Genetic landscape of pediatric acute liver failure of indeterminate origin
Por:
Lenz D, Schlieben LD, Shimura M, Bianzano A, Smirnov D, Kopajtich R, Berutti R, Adam R, Aldrian D, Baric I, Baumann U, Bozbulut NE, Brugger M, Brunet T, Bufler P, Burnyte B, Calvo PL, Crushell E, Dalgiç B, Das AM, Dezsofi A, Distelmaier F, Fichtner A, Freisinger P, Garbade SF, Gaspar H, Goujon L, Hadzic N, Hartleif S, Hegen B, Hempel M, Henning S, Hoerning A, Houwen R, Hughes J, Iorio R, Iwanicka-Pronicka K, Jankofsky M, Junge N, Kanavaki I, Kansu A, Kaspar S, Kathemann S, Kelly D, Kirsaçlioglu CT, Knoppke B, Kohl M, Kölbel H, Kölker S, Konstantopoulou V, Krylova T, Kuloglu Z, Kuster A, Laass MW, Lainka E, Lurz E, Mandel H, Mayerhanser K, Mayr JA, McKiernan P, McLean P, McLin V, Mention K, Müller H, Pasquier L, Pavlov M, Pechatnikova N, Peters B, Petkovic Ramadža D, Piekutowska-Abramczuk D, Pilic D, Rajwal S, Rock N, Roetig A, Santer R, Schenk W, Semenova N, Sokollik C, Sturm E, Taylor RW, Tschiedel E, Urbonas V, Urreizti R, Vermehren J, Vockley J, Vogel GF, Wagner M, van der Woerd W, Wortmann SB, Zakharova E, Hoffmann GF, Meitinger T, Murayama K, Staufner C and Prokisch H
Publicada:
1 may 2024
Ahead of Print:
1 nov 2023
Resumen:
Background and Aims: Pediatric acute liver failure (PALF) is a life-threatening condition. In Europe, the main causes are viral infections (12%-16%) and inherited metabolic diseases (14%-28%). Yet, in up to 50% of cases the underlying etiology remains elusive, challenging clinical management, including liver transplantation. We systematically studied indeterminate PALF cases referred for genetic evaluation by whole-exome sequencing (WES), and analyzed phenotypic and biochemical markers, and the diagnostic yield of WES in this condition.
Approach and Results: With this international, multicenter observational study, patients (0-18 y) with indeterminate PALF were analyzed by WES. Data on the clinical and biochemical phenotype were retrieved and systematically analyzed.
Results: In total, 260 indeterminate PALF patients from 19 countries were recruited between 2011 and 2022, of whom 59 had recurrent PALF. WES established a genetic diagnosis in 37% of cases (97/260). Diagnostic yield was highest in children with PALF in the first year of life (41%), and in children with recurrent acute liver failure (64%). Thirty-six distinct disease genes were identified. Defects in NBAS (n=20), MPV17 (n=8), and DGUOK (n=7) were the most frequent findings. When categorizing, the most frequent were mitochondrial diseases (45%), disorders of vesicular trafficking (28%), and cytosolic aminoacyl-tRNA synthetase deficiencies (10%). One-third of patients had a fatal outcome. Fifty-six patients received liver transplantation.
Conclusions: This study elucidates a large contribution of genetic causes in PALF of indeterminate origin with an increasing spectrum of disease entities. The high proportion of diagnosed cases and potential treatment implications argue for exome or in future rapid genome sequencing in PALF diagnostics.
