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2016 ; 39
(4
): 573-84
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Improving long term outcomes in urea cycle disorders-report from the Urea Cycle
Disorders Consortium
#MMPMID27215558
Waisbren SE
; Gropman AL
; Batshaw ML
J Inherit Metab Dis
2016[Jul]; 39
(4
): 573-84
PMID27215558
show ga
The Urea Cycle Disorders Consortium (UCDC) has conducted, beginning in 2006, a
longitudinal study (LS) of eight enzyme deficiencies/transporter defects
associated with the urea cycle. These include N-acetylglutamate synthase
deficiency (NAGSD); Carbamyl phosphate synthetase 1 deficiency (CPS1D); Ornithine
transcarbamylase deficiency (OTCD); Argininosuccinate synthetase deficiency
(ASSD) (Citrullinemia); Argininosuccinate lyase deficiency (ASLD)
(Argininosuccinic aciduria); Arginase deficiency (ARGD, Argininemia);
Hyperornithinemia, hyperammonemia, homocitrullinuria (HHH) syndrome (or
mitochondrial ornithine transporter 1 deficiency [ORNT1D]); and Citrullinemia
type II (mitochondrial aspartate/glutamate carrier deficiency [CITRIN]). There
were 678 UCD patients enrolled in 14 sites in the U.S., Canada, and Europe at the
writing of this paper. This review summarizes findings of the consortium related
to outcome, focusing primarily on neuroimaging findings and neurocognitive
function. Neuroimaging studies in late onset OTCD offered evidence that brain
injury caused by biochemical dysregulation may impact functional neuroanatomy
serving working memory processes, an important component of executive function
and regulation. Additionally, there were alteration in white mater microstructure
and functional connectivity at rest. Intellectual deficits in OTCD and other urea
cycle disorders (UCD) vary. However, when neuropsychological deficits occur, they
tend to be more prominent in motor/performance areas on both intelligence tests
and other measures. In some disorders, adults performed significantly less well
than younger patients. Further longitudinal follow-up will reveal whether this is
due to declines throughout life or to improvements in diagnostics (especially
newborn screening) and treatments in the younger generation of patients.