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首页> 外文期刊>The Application of Clinical Genetics >Adult-onset type II citrullinemia: Current insights and therapy
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Adult-onset type II citrullinemia: Current insights and therapy

机译:成人发病的II型瓜氨酸血症:当前的见解和治疗

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Citrin deficiency is a recessively inherited metabolic disorder with age-dependent clinical manifestations. It causes neonatal intrahepatic cholestasis (NICCD) and adult-onset type II citrullinemia (CTLN2). Patients with NICCD present with intrahepatic cholestasis in the neonatal period and usually respond to the treatment with medium-chain triglyceride (MCT) supplement and lactose-restricted formula. In adulthood, CTLN2 develops in 10 % of the patients showing hyperammonemic encephalopathy. Patients with CTLN2 required liver transplantation for the most promising prognosis; however, they were successfully treated with MCT supplement with a low carbohydrate formula. Citrin deficiency is caused by mutations in SLC25A13 on chromosome 7q21.3, with a high frequency in East Asia, including Japan. Citrin is aspartate/glutamate transporter in mitochondria, a component of malate-aspartate nicotinamide adenine dinucleotide hydrogen shuttle, and is essential for the hepatic glycolysis. Although the precise pathophysiology of citrin deficiency remains unclear, recent reports for the effective MCT supplement therapy and downregulation of peroxisome proliferator-activated receptor α suggest that citrin deficiency impairs hepatic de novo lipogenesis coupled with glycolysis leading to the energy deficit of hepatocytes. Herein, we review the current therapeutic and pathological understanding of CTLN2.
机译:柠檬酸缺乏症是一种隐性遗传性代谢疾病,具有年龄依赖性的临床表现。它会引起新生儿肝内胆汁淤积症(NICCD)和成人发作的II型瓜氨酸血症(CTLN2)。 NICCD患者在新生儿期出现肝内胆汁淤积,通常对中链甘油三酸酯(MCT)补充剂和乳糖受限配方的治疗产生反应。在成年期,表现出高氨血症性脑病的患者中,<10%会发展为CTLN2。 CTLN2患者需要肝移植才能获得最有希望的预后。但是,他们已经成功地接受了低碳水化合物配方的MCT补充剂的治疗。柠檬酸缺乏症是由7q21.3号染色体上的SLC25A13突变引起的,在包括日本在内的东亚地区,这种突变的发生频率很高。柠檬酸是线粒体中的天冬氨酸/谷氨酸转运蛋白,是苹果酸-天冬氨酸烟酰胺腺嘌呤二核苷酸氢穿梭的组成部分,对肝糖酵解至关重要。尽管尚不清楚柠檬酸缺乏症的确切病理生理学,但有关有效MCT补充疗法和过氧化物酶体增殖物激活受体α的下调的最新报道表明,柠檬酸缺乏症会损害肝新生脂肪形成,并伴随糖酵解,导致肝细胞能量缺乏。本文中,我们回顾了当前对CTLN2的治疗和病理学理解。

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