ABSTRACT
Abstract Objectives: This study aimed to review the literature on the repercussions of the different inborn errors of immunity on growth, drawing attention to the diagnosis of this group of diseases in patients with growth disorders, as well as to enable the identification of the different causes of growth disorders in patients with inborn errors of immunity, which can help in their treatment. Data sources: Non-systematic review of the literature, searching articles since 2000 in PubMed with the terms "growth", "growth disorders", "failure to thrive", or "short stature" AND "immunologic deficiency syndromes", "immune deficiency disease", or "immune deficiency" NOT HIV. The Online Mendelian Inheritance in Man (OMIN) database was searched for immunodeficiencies and short stature or failure to thrive. Data summary: Inborn errors of immunity can affect growth in different ways, and some of them can change growth through multiple simultaneous mechanisms: genetic syndromes; disorders of the osteoarticular system; disorders of the endocrine system; reduction in caloric intake; catabolic processes; loss of nutrients; and inflammatory and/or infectious conditions. Conclusions: The type of inborn errors of immunity allows anticipating what type of growth disorder can be expected. The type of growth disorder can help in the diagnosis of clinical conditions related to inborn errors of immunity. In many inborn errors of immunity, the causes of poor growth are mixed, involving more than one factor. In many cases, impaired growth can be adjusted with proper inborn errors of immunity treatment or proper approach to the mechanism of growth impairment.
Resumo Objetivos: Revisão da literatura sobre as repercussões dos diferentes erros inatos da imunidade sobre o crescimento, chamar a atenção para o diagnóstico desse grupo de doenças em pacientes que apresentem desordens do crescimento, assim como permitir que se identifiquem as diferentes causas de alterações do crescimento em pacientes com erros inatos da imunidade, o que pode auxiliar em seu manejo. Fonte dos dados: Revisão não sistemática da literatura, com busca de artigos desde 2000 no Pubmed com os termos "growth" ou "growth disorders" ou "failure to thrive" ou "short stature" AND "immunologic deficiency syndromes" ou "immune deficiency disease" ou "imune deficiency" NOT HIV. E buscas na base OMIN (Online Mendelian Inheritance in Man) por imunodeficiências e baixa estatura ou falha no crescimento ("failure to thrive"). Síntese dos dados: Há diferentes modos pelos quais os erros inatos da imunidade podem afetar o crescimento e alguns deles podem alterar o crescimento por múltiplos mecanismos simultâneos: síndromes genéticas; afecções do aparelho osteoarticular; afecções do sistema endócrino; redução de aporte calórico; processos catabólicos: perda de nutrientes, assim como afecções inflamatórias e/ou infecciosas. Conclusões: O tipo de erros inatos da imunidade permite prever que tipo de alteração no crescimento devemos esperar. O tipo de alteração no crescimento pode auxiliar no diagnóstico de condições clínicas associadas aos erros inatos da imunidade. Em muitos erros inatos da imunidade, as causas do crescimento deficiente são mistas, envolvem mais de um fator. Em muitos casos, o prejuízo do crescimento pode ser corrigido com o adequado tratamento dos erros inatos da imunidade ou adequada abordagem do mecanismo que causa o prejuízo do crescimento.
Subject(s)
Humans , Growth Disorders/etiology , Immunologic Deficiency Syndromes/complications , Metabolism, Inborn Errors/complications , Immunologic Deficiency Syndromes/classification , Metabolism, Inborn Errors/classificationABSTRACT
The use of tandem mass spectrometry for the diagnosis of inborn errors of metabolism has the potential to expand the newborn screening panel to include a vast number of diseases. This technology allows the detection, in the same spot of dried blood on filter paper and during one single analytical run, of different metabolic diseases. Tandem mass spectrometry is rapidly replacing the classical screening techniques approach of one-metabolite detected per analysis per disease by its ability of simultaneous quantification of several metabolites as markers of many diseases, such as acylcarnitines and amino acids. It is clear that a single metabolite can be a biomarker for several diseases, so the multiplex approach of using tandem mass spectrometry enhances, on average, the sensitivity and specificity of the screening. However, there are differences for particular metabolites and the diseases they detect within the same method. Disorders such as the tyrosinemias and among the organic acidemias, the methylmalonic acidemias, have a substantially higher false-positive rate than other more common metabolic diseases such as medium-chain acyl-CoA dehydrogenase deficiency and phenylketonuria. Before introducing this technology into routine newborn screening programs it is necessary to consider the frequency of each disease, as well as the response to early treatment or variables related to the collection of the sample.
Subject(s)
Humans , Infant, Newborn , Metabolism, Inborn Errors/diagnosis , Neonatal Screening/methods , Tandem Mass Spectrometry/methods , Biomarkers/analysis , False Positive Reactions , Metabolism, Inborn Errors/classificationABSTRACT
One thousand patients referred to genetics clinic, Medical Research Institute, Alexandria, were subjected to biochemical genetic studies and clinical genetic examinations to estimate the frequency of inborn errors of metabolism [IEM]. It was found that 70 [7%] patients had EM. Of these, 34 [48.6%] had aminoacidopathies, 3 [4.3%] had galactosemia, and 33 [47.1%] had lysosomal storage disorders. Phenylketonuria wqs the most frequent IEM [37.2%]. The rate of consanguinity among parents of patients with EM was high [77.1%] with 58.6% first cousins. Positive family history of more than one affected child was detected in 22 [31.4%] families of the patients with EM. Detection of IEM is important because it may allow a specific treatment for the patients and proper genetic counseling for the family
Subject(s)
Humans , Male , Female , Genetics , Ambulatory Care Facilities , Consanguinity , Genetic Counseling , Child , Metabolism, Inborn Errors/classification , Signs and SymptomsABSTRACT
EL presente trabajo estuvo dirigido a anlizar el avance en el campo de los errores innatos del metabolismo, tanto en el diagnóstico por el laboratorio como en el conocimiento de estas enfermedades en Colombia. Se analizo la forma como se remiten los pacientes, la procedencia de los mismos, la especialidad de los medicos remitentes, la impresion diagnostica y el diagnostico final. Los estudios del laboratorio se enfocaron tomando como base el diagnostico presuntivo, luego se aplicaron baterias de tipo general para carbohidratos, aminoacidopatias, acidurias organicas o para desordenes neurodegenerativos y se fue profundizando hasta llegar al analisis de la enzima o proteina que define el diagnostico. Para tres enfermedades hemos llegado al nivel de DNA. Hace 5 años publicamos los hallazgos efectuados en este campo en la población colombiana. La comparación entre los dos estudios permite evaluar ele avance logrado especialmente con la introduccion de la cromatografia de gas acoplada a la espectometria de masas, para el diagnostico de las acidemias organicas, de nuevas tecnicas enzimaticas para el diagnostico de mucopolisacaridosis y enfermedades neurodegenerativas. Las acidurias glutarica tipo I, tipo II, la piroglutamica y la 3 OH, 3 metilglutarica son los primeros casos que se reportan en Colombia. El porcentaje de pacientes remitidos sin impresion diagnostica o con solicitud de estudio metabolico no definido, bajo del 75 porciento al 25 porciento; lo anterior permite concluir que hemos hecho notables avances diagnosticos y por laboratorio de los EIM en Colombia