,降低新生儿遗传性代谢病出生缺陷率.新生儿科医生应综合评价筛查结果及时准确地做出临床诊断,以便 对遗传代谢疾病危象期患儿采取补救措施,使他们得到进一步评估及特殊治疗.该文就新生儿遗传代谢病主要的筛查诊断及治疗方法作一综述.     

短链酰基辅酶A脱氢酶在心脏成纤维细胞胶原表达和细胞增殖中的作用

目的:研究短链酰基辅酶A脱氢酶(short-chain acyl-CoA dehydrogenase,SCAD)在心脏成纤维细胞胶原表达和细胞增殖中的作用,探讨其与心肌纤维化之间的关系。方法:以血管紧张素Ⅱ(angiotensin Ⅱ,Ang Ⅱ)刺激心脏成纤维细胞建立胶原表达和细胞增殖模型,并采用SCAD的最优干扰序列siRNA-1186进行干扰,检测SCAD的mRNA、蛋白表达、酶活性、脂肪酸β氧化速率、ATP以及游离脂肪酸含量的变化;观察其对心脏成纤维细胞胶原表达和细胞增殖的影响。结果:与对照组相比,在Ang Ⅱ诱导的心脏成纤维细胞增殖和胶原表达模型中,SCAD的mRNA和蛋白表达均显著下调。与阴性对照序列组相比,siRNA-1186干扰后心脏成纤维细胞的SCAD表达和酶活性明显下降,心脏成纤维细胞脂肪酸β氧化速率以及ATP生成明显降低,并且游离脂肪酸含量明显增多。同时,心脏成纤维细胞出现明显增殖,Ⅰ、Ⅲ型胶原的表达明显增加。结论:SCAD表达失调可能导致了心脏成纤维细胞异常增殖、胶原分泌紊乱,上调SCAD可能成为干预心肌纤维化的重要环节之一。     

短链酰基辅酶A脱氢酶在心肌细胞凋亡中的作用

目的:研究短链酰基辅酶A脱氢酶(short-chain acyl-Co A dehydrogenase,SCAD)在心肌细胞凋亡中的变化,探讨其与心肌细胞凋亡之间的关系。方法:以叔丁基过氧化氢(tert-butyl hydroperoxide,t BHP)刺激心肌细胞建立凋亡模型。检测细胞存活率、SCAD mRNA和蛋白表达、SCAD活性以及游离脂肪酸含量变化;并采用SCAD的最优干扰序列siRNA-1186进行干扰,观察其对心肌细胞凋亡的影响。结果:与对照组相比,在t BHP诱导的心肌细胞凋亡模型中,SCAD的mRNA和蛋白表达均显著下调。与阴性对照序列组相比,siRNA-1186干扰后心肌细胞的SCAD表达和活性明显下降,心肌细胞游离脂肪酸含量明显增加,同时,心肌细胞出现了明显凋亡,与t BHP诱导的心肌细胞凋亡趋势一致。结论:SCAD表达失调可能参与心肌细胞凋亡的过程,上调SCAD可能成为干预心肌细胞凋亡的重要环节之一。     

短链酰基辅酶A脱氢酶在高血压血管重构中的作用

目的:研究短链酰基辅酶A脱氢酶(short-chain acyl-CoA dehydrogenase,SCAD)在高血压血管重构中的变化,探讨SCAD与高血压血管重构之间的关系。方法:采用游泳耐力训练方式训练16周龄的自发性高血压大鼠(spontaneously hypertensive rats,SHR)和健康Wistar大鼠8周,分别以24周龄的SHR和Wistar大鼠作为实验对照,定期测量鼠尾收缩压,测定各组大鼠胸主动脉血管腔内径和血管壁中层厚度、SCAD的mRNA和蛋白表达水平、SCAD酶活性的变化、ATP和ROS水平及血清和胸主动脉游离脂肪酸含量。结果:与Wistar组比较,SHR组大鼠血压升高,血管腔内径减小,血管壁中层厚度增大,血管壁中层厚度与血管腔内径比值增大;与SHR组相比,SHR游泳组血压下降,血管腔内径增大,血管壁中层厚度减小,血管壁中层厚度与血管腔内径比值减小(P0.05)。与Wistar组比较,SHR组大鼠主动脉SCAD的mRNA和蛋白表达水平显著下调,主动脉中SCAD酶活性下降,ATP含量降低,血清和主动脉游离脂肪酸含量明显增加,ROS含量增加;分别与Wistar组和SHR组比较,Wistar游泳组和SHR游泳组主动脉SCAD的mRNA和蛋白表达水平均明显上调,主动脉中SCAD的酶活性增高,ATP含量增加,血清和主动脉的游离脂肪酸含量明显减少,ROS含量减少。结论:主动脉SCAD的表达下调可能与高血压血管重构密切相关。游泳运动可能通过上调SCAD表达,从而逆转高血压血管重构。     

