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dc.contributor.authorStrauss, Kevin A
dc.date2022-08-11T08:09:57.000
dc.date.accessioned2022-08-23T16:50:19Z
dc.date.available2022-08-23T16:50:19Z
dc.date.issued2020-11-01
dc.date.submitted2020-12-16
dc.identifier.citation<p>Strauss KA, Williams KB, Carson VJ, Poskitt L, Bowser LE, Young M, Robinson DL, Hendrickson C, Beiler K, Taylor CM, Haas-Givler B, Hailey J, Chopko S, Puffenberger EG, Brigatti KW, Miller F, Morton DH. Glutaric acidemia type 1: Treatment and outcome of 168 patients over three decades. Mol Genet Metab. 2020 Nov;131(3):325-340. doi: 10.1016/j.ymgme.2020.09.007. Epub 2020 Oct 4. PMID: 33069577. <a href="https://doi.org/10.1016/j.ymgme.2020.09.007">Link to article on publisher's site</a></p>
dc.identifier.issn1096-7192 (Linking)
dc.identifier.doi10.1016/j.ymgme.2020.09.007
dc.identifier.pmid33069577
dc.identifier.urihttp://hdl.handle.net/20.500.14038/41637
dc.description<p>Full author list omitted for brevity. For the full list of authors, see article.</p>
dc.description.abstractGlutaric acidemia type 1 (GA1) is a disorder of cerebral organic acid metabolism resulting from biallelic mutations of GCDH. Without treatment, GA1 causes striatal degeneration in > 80% of affected children before two years of age. We analyzed clinical, biochemical, and developmental outcomes for 168 genotypically diverse GA1 patients managed at a single center over 31 years, here separated into three treatment cohorts: children in Cohort I (n = 60; DOB 2006-2019) were identified by newborn screening (NBS) and treated prospectively using a standardized protocol that included a lysine-free, arginine-enriched metabolic formula, enteral l-carnitine (100 mg/kg*day), and emergency intravenous (IV) infusions of dextrose, saline, and l-carnitine during illnesses; children in Cohort II (n = 57; DOB 1989-2018) were identified by NBS and treated with natural protein restriction (1.0-1.3 g/kg*day) and emergency IV infusions; children in Cohort III (n = 51; DOB 1973-2016) did not receive NBS or special diet. The incidence of striatal degeneration in Cohorts I, II, and III was 7%, 47%, and 90%, respectively (p < .0001). No neurologic injuries occurred after 19 months of age. Among uninjured children followed prospectively from birth (Cohort I), measures of growth, nutritional sufficiency, motor development, and cognitive function were normal. Adherence to metabolic formula and l-carnitine supplementation in Cohort I declined to 12% and 32%, respectively, by age 7 years. Cessation of strict dietary therapy altered plasma amino acid and carnitine concentrations but resulted in no serious adverse outcomes. In conclusion, neonatal diagnosis of GA1 coupled to management with lysine-free, arginine-enriched metabolic formula and emergency IV infusions during the first two years of life is safe and effective, preventing more than 90% of striatal injuries while supporting normal growth and psychomotor development. The need for dietary interventions and emergency IV therapies beyond early childhood is uncertain.
dc.language.isoen_US
dc.relation<p><a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=33069577&dopt=Abstract">Link to Article in PubMed</a></p>
dc.rights© 2020 The Authors. This is an open access article under the CC BY license (http://creativecommons.org/licenses/BY/4.0/).
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/
dc.subjectArginine
dc.subjectCarnitine
dc.subjectDystonia
dc.subjectGlutaric acidemia
dc.subjectLysine
dc.subjectMedical food
dc.subjectStriatal degeneration
dc.subjectCongenital, Hereditary, and Neonatal Diseases and Abnormalities
dc.subjectNutritional and Metabolic Diseases
dc.subjectPediatrics
dc.titleGlutaric acidemia type 1: Treatment and outcome of 168 patients over three decades
dc.typeJournal Article
dc.source.journaltitleMolecular genetics and metabolism
dc.source.volume131
dc.source.issue3
dc.identifier.legacyfulltexthttps://escholarship.umassmed.edu/cgi/viewcontent.cgi?article=5459&amp;context=oapubs&amp;unstamped=1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/oapubs/4429
dc.identifier.contextkey20637425
refterms.dateFOA2022-08-23T16:50:19Z
html.description.abstract<p>Glutaric acidemia type 1 (GA1) is a disorder of cerebral organic acid metabolism resulting from biallelic mutations of GCDH. Without treatment, GA1 causes striatal degeneration in > 80% of affected children before two years of age. We analyzed clinical, biochemical, and developmental outcomes for 168 genotypically diverse GA1 patients managed at a single center over 31 years, here separated into three treatment cohorts: children in Cohort I (n = 60; DOB 2006-2019) were identified by newborn screening (NBS) and treated prospectively using a standardized protocol that included a lysine-free, arginine-enriched metabolic formula, enteral l-carnitine (100 mg/kg*day), and emergency intravenous (IV) infusions of dextrose, saline, and l-carnitine during illnesses; children in Cohort II (n = 57; DOB 1989-2018) were identified by NBS and treated with natural protein restriction (1.0-1.3 g/kg*day) and emergency IV infusions; children in Cohort III (n = 51; DOB 1973-2016) did not receive NBS or special diet. The incidence of striatal degeneration in Cohorts I, II, and III was 7%, 47%, and 90%, respectively (p < .0001). No neurologic injuries occurred after 19 months of age. Among uninjured children followed prospectively from birth (Cohort I), measures of growth, nutritional sufficiency, motor development, and cognitive function were normal. Adherence to metabolic formula and l-carnitine supplementation in Cohort I declined to 12% and 32%, respectively, by age 7 years. Cessation of strict dietary therapy altered plasma amino acid and carnitine concentrations but resulted in no serious adverse outcomes. In conclusion, neonatal diagnosis of GA1 coupled to management with lysine-free, arginine-enriched metabolic formula and emergency IV infusions during the first two years of life is safe and effective, preventing more than 90% of striatal injuries while supporting normal growth and psychomotor development. The need for dietary interventions and emergency IV therapies beyond early childhood is uncertain.</p>
dc.identifier.submissionpathoapubs/4429
dc.contributor.departmentDepartment of Pediatrics
dc.source.pages325-340


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© 2020 The Authors. This is an open access article under the CC BY license (http://creativecommons.org/licenses/BY/4.0/).
Except where otherwise noted, this item's license is described as © 2020 The Authors. This is an open access article under the CC BY license (http://creativecommons.org/licenses/BY/4.0/).