Abstract:
:Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a fatal disorder characterized by progressive gastrointestinal dysmotility, peripheral neuropathy, leukoencephalopathy, skeletal myopathy, ophthalmoparesis, and ptosis. MNGIE stems from deficient thymidine phosphorylase activity (TP) leading to toxic elevations of plasma thymidine. Hematopoietic stem cell transplant (HSCT) restores TP activity and halts disease progression but has high transplant-related morbidity and mortality. Liver transplant (LT) was reported to restore TP activity in two adult MNGIE patients. We report successful LT in four additional MNGIE patients, including a pediatric patient. Our patients were diagnosed between ages 14 months and 36 years with elevated thymidine levels and biallelic pathogenic variants in TYMP. Two patients presented with progressive gastrointestinal dysmotility, and three demonstrated progressive peripheral neuropathy with two suffering limitations in ambulation. Two patients, including the child, had liver dysfunction and cirrhosis. Following LT, thymidine levels nearly normalized in all four patients and remained low for the duration of follow-up. Disease symptoms stabilized in all patients, with some manifesting improvements, including intestinal function. No patient died, and LT appeared to have a more favorable safety profile than HSCT, especially when liver disease is present. Follow-up studies will need to document the long-term impact of this new approach on disease outcome. Take Home Message: Liver transplantation is effective in stabilizing symptoms and nearly normalizing thymidine levels in patients with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) and may have an improved safety profile over hematopoietic stem cell transplant.
journal_name
Mol Genet Metabjournal_title
Molecular genetics and metabolismauthors
Kripps K,Nakayuenyongsuk W,Shayota BJ,Berquist W,Gomez-Ospina N,Esquivel CO,Concepcion W,Sampson JB,Cristin DJ,Jackson WE,Gilliland S,Pomfret EA,Kueht ML,Pettit RW,Sherif YA,Emrick LT,Elsea SH,Himes R,Hirano M,Van Hdoi
10.1016/j.ymgme.2020.03.001subject
Has Abstractpub_date
2020-05-01 00:00:00pages
58-64issue
1eissn
1096-7192issn
1096-7206pii
S1096-7192(20)30060-3journal_volume
130pub_type
杂志文章abstract::Mucopolysaccharidosis (MPS) type VII is a lysosomal storage disease caused by deficiency of the lysosomal enzyme β-glucuronidase (GUS), leading to accumulation of glycosaminoglycans (GAGs). Enzyme replacement therapy (ERT) effectively clears GAG storage in the viscera. Recent studies showed that a chemically modified ...
journal_title:Molecular genetics and metabolism
pub_type: 杂志文章
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更新日期:2012-09-01 00:00:00
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journal_title:Molecular genetics and metabolism
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pub_type: 杂志文章,随机对照试验
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pub_type: 杂志文章,评审
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更新日期:2004-04-01 00:00:00
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journal_title:Molecular genetics and metabolism
pub_type: 杂志文章
doi:10.1016/j.ymgme.2009.03.006
更新日期:2009-07-01 00:00:00
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pub_type: 杂志文章
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doi:10.1006/mgme.1999.2906
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pub_type: 杂志文章
doi:10.1016/j.ymgme.2016.04.003
更新日期:2016-06-01 00:00:00
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pub_type: 杂志文章
doi:10.1016/j.ymgme.2005.06.005
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pub_type: 临床试验,杂志文章
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pub_type: 杂志文章
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doi:10.1006/mgme.1998.2748
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pub_type: 杂志文章
doi:10.1016/j.ymgme.2013.02.010
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journal_title:Molecular genetics and metabolism
pub_type: 杂志文章
doi:10.1016/j.ymgme.2012.06.015
更新日期:2012-11-01 00:00:00
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pub_type: 杂志文章
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journal_title:Molecular genetics and metabolism
pub_type: 杂志文章
doi:10.1016/j.ymgme.2004.10.002
更新日期:2004-12-01 00:00:00
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journal_title:Molecular genetics and metabolism
pub_type: 杂志文章
doi:10.1016/j.ymgme.2009.04.004
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journal_title:Molecular genetics and metabolism
pub_type: 临床试验,杂志文章,多中心研究
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pub_type: 杂志文章
doi:10.1016/j.ymgme.2014.04.001
更新日期:2014-11-01 00:00:00