Retrospective study of the medium‐chain acyl‐CoA dehydrogenase deficiency in Portugal

Medium‐chain acyl‐CoA dehydrogenase deficiency (MCADD) is the commonest genetic defect of mitochondrial fatty acid β‐oxidation. About 60% of MCADD patients are homozygous for the c.985A>G (p.Lys329Glu) mutation in the ACADM gene (G985 allele). Herein, we present the first report on the molecular and biochemical spectrum of Portuguese MCADD population. From the 109 patients studied, 83 were diagnosed after inclusion of MCADD in the national newborn screening, 8 following the onset of symptoms and 18 through segregation studies. Gypsy ancestry was identified in 85/109 patients. The G985 allele was found in homozygosity in 102/109 patients, in compound heterozygosity in 6/109 and was absent in one patient. Segregation studies in the Gypsy families showed that 93/123 relatives were carriers of the G985 allele, suggesting its high prevalence in this ethnic group. Additionally, three new substitutions—c.218A>G (p.Tyr73Cys), c.503A>T (p.Asp168Val) and c.1205G>T (p.Gly402Val)—were identified. Despite the particularity of the MCADD population investigated, the G985 allele was found in linkage disequilibrium with H1(112) haplotype. Furthermore, two novel haplotypes, H5(212) and H6(122) were revealed.     

Pathologic characterization of short-chain acyl-CoA dehydrogenase deficiency in BALB/cByJ mice

BALB/cByJ mice have a deficiency of short-chain acyl-CoA dehydrogenase (SCAD) and are a useful model for studying the inborn errors of fatty acid metabolism which affect humans. Patients with some of these disorders present with hypoglycemia, hyperamonemia, and microvesicular fatty change of hepatocytes. In the present study we examined pathogen-free, SCAD deficient BALB/cByJ mice and control BALB/cBy mice for biochemical and tissue changes following fasting or salicylate challenge. We observed mitochondrial swelling and microvesicular fatty changes in hepatocytes in mutant mice, especially severe following a fast. However, fasting did not alter their blood ammonia and there was no apparent clinical disease. Similarly, salicylates did not produce disease in the BALB/cByJ mice. We did detect in mice an alternative pathway for salicylate metabolism, by-passing glycine conjugation which is the principal metabolic pathway in humans. © 1993 Wiley-Liss, Inc.     

ERK1/2/PPARα/SCAD信号途径对生理性和病理性心肌肥大的调控

 目的：研究ERK1/2/PPARα/SCAD（短链脂酰辅酶A脱氢酶）信号途径对生理性和病理性心肌肥大调控的不同机制,探索病理性心肌肥大治疗的新靶点。方法：分别以胰岛素样生长因子1（insulin-like growth factor 1,IGF-1）和苯肾上腺素（phenylephrine,PE）刺激心肌细胞,复制生理性和病理性心肌肥大模型,检测心肌细胞表面积,p-ERK1/2和PPARα蛋白表达变化,SCAD mRNA、蛋白表达和酶活性变化,心肌细胞游离脂肪酸含量变化。结果：与对照组比较,PE和IGF-1刺激后心肌细胞表面积均显著增大。与对照组相比,IGF-1刺激的心肌细胞SCAD mRNA和蛋白表达均上调,酶活性显著增高,游离脂肪酸含量明显减少,且PPARα mRNA和蛋白表达均上调,p-ERK1/2的蛋白表达显著下调;PE刺激的心肌细胞SCAD mRNA和蛋白表达均下调,酶活性显著降低,游离脂肪酸含量明显增加,且PPAR αmRNA和蛋白表达均下调,p-ERK1/2蛋白表达显著上调。结论：p-ERK1/2/PPARα/SCAD在生理性和病理性心肌肥大中呈现出不一致的变化趋势,表明ERK1/2/PPARα/SCAD信号途径对2种不同肌肥大的调控作用不同。SCAD可能作为2种不同心肌肥大的分子标志物及病理性心肌肥大的潜在治疗靶点。     

