Jacques Jaeken

Congenital Disorders of Glycosylation: A Review

Congenital disorders of glycosylation (CDGs) are a rapidly growing group of inherited disorders caused by defects in the synthesis and processing of the asparagine(ASN)-linked oligosaccharides of glycoproteins. The first CDG patients were described in 1980. Fifteen years later, a phosphomannomutase deficiency was found as the basis of the most frequent type, CDG-Ia. In recent years several novel types have been identified. The N-glycosylation pathway is highly conserved from yeast to human, and the rapid progress in this field can largely be attributed to the systematic application of the knowledge of yeast mutants. Up to now, eight diseases have been characterized, resulting from enzyme or transport defects in the cytosol, endoplasmic reticulum, or Golgi compartment. CDGs affect all organs and particularly the CNS, except for CDG-Ib, which is mainly a hepatic-intestinal disease.

3-Phosphoglycerate dehydrogenase deficiency: an inborn error of serine biosynthesis.

Serine concentrations were markedly decreased in the cerebrospinal fluid of two brothers with congenital microcephaly, profound psychomotor retardation, hypertonia, epilepsy, growth retardation, and hypogonadism. The youngest boy also had congenital bilateral cataract. Magnetic resonance imaging of the brain showed evidence of dysmyelination. Plasma serine as well as plasma and cerebrospinal fluid glycine concentrations were also decreased but to a lesser extent. Treatment with oral serine in the youngest patient significantly increased cerebrospinal fluid serine and abolished the convulsions. In fibroblasts of both patients, a decreased activity was demonstrated of 3-phosphoglycerate dehydrogenase, the first step of serine biosynthesis (22% and 13% of the mean control value). This is an unusual disorder as the great majority of aminoacidopathies are catabolic defects. It is a severe but potentially treatable inborn error of metabolism that has not been previously reported in man.

The carbohydrate-deficient glycoprotein syndromes: an overview.

SummaryThe carbohydrate-deficient glycoprotein (CDG) syndromes are a newly recognized family of diseases with autosomal recessive inheritance. The basic defects are probably in the glycosylation pathway (endoplasmic reticulum, Golgi apparatus or post-Golgi). In the present state of our knowledge the central nervous system is always severely affected but nearly all other organs are involved to a variable degree. Like the peroxisomal disorders they also comprise dysmorphic features, the most typical being an abnormal distribution of subcutaneous adipose tissue. A reliable diagnostic test is isoelectric focusing of serum transferrin showing a cathodal shift as a consequence of the partial sialic acid deficiency. Prenatal diagnosis and heterozygote detection are not yet available. These diseases should be differentiated from secondary CDG syndromes such as classical galactosaemia.

Adenylosuccinase Deficiency - An Inborn Error of Purine Nucleotide Synthesis

Clinical and biochemical data are presented on eight children with adenylosuccinase deficiency. This newly discovered inborn error of purine metabolism is characterized by an accumulation in body fluids of succinyladenosine (S-Ado) and succinylaminoimidazole carboxamide riboside (SAICA riboside), the dephosphorylated derivatives of the two substrates of adenylosuccinase. Six living children (three boys and three girls) and one deceased sibling displayed severe psychomotor retardation. Epilepsy was documented in five cases, autistic features in three, and growth retardation associated with muscular wasting in a brother and sister. In the cerebrospinal fluid, plasma and urine of these patients, the S-Ado/SAICA riboside ratio was between 1 and 2. In striking contrast, the eighth patient (a girl) was markedly less mentally retarded. Most noteworthy, the S-Ado/SAICA riboside ratio in her body fluids was around 5, suggesting that her milder psychomotor retardation was causally linked to this higher ratio. Adenylosuccinase deficiency was demonstrated in the liver of all seven living children, in the kidney of three patients in whom the enzymatic activity was measured, and in the muscle of three patients, including the two with muscular wasting. In fibroblasts of the six severely retarded patients, adenylosuccinase activity was reduced to approximately 40% of normal; in the patient with the higher S-Ado/SAICA riboside ratio, it reached only 6% of normal. The clinical heterogeneity of adenylosuccinase deficiency justifies systematic screening for the enzyme defect in unexplained neurological disease.

