Nguyen Ngoc-Lan, Thi Bich Ngoc Can, Dung Vu Chi, Van Tung Nguyen, Hoang Nguyen Huy
Graduate University of Science and Technology, Vietnam Academy of Science and Technology, 18 Hoang Quoc Viet str., Cau Giay, Hanoi 100000, Viet Nam; Institute of Genome Research, Vietnam Academy of Science and Technology, 18 Hoang Quoc Viet str., Cau Giay, Hanoi 100000, Viet Nam.
Center for Rare Diseases and Newborn Screening, Department of Endocrinology, Metabolism and Genetics, Vietnam National Hospital of Pediatrics, 18/879 La Thanh str., Dong Da, Hanoi 100000, Viet Nam.
Clin Chim Acta. 2020 Sep;508:9-15. doi: 10.1016/j.cca.2020.05.010. Epub 2020 May 7.
Glycogen storage diseases (GSDs) are clinically and genetically heterogeneous disorders. Overlapping features between liver GSDs are a major challenge in the clinical diagnosis of them. Genetic testing can provide an early and accurate diagnosis of patients suspected with GSDs.
In this study, we report two siblings born to healthy, non-consanguineous Vietnamese parents with hepatomegaly. The proband presented with hepatomegaly, normal spleen, elevated transaminases, without hypoglycemia, normal lactate dehydrogenase and creatine kinase. Liver biopsy revealed degeneration and swollen hepatocytes, suggesting a diagnosis with GSDs.
Whole exome sequencing was applied to identify genetic variants in the proband. Variant validation and familial co-segregation analysis were examined using Sanger sequencing.
A novel frameshift duplication mutation c.3308_3312dupATGTC (p.L1105Mfs*11) of the PHKA2 gene was identified in the proband and his elder brother at the hemizygous state. This mutation was inherited from their mother. Their father and younger brother were normal genotype.
The two siblings were accurately diagnosed with GSD type XIa. This is the first case report of GSD type IXa in Vietnamese patients with a mutation in the PHKA2 gene. This finding may support for genetics diagnosis of unknown cause of hepatomegaly.
糖原贮积病(GSDs)是临床和遗传异质性疾病。肝脏糖原贮积病之间的重叠特征是其临床诊断的主要挑战。基因检测可为疑似糖原贮积病的患者提供早期准确诊断。
在本研究中,我们报告了两名出生于健康、非近亲的越南父母的同胞,他们患有肝肿大。先证者表现为肝肿大、脾脏正常、转氨酶升高,无低血糖,乳酸脱氢酶和肌酸激酶正常。肝活检显示肝细胞变性和肿胀,提示诊断为糖原贮积病。
应用全外显子组测序鉴定先证者的基因变异。使用桑格测序法进行变异验证和家族共分离分析。
在先证者及其哥哥中鉴定出PHKA2基因的一个新的移码重复突变c.3308_3312dupATGTC(p.L1105Mfs*11),呈半合子状态。该突变遗传自他们的母亲。他们的父亲和弟弟基因型正常。
这两名同胞被准确诊断为XIa型糖原贮积病。这是越南患者中首例因PHKA2基因突变导致的IXa型糖原贮积病病例报告。这一发现可能有助于不明原因肝肿大的遗传学诊断。