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Quintana E.,Institute Bioquimica Clinica | Pineda M.,Hospital Sant Joan Of Deu | Pineda M.,CIBER ISCIII | Font A.,CIBER ISCIII | And 5 more authors.
Journal of Inherited Metabolic Disease | Year: 2010

We present a 32-year-old patient who, from age 7 months, developed photophobia, left-eye ptosis and progressive muscular weakness. At age 7 years, she showed normal psychomotor development, bilateral ptosis and exercise-induced weakness with severe acidosis. Basal blood and urine lactate were normal, increasing dramatically after effort. PDHc deficiency was demonstrated in muscle and fibroblasts without detectable PDHA1 mutations. Ketogenic diet was ineffective, however thiamine gave good response although bilateral ptosis and weakness with acidosis on exercise persisted. Recently, DLD gene analysis revealed a homozygous missense mutation, c.1440 A>G (p.I480M), in the interface domain. Both parents are heterozygous and DLD activity in the patient's fibroblasts is undetectable. The five patients that have been reported with DLD-interface mutations suffered fatal deteriorations. Our patient's disease is milder, only myopathic, more similar to that due to mutation p.G229C in the NAD+-binding domain. Two of the five patients presented mutations (p.D479V and p.R482G) very close to the present case (p.I480M). Despite differing degrees of clinical severity, all three had minimal clues to DLD deficiency, with occasional minor increases in α-ketoglutarate and branched-chain amino acids. In the two other patients, hypertrophic cardiomyopathy was a significant feature that has been attributed to moonlighting proteolytic activity of monomeric DLD, which can degrade other mitochondrial proteins, such as frataxin. Our patient does not have cardiomyopathy, suggesting that p.I480M may not affect the DLD ability to dimerize to the same extent as p.D479V and p.R482G. Our patient, with a novel mutation in the DLD interface and mild clinical symptoms, further broadens the spectrum of this enzyme defect. © SSIEM and Springer 2010.

Serrano M.,Hospital Sant Joan Of Deu | Martins C.,Hospital Sant Joan Of Deu | Perez-Duenas B.,Hospital Sant Joan Of Deu | Gomez-Lopez L.,Hospital Sant Joan Of Deu | And 11 more authors.
Journal of Child Neurology | Year: 2010

Inherited urea cycle disorders represent one of the most common groups of inborn errors of metabolism. Late-onset urea cycle disorders caused by partial enzyme deficiencies may present with unexpected clinical phenotypes. We report 9 patients followed up in our hospital presenting late-onset urea cycle disorders who initially manifested neuropsychiatric/neurodevelopmental symptoms (the most prevalent neuropsychiatric/neurodevelopmental diagnoses were mental retardation, attention-deficit hyperactivity disorder [ADHD], language disorder, and delirium). Generally, these clinical pictures did not benefit from pharmacological treatment. Conversely, dietary treatment improved the symptoms. Regarding biochemical data, 2 patients showed normal ammonium but high glutamine levels. This study highlights the fact that neuropsychiatric/neurodevelopmental findings are common among the initial symptomatology of late-onset urea cycle disorders. The authors recommend that unexplained or nonresponsive neuropsychiatric/neurodevelopmental symptoms appearing during childhood or adolescence be followed by a study of ammonia and amino acid plasmatic levels to rule out a urea cycle disorder.

Colombo G.,Consultorio | Ostera D.E.,Institute Bioquimica Clinica | Pugliessi M.,Institute Bioquimica Clinica
Psiquiatria Biologica | Year: 2014

The following work investigates the relationship between dopaminergic D3 receptor -Ser9Gly- (rs6280) polymorphism and the «insecure» personalities described by K. Schneider. The DNA obtained from 10 patients diagnosed as «unsure of themselves» was compared with that of 4 control patients. The results suggest a strong association between the Ser9/Gly9 y Gly9/Gly9 genotypes and insecure personalities. © 2014 Elsevier España, S.L. and Sociedad Española de Psiquiatría y Sociedad Española de PsiquiatríaBiológica. All rights reserved.

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