Abstract
Background
Citrin deficiency (CD), a disorder caused by mutations in the SLC25A13 gene, may result in neonatal intrahepatic cholestasis. This study was purposely to explore the mutation spectrum of SLC25A13 gene in Vietnamese CD patients.
Methods
The 292 unrelated CD patients were first screened for four high-frequency mutations by PCR/PCR-RFLP. Then, Sanger sequencing was performed directly for heterozygous or undetected patients. Novel mutations identified would need to be confirmed by their parents.
Results
12 pathogenic SLC25A13 mutations were identified in all probands, including three deletions c.851_854del (p.R284Rfs*3), c.70-63_133del (p.Y24_72Ifs*10), and c.[1956C>A;1962del] (p.[N652K;F654Lfs*45]), two splice-site mutations (IVS6+5G>A and IVS11+1G>A), one nonsense mutations c.1399C>T (p.R467*), one duplication mutation c.1638_1660dup (p.A554fs*570), one insertion IVSl6ins3kb (p.A584fs*585), and four missense mutation c.2T>C (p.M1T), c.1231G>A (p.V411M), c.1763G>A (p.R588Q), and c.135G>C (p.L45F). Among them, c.851_854del (mut I) was the most identified mutant allele (91.78%) with a total of 247 homozygous and 42 heterozygous genotypes of carriers. Interestingly, two novel mutations were identified: c.70-63_133del (p.Y24_72Ifs*10) and c.[1956C>A;1962del] (p.[N652K;F654Lfs*45]).
Conclusion
The SLC25A13 mutation spectrum related to intrahepatic cholestasis infants in Vietnam revealed a quite similar pattern to Asian countries’ reports. This finding supports the use of targeted SLC25A13 mutation for CD screening in Vietnam and contributed to the SLC25A13 mutation spectra worldwide. It also helps emphasize the role of DNA analysis in treatment, genetic counseling, and prenatal diagnosis.
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Data availability
The datasets generated and analyzed during the current study are available in the ClinVar repository, accession numbers to datasets: SCV002546525-SCV002546535 and SCV002546358.
References
Kobayashi K, Sinasac DS, Iijima M, et al. The gene mutated in adult-onset type II citrullinaemia encodes a putative mitochondrial carrier protein. Nat Genet. 1999;22:159–63.
Kimelman D, Confino R, Confino E, et al. Do patients who achieve pregnancy using IVF-PGS do the recommended genetic diagnostic testing in pregnancy? J Assist Reprod Genet. 2018;35:1881–5.
Saheki T, Kobayashi K, Iijima M, et al. Adult-onset type II citrullinemia and idiopathic neonatal hepatitis caused by citrin deficiency: involvement of the aspartate glutamate carrier for urea synthesis and maintenance of the urea cycle. Mol Genet Metab. 2004;81:S20–6.
Andres JM, Haafiz AB. Neonatal cholestasis. Gastroenterology and nutrition: neonatology questions and controversies. 2nd ed. Elsevier; 2012. p. 251–91.
Zhang ZH, Lin WX, Zheng QQ, et al. Molecular diagnosis of citrin deficiency in an infant with intrahepatic cholestasis: identification of a 21.7kb gross deletion that completely silences the transcriptional and translational expression of the affected SLC25A13 allele. Oncotarget. 2017;8:87182–93.
Kobayashi K, Bang LuY, Xian LiM, et al. Screening of nine SLC25A13 mutations: their frequency in patients with citrin deficiency and high carrier rates in Asian populations. Mol Genet Metab. 2003;80:356–9.
Lu YB, Kobayashi K, Ushikai M, et al. Frequency and distribution in East Asia of 12 mutations identified in the SLC25A13 gene of Japanese patients with citrin deficiency. J Hum Genet. 2005;50:338–46.
Tran NH, Nguyen Thi TH, Tang HS, et al. Genetic landscape of recessive diseases in the Vietnamese population from large-scale clinical exome sequencing. Hum Mutat. 2021;42:1229–38.
Grünert SC, Schumann A, Freisinger P, et al. Citrin deficiency mimicking mitochondrial depletion syndrome. BMC Pediatr. 2020;20:518.
Saheki T, Kobayashi K, Iijima M, et al. Pathogenesis and pathophysiology of citrin (a mitochondrial aspartate glutamate carrier) deficiency. Metab Brain Dis. 2002;17:335–46.