A novel mutation in the dihydrolipoamide dehydrogenase E3 subunit gene (DLD) resulting in an atypical form of alpha-ketoglutarate dehydrogenase deficiency

The alpha-ketoglutarate dehydrogenase complex (KGDC) catalyses the decarboxylation of alpha-ketoglutarate into succinyl-coenzyme A in the Krebs cycle. This enzymatic complex is made up of three subunits (E1, encoded by PDHA1; E2, encoded by DLST; and E3, encoded by DLD). The E3 subunit is common to two other enzymatic complexes, namely pyruvate dehydrogenase complex (PDC) and branched-chain ketoacid dehydrogenase complex (BCKDC). KGDC deficiency is a rare autosomal recessive disorder, most often presenting with severe encephalopathy and hyperlactatemia with neonatal onset. We found a KGDC deficiency in cultured skin fibroblasts from three siblings born to consanguinous parents. E3 subunit activity was shown to be deficient (20% of control values), despite the absence of usual clinical clues to E3 deficiency, i.e. accumulation of pyruvate and branched-chain amino acids in plasma and branched-chain alpha-ketoacids in urine. RT-PCR of E3 mRNA from the three patients, followed by sequencing, revealed an homozygous c.1444A>G substitution located in E3 exon 13, predictive of a p.R482G (or R447G in the processed gene product) substitution in a highly conserved domain of the protein. Only eleven E3 mutations have been reported so far. The only other case of E3 deficiency without clinical or biochemical evidences of PDC and BCKDC deficiencies has been ascribed to a c.1436A>T (p.D479V; or D444V in the processed gene product) mutation, very close to the mutation reported herein. Since c.1444A>G (p.R482G; or R447G in the processed gene product) and c.1436A>T (p.D479V; or D444V in the processed gene product) lie within the interface domain of E3 with E2 (KGDC and BCKDC) or the E3-binding protein (PDC), our data suggest that interaction of E3 with these other subunits differs in some extent among KGDC, PDC, and BCKDC.     

应用高分辨率熔解曲线分析快速筛查和诊断citrin缺陷导致的新生儿肝内胆汁淤积症

目的 探讨高分辨率熔解曲线(high-resolution melting,HRM)分析技术用于citrin缺陷导致的新生儿肝内胆汁淤积症(neonatal intrahepatic cholestasis caused by citrin deficiency,NICCD)筛查和诊断的可行性.方法 根据中国人群SLC25A13基因的热点突变类型(851del4、1638ins23、IVS6+5G＞A和IVS16ins3kb)设计特异性HRM扩增引物,挑选经测序证实的50名正常对照和20例NICCD患儿,建立和完善HRM检测条件.用优化后的HRM检测方法对171例临床疑似的NICCD患者进行HRM筛查.若受检样本的熔解曲线与阳性质控样品相吻合,则进行DNA测序分析.结果 优化后的HRM方法能准确地对50名正常对照及20例NICCD患儿进行基因分型,其灵敏度和特异性均为100％ (70/70).重复实验表明,相同基因型的不同样品HRM熔解曲线完全吻合,重复性好.在171例疑似患儿中,有7例患儿熔解曲线与阳性质控样品基因型相符,其HRM基因分型为:1例851del4纯合突变,1例IVS6+5G＞A杂合突变,3例851del4杂合突变,1例[IVS6+5G＞ A]+[851del4],1例[1638ins23+IVS16ins3kb]+[1638ins23].DNA测序证实了HRM基因分型,准确率为100％.结论 HRM技术具有高通量、操作简便、结果准确、重复性好等优点,可对临床疑似的NICCD患儿进行基因筛查和诊断.     

