[Globoid cell leukodystrophy of adult. A first case in Poland]. / Leukodystrofia globoidalna doroslych. Pierwszy przypadek w Polsce.

Krabbe disease (globoid cell leukodystrophy) is a progressive, autosomal recessive disorder affecting peripheral and central nervous system. This disease is associated with mutation in GALC gene and its locus has been mapped to chromosome 14q31. GALC gene codes lysosomal hydrolytic enzyme: galactocerebroside ß-galactosidase (galactosylceramidase) which is crucial for degradation of galactolipids, mostly galactosylceramide and galactosylsphingosine (psychosine). The disease may be subdivided into four types: infantile form with onset within the first six months, child form presenting between 6 months and 3 years, juvenile form presenting between 3 and 10 years and the rarest adult form with onset after 10 years. The diagnosis of Krabbe disease is based on clinical findings and confirmed with galactocerebroside ß-galactosidase deficiency. We have found family with adult-onset disease. To our knowledge, this is the first observation of patient with adult form of Krabbe disease in Poland.

Enzyme replacement therapy for mucopolysaccharidosis II from 3 months of age: a 3-year follow-up.

AIM: We present a 3-year follow-up of a boy with mucopolysaccharidosis type II (MPS II) who had idursulfase therapy initiated at the age of 3 months and compare his clinical course to his healthy twin brother. METHODS: Detailed anthropometric features, ultrasound studies of liver and spleen volumes, echocardiography and audiological examinations, psychological tests, joint range of motion (ROM) and skeletal radiographs were monitored. RESULTS: After 3 years of treatment, the patient has not developed any clinical manifestations of MPS II. He did not develop coarse facial features, joint disease, or organomegaly, and his cardiac function remained normal. There were no pronounced signs of dysostosis multiplex on radiographs. The only difference when compared with his healthy twin brother was lower IQ (Termann-Merrill 98 vs. 118) and mild deformity of one vertebrae. CONCLUSION: Our study suggests that early initiation of enzyme replacement therapy may significantly slow or prevent the development of irreversible disease manifestations and therefore modify the natural history of MPS II.

Female Hunter syndrome caused by a single mutation and familial XCI skewing: implications for other X-linked disorders.

Familial X-chromosome inactivation (XCI) skewing was investigated in a family in which a female mucopolysaccharidosis type II (MPS II) (Hunter syndrome, an X-linked genetic disease) occurred. Among eight related females aged under 60 years from three generations who were tested, four revealed a non-random pattern of XCI. Detailed genetic analysis failed to find mutations in genes that were previously reported as important for the XCI process. Haplotype analysis excluded linkage of non-random XCI with genes localized on the X-chromosome. We propose that analysis of the XCI pattern should be taken into consideration when assessing risk factors for X-linked recessive genetic disorders.

Arylsulfatase A pseudodeficiency--incidence in Poland.

Arylsulfatase A (ASA) pseudodeficiency (Pd) was defined as the in vitro measurement of low enzyme activity in a healthy person. A variable incidence of the Pd allele was found in different populations; it was 10-20 times higher than that of metachromatic leukodystrophy (MLD). In Poland we estimated the incidence of the Pd allele at 6% and that of isolated 1788 mutation (loss of glycosylation site) at 3%. Out of 8 cases with neurological symptoms and low ASA activity, 2 were found to be homozygous for the Pd allele; 2 MLD patients had healthy siblings homozygous for the Pd allele and another patient's allele bore two mutations, Pd and that causing MLD.

Types I and III Gaucher disease in Poland: incidence of the most common mutations and phenotypic manifestations.

Gaucher disease caused by hereditary deficiency of beta-glucocerebrosidase is the most prevalent lysosomal storage disease. The incidence of the 5 commonest mutations was estimated in the Polish Gaucher disease population. A trial to establish genotype/phenotype correlations was performed. A relatively high frequency of type III disease can be stated in the studied Polish Gaucher patients. The most frequent mutation was L444P, followed by the N370S mutation. A distinct correlation between genotype and phenotype was observed in the studied group of Polish patients with Gaucher disease.

Serum chitotriosidase activity in Gaucher patients on enzyme replacement therapy (ERT).