Filiaciones:
Lenz D:
Division of Neuropaediatrics and Paediatric Metabolic Medicine, Centre for Paediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
Schlieben LD:
School of Medicine, Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
Institute of Neurogenomics, Computational Health Centre, Helmholtz Zentrum München, Neuherberg, Germany
Shimura M:
Institute of Neurogenomics, Computational Health Centre, Helmholtz Zentrum München, Neuherberg, Germany
Chiba Children's Hospital, Centre for Medical Genetics and Department of Metabolism, Chiba, Japan
Bianzano A:
Division of Neuropaediatrics and Paediatric Metabolic Medicine, Centre for Paediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
Smirnov D:
School of Medicine, Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
Institute of Neurogenomics, Computational Health Centre, Helmholtz Zentrum München, Neuherberg, Germany
Kopajtich R:
School of Medicine, Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
Institute of Neurogenomics, Computational Health Centre, Helmholtz Zentrum München, Neuherberg, Germany
Berutti R:
School of Medicine, Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
Institute of Neurogenomics, Computational Health Centre, Helmholtz Zentrum München, Neuherberg, Germany
Adam R:
University Children's Hospital
Paediatric Gastroenterology, Hepatology and Nutrition
Medical Faculty Mannheim
Heidelberg University
Mannheim, Germany
Aldrian D:
Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria
Baric I:
University Hospital Centre Zagreb, Department of Paediatrics and University of Zagreb, School of Medicine, Zagreb, Croatia
Baumann U:
Division for Paediatric Gastroenterology and Hepatology, Department of Peadiatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
Bozbulut NE:
Gazi University Faculty of Medicine, Department of Paediatric Gastroenterology, Ankara, Turkey
Brugger M:
School of Medicine, Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
Brunet T:
School of Medicine, Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
Bufler P:
Charité - Universitätsmedizin Berlin, Department of Paediatric Gastroenterology, Nephrology and Metabolic Diseases, Berlin, Germany
Burnyte B:
Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Calvo PL:
Regina Margherita Children's Hospital, Paediatic Gastroenterology Unit, Torino, Italy
Crushell E:
National Centre for Inherited Metabolic Disorders, Children's Health Ireland at Temple st, Dublin, Ireland
Dalgiç B:
Gazi University Faculty of Medicine, Department of Paediatric Gastroenterology, Ankara, Turkey
Das AM:
Hannover Medical School, Clinic for Paediatric Kidney, Liver, and Metabolic Diseases, Hannover, Germany
Dezsofi A:
First Department of Paediatrics, Semmelweis University, Budapest, Hungary
Distelmaier F:
University Children's Hospital, Heinrich-Heine-University Düsseldorf, Department of General Paediatrics, Neonatology and Paediatric Cardiology, Düsseldorf, Germany
Fichtner A:
Division of Neuropaediatrics and Paediatric Metabolic Medicine, Centre for Paediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
Freisinger P:
Hospital Reutlingen, Department of Paediatrics, Reutlingen, Germany
Garbade SF:
Division of Neuropaediatrics and Paediatric Metabolic Medicine, Centre for Paediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
Gaspar H:
Department of Human Genetics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Goujon L:
CLAD Ouest CHU Hôpital Sud, CRMR Déficiences intellectuelles, Service de Génétique Médicale, Rennes, France
Hadzic N:
King's College Hospital, Paediatric Liver, GI & Nutrition Centre, London, United Kingdom
Hartleif S:
Eberhard Karls University Tuebingen, Paediatric Gastroenterology and Hepatology, Tuebingen, Germany
Hegen B:
University Medical Centre Hamburg-Eppendorf, Department of Paediatrics, Hamburg, Germany
Hempel M:
University Hospital Heidelberg, Institute of Human Genetics, Heidelberg, Germany
University Medical Centre Hamburg-Eppendorf, Institute of Human Genetics, Hamburg
Henning S:
Charité - Universitätsmedizin Berlin, Department of Paediatric Gastroenterology, Nephrology and Metabolic Diseases, Berlin, Germany
