Glut-1 deficiency syndrome: clinical, genetic, and therapeutic aspects.

Dong Wang, Juan M Pascual, Hong Yang, Kristin Engelstad, Sarah Jhung, Ruo Peng Sun, Darryl C De Vivo

Journal: Annals of neurology 2005;57(1):111-8

PMID: 15622525

Abstract

Impaired glucose transport across the blood-brain barrier results in Glut-1 deficiency syndrome (Glut-1 DS, OMIM 606777), characterized by infantile seizures, developmental delay, acquired microcephaly, spasticity, ataxia, and hypoglycorrhachia. We studied 16 new Glut-1 deficiency syndrome patients focusing on clinical and laboratory features, molecular genetics, genotype-phenotype correlation, and treatment. These patients were classified phenotypically into three groups. The mean cerebrospinal fluid glucose concentration was 33.1 +/- 4.9mg/dl equal to 37% of the simultaneous blood glucose concentration. The mean cerebrospinal fluid lactate concentration was 1.0 +/- 0.3mM, which was less than the normal mean value of 1.63mM. The mean V(max) for the 3-O-methyl-D-glucose uptake into erythrocytes was 996 fmol/10(6) red blood cells per second, significantly less (54 +/- 11%; t test, p < 0.05) than the mean control value of 1,847. The mean Km value for the patient group (1.4 +/- 0.5mM) was similar to the control group (1.7 +/- 0.5mM; t test, p > 0.05). We identified 16 rearrangements, including seven missense, one nonsense, one insertion, and seven deletion mutations. Fourteen were novel mutations. There were no obvious correlations between phenotype, genotype, or biochemical measures. The ketogenic diet produced good seizure control.

Address: Colleen Giblin Laboratories for Pediatric Neurology Research, Department of Neurology, Columbia University, 710 West 168th Street, New York, NY 10032, USA.

DOI: 10.1002/ana.20331

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MeSH Terms: 3-O-Methylglucose, Adolescent, Blood Glucose, Brain, Carbohydrate Metabolism, Inborn Errors, Child, Child, Preschool, DNA Mutational Analysis, Diet Therapy, Electroencephalography, Exons, Female, Glucose, Glucose Transporter Type 1, Humans, Infant, Ketoses, Lactic Acid, Male, Monosaccharide Transport Proteins, Mutation, Phenotype, Polymorphism, Genetic