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Clinical manifestations in female carriers of mucopolysaccharidosis type II: a Spanish cross-sectional study.
Orphanet J Rare Dis 2013; 8:92OJ

Abstract

BACKGROUND

Mucopolysaccharidosis type II (MPS II) is an inherited X-linked disease associated with a deficiency in the enzyme iduronate 2-sulfatase due to iduronate 2-sulfatase gene (IDS) mutations. Recent studies in MPS II carriers did not find clinical involvement, but these were mainly performed by anamnesis and patients' self-reported description of signs and symptoms. So although it is rare in heterozygous carriers, investigations in other types of inherited X-linked disorders suggest that some clinical manifestations may be a possibility. The aim of this study was to evaluate the clinical pattern in female carriers of MPS II and to determine whether clinical symptoms were associated with the X-chromosome inactivation (XCI) pattern and age.

METHODS

Female carriers of MPS II were genetically identified by molecular analysis of IDS. The clinical evaluation protocol included pedigree analysis, a comprehensive anamnesis, complete physical examination, ophthalmological evaluation, brain-evoked auditory response, electrocardiogram, echocardiogram, pulmonary function tests, abdominal sonogram, skeletal survey, neurophysiological studies, blood cell counts and biochemistry, urine glycosaminoglycan (GAGs) quantification, karyotype and pattern of XCI.

RESULTS

Ten women were included in the study. The mean age of the participants was 40.2 ± 13.1 years. Six carriers presented a skewed XCI pattern, 3 of whom (aged 38, 42 and 52 years) had increased levels of GAGs in the urine and showed typical MPS II clinical manifestations, such as skeletal anomalies, liver abnormalities, carpal tunnel syndrome, recurrent ear infection, hypoacusia and more frequent severe odontological problems without coarse facial features.

CONCLUSIONS

This is the first study performing a comprehensive evaluation of heterozygous MPS II carriers. Our results provide evidence of possible progressive, age-dependent, mild clinical manifestations in MPS II female carriers with a skewed XCI pattern, most likely affecting the normal allele. Further comparative studies with systematized clinical examinations in larger age-stratified populations of MPS II female carriers are required.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23800320

Citation

Guillén-Navarro, Encarna, et al. "Clinical Manifestations in Female Carriers of Mucopolysaccharidosis Type II: a Spanish Cross-sectional Study." Orphanet Journal of Rare Diseases, vol. 8, 2013, p. 92.
Guillén-Navarro E, Domingo-Jiménez MR, Alcalde-Martín C, et al. Clinical manifestations in female carriers of mucopolysaccharidosis type II: a Spanish cross-sectional study. Orphanet J Rare Dis. 2013;8:92.
Guillén-Navarro, E., Domingo-Jiménez, M. R., Alcalde-Martín, C., Cancho-Candela, R., Couce, M. L., Galán-Gómez, E., & Alonso-Luengo, O. (2013). Clinical manifestations in female carriers of mucopolysaccharidosis type II: a Spanish cross-sectional study. Orphanet Journal of Rare Diseases, 8, p. 92. doi:10.1186/1750-1172-8-92.
Guillén-Navarro E, et al. Clinical Manifestations in Female Carriers of Mucopolysaccharidosis Type II: a Spanish Cross-sectional Study. Orphanet J Rare Dis. 2013 Jun 25;8:92. PubMed PMID: 23800320.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical manifestations in female carriers of mucopolysaccharidosis type II: a Spanish cross-sectional study. AU - Guillén-Navarro,Encarna, AU - Domingo-Jiménez,María Rosario, AU - Alcalde-Martín,Carlos, AU - Cancho-Candela,Ramón, AU - Couce,María Luz, AU - Galán-Gómez,Enrique, AU - Alonso-Luengo,Olga, Y1 - 2013/06/25/ PY - 2013/03/12/received PY - 2013/06/20/accepted PY - 2013/6/27/entrez PY - 2013/6/27/pubmed PY - 2015/3/31/medline SP - 92 EP - 92 JF - Orphanet journal of rare diseases JO - Orphanet J Rare Dis VL - 8 N2 - BACKGROUND: Mucopolysaccharidosis type II (MPS II) is an inherited X-linked disease associated with a deficiency in the enzyme iduronate 2-sulfatase due to iduronate 2-sulfatase gene (IDS) mutations. Recent studies in MPS II carriers did not find clinical involvement, but these were mainly performed by anamnesis and patients' self-reported description of signs and symptoms. So although it is rare in heterozygous carriers, investigations in other types of inherited X-linked disorders suggest that some clinical manifestations may be a possibility. The aim of this study was to evaluate the clinical pattern in female carriers of MPS II and to determine whether clinical symptoms were associated with the X-chromosome inactivation (XCI) pattern and age. METHODS: Female carriers of MPS II were genetically identified by molecular analysis of IDS. The clinical evaluation protocol included pedigree analysis, a comprehensive anamnesis, complete physical examination, ophthalmological evaluation, brain-evoked auditory response, electrocardiogram, echocardiogram, pulmonary function tests, abdominal sonogram, skeletal survey, neurophysiological studies, blood cell counts and biochemistry, urine glycosaminoglycan (GAGs) quantification, karyotype and pattern of XCI. RESULTS: Ten women were included in the study. The mean age of the participants was 40.2 ± 13.1 years. Six carriers presented a skewed XCI pattern, 3 of whom (aged 38, 42 and 52 years) had increased levels of GAGs in the urine and showed typical MPS II clinical manifestations, such as skeletal anomalies, liver abnormalities, carpal tunnel syndrome, recurrent ear infection, hypoacusia and more frequent severe odontological problems without coarse facial features. CONCLUSIONS: This is the first study performing a comprehensive evaluation of heterozygous MPS II carriers. Our results provide evidence of possible progressive, age-dependent, mild clinical manifestations in MPS II female carriers with a skewed XCI pattern, most likely affecting the normal allele. Further comparative studies with systematized clinical examinations in larger age-stratified populations of MPS II female carriers are required. SN - 1750-1172 UR - https://www.unboundmedicine.com/medline/citation/23800320/Clinical_manifestations_in_female_carriers_of_mucopolysaccharidosis_type_II:_a_Spanish_cross_sectional_study_ L2 - https://ojrd.biomedcentral.com/articles/10.1186/1750-1172-8-92 DB - PRIME DP - Unbound Medicine ER -