Saheki T, Song YZ. Citrin deficiency. In: Adam MP, Everman DB, Mirzaa GM, Pagon RA, Wallace SE, Bean LJH, et al., editors. GeneReviews(®). Seattle (WA): University of Washington, Seattle; 1993. Copyright © 1993-2022, University of Washington, Seattle. GeneReviews is a registered trademark of the University of Washington, Seattle. All rights reserved.
Wang L-Y, Chen N-I, Chen P-W, et al. Newborn screening for citrin deficiency and carnitine uptake defect using second-tier molecular tests. BMC Med Genet. 2013;14:24.
Hayasaka K. Metabolic basis and treatment of citrin deficiency. J Inherit Metab Dis. 2021;44:110–7.
Zeng Q, Yang Y, Luo J, Xu J, Deng C, Yang Y. et al. Rapid Genetic Diagnosis of Citrin Deficiency by Multicolor Melting Curve Analysis. Front Pediatr. 2021;9:654527
Fu HY, Zhang SR, Wang XH, et al. The mutation spectrum of the SLC25A13 gene in Chinese infants with intrahepatic cholestasis and aminoacidemia. J Gastroenterol. 2011;46:510–8.
den Dunnen JT, Dalgleish R, Maglott DR, et al. HGVS recommendations for the description of sequence variants: 2016 update. Hum Mutat. 2016;37:564–9.
Tabata A, Sheng JS, Ushikai M, et al. Identification of 13 novel mutations including a retrotransposal insertion in SLC25A13 gene and frequency of 30 mutations found in patients with citrin deficiency. J Hum Genet. 2008;53:534–45.
Chong SC, Lo P, Chow CW, et al. Molecular and clinical characterization of citrin deficiency in a cohort of Chinese patients in Hong Kong. Mol Genet Metab Rep. 2018;17:3–8.
Zhang L, Li Y, Shi W, et al. Identification of a novel splicing mutation in the SLC25A13 gene from a patient with NICCD: a case report. BMC Pediatr. 2019;19:348.
Wongkittichote P, Sukasem C, Kikuchi A, et al. Screening of SLC25A13 mutation in the Thai population. World J Gastroenterol. 2013;19:7735–42.
Oh SH, Lee BH, Kim GH, et al. Biochemical and molecular characteristics of citrin deficiency in Korean children. J Hum Genet. 2017;62:305–7.
Kikuchi A, Arai-Ichinoi N, Sakamoto O, et al. Simple and rapid genetic testing for citrin deficiency by screening 11 prevalent mutations in SLC25A13. Mol Genet Metab. 2012;105:553–8.
Dimmock D, Maranda B, Dionisi-Vici C, et al. Citrin deficiency, a perplexing global disorder. Mol Genet Metab. 2009;96:44–9.
Avdjieva-Tzavella DM, Ivanova MB, Todorov TP, et al. First Bulgarian case of citrin deficiency caused by one novel and one recurrent mutation in the SLC25A13 gene. Genet Couns. 2014;25:271–6.
Kose MD, Kagnici M, Ozdemir TR, et al. Clinical findings in five Turkish patients with citrin deficiency and identification of a novel mutation on SLC25A13. J Pediatr Endocrinol Metab. 2020;33:157–63.
Yamaguchi N, Kobayashi K, Yasuda T, et al. Screening of SLC25A13 mutations in early and late onset patients with citrin deficiency and in the Japanese population: Identification of two novel mutations and establishment of multiple DNA diagnosis methods for nine mutations. Hum Mutat. 2002;19:122–30.
Song YZ, Zhang ZH, Lin WX, et al. SLC25A13 gene analysis in citrin deficiency: sixteen novel mutations in East Asian patients, and the mutation distribution in a large pediatric cohort in China. PLoS One. 2013;8:e74544.
Zhang ZH, Zhao XJ, Song YZ, et al. Cloning and sequence analysis of SLC25A13 transcripts in human amniocytes. Transl Pediatr. 2012;1:85–90.
Lau NKC, Lee HHC, Chen SPL, et al. In-house multiplex ligation-dependent probe amplification assay for citrin deficiency: analytical validation and novel exonic deletions in SLC25A13. Pathology. 2021;53:867–74.
Yeh JN, Jeng YM, Chen HL, et al. Hepatic steatosis and neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) in Taiwanese infants. J Pediatr. 2006;148:642–6.
Lee NC, Chien YH, Kobayashi K, et al. Time course of acylcarnitine elevation in neonatal intrahepatic cholestasis caused by citrin deficiency. J Inherit Metab Dis. 2006;29:551–5.
Lin WX, Zeng HS, Zhang ZH, et al. Molecular diagnosis of pediatric patients with citrin deficiency in China: SLC25A13 mutation spectrum and the geographic distribution. Sci Rep. 2016;6:29732.