Cardiac conduction improvement in two heterozygotes for primary carnitine deficiency on l‐carnitine supplementation

Sarafoglou K, Tridgell AHC, Bentler K, Redlinger‐Grosse K, Berry SA, Schimmenti LA. Cardiac conduction improvement in two heterozygotes for primary carnitine deficiency on l ‐carnitine supplementation. Expanded newborn screening (NBS) for free carnitine levels has led to the identification of a larger number of heterozygous infants of undiagnosed mothers affected with systemic primary carnitine deficiency (PCD), which in turn leads to the identification of other undiagnosed heterozygous family members. There is an increasing recognition that individuals heterozygous for mutations of genes involved in fatty acid oxidation (FAO) may become symptomatic under environmental stress (fasting, prolonged exercise and illness). Considering the importance of carnitine in FAO, its role in heart and bowel function and in lipid metabolism, what is still little known is the phenotypic variability, biochemical parameters and clinical course of PCD heterozygotes with consistently low‐to‐normal levels to low levels of carnitine over a lifetime. We report on three generations of a family—an asymptomatic PCD heterozygous infant identified through NBS that led to the diagnosis of her asymptomatic PCD‐affected mother and the heterozygous status of the maternal grandparents who report some cardiac symptoms that overlap with PCD that improved with l ‐carnitine supplementation.     

Free carnitine concentrations and biochemical parameters in medium-chain acyl-CoA dehydrogenase deficiency: Genotype–phenotype correlation

Biallelic variants in the ACADM gene cause medium-chain acyl-CoA dehydrogenase deficiency (MCADD). This study reports on differences in the occurrence of secondary free carnitine (C0) deficiency and different biochemical phenotypes related to genotype and age in 109 MCADD patients followed-up at a single tertiary care center during 22 years. C0 deficiency occurred earlier and more frequently in c.985A>G homozygotes (genotype A) compared to c.985A>G compound heterozygotes (genotype B) and individuals carrying variants other than c.985A>G and c.199C>T (genotype D) (median age 4.2 vs. 6.6 years; p < 0.001). No patient carrying c.199C>T (genotype C) developed C0 deficiency. A daily dosage of 20–40 mg/kg carnitine was sufficient to maintain normal C0 concentrations. Compared to genotype A as reference group, octanoylcarnitine (C8) was significantly lower in genotypes B and C, whereas C0 was significantly higher by 8.28 μmol/L in genotype C (p < 0.05). In conclusion, C0 deficiency is mainly found in patients with pathogenic genotypes associated with high concentrations of presumably toxic acylcarnitines, while individuals carrying the variant c.199C>T are spared and show consistently mild biochemical phenotypes into adulthood. Low-dose carnitine supplementation maintains normal C0 concentrations. However, future studies need to evaluate clinical benefits on acute and chronic manifestations of MCADD.     

Diagnostische Bedeutung von Muskelbiopsien bei metabolischen Myopathien

Summary In the diagnosis of metabolic myopathies the use of biochemical methods, in addition to morphological examination of muscle biopsies, is often necessary in order to identify a specific metabolic defect. In order to narrow down the spectrum of biochemical methods, extensive clinical investigation and morphological examination, including histology, enzyme histochemistry and electromicroscopy if necessary have to be done beforehand. Patients are classified in the following groups: 1) progressive muscular weakness and/or muscle wasting with storage of a) glycogen, b) lipid or c) mitochondrial alterations; 2) recurrent rhabdomyolysis induced by fasting or exercise a) with glycogen storage or b) without any specific morphological alterations. The spectrum of metabolic defects comprises disorders of glycogen and glucose metabolism (deficiency of acid maltase, debranching and branching enzyme, phosphorylase, phosphofructokinase and other glycolytic enzymes), lipid metabolism (carnitine deficiency, carnitine palmitoyl transferase deficiency), mitochondria (respiratory chain disorders, pyruvate dehydrogenase deficiency) and others such as adenylate deaminase deficiency. In some of these e.g. infantile acid maltase deficiency and mitochondriopathies, it is clinically more important when organs other than muscle are affected; however, muscle biopsy is a useful substrate for diagnosis of these metabolic disorders.

