Isolated sulfite oxidase deficiency: a case report with a novel mutation and review of the literature.

Isolated sulfite oxidase deficiency is a rare but devastating neurologic disease that usually presents in early infancy with seizures and alterations in muscle tone. Only 21 cases have been reported in the literature. We report a case of a newborn infant boy with isolated sulfite oxidase deficiency who presented with generalized seizures on his fourth day of life. Plasma total homocysteine was not detectable. Urinary sulfite, thiosulfate, and S-sulfocysteine levels were elevated. The patient began a low-methionine and low-cysteine diet and was treated with thiamine and dextromethorphan. However, he became increasingly microcephalic and was severely developmentally delayed. Mutation analysis of the sulfite oxidase gene revealed that the patient was homozygous for a novel 4-base pair deletion, and both of his parents were found to be heterozygous carriers of the same deletion. We reviewed the clinical, biochemical, neuroradiologic, and neuropathologic features in all published cases of isolated sulfite oxidase deficiency. Seizures or abnormal movements were prominent features in all cases. Developmental delays were reported in 17 cases. Ectopia lentis was detected in 9 cases. Clinical improvement with dietary therapy was seen in only 2 patients, both of whom presented after the age of 6 months and had relatively mild developmental delays. Plasma or urinary S-sulfocysteine levels were elevated in all cases. Urinary sulfite was detected in all except 1 case. Cerebral atrophy and cystic encephalomalacia were observed with neuroradiologic imaging and were noted in all 3 postmortem reports of isolated sulfite oxidase deficiency. The main alternative in the differential diagnosis of isolated sulfite oxidase deficiency is molybdenum cofactor deficiency.

Reexpression of vimentin in differentiated neuroblastoma cells enhances elongation of axonal neurites.

Vimentin (Vm) is initially expressed by early neuronal precursors in situ and in culture. Vm is essential for neuritogenesis at least in culture and is gradually replaced by neurofilaments (NFs) because of down-regulation of Vm expression. This period is accompanied by a slowing of axonal elongation. We examined whether continued expression of Vm could foster continued axonal elongation. NB2a/d1 cells differentiated with dibutyryl cAMP were transfected with constructs expressing Vm or the middle-molecular-weight NF subunit (NF-M) each conjugated to green fluorescent protein (GFP). Axonal neurites of cells expressing GFP-Vm were 30% longer than those of nonexpressing cells, or cells expressing GFP-M, and exhibited a decrease in neurite caliber. Expression of GFP-M did not enhance axonal neurite length but significantly increased caliber. These findings provide further evidence of a role for Vm in axonal outgrowth. Culturing of nontransfected cells on laminin increased neurite length, but cells expressing GFP-Vm demonstrated an equivalent increase whether cultured on laminin or culture plastic. Axonal neurites of cells expressing GFP-Vm turned to avoid a nonfavorable substrate (nitrocellulose), but culturing of these cells on nitrocellulose did not impair axonal outgrowth. These latter findings indicate that the more robust outgrowth following reexpression of Vm is independent of a favorable or nonfavorable substrate but that axonal neurites of these cells still interact with the substrate to the extent that the substrate can influence directionality.