Hoerning A:
University Hospital Erlangen, Department of Paediatrics, Erlangen, Germany
Houwen R:
Paediatric Gastroenterology, UMC Utrecht, Utrecht, The Netherlands
Hughes J:
Children's Health Ireland, Temple Street Hospital, Dublin, Ireland
Iorio R:
University of Naples Federico II, Department of Translational Medical Sciences, Naples, Italy
Iwanicka-Pronicka K:
Children's Memorial Health Institute, Department of Medical Genetics, Warsaw, Poland
Jankofsky M:
University Medical Centre Hamburg-Eppendorf, Department of Paediatrics, Hamburg, Germany
Junge N:
Division for Paediatric Gastroenterology and Hepatology, Department of Peadiatric Kidney, Liver, and Metabolic Diseases, Hannover Medical School, Hannover, Germany
Kanavaki I:
Department of Paediatric Gastroenterology, Hepatology and Nutrition, Third Department of Paediatrics, Attikon University General Hospital, National and Kapodistrian University of Athens, Athens, Greece
Kansu A:
Ankara University, School of Medicine, Department of Paediatric Gastroenterology, Ankara, Turkey
Kaspar S:
University Hospital Erlangen, Department of Paediatrics, Erlangen, Germany
Kathemann S:
University Hospital Essen, Department of Paediatrics II, Paediatric Gastroenterology, Hepatology and Liver Transplantation, Essen, Germany
Kelly D:
Birmingham Children's Hospital NHS Trust, Liver Unit, Birmingham, United Kingdom
Kirsaçlioglu CT:
Ankara University, School of Medicine, Department of Paediatric Gastroenterology, Ankara, Turkey
Knoppke B:
University Hospital Regensburg, KUNO University Children's Hospital, Regensburg, Germany
Kohl M:
University Medical Centre Schleswig-Holstein, Department of General Paediatrics, Kiel, Germany
Kölbel H:
Department of Paediatric Neurology, Centre for Neuromuscular Disorders, Centre for Translational Neuro and Behavioral Sciences, University Duisburg-Essen, Essen, Germany
Kölker S:
Division of Neuropaediatrics and Paediatric Metabolic Medicine, Centre for Paediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
Konstantopoulou V:
Medical University of Vienna, Department of Paediatrics and Adolescent Medicine, Vienna, Austria
Krylova T:
Research Centre for Medical Genetics, Moscow, Russian Federation
Kuloglu Z:
Ankara University, School of Medicine, Department of Paediatric Gastroenterology, Ankara, Turkey
Kuster A:
University Hospital of Nantes, Department of Neurometabolism, Nantes, France
Laass MW:
Department of Pediatrics, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
Lainka E:
University Hospital Essen, Department of Paediatrics II, Paediatric Gastroenterology, Hepatology and Liver Transplantation, Essen, Germany
Lurz E:
Department of Paediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
Mandel H:
Rambam Medical Centre, Meyer Children's Hospital, Department of Paediatrics, Metabolic Unit, Haifa, Israel
Mayerhanser K:
School of Medicine, Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
Mayr JA:
University Children's Hospital, Paracelsus Medical University Salzburg, Salzburg, Austria
McKiernan P:
University of Pittsburgh and Children's Hospital of Pittsburgh of UPMC, Pittsburgh Liver Research Centre, Pittsburgh, PA, United States
McLean P:
Children's Liver Unit, Leeds Children's Hospital, Leeds, UK
McLin V:
Swiss Paediatric Liver Centre, Paediatric Gastroenterology, Hepatology and Nutrition Unit, Division of Paediatric Subspecialities, Department of Paediatrics, Gynecology, and Obstetrics, University of Geneva, Geneva, Switzerland
Mention K:
Jeanne de Flandres Hospital, Reference Centre for Inherited Metabolic Diseases, Lille, France
Müller H:
Division of Neonatology and Paediatric Intensive Care, Department of Paediatrics, University Hospital Marburg, Marburg, Germany
Pasquier L:
CLAD Ouest CHU Hôpital Sud, CRMR Déficiences intellectuelles, Service de Génétique Médicale, Rennes, France
Pavlov M:
School of Medicine, Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
Institute of Neurogenomics, Computational Health Centre, Helmholtz Zentrum München, Neuherberg, Germany
