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author:("nemethy, anal")
1.  Complete Deletion of a POLG1 Allele in a Patient with Alpers Syndrome 
JIMD Reports  2011;4:67-73.
Mutations in the gene encoding the catalytic subunit of polymerase γ (POLG1) are a major cause of human mitochondrial disease. More than 150 different point mutations in the gene have been reported to be disease causing, resulting in a large range of clinical symptoms. Depending on the mutation or combination of mutations, disease onset can occur in early infancy or late in adult life. Here, we describe the use of multiplex ligation-dependent probe amplification (MLPA) analysis to detect deletions within POLG1, which could otherwise go undetected by solely sequencing of the gene. We present a case where an entire POLG1 allele is deleted, with a known pathogenic mutation (W748S) on the remaining allele. The deletion was found in a boy with Alpers syndrome, presenting at 18 months of age with slightly retarded motor development, balance problems, and seizures. Administration of valproic acid (VPA) led to rapidly progressive fatal liver failure in our patient, and we would like to highlight the need to carry out complete POLG1 gene analysis before administration of VPA in cases of pediatric seizure disorders of unknown origin. Debut and severity of the disease in this patient was unique when compared to homozygous or heterozygous patients with the W748S mutation, leading to the conclusion that gene dosage plays a role in the clinical phenotype of this disease.
doi:10.1007/8904_2011_73
PMCID: PMC3509876  PMID: 23430898
2.  Differences in presentation and progression between severe FIC1 and BSEP deficiencies 
Journal of hepatology  2010;53(1):170-178.
Background & Aims
Progressive familial intrahepatic cholestasis (PFIC) with normal serum levels of gamma-glutamyltranspeptidase can result from mutations in ATP8B1 (encoding familial intrahepatic cholestasis 1 [FIC1]) or ABCB11 (encoding bile salt export pump [BSEP]). We evaluated clinical and laboratory features of disease in patients diagnosed with PFIC, who carried mutations in ATP8B1 (FIC1 deficiency) or ABCB11 (BSEP deficiency). Our goal was to identify features that distinguish presentation and course of these 2 disorders, thus facilitating diagnosis and elucidating the differing consequences of ATP8B1 and ABCB11 mutations.
Methods
A retrospective multi-center study was conducted, using questionnaires and chart review. Available clinical and biochemical data from 145 PFIC patients with mutations in either ATP8B1 (61 “FIC1 patients”) or ABCB11 (84 “BSEP patients”) were evaluated.
Results
At presentation, serum aminotransferase and bile salt levels were higher in BSEP patients; serum alkaline phosphatase values were higher, and serum albumin values were lower, in FIC1 patients. Elevated white blood cell counts, and giant or multinucleate cells at liver biopsy, were more common in BSEP patients. BSEP patients more often had gallstones and portal hypertension. Diarrhea, pancreatic disease, rickets, pneumonia, abnormal sweat tests, hearing impairment, and poor growth were more common in FIC1 patients. Among BSEP patients, the course of disease was less rapidly progressive in patients bearing the D482G mutation.
Conclusions
Severe forms of FIC1 and BSEP deficiency differed. BSEP patients manifested more severe hepatobiliary disease, while FIC1 patients showed greater evidence of extrahepatic disease.
doi:10.1016/j.jhep.2010.01.034
PMCID: PMC3042805  PMID: 20447715
cholestasis; genetics; transport protein; pediatrics; P-type ATPase; ATP binding cassette protein; ATP8B1; FIC1; ABCB11; BSEP
3.  Analysis of GB Virus C Markers in Families Over Three Generations 
Journal of Clinical Microbiology  1999;37(12):4153-4155.
GB virus C (GBV-C) markers were analyzed in two to three generations in three families with documented vertical transmission of GBV-C. None of the maternal grandparents had GBV-C markers, whereas the male spouses had GBV-C envelope 2 antibodies. Evidence was found for intrafamilial transmission but not for GBV-C transmission over three generations.
PMCID: PMC85907  PMID: 10565950

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