Inherited Metabolic Disorders
Inherited metabolic disorders are genetic conditions that result in metabolism problems. Most people with inherited metabolic disorders have a defective gene that results in an enzyme deficiency. There are hundreds of different genetic metabolic disorders, and their symptoms, treatments, and prognoses vary widely.
What Is Metabolism?Metabolism refers to all the chemical reactions taking place in the body to convert or use energy. A few major examples of metabolism include:
Metabolism is an organized but chaotic chemical assembly line. Raw materials, half-finished products, and waste materials are constantly being used, produced, transported, and excreted. The "workers" on the assembly line are enzymes and other proteins that make chemical reactions happen.
Causes of Inherited Metabolic DisordersIn most inherited metabolic disorders, a single enzyme is either not produced by the body at all or is produced in a form that doesn't work. The missing enzyme is like an absentee worker on the assembly line. Depending on that enzyme's job, its absence means toxic chemicals may build up, or an essential product may not be produced.
The code or blueprint to produce an enzyme is usually contained on a pair of genes. Most people with inherited metabolic disorders inherit two defective copies of the gene -- one from each parent. Both parents are "carriers" of the bad gene, meaning they carry one defective copy and one normal copy.
In the parents, the normal gene copy compensates for the bad copy. Their enzyme levels are usually adequate, so they may have no symptoms of a genetic metabolic disorder. However, the child who inherits two defective gene copies cannot produce enough effective enzyme and develops the genetic metabolic disorder. This form of genetic transmission is called autosomal recessive inheritance.
The original cause of most genetic metabolic disorders is a gene mutation that occurred many, many generations ago. The gene mutation is passed along through the generations, ensuring its preservation.
Each inherited metabolic disorder is quite rare in the general population. Considered all together, inherited metabolic disorders may affect about 1 in 1,000 to 2,500 newborns. In certain ethnic populations, such as Ashkenazi Jews (Jews of central and eastern European ancestry), the rate of inherited metabolic disorders is higher.
Types of Inherited Metabolic DisordersHundreds of inherited metabolic disorders have been identified, and new ones continue to be discovered. Some of the more common and important genetic metabolic disorders include:
Lysosomal storage disorders: Lysosomes are spaces inside cells that break down waste products of metabolism. Various enzyme deficiencies inside lysosomes can result in buildup of toxic substances, causing metabolic disorders including:
Galactosemia: Impaired breakdown of the sugar galactose leads to jaundice, vomiting, and liver enlargement after breast or formula feeding by a newborn.
Maple syrup urine disease: Deficiency of an enzyme called BCKD causes buildup of amino acids in the body. Nerve damage results, and the urine smells like syrup.
Phenylketonuria (PKU): Deficiency of the enzyme PAH results in high levels of phenylalanine in the blood. Intellectual disability results if the condition is not recognized.
Glycogen storage diseases: Problems with sugar storage lead to low blood sugar levels, muscle pain, and weakness.
Mitochondrial disorders: Problems inside mitochondria, the powerhouses of cells, lead to muscle damage.
Friedreich ataxia: Problems related to a protein called frataxin cause nerve damage and often heart problems. Inability to walk usually results by young adulthood.
Peroxisomal disorders: Similar to lysosomes, peroxisomes are tiny spaces filled with enzymes inside cells. Poor enzyme function inside peroxisomes can lead to buildup of toxic products of metabolism. Peroxisomal disorders include:
Metal metabolism disorders: Levels of trace metals in the blood are controlled by special proteins. Inherited metabolic disorders can result in protein malfunction and toxic accumulation of metal in the body:
Organic acidemias:methylmalonic acidemia and propionic acidemia.
Urea cycle disorders:ornithine transcarbamylase deficiency and citrullinemia
Symptoms of Inherited Metabolic DisordersThe symptoms of genetic metabolic disorders vary widely depending on the metabolism problem present. Some symptoms of inherited metabolic disorders include:
The symptoms may come on suddenly or progress slowly. Symptoms may be brought on by foods, medications, dehydration, minor illnesses, or other factors. Symptoms appear within a few weeks after birth in many conditions. Other inherited metabolic disorders may take years for symptoms to develop.
Diagnosis of Inherited Metabolic DisordersInherited metabolic disorders are present at birth, and some are detected by routine screening. All 50 states screen newborns for phenylketonuria (PKU). Most states also test newborns for galactosemia. However, no state tests babies for all known inherited metabolic disorders.
Improved testing technology is leading many states to expand newborn screening for genetic metabolic disorders. The National Newborn Screening and Genetics Resources Center provides information on each state's screening practices.
If an inherited metabolic disorder is not detected at birth, it is often not diagnosed until symptoms appear. Once symptoms develop, specific blood or DNA tests are available to diagnose most genetic metabolic disorders. Referral to a specialized center (usually at a university) increases the chances of a correct diagnosis.
Treatment of Inherited Metabolic DisordersLimited treatments are available for inherited metabolic disorders. The essential genetic defect causing the condition can't be corrected with current technology. Instead, treatments try to work around the problem with metabolism.
