Practical aspects of therapy for glutaric aciduria type 1
https://doi.org/10.17650/2222-8721-2021-11-4-12-25
Abstract
Treatment of many of the diseases in the panel of expanded newborn screening includes dietary therapy. Glutaric aciduria type 1 (GA1) is a hereditary disorder caused by mutations in the gene GCDH, encoding glutaryl‑CoA dehydrogenase, an enzyme in the amino acid metabolic pathways. The decreased activity of the enzyme leads to accumulation of neuro‑ toxic metabolites. The recommended treatment approaches for GA1 are the prescription of specialized nutrition products, levocarnitine, and symptomatic management. In 2021, clinical guidelines for the treatment of this rear disease were published in Russian Federation. To provide for the timely treatment, it is essential for a practitioner involved in the care patients with such a rare disorder as GA1 to have the knowledge of the principles of management, as well as practical algorithms for diet calculation.
The article gives a detailed case‑based description of management during metabolic decompensation and the choice of dietary therapy for GA1 patients of different age groups.
About the Authors
E. Yu. ZakharovaRussian Federation
Ekaterina Yuryevna Zakharova
1 Moskvorechye St., Moscow 115522
S. V. Mikhailova
Russian Federation
117 Leninsky Prospect, Moscow 119571
V. V. Zarubina
Russian Federation
1/9 4-yi Dobryninskiy Pereulok, Moscow 119049
N. A. Krasnoshchekova
Russian Federation
1/9 4-yi Dobryninskiy Pereulok, Moscow 119049
N. L. Pechatnikova
Russian Federation
1/9 4-yi Dobryninskiy Pereulok, Moscow 119049
V. P. Vorontsova
Russian Federation
117 Leninsky Prospect, Moscow 119571
D. I. Gribov
Russian Federation
117 Leninsky Prospect, Moscow 119571
M. V. Zazivihina
Russian Federation
117 Leninsky Prospect, Moscow 119571
А. N. Slatetskaya
Russian Federation
117 Leninsky Prospect, Moscow 119571
M. V. Kurkina
Russian Federation
1 Moskvorechye St., Moscow 115522
P. V. Baranova
Russian Federation
1 Moskvorechye St., Moscow 115522
L. P. Nazarenko
Russian Federation
10 Naberezhnaya reki Ushayki, Tomsk 634050
S. А. Repina
Russian Federation
1 Moskvorechye St., Moscow 115522
L. R. Selimsyanova
Russian Federation
Build. 1, 10 Fotievoj St., Moscow 119333
Build. 2, 8 Trubetskaya St., Moscow 119991
N. D. Vashakmadse
Russian Federation
Build. 1, 10 Fotievoj St., Moscow 119333
Build. 2, 8 Trubetskaya St., Moscow 119991
T. V. Bushueva
Russian Federation
Build. 1, 2 Lomonosovskiy Prospect, Moscow 119991
References
1. Стенограмма совещания о совершенствовании медицинской помощи детям. Правительство России. Доступно по: http://government.ru/news/42363/. [Transcript of the meeting on improving medical care for children. Russian Government. Available at: http:// government.ru/news/42363/. (In Russ.)].
2. Baric I., Wagner L., Feyh P. et al. Sensitivity and specificity of free and total glutaric acid and 3-hydroxyglutaric acid measurements by stable-isotope dilution assays for the diagnosis of glutaric aciduria type I. J Inherit Metab Dis 1999;22(8):867–81. DOI: 10.1023/a:1005683222187.
3. Morton D.H., Bennett M.J., Seargeant L.E. et al. Glutaric aciduria type I: a common cause of episodic encephalopathy and spastic paralysis in the Amish of Lancaster County, Pennsylvania. Am J Med Genet 1991;41(1):89–95. DOI: 10.1002/ajmg.1320410122.
4. Haworth J.C., Booth F.A., Chudley A.E. et al. Phenotypic variability in glutaric aciduria type I: Report of fourteen cases in five Canadian Indian kindreds. J Pediatr 1991;118(1):52–8. DOI: 10.1016/s0022-3476(05)81843-8.
5. Sauer S.W., Okun J.G., Fricker G. et al. Intracerebral accumulation of glutaric and 3-hydroxyglutaric acids secondary to limited flux across the bloodbrain barrier constitute a biochemical risk factor for neurodegeneration in glutaryl-CoA dehydrogenase deficiency. J Neurochem 2006;97:899–910. DOI: 10.1111/j.1471-4159.2006.03813.x.
6. Михайлова С.В., Захарова Е.Ю., Бобылова М.Ю. и др. Глутаровая ацидурия тип 1: клиника, диагностика и лечение. Журнал неврологии и психиатрии им. С.С. Корсакова 2007;(10):4–12. [Mikhailova S.V., Zakharova E.Yu., Bobylova M.Yu. et al. Glutaric aciduria type 1: clinical presentations, diagnostics and treatment. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova = Neuroscience and Behavioral Physiology 2007;(10):4–12. (In Russ.)].
