An incidental finding in newborn screening leading to the diagnosis of a patient with ECHS1 mutations.
Mol Genet Metab Rep
; 22: 100553, 2020 Mar.
Article
em En
| MEDLINE
| ID: mdl-31908952
ABSTRACT
Short-chain enoyl-CoA hydratase (ECHS1) is a mitochondrial beta-oxidation enzyme involved in the metabolism of acyl-CoA fatty acid esters, as well as in valine metabolism. ECHS1 deficiency has multiple manifestations, including Leigh syndrome early at birth or in childhood with poor prognosis, to cutis laxa, exercise-induced dystonia and congenital lactic acidosis. Here we describe the case of a newborn with mutations in ECHS1 that caught our attention after the incidental finding of 3-hydroxy-butyryl\3-hydroxy-isobutyryl\malonylcarnitine (C4OH\C3DC) and tiglylcarnitine (C51) on blood spot in the newborn screening (NBS) program. Diagnosis was suspected based on the analysis of organic acids on dried urine spot. A moderate increase of 2-methyl-2,3-dihydroxybutyric acid, was detected, which is a known marker of this disease. Exome analysis showed c.404A>G (p.Asn135Ser) mutation in homozygosis in the ECHS1 gene. The child was therefore admitted to the hospital. Initial examination showed little response to auditory stimuli and mild hypertonia of the extremities. Clinical deterioration was evident at 4 months of age, including neurological and cardiac involvement, and the patient died at 5 months of age. This case illustrates how an incidental detection in the NBS Program can lead to the diagnosis ECHS1 deficiency. Although it is a severe disease, with no treatment available, early detection would allow adequate genetic counseling avoiding the odyssey that suffered most of these families.
2-methyl-2,3-dihydroxybutyric acid; 3-hydroxy-butyrylcarnitine\3-hydoxy-isobutyrylcarnitine; 3MGA, 3-methylglutaconic acid; C3DC, malonylcarnitine; C4OH, 3-hydroxy-butyrylcarnitine\3-hydoxy-isobutyrylcarnitine; C5:1, tiglylcarnitine; DBS, dried blood spot; DUS, dried urine spot; ECHS1 deficiency; ECHS1, short-chain enoyl-CoA hydratase; GC, gas chromatography; HIBCH, 3-hydroxy-isobutyryl-CoA hydrolase; MRI, magnetic resonance imaging; MS, mass spectrometry; Mutations in ECHS1; NBS, Newborn Screening; Newborn screening; PDH, pyruvate dehydrogenase; TMS, trimethylsilyl; Tiglylcarnitine
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Base de dados:
MEDLINE
Tipo de estudo:
Diagnostic_studies
/
Prognostic_studies
/
Screening_studies
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article