Abstract
Objectives
Glycogen storage diseases (GSDs) are heterogeneous disorders caused by various enzyme deficiencies. GSD type IX α2, the most common subtype of GSD IX, is due to a deficiency of hepatic phosphorylase kinase. Herein we will report a novel mutation in this disease with an unusual presentation.
Case presentation
we describe a 3-year-old boy who suffered from hepatomegaly, fatty liver disease, and liver cirrhosis. The cause of cirrhosis at a young age was unknown based on the laboratory data and liver biopsy, so we performed a targeted-gene sequencing (TGS) covering 450 genes involved in inborn metabolic diseases consisting of glycogen storage disorders genes with hepatic involvement. He was found out to have a rare novel pathogenic variant in the PHKA2 gene.
Conclusions
This novel variant c.2226+2T > C expands the mutational spectrum of the PHKA2 gene. Also, severe liver damage (cirrhosis) in patients with GSD- IX α2 has rarely been reported, which needs further discussion. We hypothesize that unidentified PHKA2 variants may be a rare cause of childhood liver cirrhosis.
Funding source: National Institute for Medical Research Development
Award Identifier / Grant number: 976961
Award Identifier / Grant number: 1396-01-106-15748
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Research funding: This work was supported by National Institute for Medical Research Development, (Grant-number 976961). Shiraz Transplant Research Center, Shiraz University of Medical Sciences, (Grant-number 1396-01-106-15748).
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Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
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Competing interests: Authors state no conflict of interest.
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Informed consent: Informed consent was obtained from all individuals included in this study.
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Ethical approval: The local Institutional Review Board deemed the study exempt from review.
References
1. Tsilianidis, LA, Fiske, LM, Siegel, S, Lumpkin, C, Hoyt, K, Wasserstein, M, et al.. Aggressive therapy improves cirrhosis in glycogen storage disease type IX. Mol Genet Metabol 2013;109:179–82. https://doi.org/10.1016/j.ymgme.2013.03.009.Search in Google Scholar
2. Bali, DS, Goldstein, JL, Fredrickson, K, Austin, S, Pendyal, S, Rehder, C, et al.. Clinical and molecular variability in patients with PHKA2 variants and liver phosphorylase b kinase deficiency. J Inherit Metab Dis 2017;37:63–72. https://doi.org/10.1007/8904_2017_8.Search in Google Scholar
3. Herbert, M, Goldstein, JL, Rehder, C, Austin, S, Kishnani, PS, Bali, DS. Phosphorylase kinase deficiency. In: Adam, MP, Ardinger, HH, Pagon, RA, Wallace, SE, Bean, LJH, Mirzaa, G, et al., editors. GeneReviews. Seattle, WA: University of Washington; 2011:1993–2021 pp.Search in Google Scholar
4. Nguyena, NL, Ngocc, CTB, Vuc, CD, Tunga, NV, Nguyen, HH. A novel frameshift PHKA2 mutation in a family with glycogen storage disease type IXa: a first report in Vietnam and review of literature. Clin Chim Acta 2020;508:9–15. https://doi.org/10.1016/j.cca.2020.05.010.Search in Google Scholar
5. Richards, S, Aziz, N, Bale, S, Bick, D. Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American college of medical genetics and genomics and the association for molecular pathology. Genet Med 2015;17:405–23. https://doi.org/10.1038/gim.2015.30.Search in Google Scholar
6. Den Dunnen, JT, Antonarakis, SE. Mutation nomenclature extensions and suggestions to describe complex mutations: a discussion. Hum Mutat 2000;15:7–12. https://doi.org/10.1002/(sici)1098-1004(200001)15:1<7::aid-humu4>3.0.co;2-n.10.1002/(SICI)1098-1004(200001)15:1<7::AID-HUMU4>3.0.CO;2-NSearch in Google Scholar
7. Kishnani, PS, Goldstein, J, Austin, SL, Arn, P, Bachrach, B, Bali, DS, et al.. Diagnosis and management of glycogen storage diseases type VI and IX: a clinical practice resource of the American College of Medical Genetics and Genomics (ACMG). Genet Med 2019;21:772–89. https://doi.org/10.1038/s41436-018-0364-2.Search in Google Scholar
8. Roscher, A, Hewson, S, Nagy, L. The natural history of glycogen storage disease types VI and IX: long-term outcome from the largest metabolic center in Canada. Mol Genet Metabol 2014;113:171–6. https://doi.org/10.1016/j.ymgme.2014.09.005.Search in Google Scholar
9. Fernandes, SA, Cooper, GE, Gibson, RA, Kishnani, PS. Benign or not benign? Deep phenotyping of liver glycogen storage disease IX. Mol Genet Metabol 2020;131:299–305. https://doi.org/10.1016/j.ymgme.2020.10.004.Search in Google Scholar
10. Beyzaei, Z, Geramizadeh, B, Karimzadeh, S. Diagnosis of hepatic Glycogen storage disease patients with overlapping clinical symptoms by massively parallel sequencing: a systematic review of literature. Orphanet J Rare Dis 2020;15:217. https://doi.org/10.1186/s13023-020-01573-8.Search in Google Scholar
© 2021 Walter de Gruyter GmbH, Berlin/Boston
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Articles in the same Issue
- Frontmatter
- Review Article
- Congenital hyperinsulinism: recent updates on molecular mechanisms, diagnosis and management
- Original Articles
- Weight changes of children in 1 year during COVID-19 pandemic
- Three novel mutations of the BCKDHA, BCKDHB and DBT genes in Chinese children with maple syrup urine disease
- Rates of adrenal insufficiency using a monoclonal vs. polyclonal cortisol assay
- Hyperinsulinemic hypoglycemia in growth restricted convalescent preterm neonates: clinical characteristics and impediments to early diagnosis
- Identification of three novel pathogenic mutations in cystathionine beta-synthase gene of Pakistani intellectually disabled patients
- The prevalence of incidental finding of gynecomastia on thoracic computed tomography in the pediatric age group
- The prevalence of hypertension and elevated blood pressure and its correlation with overweight/obesity among students aged 6–17 years in Suzhou
- Investigation of androgen receptor gene CAG repeat length polymorphism in pubertal gynecomastia
- A single-centre study of genetic mutations, audiology, echocardiogram and pulmonary function in Saudi children with osteogenesis imperfecta
- A 10-year retrospective single-center study of alpha-fetoprotein and beta-human chorionic gonadotropin in Romanian children with (para)gonadal tumors and cysts
- Clinical, pathological and molecular spectrum of patients with glycogen storage diseases in Pakistan
- Allelic dropout in PAH affecting the results of genetic diagnosis in phenylketonuria
- Short Communication
- Role of the SARS-CoV-2 virus in the appearance of new onset type 1 diabetes mellitus in children in Gran Canaria, Spain
- Case Reports
- 3-M syndrome – a primordial short stature disorder with novel CUL7 mutation in two Indian patients
- The coincidence of two rare diseases with opposite metabolic phenotype: a child with congenital hyperinsulinism and Bloom syndrome
- Growth hormone deficiency in a child with benign hereditary chorea caused by a de novo mutation of the TITF1/NKX2-1 gene
- Identification of a novel mutation in the PHKA2 gene in a child with liver cirrhosis