7. Михайлова С.В., Захарова Е.Ю., Петрухин А.С. Нейрометаболические заболевания у детей и подростков: диагностика и подходы к лечению. 2-е изд., перераб. и доп. М.: Литтерра, 2017. 368 с. [Mikhailova S.V., Zakharova E.Yu., Petrukhin A.S. Neurometabolic diseases in children and adolescents: diagnosis and treatment approaches. 2nd edn., rev. and add. Moscow: Litterra, 2017. 368 p. (In Russ.)].
8. Boy N., Garbade S.F., Heringer J. et al. Patterns, evolution, and severity of striatal injury in insidious- versus acute-onset glutaric aciduria type 1. J Inherit Metab Dis 2019;42(1):117–27. DOI: 10.1002/jimd.12033.
9. Sauer S., Opp S., Hoffman G.F. et al. Therapeutic modulation of cerebral l-lysine metabolism in a mouse model for glutaric aciduria type 1. Brain 2011;134:157–70. DOI: 10.1093/brain/awq269.
10. Guerreiro G., Faverzani J., Jacques C.E.D. et al. Oxidative damage in glutaric aciduria type 1 patients and the protective effects of l-carnitine treatment. J Cell Biochem 2018;119(12);10021–32. DOI: 10.1002/jcb.27332.
11. Boy N., Mengler K., Thimm E. et al. Newborn screening: a disease-changing intervention for glutaric aciduria type 1. Ann Neurol 2018;83:970–97. DOI: 10.1002/jcb.27332.
12. Heringer J., Boy S.P.N., Ensenauer R. et al. Use of guidelines improves the neurological outcome in glutaric aciduria type I. Ann Neurol 2010;68:743–52. DOI: 10.1002/ana.22095.
13. Viau K., Ernst S.L., Vanzo R.J. et al. Glutaric acidemia type 1: Outcomes before and after expanded newborn screening. Mol Genet Metab 2012;106:430–8. DOI: 10.1016/j.ymgme.2012.05.024.
14. Beauchamp M.H., Boneh A., Anderson V. Cognitive, behavioral and adaptive profiles of children with glutaric aciduria type 1 detected through newborn screening. J Inherit Metab Dis 2009;32(1):207–13. DOI: 10.1007/s10545-009-1167-z.
15. Kölker S., Christensen E., Leonard J.V. et al. Diagnosis and management of glutaric aciduria type I – revised recommendations. J Inherit Metab Dis 2011;34:677–94. DOI: 10.1007/s10545-011-9289-5.
16. Boy N., Mühlhausen C., Maier E.M. et al. Additional individual contributors, proposed recommendations for diagnosing and managing individuals with glutaric aciduria type I: Second revision. J Inherit Metab Dis 2017;40:75–101. DOI: 10.1007/s10545-016-9999-9.
17. Kölker S., Christensen E., Leonard J.V., et al. Guideline for the diagnosis and management of glutaryl-CoA dehydrogenase deficiency (glutaric aciduria type I). J Inherit Metab Dis 2007;30:5–22. DOI: 10.1007/s10545-006-0451-4.
18. Ассоциация медицинских генетиков, Союз педиатров России, Национальная ассоциация детских реабилитологов. Клинические рекомендации. Глутаровая ацидурия, тип 1. Доступно по: https://cr.minzdrav.gov.ru/schema/406_2. [Association of Medical Geneticists, Union of Pediatricians of Russia, National Association of Pediatric Rehabilitation Therapists. Clinical guidelines. Glutaric aciduria, type 1. Available at: https://cr.minzdrav.gov.ru/schema/406_2. (In Russ.)].
19. Bernstein L., Coughlin C.R., Drumm M. et al. Inconsistencies in the nutrition management of glutaric aciduria type 1: An international survey. Nutrients 2020;12(10):3162. DOI: 10.3390/nu12103162.
20. Clinical Paediatric Dietetics. Ed. by Vanessa Shaw. 5th edn. Hoboken: Wiley-Blackwell, 2020.
21. Gokmen-Ozel H., MacDonald A., Daly A. et al. Dietary practices in glutaric aciduria type 1 over 16 years. J Hum Nutr Diet 2012;25(6):514–9. DOI: 10.1111/j.1365-277X.2012.01269.x.
Review
For citations:
Zakharova E.Yu., Mikhailova S.V., Zarubina V.V., Krasnoshchekova N.A., Pechatnikova N.L., Vorontsova V.P., Gribov D.I., Zazivihina M.V., Slatetskaya А.N., Kurkina M.V., Baranova P.V., Nazarenko L.P., Repina S.А., Selimsyanova L.R., Vashakmadse N.D., Bushueva T.V. Practical aspects of therapy for glutaric aciduria type 1. Neuromuscular Diseases. 2021;11(4):12-25. (In Russ.) https://doi.org/10.17650/2222-8721-2021-11-4-12-25