CDG nomenclature: Time for a change!

Congenital disorders of glycosylation (CDG) are a rapidly growing disease family with about 40 diseases reported since its first clinical description in 1980 [1]. The large majority of these are diseases of protein hypoglycosylation, but in recent years several defects in lipid glycosylation have also been identified [2,3]. Most protein glycosylation disorders are due to defects in the N-glycosylation pathway, the remaining ones affecting the O-glycosylation pathway or combined N-and O-glycosylation pathways. No defects in C-glycosylation have been detected yet. The first described CDG patients were shown to have an abnormal serum transferrin (Tf) isoelectrofocusing (IEF) pattern with increases in the di-and asialotransferrin fractions [4]. They were found to have deficient phosphomannomutase (PMM) activity [5] and mutations in the PMM2 gene [6]. PMM-deficient patients were designated as CDG-Ia. Subsequently, a patient was discovered with a serum Tf IEF pattern characterized by increases not only of the even (2 and 0) but also of the uneven (3 and 1) sialoTf bands [7]. Since these patterns were qualitatively different, we called the latter a type 2 pattern as opposed to the type 1 pattern seen in PMM deficiency. In the patient with the type 2 pattern, a deficiency was demonstrated to be in a Golgi glycosyltransferase, namely N-acetylglucosaminyltransferase II [8]. This disease was labeled CDG-IIa. New patients were classified as CDG-I or CDG-II according to the Tf IEF pattern, and each new defect took the next letter of the alphabet. We presently count 14 CDG-I diseases (CDG-Ia up to CDG-In), and 8 CDG-II diseases (CDG-IIa up to CDG-IIh). Since this nomenclature is based on the Tf IEF pattern, it relates only to N-glycosylation diseases associated with deficient sialylation. Gradually it became clear that CDG-I defects were limited to defects in pre-ER or ER proteins whereas CDG-II defects were caused by defects in Golgi or Golgi-associated proteins. However, some of these disorders also show abnormal O-glycosylation such as the COG defects (review in [9]) and the V-ATPase defect in cutis laxa type II [10]. Also, it appeared that a patient with an alpha-glucosidase I deficiency in the ER had a normal Tf IEF pattern [11]. Still this patient was labeled as CDG-IIb, which is an inconsistency of this classification. For this reason and for a number of other reasons explained elsewhere [12], we strongly suggest that this nomenclature should be discontinued in favor of a transparent designation of glycosylation disorders and that it be applied to new and established types of CDG. We propose using only the official gene symbol (not in italics) followed by ‘-CDG’ (list of approved gene names at http://www.genenames.org). A classification of the known types of CDG, along with the traditional and new nomenclature, is shown in Table 1 (adapted from [12]). Table 1 Proposed nomenclature for CDG (nomenclature to be superseded is included in italics and enclosed in parenthesis).a

A novel carbohydrate-deficient glycoprotein syndrome characterized by a deficiency in glucosylation of the dolichol-linked oligosaccharide.

Carbohydrate-deficient glycoprotein syndromes (CDGS) type I are a group of genetic diseases characterized by a deficiency of N-linked protein glycosylation in the endoplasmic reticulum. The majority of these CDGS patients have phosphomannomutase (PMM) deficiency (type A). This enzyme is required for the synthesis of GDP-mannose, one of the substrates in the biosynthesis of the dolichol-linked oligosaccharide Glc3Man9GlcNAc2. This oligosaccharide serves as the donor substrate in the N-linked glycosylation process. We report on the biochemical characterization of a novel CDGS type I in fibroblasts of four related patients with normal PMM activity but a strongly reduced ability to synthesize glucosylated dolichol-linked oligosaccharide leading to accumulation of dolichol-linked Man9GlcNAc2. This deficiency in the synthesis of dolichol-linked Glc3Man9GlcNAc2 oligosaccharide explains the hypoglycosylation of serum proteins in these patients, because nonglucosylated oligosaccharides are suboptimal substrates in the protein glycosylation process, catalyzed by the oligosaccharyltransferase complex. Accordingly, the efficiency of N-linked protein glycosylation was found to be reduced in fibroblasts from these patients.