Kido J, Häberle J, Sugawara K, et al. Clinical manifestation and long-term outcome of citrin deficiency: report from a nationwide study in Japan. J Inherit Metab Dis. 2022;45:431–44.
Shi S, Tang X, Shi Z, et al. [Analysis of SLC25A13 gene mutations and prenatal diagnosis for 20 families affected with citrin deficiency]. Zhonghua Yi Xue Yi Chuan Xue Za Zhi. 2018;35:475–9.
Lin W-X, Deng L-J, Liu R, et al. Neonatal intrahepatic cholestasis caused by citrin deficiency: in vivo and in vitro studies of the aberrant transcription arising from two novel splice-site variants in SLC25A13. Eur J Med Genet. 2021;64:104145.
Adzhubei IA, Schmidt S, Peshkin L, et al. A method and server for predicting damaging missense mutations. Nat Methods. 2010;7:248–9.
Choi Y, Sims GE, Murphy S, et al. Predicting the functional effect of amino acid substitutions and indels. PLoS One. 2012;7:e46688.
Lubeck E, Coskun AF, Zhiyentayev T, et al. Single-cell in situ RNA profiling by sequential hybridization. Nat Methods. 2014;11:360–1.
Choi Y, Chan AP. PROVEAN web server: a tool to predict the functional effect of amino acid substitutions and indels. Bioinformatics. 2015;31:2745–7.
Adzhubei I, Jordan DM, Sunyaev SR. Predicting functional effect of human missense mutations using PolyPhen-2. Curr Protoc Hum Genet. 2013;Chapter 7:Unit7.20. https://doi.org/10.1002/0471142905.
Chen JL, Zhang ZH, Li BX, et al. Bioinformatic and functional analysis of promoter region of human SLC25A13 gene. Gene. 2019;693:69–75.
Shigematsu Y, Hirano S, Hata I, et al. Newborn mass screening and selective screening using electrospray tandem mass spectrometry in Japan. J Chromatogr B Anal Technol Biomed Life Sci. 2002;776:39–48.
Tamamori A, Okano Y, Ozaki H, et al. Neonatal intrahepatic cholestasis caused by citrin deficiency: severe hepatic dysfunction in an infant requiring liver transplantation. Eur J Pediatr. 2002;161:609–13.
Hu SW, Lu WL, Chiang IP, Wu SF, Wang CH, Chen AC. Neonatal Intrahepatic Cholestasis Caused by Citrin Deficiency with SLC25A13 Mutation Presenting Hepatic Steatosis and Prolonged Jaundice. A Rare Case Report. Medicina (Kaunas). 2021;57:1032.
Hao H, Li S, Wu S, et al. Application of high-throughput sequencing technologies with target capture/target next-generation sequencing in diagnosis of neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD). Int J Clin Exp. 2017;10:3480–7.
Saheki T, Moriyama M, Funahashi A, Kuroda E. AGC2 (Citrin) Deficiency-From Recognition of the Disease till Construction of Therapeutic Procedures. Biomolecules. 2020;10:1100.
Zhang R, Qiang R, Song C, et al. Spectrum analysis of inborn errors of metabolism for expanded newborn screening in a northwestern Chinese population. Sci Rep. 2021;11:2699.
Acknowledgements
The authors appreciate the participation of the patient’s family in this study. This work was supported by the Vietnam National Children’s Hospital, Ministry of Health.
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M-HNT designed the study, coordinated the study, analyzed data, and wrote the manuscript. A-HNP examined the patients and collected the samples. P-MNT and D-NN performed experiments. H-ST, HG, H-NN, and Y-TL helped with manuscript preparation. M-DT helped to revise the manuscript. All authors reviewed the manuscript.
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All the methods were obtained in accordance with relevant guidelines and regulations and approved by the Research Institute for Child Health (RICH) - Vietnam National Children’s Hospital (VNCH) and Hanoi University of Public Health (HUPH), Ministry of Health, Hanoi, Vietnam. Informed consent for genetic analysis was obtained from the child’s parent or guardian prior.
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Nguyen, MH.T., Nguyen, AH.P., Ngo, DN. et al. The mutation spectrum of SLC25A13 gene in citrin deficiency: identification of novel mutations in Vietnamese pediatric cohort with neonatal intrahepatic cholestasis. J Hum Genet 68, 305–312 (2023). https://doi.org/10.1038/s10038-022-01112-2
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DOI: https://doi.org/10.1038/s10038-022-01112-2