Mit Unterstützung durch die DFG und die Friedrich Baur Stiftung, München     

Genetic, structural and biochemical basis of carbamoyl phosphate synthetase 1 deficiency

Carbamoyl phosphate synthetase 1 (CPS1) plays a paramount role in liver ureagenesis since it catalyzes the first and rate-limiting step of the urea cycle, the major pathway for nitrogen disposal in humans. CPS1 deficiency (CPS1D) is an autosomal recessive inborn error which leads to hyperammonemia due to mutations in the CPS1 gene, or is caused secondarily by lack of its allosteric activator NAG.Proteolytic, immunological and structural data indicate that human CPS1 resembles Escherichia coli CPS in structure, and a 3D model of CPS1 has been presented for elucidating the pathogenic role of missense mutations. Recent availability of CPS1 expression systems also can provide valuable tools for structure–function analysis and pathogenicity-testing of mutations in CPS1. In this paper, we provide a comprehensive compilation of clinical CPS1 mutations, and discuss how structural knowledge of CPS enzymes in combination with in vitro analyses can be a useful tool for diagnosis of CPS1D.     

Late Mortality after Allogeneic Blood or Marrow Transplantation for Inborn Errors of Metabolism: A Report from the Blood or Marrow Transplant Survivor Study-2 (BMTSS-2)

Allogeneic blood or marrow transplantation (BMT) is currently considered the standard of care for patients with specific inborn errors of metabolism (IEM). However, there is a paucity of studies describing long-term survival and cause-specific late mortality after BMT in these patients with individual types of IEM. We studied 273 patients who had survived ≥2 years after allogeneic BMT for IEM performed between 1974 and 2014. The most prevalent IEM in our cohort were X-linked adrenoleukodystrophy (ALD; 37.3%), Hurler syndrome (35.1%), and metachromatic leukodystrophy (MLD; 10.2%). Conditional on surviving ≥2 years after BMT, the overall survival for the entire cohort was 85.5 ± 2.4% at 10 years and 73.5 ± 3.7% at 20 years. The cohort had a 29-fold increased risk of late death compared with an age- and sex-matched cohort from the general US population (95% CI, 22- to 38-fold). The increased relative mortality was highest in the 2- to 5-year period after BMT (standardized mortality ratio [SMR], 207; 95% confidence interval [CI], 130 to 308) and declined with increasing time from BMT, but remained elevated for ≥21 years after BMT (SMR, 9; 95% CI, 4 to 18). Sequelae from the progression of primary disease were the most common causes of late mortality in this cohort (76%). The use of T cell-depleted grafts in patients with ALD and Hurler syndrome was a risk factor for late mortality. Younger age at BMT and use of busulfan and cyclosporine were protective in patients with Hurler syndrome. Our findings demonstrate relatively favorable overall survival in ≥2-year survivors of allogeneic BMT for IEM, although primary disease progression continues to be responsible for the majority of late deaths.     

一个琥珀酸半醛脱氢酶缺陷病家系ALDH5A1基因突变分析

目的 对1例临床怀疑且经尿筛查诊断为琥珀酸半醛脱氢酶缺陷病的患儿及家系进行ALDH5A1基因突变分析,以进一步明确诊断和辅助遗传咨询.方法 应用聚合酶链反应及DNA直接测序技术对1例琥珀酸半醛脱氢酶缺陷病患儿及其父母的ALDH5A1基因进行突变位点检测,同时检测100名健康对照者的ALDH5A1基因以排除多态性变异.结果 患儿携带有ALDH5A1基因编码区序列第3外显子c.527G＞A(p.Gly176Glu)和第4外显子c.691G＞A(p.Glu231Lys)两种杂合突变,其母亲为c.527G＞A杂合突变携带者,父亲为c.691G＞A杂合突变携带者.另外患儿还存在两种已报道的核酸多态性改变:c.545C＞T杂合突变和c.538C＞T纯合突变.患儿的c.545C＞T突变来源于父亲,c.538C＞T突变分别来源于父母.100名健康对照者中未检测到c.527G＞A和c.691G＞A突变.结论 c.527G＞A(p.Gly176Glu)和c.691G＞A(p.Glu231 Lys)错义突变可能是该患儿的致病突变.