Pechatnikova N:
Morozov Children's City Clinical Hospital of the Moscow City Healthcare Department, Moscow
Peters B:
Division of Neuropaediatrics and Paediatric Metabolic Medicine, Centre for Paediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
Petkovic Ramadža D:
University Hospital Centre Zagreb, Department of Paediatrics and University of Zagreb, School of Medicine, Zagreb, Croatia
Piekutowska-Abramczuk D:
Children's Memorial Health Institute, Department of Medical Genetics, Warsaw, Poland
Pilic D:
University Hospital Essen, Department of Paediatrics II, Paediatric Gastroenterology, Hepatology and Liver Transplantation, Essen, Germany
Rajwal S:
Swiss Paediatric Liver Centre, Paediatric Gastroenterology, Hepatology and Nutrition Unit, Division of Paediatric Subspecialities, Department of Paediatrics, Gynecology, and Obstetrics, University of Geneva, Geneva, Switzerland
Rock N:
Swiss Paediatric Liver Centre, Paediatric Gastroenterology, Hepatology and Nutrition Unit, Division of Paediatric Subspecialities, Department of Paediatrics, Gynecology, and Obstetrics, University of Geneva, Geneva, Switzerland
Roetig A:
University Paris Cité, Imagine Institute, Laboratory of Genetics of Mitochondrial Diseases, INSERM UMR 1163, Paris, France
Santer R:
University Medical Centre Hamburg-Eppendorf, Department of Paediatrics, Hamburg, Germany
Schenk W:
Department of Paediatrics, university hospital Augsburg, Augsburg, Germany
Semenova N:
Research Centre for Medical Genetics, Moscow, Russian Federation
Sokollik C:
Division of Paediatric Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Sturm E:
Eberhard Karls University Tuebingen, Paediatric Gastroenterology and Hepatology, Tuebingen, Germany
Taylor RW:
Wellcome Centre for Mitochondrial Research, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
Tschiedel E:
Department of Paediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Urbonas V:
Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
Urreizti R:
Clinical Biochemistry Department, Hospital Sant Joan de Déu, IRSJD, Esplugues de Llobregat, Barcelona, Spain and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER)- Instituto de Salud Carlos III, Spain
Vermehren J:
University Hospital Regensburg, KUNO University Children's Hospital, Regensburg, Germany
Vockley J:
University of Pittsburgh and Children's Hospital of Pittsburgh of UPMC, Pittsburgh Liver Research Centre, Pittsburgh, PA, United States
Vogel GF:
Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria
Institute of Cell Biology, Medical University of Innsbruck, Innsbruck, Austria
Wagner M:
School of Medicine, Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
van der Woerd W:
Paediatric Gastroenterology, UMC Utrecht, Utrecht, The Netherlands
Wortmann SB:
University Children's Hospital, Paracelsus Medical University Salzburg, Salzburg, Austria
Zakharova E:
Research Centre for Medical Genetics, Moscow, Russian Federation
Hoffmann GF:
Division of Neuropaediatrics and Paediatric Metabolic Medicine, Centre for Paediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
Meitinger T:
School of Medicine, Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
Murayama K:
Chiba Children's Hospital, Centre for Medical Genetics and Department of Metabolism, Chiba, Japan
Staufner C:
Division of Neuropaediatrics and Paediatric Metabolic Medicine, Centre for Paediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
Prokisch H:
School of Medicine, Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
Institute of Neurogenomics, Computational Health Centre, Helmholtz Zentrum München, Neuherberg, Germany
Division of Neuropaediatrics and Paediatric Metabolic Medicine, Centre for Paediatric and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany.; School of Medicine, Institute of Human Genetics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.; Institute of Neurogenomics, Computational Health Centre, Helmholtz Zentrum Munchen, Neuherberg, Germany.; Chiba Children's Hospital, Centre for Medical Genetics and Department of Metabolism, Chiba, Japan.; Univ
Green Submitted, hybrid
|