TY - JOUR
T1 - Galactose supplementation in patients with TMEM165-CDG rescues the glycosylation defects
AU - Morelle, Willy
AU - Potelle, Sven
AU - Witters, Peter
AU - Wong, Sunnie
AU - Climer, Leslie
AU - Lupashin, Vladimir
AU - Matthijs, Gert
AU - Gadomski, Therese
AU - Jaeken, Jaak
AU - Cassiman, David
AU - Morava, Eva
AU - Foulquier, François
N1 - Publisher Copyright:
Copyright © 2017 Endocrine Society.
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Context: TMEM165 deficiency is a severe multisystem disease that manifests with metabolic, endocrine, and skeletal involvement. It leads to one type of congenital disorders of glycosylation (CDG), a rapidly growing group of inherited diseases in which the glycosylation process is altered. Patients have decreased galactosylation by serum glycan analysis. There are >100 CDGs, but only specific types are treatable. Objective: Galactose has been shown to be beneficial in other CDG types with abnormal galactosylation. The aim of this study was to characterize the effects of galactose supplementation on Golgi glycosylation in TMEM165-depleted HEK293 cells, as well as in 2 patients with TMEM165-CDG and in their cultured skin fibroblast cells. Design and Setting: Glycosylation was assessed by mass spectrometry, western blot analysis, and transferrin isoelectrofocusing. Patients and Interventions: Both unrelated patients with TMEM165-CDG with the same deep intronic homozygous mutation (c.792+182G>A) were allocated to receive D-galactose in a daily dose of 1 g/kg. Results:WeanalyzedN-linked glycans and glycolipids in knockout TMEM165 HEK293 cells, revealing severe hypogalactosylation and GalNAc transfer defects. Although these defects were completely corrected by the addition of Mn2+, we demonstrated that the observed N-glycosylation defect could also be overcome by galactose supplementation. We then demonstrated that oral galactose supplementation in patients with TMEM165-deficient CDG improved biochemical and clinical parameters, including a substantial increase in the negatively charged transferrin isoforms, and a decrease in hypogalactosylated total N-glycan structures, endocrine function, and coagulation parameters. Conclusion: To our knowledge, this is the first description of abnormal glycosylation of lipids in the TMEM165 defect and the first report of successful dietary treatment in TMEM165 deficiency. We recommend the use of oral D-galactose therapy in TMEM165-CDG.
AB - Context: TMEM165 deficiency is a severe multisystem disease that manifests with metabolic, endocrine, and skeletal involvement. It leads to one type of congenital disorders of glycosylation (CDG), a rapidly growing group of inherited diseases in which the glycosylation process is altered. Patients have decreased galactosylation by serum glycan analysis. There are >100 CDGs, but only specific types are treatable. Objective: Galactose has been shown to be beneficial in other CDG types with abnormal galactosylation. The aim of this study was to characterize the effects of galactose supplementation on Golgi glycosylation in TMEM165-depleted HEK293 cells, as well as in 2 patients with TMEM165-CDG and in their cultured skin fibroblast cells. Design and Setting: Glycosylation was assessed by mass spectrometry, western blot analysis, and transferrin isoelectrofocusing. Patients and Interventions: Both unrelated patients with TMEM165-CDG with the same deep intronic homozygous mutation (c.792+182G>A) were allocated to receive D-galactose in a daily dose of 1 g/kg. Results:WeanalyzedN-linked glycans and glycolipids in knockout TMEM165 HEK293 cells, revealing severe hypogalactosylation and GalNAc transfer defects. Although these defects were completely corrected by the addition of Mn2+, we demonstrated that the observed N-glycosylation defect could also be overcome by galactose supplementation. We then demonstrated that oral galactose supplementation in patients with TMEM165-deficient CDG improved biochemical and clinical parameters, including a substantial increase in the negatively charged transferrin isoforms, and a decrease in hypogalactosylated total N-glycan structures, endocrine function, and coagulation parameters. Conclusion: To our knowledge, this is the first description of abnormal glycosylation of lipids in the TMEM165 defect and the first report of successful dietary treatment in TMEM165 deficiency. We recommend the use of oral D-galactose therapy in TMEM165-CDG.
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U2 - 10.1210/jc.2016-3443
DO - 10.1210/jc.2016-3443
M3 - Article
C2 - 28323990
AN - SCOPUS:85017287830
SN - 0021-972X
VL - 102
SP - 1375
EP - 1386
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
IS - 4
ER -