Treatments for genetic metabolic disorders follow a few general principles:
Treatment may include such measures as:
Whenever possible, a person with an inherited metabolic disorder should receive care at a medical center with experience with these rare conditions.
Children and adults with inherited metabolic disorders can become quite ill, requiring hospitalization and sometimes life support. Treatment during these episodes focuses on emergency care and improving organ function.
All About Common Skin Disorders
Skin disorders, such as acne and eczema, vary greatly in symptoms and severity. They can be temporary or permanent and may be painless or painful. Some can be life threatening.
Some skin disorders have situational causes, while others may be genetic. While most skin disorders are minor, others can indicate a more serious issue.
Contact a doctor if you believe you may have one of these common skin problems.
There are many different types of skin disorders. Here are pictures of 25 different conditions, followed by a list of details for each.
AcneLearn more about acne.
Cold soreLearn more about cold sores and cold sores on dark skin.
BlisterLearn more about blisters.
HivesLearn more about hives.
Actinic keratosisLearn more about actinic keratosis.
RosaceaLearn more about rosacea.
CarbuncleLearn more about carbuncles.
Latex allergyThis condition is considered a medical emergency. Urgent care may be required. Contact 911 or local emergency services.
Learn more about latex allergies.
EczemaLearn more about eczema.
PsoriasisLearn more about psoriasis.
CellulitisCellulitis is a medical emergency. A person should contact 911 or local emergency services if they have any symptoms of cellulitis.
Learn more about cellulitis.
MeaslesLearn more about measles.
Basal cell carcinomaLearn more about basal cell carcinoma.
Squamous cell carcinomaLearn more about squamous cell carcinoma.
MelanomaLearn more about melanoma.
LupusLearn more about lupus.
Contact dermatitisLearn more about contact dermatitis.
VitiligoLearn more about vitiligo.
WartLearn more about warts.
ChickenpoxLearn more about chickenpox.
Seborrheic eczemaLearn more about seborrheic eczema.
Keratosis pilarisLearn more about keratosis pilaris.
RingwormLearn more about ringworm.
MelasmaLearn more about melasma.
ImpetigoLearn more about impetigo.
Contact dermatitisContact dermatitis is one of the most common occupational illnesses, often resulting from contact with chemicals or other irritating materials.
These substances can trigger a reaction that causes the skin to become itchy and inflamed. Affected areas might also appear red, purple, gray, or dark brown. Most cases of contact dermatitis aren't severe, but they can be rather itchy.
Topical creams and avoiding the irritant are typical treatments.
Keratosis pilarisKeratosis pilaris is a minor condition that causes small, rough bumps on the skin. These bumps usually form on the upper arms, thighs, or cheeks. They're typically red or white and don't hurt or itch.
Treatment isn't necessary, but medicated creams can improve skin appearance.
Some chronic skin conditions present from birth, while others appear suddenly later.
The cause of these disorders isn't always known. Many permanent skin disorders have effective treatments that enable extended periods of remission. However, they're incurable, and symptoms can reappear at any time.
Examples of chronic skin conditions include:
Skin disorders are common in children. Children can experience many of the same skin conditions as adults. Infants and toddlers are also at risk of diaper-related skin problems.
Since children have more frequent exposure to other children and germs, they may also develop skin disorders that rarely occur in adults.
Many childhood skin problems disappear with age, but children can also inherit permanent skin disorders. In most cases, doctors can treat childhood skin disorders with topical creams, medicated lotions, or condition-specific drugs.
Common childhood skin disorders include:
Skin conditions have a wide range of symptoms. Symptoms on your skin that appear due to common problems aren't always the result of a skin disorder. Such symptoms can include blisters from new shoes or chafing from tight pants.
However, skin problems with no obvious cause may indicate the presence of a skin disorder that requires treatment.
Skin irregularities that are typically symptoms of a skin disorder include:
Common known causes of skin disorders include:
Numerous health conditions and lifestyle factors can also lead to the development of certain skin disorders. Some skin conditions have no known cause.
Inflammatory bowel diseaseInflammatory bowel disease is a term for a group of intestinal disorders that cause prolonged inflammation of the digestive tract. These bowel-related disorders often cause skin problems.
The drugs used to treat these diseases can cause certain skin conditions, such as:
DiabetesMany people with diabetes experience a skin problem due to their condition at some point.
Some of these skin disorders only affect people with diabetes. Others occur more frequently in people with diabetes because the disease increases the risk of infection and blood circulation problems.
Diabetes-related skin conditions include:
LupusLupus is a chronic inflammatory disease that can damage the skin, joints, or organs inside the body. Common skin problems that occur from lupus include:
Pregnancy causes significant changes in hormone levels that may lead to skin problems. Preexisting skin problems may change or get worse during pregnancy. Most skin conditions that arise during pregnancy go away after the baby is born. Others require medical attention during pregnancy.
