Sawada Takaaki, Kido Jun, Sugawara Keishin, Yoshida Shinichiro, Matsumoto Shirou, Shimazu Tomoyuki, Matsushita Yuki, Inoue Takahito, Hirose Shinichi, Endo Fumio, Nakamura Kimitoshi
Department of Pediatrics, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Department of Pediatrics, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
Mol Genet Metab Rep. 2022 Feb 18;31:100850. doi: 10.1016/j.ymgmr.2022.100850. eCollection 2022 Jun.
Gaucher disease (GD) is an autosomal recessive inborn metabolic disorder caused by a glucocerebrosidase (GCase) defect. GD is classified into three main types depending on accompanying neurological symptoms. Enzyme replacement therapy and substrate reduction therapy are limited in the treatment of neurological symptoms, and using genotype and GCase activity to discriminate between non-neuronopathic and neuronopathic GD may be challenging as the two sometimes phenotypically overlap. The number of patients exhibiting neurological symptoms in Japan is significantly higher than that in Europe and the United States, and newborn screening (NBS) is still not actively performed in Japan. Definitive determination of the actual frequency and proportion of the type of GD from the results of NBS remains inconclusive. We performed NBS for Fabry disease, Pompe disease, and GD, mainly in the Kyushu area in Japan. Herein, we discuss the results of NBS for GD, as well as, the insights gained from following the clinical course of patients diagnosed through NBS. A total of 155,442 newborns were screened using an enzyme activity assay using dried blood spots. We found four newborns showing lower GCase activity and were definitively diagnosed with GD by gene analysis. The frequency of GD diagnosis through NBS was 1 in 77,720 when limited to the probands. This frequency is higher than that previously estimated in Japan. In the future, NBS for GD is expected to be performed in many regions of Japan and contribute to detecting more patients with GD. Early screening and diagnosis may have a very significant impact on the quality of life and potentially longevity in infants with GD.
戈谢病(GD)是一种由葡糖脑苷脂酶(GCase)缺陷引起的常染色体隐性先天性代谢紊乱疾病。根据伴随的神经症状,GD主要分为三种类型。酶替代疗法和底物减少疗法在治疗神经症状方面存在局限性,由于非神经病变型和神经病变型GD有时在表型上会重叠,因此利用基因型和GCase活性来区分这两种类型可能具有挑战性。在日本,出现神经症状的患者数量明显高于欧洲和美国,而且日本仍未积极开展新生儿筛查(NBS)。根据NBS结果确定GD实际的发病频率和类型比例仍无定论。我们主要在日本九州地区对法布里病、庞贝病和GD进行了NBS。在此,我们讨论GD的NBS结果,以及对通过NBS确诊的患者临床病程跟踪所获得的见解。我们使用干血斑酶活性测定法对总共155442名新生儿进行了筛查。我们发现4名新生儿的GCase活性较低,并通过基因分析最终确诊为GD。仅就先证者而言,通过NBS诊断出GD的频率为1/77720。这一频率高于日本此前的估计。未来,预计日本许多地区将开展GD的NBS,并有助于发现更多的GD患者。早期筛查和诊断可能会对患有GD的婴儿的生活质量以及潜在寿命产生非常重大的影响。
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