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螯合疗法对一名因SLC39A14基因复合杂合突变导致脑锰沉积的韩国患者的影响。

Effect of Chelation Therapy on a Korean Patient With Brain Manganese Deposition Resulting From a Compound Heterozygous Mutation in the SLC39A14 Gene.

作者信息

Lee Jae-Hyeok, Shin Jin-Hong

机构信息

Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.

Medical Research Institute, Pusan National University School of Medicine, Yangsan, Korea.

出版信息

J Mov Disord. 2022 May;15(2):171-174. doi: 10.14802/jmd.21143. Epub 2022 Mar 22.

Abstract

Mutations in the manganese transporter gene SLC39A14 lead to inherited disorders of manganese metabolism. Chelation therapy with edetate calcium disodium (CaNa2EDTA) is known to effectively reduce manganese deposition. We describe the first identified Korean case of SLC39A14-associated manganism and the treatment response to a 5-year chelation therapy. An 18-year-old female presented with childhood-onset dystonia. Magnetic resonance imaging showed T1 hyperintensity throughout the basal ganglia, brainstem, cerebellum, cerebral and cerebellar white matter, and pituitary gland. Blood manganese levels were elevated, and whole-exome sequencing revealed compound heterozygous mutations in SLC39A14. Treatment with intravenous CaNa2EDTA led to a significant reduction in serum manganese levels and T1 hyperintensities. However, her dystonia improved insignificantly. Hence, early diagnosis of this genetic disorder is essential because it is potentially treatable. Even though our treatment did not significantly reverse the establish deficits, chelation therapy could have been more effective if it was started at an earlier stage of the disease.

摘要

锰转运蛋白基因SLC39A14的突变会导致遗传性锰代谢紊乱。已知用依地酸钙钠(CaNa2EDTA)进行螯合疗法可有效减少锰沉积。我们描述了首例经鉴定的韩国SLC39A14相关锰中毒病例以及5年螯合疗法的治疗反应。一名18岁女性自幼起病,出现肌张力障碍。磁共振成像显示基底神经节、脑干、小脑、大脑和小脑白质以及垂体均有T1高信号。血锰水平升高,全外显子测序显示SLC39A14存在复合杂合突变。静脉注射CaNa2EDTA治疗导致血清锰水平和T1高信号显著降低。然而,她的肌张力障碍改善不明显。因此,早期诊断这种遗传疾病至关重要,因为它有可能得到治疗。尽管我们的治疗未能显著逆转已有的缺陷,但如果在疾病早期开始螯合疗法,可能会更有效。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e7fb/9171315/858980bbb542/jmd-21143f1.jpg

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