Common skin conditions caused by pregnancy include:
StressStress can cause hormonal imbalances, which may trigger or aggravate skin disorders. Stress-related skin problems include:
SunThe sun can cause many different skin disorders. Some are common and harmless, while others are rare or life threatening. Knowing if the sun causes or worsens your skin disorder is important for treating it properly.
Sunlight exposure may cause or aggravate the following conditions:
Many skin disorders are treatable. Common treatment methods for skin conditions include:
Not all skin disorders respond to treatment, and some conditions go away without treatment.
People with permanent skin conditions often go through periods of severe symptoms. Sometimes people are able to force incurable conditions into remission. However, most skin conditions reappear due to certain triggers, such as stress or illness.
You can often treat skin disorders that are temporary and cosmetic with:
Certain skin disorders aren't preventable, including genetic conditions and some skin problems due to other illnesses. However, it's possible to prevent some skin disorders.
Follow these tips to prevent infectious skin disorders:
Noninfectious skin disorders, such as acne and atopic dermatitis, are sometimes preventable. Prevention techniques vary depending on the condition. Here are some tips for preventing some noninfectious skin disorders:
Learning about proper skin care and treatment for skin disorders can be very important for skin health. Some conditions require a doctor's attention, while you can address others safely at home.
You should learn about your symptoms or condition and talk with a doctor to determine the best treatment methods.
What are the most common skin disorders?According to the American Academy of Dermatology Association, acne is the most common skin condition in the United States. Other common skin disorders include atopic dermatitis, hair loss, and rosacea.
What is the most serious skin disease?There are several serious skin conditions. In particular, melanoma is a type of skin cancer that can be especially dangerous, as it could spread to other parts of the body if not caught early. Cellulitis and latex allergy can also be very serious if left untreated.
Which skin disease is not curable?A few examples of chronic skin conditions include rosacea, psoriasis, and vitiligo. While these conditions can't be cured, some may have treatments available to help manage symptoms.
Insights Into Causes Of Rare Genetic Immune Disorders
The cellular glitches underlying a rare genetic disorder called activated PI3K Delta syndrome 2 (APDS2) have been identified by researchers at the Garvan Institute of Medical Research. The disorder is caused by genetic variations that disrupt immune cell signaling through a protein called PI3K.
"This study tells us how signaling in the immune system needs to be tightly balanced to make an effective response to infection. Sometimes it's turned down and you have a problem, and sometimes signaling being turned up can interfere with an immune response," says Associate Professor Elissa Deenick, Head of the Lymphocyte Signaling and Activation Lab, co-Lead of the Precision Immunology Program at Garvan and senior author of the paper, published in the Journal of Experimental Medicine.
PI3K plays a crucial role in activating immune cells for growth, proliferation, survival, migration and function. The researchers found that the genetic variations in APDS2 and a similar disorder, APDS1, alter PI3K signaling in different ways, leading to distinct effects on the immune system.
The APDS disorders are similar in their impacts but follow different genetic pathways. Variations in the PIK3R1 gene underlie APDS2, while variations in PIK3CD underlie APDS1. Though both result in increased PI3K signaling, their subtle differences—in specific cells, timescales, and mechanisms—yield distinct immune effects. In APDS2, fewer responding B cells are generated in response to vaccination, whereas in APDS1, the number of T cells is reduced. But in both cases, the disorders result in poor antibody responses. In addition, APDS2 variations appear to affect non-immune cells, resulting in growth delays.
These results also tell us about the signals that are required to achieve good vaccine responses in general. "Even for people who don't have these two rare genetic conditions, other genes can impact these pathways—which could contribute to why different people have varied responses to vaccinations," says Dr. Tina Nguyen, co-lead author of the study and Research Officer at Garvan.
The findings reveal how finely tuned immune cell signaling must be, and how even minor disruptions can lead to immune deficiency or dysfunction. They are a significant step towards understanding the molecular processes and developing more targeted and effective treatments for the disorders.
"People with mysterious conditions often face challenges in obtaining an accurate diagnosis and understanding the root causes of their health issues. With better access to genomic testing, it's going to become much easier for patients to receive diagnoses for conditions like APDS2. Knowing the genetic basis of a disease can enable targeted, personalized treatment plans that give patients the best chance of effective management or, hopefully over time, a cure," says Professor Stuart Tangye, a senior investigator of the paper and Head of the Immunobiology and Immunodeficiency Lab at Garvan.
The next step is to study how to track individual responses to treatment, developing blood tests to monitor immune health and dysfunction in order to give the right drug, at the right dose, at the right time.
More information: Tina Nguyen et al, Human PIK3R1 mutations disrupt lymphocyte differentiation to cause activated PI3K- delta syndrome 2, Journal of Experimental Medicine (2023). DOI: 10.1084/jem.20221020
Citation: Insights into causes of rare genetic immune disorders (2023, March 21) retrieved 26 March 2023 from https://medicalxpress.Com/news/2023-03-insights-rare-genetic-immune-disorders.Html
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