OBJECTIVE: Changes of serum chitotriosidase activity during Ceredase treatment of Gaucher patients. DESIGN AND METHODS: Ten Gaucher patients were treated with Ceredase for up to 30 months. Serum or plasma chitotriosidase activity was measured using 4-methylumbelliferyl-beta-D-N,N',N"triacetyl-chitotrioside. RESULTS: In untreated patients, serum chitotriosidase activity did not depend on the patient's age and was not a measure of clinical status, type or progress of the disease. Chitotriosidase activity declined during treatment with Ceredase, but still remained high. The largest decline in enzyme activity was observed in patients with type III of the disease who had intact spleens; splenectomized type III patients, and type I patients reacted more slowly. CONCLUSIONS: Serum chitotriosidase activity may indicate that a patient has reacted to treatment, however, it can not be considered a direct marker of treatment effectiveness.

Hyaluronidase in human somatic tissues and urine: polymorphism and the activity in diseases.

The polymorphism of hyaluronidase (EC 3.2.1.35) (Hyase) was studied on a hyaluronan-polyacrylamide gel. Liver, placenta, ovary and breast tissue were found to have 7 active isoforms while leukocytes and platelets 5 and fibroblasts displayed no hyaluronidase activity. In serum, synovial fluid and urine soluble the most acidic forms are present. Desialylation showed that most of the hyaluronidase isoforms differ in the content of sialic acid. In patients with rheumatoid arthritis, hyaluronidase activity in the synovial fluid varied from not detectable to very high. A partial deficiency was demonstrated in sera from some patients with dysostosis multiplex without mucopolysacchariduria. In I-cell disease, hyaluronidase activity in serum was as that in controls.

N-acetyl-beta-glucosaminidase, beta-glucuronidase and beta-galactosidase in the leukocytes, serum and urine of healthy subjects and patients with immunocytoma.

The activity of GlcNAc-ase, GlcUA-ase and Gal-ase was determined in the leukocytes serum and urine of 23 patients with M. M., 11 patients with other neoplasms including 9 with lymphoreticular proliferative processes without associated monoclonal gammapathy. The range of normal enzyme activity was established in the investigations carried out in 45 health subjects. In the group of patients with M. M. without complications. normal activity of GlcNAc-ase, GlcUA-ase and Gal-ase was found in the leukocytes. In the group of patients with white blood cell count below 2.5 g/l and in cases after long-term treatment with Alkeran the activity of GlcNAc-ase and GlcUA-ase in the leukocytes was reduced. In the patients with M. M. the activity of GlcNAc-ase was raised in the serum and urine, and this activity was higher in cases with longer duration of the disease and more advanced pathological process. The patients with M-IgG protein showed a higher GlcNAc-ase activity in the serum and urine than those with protein M-IgA. A higher activity of GlcNAc-ase in the serum and urine than those with protein M-IgGK than in those with M-IgG gamma. In patients with M. M with renal complications the urinary activity of GlcNAc-ase was higher than in patients with M. M. without renal complications. In CLL the activity of GlcNAc-ase was found to be decreased in the leukocytes and raised in the urine. In patients with Hodgkin's disease the activity of the studied enzymes was raised in leukocytes while the results of their determinations in serum and urine were equivocal.

Lysozyme in the serum, urine and peripheral blood leukocytes in patients with immunocytoma.

Lysozyme activity was determined in the serum, urine and leukocytes of 53 patients with immunocytoma and 24 patients with lymphoproliferative syndromes without associated monoclonal gammapathy. In patients with multiple myeloma the frequency of low serum lysozyme activity and high leukocyte lysozyme activity was higher. In the cases with renal failure, lysozyme activity was raised in serum and urine, and the 24-hour urinary lysozyme excretion was increased. In 7 patients with increased urinary lysozyme excretion no clinical or laboratory evidence of renal complications was found. Relative monocytosis in peripheral blood was observed in half of the cases of multiple myeloma, and in these patients also in about half of the cases the lysozyme activity was raised in the leukocytes and urine, and the 24-hour urinary lysozyme excretion was increased. In patients with Hodgkin's disease, lymphosarcoma and chronic lymphatic leukemia the frequency of low serum lysozyme activity was increased.

Mechanism of unbalanced growth-induced cell damage. I. A probable role for hydrolytic enzymes synthesis.

