Concordance Between Biochemical and Molecular Diagnosis Obtained by WES in Mexican Patients with Inborn Errors of Intermediary Metabolism: Utility for Therapeutic Management
Por:
Vela-Amieva, M, Alcántara-Ortigoza, MA, González-del Angel, A, Fernández-Hernández, L, Reyna-Fabián, ME, Estandía-Ortega, B, Guillén-López, S, López-Mejía, L, Belmont-Martínez, L, Carrillo-Nieto, RI, Ibarra-González, I, Ryu, SW, Lee, H, Fernández-Lainez, C
Publicada:
1 nov 2024
Resumen:
Biochemical phenotyping has been the milestone for diagnosing and managing patients affected by inborn errors of intermediary metabolism (IEiM); however, identifying the genotype responsible for these monogenic disorders greatly contributes to achieving these goals. Herein, whole-exome sequencing (WES) was used to determine the genotypes of 95 unrelated Mexican pediatric patients suspected of having IEiM. They were classified into those bearing specific biochemical abnormalities (Group 1), and those presenting unspecific biochemical profiles (Group 2). The overall concordance between the initial biochemical diagnosis and final genotypic diagnoses was 72.6% (N = 69/95 patients), with the highest concordance achieved in Group 1 (91.3%, N = 63/69), whereas the concordance was limited in Group 2 (23.07%). This finding suggests that previous biochemical phenotyping correlated with the high WES diagnostic success. Concordance was high for urea cycle disorders (94.1%) and organic acid disorders (77.4%). The identified mutational spectrum comprised 83 IEiM-relevant variants (pathogenic, likely pathogenic, and variants of uncertain significance or VUS), including three novel ones, distributed among 29 different genes responsible for amino acid, organic acid, urea cycle, carbohydrate, and lipid disorders. Inconclusive WES results (7.3%, N = 7/95) relied on monoallelic pathogenic genotypes or those involving two VUS for autosomal-recessive IEiMs. A second monogenic disease was observed in 10.5% (N = 10/95) of the patients. According to the WES results, modifications in treatment had to be made in 33.6% (N = 32/95) of patients, mainly attributed to the presence of a second monogenic disease, or to an actionable trait. This study includes the largest cohort of Mexican patients to date with biochemically suspected IEiM who were genetically diagnosed through WES, underscoring its importance in medical management.
Filiaciones:
Vela-Amieva, M:
Inst Nacl Pediat, Lab Errores Innatos Metab & Tamiz, Secretaria Salud, Mexico City 04530, Mexico
Alcántara-Ortigoza, MA:
Inst Nacl Pediat, Lab Biol Mol, Secretaria Salud, Mexico City 04530, Mexico
González-del Angel, A:
Inst Nacl Pediat, Lab Biol Mol, Secretaria Salud, Mexico City 04530, Mexico
Fernández-Hernández, L:
Inst Nacl Pediat, Lab Biol Mol, Secretaria Salud, Mexico City 04530, Mexico
Reyna-Fabián, ME:
Inst Nacl Pediat, Lab Biol Mol, Secretaria Salud, Mexico City 04530, Mexico
Estandía-Ortega, B:
Inst Nacl Pediat, Lab Biol Mol, Secretaria Salud, Mexico City 04530, Mexico
Guillén-López, S:
Inst Nacl Pediat, Lab Errores Innatos Metab & Tamiz, Secretaria Salud, Mexico City 04530, Mexico
López-Mejía, L:
Inst Nacl Pediat, Lab Errores Innatos Metab & Tamiz, Secretaria Salud, Mexico City 04530, Mexico
Belmont-Martínez, L:
Inst Nacl Pediat, Lab Errores Innatos Metab & Tamiz, Secretaria Salud, Mexico City 04530, Mexico
Carrillo-Nieto, RI:
Inst Nacl Pediat, Lab Errores Innatos Metab & Tamiz, Secretaria Salud, Mexico City 04530, Mexico
Ibarra-González, I:
Univ Nacl Autonoma Mexico, Unidad Genet Nutr, Inst Invest Biomed, Mexico City 04530, Mexico
Ryu, SW:
3billion Inc, Seoul 03161, South Korea
Lee, H:
3billion Inc, Seoul 03161, South Korea
Fernández-Lainez, C:
Inst Nacl Pediat, Lab Errores Innatos Metab & Tamiz, Secretaria Salud, Mexico City 04530, Mexico
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