Endocrinology of the Carbohydrate-Deficient Glycoprotein Syndrome Type 1 from Birth through Adolescence

ABSTRACT: The carbohydrate-deficient glycoprotein (CDG) syndrome type 1 is a genetic multisystem disorder, characterized by hypoglycosylation of glycoproteins and presenting with neurologic impairment. In 12 girls and 14 boys, we confirmed the diagnosis of CDG syndrome type 1 by immune-isoclectric focusing of serum sialotransferrins, and we examined the endocrine status singly or sequentially, including a 16-y follow-up of the index cases, a pair of monozygotic girls. Serum FSH levels were normal in newborns and prepubertal children, but elevated in female toddlers and teenagers, as well as in adolescent males. Serum LH concentrations displayed an analogous age-dependent pattern. In adolescent girls, serum estradiol remained low. FSH bioactivity was low normal, as was the bioactive/immunoreactive FSH ratio. However, exogenous gonadotropins evoked an estradiol response and induced ovarian follicular growth. Male patients virilized at puberty; however, testicular volume was subnormal. The thyroid axis was hallmarked by thyroid-binding globin deficiency and, during infancy, increased serum TSH concentrations. A subgroup of female patients presented hypersomatotropism and/or hyperprolactinemia. During adolescence, the index cases responded to glucagon with normal glycemic, but exaggerated insulin and paradoxally augmented growth hormone responses. The hypothalamo-pituitary area appeared intact on magnetic resonance imaging. Circulating IGF-1 levels were in the lower normal range and transcortin concentrations decreased. In conclusion, a study of endocrine aspects of a major glycosylation disorder revealed an age-dependent constellation, including hypergonadotropic hypogonadism with deficient FSH rather than LH action; transient hyperthyrotropinemia; inconsistent hyperprolactinemia; hyperglycemia-induced growth hormone release; deficiencies of hormone-binding glycoproteins and possibly decreased insulin sensitivity, thus pointing to the importance of glycoprotein glycosylation for pediatric endocrinology.

On the nomenclature of congenital disorders of glycosylation (CDG)

SummaryA new nomenclature of CDG is proposed because the current one is too complex for clinicians and provides no added value.

Clinical and biochemical characteristics of congenital disorder of glycosylation type Ic, the first recognized endoplasmic reticulum defect in N-glycan synthesis

We report on 8 patients with a recently described novel subtype of congenital disorder of glycosylation type Ic (CDG‐Ic). Their clinical presentation was mainly neurological with developmental retardation, muscular hypotonia, and epilepsy. Several symptoms commonly seen in CDG‐Ia such as inverted nipples, abnormal fat distribution, and cerebellar hypoplasia were not observed. The clinical course is milder overall, with a better neurological outcome, than in CDG‐Ia. The isoelectric focusing pattern of serum transferrin in CDG‐Ia and CDG‐Ic is indistinguishable. Interestingly, β‐trace protein in cerebrospinal fluid derived from immunoblot analysis of the brain showed a less pronounced hypoglycosylation pattern in CDG‐Ic patients than in CDG‐Ia patients. Analysis of lipid‐linked oligosaccharides revealed an accumulation of Man9GlcNAc2 intermediates due to dolichol pyrophosphate–Man9GlcNAc2 α‐1,3 glucosyltransferase deficiency. All patients were homozygous for an A333V mutation. Ann Neurol 2000;47:776–781

Congenital folate malabsorption

A Turkish girl presented with a history of fever, diarrhoea, convulsions, recurrent infections and failure to thrive from the age of 5 months. Megaloblastic anaemia was present and profound folate deficiency was evidenced in plasma and in CSF. Treatment with oral folic acid cured the anaemia, diarrhoea and infections but failed to prevent convulsions and the appearance of mental retardation and cerebral calcifications. Loading tests with folic acid and its derivatives led to the conclusion that the folate deficiency was caused by a defect in folate transport both across the gut and the blood-brain barrier. Low plasma concentrations of methionine prompted a therapeutic trial with methionine associated with vitamin B12 and folic acid that spectacularly improved the convulsions.