This study examines the relationship between cell progress into the state of unbalanced growth, hydrolytic enzyme activities and cell survival during the exposure of L5178Y cells to hydroxyurea (HU), excess thymidine (dThR), hydroxyurea with excess of four deoxyribonucleosides (dNR) or excess dTHR with deoxycytidine (dCR). Cell progress into the state of unbalanced growth was measured as cell size, protein/DNA ratio and protein content per cell. Activities of two lysosomal (acid phosphatase, beta-N-acetylglucosaminidase) and one cytoplasmic non-lysosomal (LDH) enzymes were determined. It has been found that in cells arrested by HU or excess dThR, a progressive cell volume increase with protein/DNA imbalance is correlated with a progressive increase in lysosomal and non-lysosomal hydrolase activities in the cells and in the medium and with a marked lethal effect. Cell volume increase, enhancement of enzyme activities and cell killing could be prevented in HU-arrested cells by concomitant addition of excess dNR (deoxyadenosine, deoxyguanosine, thymidine, deoxycytidine) leading to equal inhibition of DNA and protein synthesis. Control-like values of all parameters were achieved also in cells in which the dThR-inhibiting effect was reversed by dCR addition. It is suggested that a common pathway in the mode of action of the chemotherapeutic agents inducing cell killing through the state of unbalanced growth can be the over-production, abnormal accumulation and progressive leakage of numerous hydrolytic enzymes through the cell membranes, leading in consequence to 'lytic' cell death.

Lipidoses detected in Poland through 1993.

It is estimated that 70-100 children suffering from a lysosomal storage disease are born in Poland every year. From 1975 to 1993, the activity of various lysosomal enzymes was determined in the leukocytes, cultured skin fibroblasts, or hair roots from 5,594 patients, mainly children, in whom the diagnosis of a lipidosis was suspected. In that material 162 cases of a lipidosis were diagnosed. Metachromatic leukodystrophy seems to be the most frequent of the lipidoses; GM1 gangliosidosis is more frequent than GM2 gangliosidosis and Gaucher and Niemann-Pick diseases appear to be almost as frequent as the former.

Effect of hydroxyurea treatment on lysosomal membrane stability and enzyme latency in L5178Y cells in culture.

The stability of lysosomes prepared from hydroxyurea (HU) treated or untreated L5178Y cells and exposed to an HU-free iso- or hypoosmotic solution was compared. The data revealed that exposure of the cells to 1-10 mM HU for few hours tends to stabilize lysosomes. Partial protection against this effect could be afforded by catalase and superoxide dismutase. Under the same conditions of HU treatment lysosomal enzyme latency remained similar in HU treated and untreated cells.

[Pseudodeficiency of lysosomal enzymes]. / Pseudoniedobory enzymów lizosomalnych.

Genetically determined enzyme deficiency causing failure of the lysosomal apparatus is called lysosomal disease. In normal cell the activity of lysosomal enzymes exceeds many times the requirements of the cell. In some individuals due to gene mutation the activity of an intracellular enzyme is only slightly higher than in patients with lysosomal disease but much lower than in the general population, although without evident metabolic and clinical consequences. This situation is called enzyme pseudodeficiency. As yet cases have been reported of the pseudodeficiency of beta-galactocerebrosidase, beta-glucoronidase, beta-glucosidase, beta-hexosoaminidase A and arylosulfatase A. The character of the mutation is called in the case of the two last enzymes and a laboratory method is available for differentiation of pseudodeficiency from the actual lysosomal disease. It is not known whether in pseudodeficiency of an enzyme clinical manifestations could appear in older age.

[A case of mannosidosis type II]. / Przypadek mannozydozy typu II.

A case of L-mannosidosis, a recessively inherited thesaurosis, is reported. Since birth the patient had evidence of immunodeficiency. The neurological manifestations developed during adolescence with slurred and slow speech with scanning, muscle flaccidity, sings of Trömner and Jacobson, intentional tremor, equilibrium disturbances. After many laboratory investigations the tests for inherited metabolic disorders made the correct diagnosis possible.

[Prenatal diagnosis: a chance? risk? dilemma?]. / Diagnostyka prenatalna: szansa? Zagrozenie? Dylemat?

PIP: In research on congenital metabolic disorders, a biochemist can choose between the theoretical and the practical approach. The diagnosis of metabolic diseases relies on 1) the determination of the presence of metabolites under normal conditions that are direct substrates of the defective enzyme (e.g., the Gm2 ganglioside in the brain tissue of a patient with Tay-Sachs disease); 2) the determination of the lack or insufficiency of the direct product of the defective enzyme (e.g., aryl sulfatase A in the cells of patients with metachromatic leukodystrophy), hormone (hypothyroidism), or receptor (congenital hypercholesterolemia); 3) determination of substance whose reduction was established by experimentation, but the cause of the decrease is not known (ceruloplasmin in Wilson's disease); and 4) DNA analysis. Metabolic impairment of genetic origin is not treatable. The disease can be prevented by 1) removing the inappropriate metabolite (e.g., copper accumulation can be avoided by giving penicillamine or zinc salts); 2) limiting those substances in the critical phase of childhood that are components of the defective enzyme (e.g. gluten reduction in colic and protein in phenylketonuria); 3) supplementing the insufficient metabolite (e.g., phosphate in hypophosphatemia by sound for 12 hours a day); 4) protecting the patients (e.g. from light in porphyria); and 5) treatment by substances (giving coagulation factor VIII in hemophilia and thyroid hormones in hypothyroidism). There is a dilemma in subjecting patients to a diagnosis of progression to Huntington's chorea 20 years in advance or informing them about the high risk of hereditary disease for the next child (25% for the recessive and 50% for the dominant mode). Ethical committees have usually opted for a recommendation of selective abortion in clear-cut cases. Increasingly refined diagnostic methods have magnified the responsibility of the biochemist.^ieng

[Hyperactivity and behavioral disorders in Sanfilippo A (mucopolysaccharidosis type IIIA)--case report and review of the literature]. / Nadpobudliwosc psychoruchowa i zaburzenia behawioralne w przebiegu choroby Sanfilippo A (mukopolisacharydozy typu IIIA)--opis przypadku i przeglad pismiennictwa.

Sanfilippo syndrome is one of mucopolysaccharidoses. The main symptom of this syndrome is regression of psychomotor development and neurological signs which occur between 2 and 6 years old. Unlike other mucopolysaccharidoses body dysmorfic features are relatively rare. Course of disease is progressive, most of the patients die before 20. The diagnosis is often difficult. In our opinion in each case presenting psychomotor regression of unknown origin metabolic disease should be excluded (e.g. urine analysis for mucopolysaccharides should be indicated). A 6 year old boy has been under psychiatric and psychological control since he was 3 due to psychomotor retardation, hyperactivity, autistic features, and behavioural disorder. In paediatric examination thickened facial features, coarse hair, knock-knees, short neck were noted. Genetic consultation set up the diagnosis of mucopolysaccharidosis type IIIA (Sanfilippo A disease).

[Urinary beta-hexosaminidase activity as a marker for the monitoring of sobriety]. / Aktywnosc beta-heksozoaminidazy w moczu jako maker naduzywania alkoholu u osób uzaleznionych.

The aim of this study was to check the usefulness of urine beta-hexosaminidase activity determination as a tool of monitoring sobriety in alcohol dependent individuals. The examinations were performed in 93 patients undergoing detoxification treatment after heavy drinking and in 29 individuals who were starting psychotherapeutic treatment after declaring at least 2 weeks abstinence period. Enzyme activity was determined using a spectrofluorimetric method and was referred to urine creatinine level. In the detoxification group the abnormally high beta-hexosaminidase activity was decreasing gradually toward normal values within 2 weeks. In less than 10% of the patients atypical increase was observed in the course of treatment, what could be attributed to an, influence of nonspecific factors or possibly to misbehavior (alcohol drinking or urine samples substitution). Among individuals who declared at least 2 weeks abstinence period (psychotherapeutic group) in 25% of cases abnormally high enzyme activity was detected, what suggested their more recent alcohol drinking.

[Familial metachromatic leukodystrophy as a cause of psychotic manifestations in young adults]. / Rodzinna leukodystrofia metachromatyczna jako przyczyna zaburzen psychicznych u mlodych osób doroslych.

Cases of metachromatic leucodystrophy in brother and sister are presented. The clinical pattern in the female was characterised by the progressing dementia, whereas in the male the first symptom was the manic syndrome. The neurological status was normal. The cases were diagnosed by the demyelination visible in MRI pattern and in the decreased activity of arylsulphatase A in blood leukocytes.

[Activity of beta-hexosaminidase in serum of patients with alcoholic and nonalcoholic liver diseases]. / Aktywnosc beta-heksozoaminidazy surowicy w chorobach watroby pochodzenia alkoholowego i niealkoholowego.

The total activity and thermostable activity of serum beta-hexosaminidase were determined in alcohol-dependent patients with liver damage, in non-drinking hepatic patients, in alcohol-dependent presently drinking patients who had no hepatic symptoms and signs, and in healthy persons drinking alcohol occasionally in moderate quantities who served as the control group. The enzyme activity was determined by the spectrofluorometric method using 4-methylumbelliferone derivative as substrate. The activity of beta-hexosaminidase in both groups with liver disease of both alcoholic and non-alcoholic origin exceeded significantly the control values. In those alcohol-dependent patients with liver disease who did not stop drinking, the activity was higher after recent drinking in relation to that after a period of abstinence. The determination can thus serve as a marker of alcohol abuse also in alcohol-dependent patients with liver damage. The share of thermostable component in the total increase of beta-hexosaminidase activity in alcohol-abusing persons was higher than that in the case of hepatic diseases of non-alcoholic origin.