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Dihydropyrimidine dehydrogenase deficiency(DPYDD)

MedGen UID:
409522
Concept ID:
C1959620
Disease or Syndrome
Synonyms: DPD deficiency; DPYD DEFICIENCY; DPYDD; Hereditary Thymine-Uraciluria; Pyrimidinemia familial
SNOMED CT: Dihydrouracil dehydrogenase (NADP^+^) deficiency (77365006); Dihydropyrimidine dehydrogenase deficiency (77365006); Dihydrothymine dehydrogenase deficiency (77365006); Sensitivity to fluorouracil toxicity (77365006); Hereditary thymine-uraciluria (77365006); Familial pyrimidinemia (77365006); Dihydrouracil dehydrogenase (nicotinamide adenine dinucleotide phosphate ^+^) deficiency (77365006); DPD - dihydropyrimidine dehydrogenase deficiency (77365006); Dihydrouracil dehydrogenase (NADP) deficiency (77365006)
 
Gene (location): DPYD (1p21.3)
 
Monarch Initiative: MONDO:0010130
OMIM®: 274270
Orphanet: ORPHA1675

Definition

Dihyropyrimidine dehydrogenase deficiency (DPYDD) shows large phenotypic variability, ranging from no symptoms to a convulsive disorder with motor and mental retardation in homozygous patients. In addition, homozygous and heterozygous mutation carriers can develop severe toxicity after the administration of the antineoplastic drug 5-fluorouracil (5FU), which is also catabolized by the DPYD enzyme. This is an example of a pharmacogenetic disorder (Van Kuilenburg et al., 1999). Since there is no correlation between genotype and phenotype in DPD deficiency, it appears that the deficiency is a necessary, but not sufficient, prerequisite for the development of clinical abnormalities (Van Kuilenburg et al., 1999; Enns et al., 2004). [from OMIM]

Clinical features

From HPO
Uraciluria
MedGen UID:
867456
Concept ID:
C4021833
Finding
Increased concentration of uracil in the urine.
Elevated urinary dihydrothymine level
MedGen UID:
1053791
Concept ID:
CN376628
Finding
The amount of dihydrothymine in the urine, normalized for urine concentration, is above the upper limit of normal.
Growth delay
MedGen UID:
99124
Concept ID:
C0456070
Pathologic Function
A deficiency or slowing down of growth pre- and postnatally.
Failure to thrive
MedGen UID:
746019
Concept ID:
C2315100
Disease or Syndrome
Failure to thrive (FTT) refers to a child whose physical growth is substantially below the norm.
Autism
MedGen UID:
13966
Concept ID:
C0004352
Mental or Behavioral Dysfunction
Autism, the prototypic pervasive developmental disorder (PDD), is usually apparent by 3 years of age. It is characterized by a triad of limited or absent verbal communication, a lack of reciprocal social interaction or responsiveness, and restricted, stereotypic, and ritualized patterns of interests and behavior (Bailey et al., 1996; Risch et al., 1999). 'Autism spectrum disorder,' sometimes referred to as ASD, is a broader phenotype encompassing the less severe disorders Asperger syndrome (see ASPG1; 608638) and pervasive developmental disorder, not otherwise specified (PDD-NOS). 'Broad autism phenotype' includes individuals with some symptoms of autism, but who do not meet the full criteria for autism or other disorders. Mental retardation coexists in approximately two-thirds of individuals with ASD, except for Asperger syndrome, in which mental retardation is conspicuously absent (Jones et al., 2008). Genetic studies in autism often include family members with these less stringent diagnoses (Schellenberg et al., 2006). Levy et al. (2009) provided a general review of autism and autism spectrum disorder, including epidemiology, characteristics of the disorder, diagnosis, neurobiologic hypotheses for the etiology, genetics, and treatment options. Genetic Heterogeneity of Autism Autism is considered to be a complex multifactorial disorder involving many genes. Accordingly, several loci have been identified, some or all of which may contribute to the phenotype. Included in this entry is AUTS1, which has been mapped to chromosome 7q22. Other susceptibility loci include AUTS3 (608049), which maps to chromosome 13q14; AUTS4 (608636), which maps to chromosome 15q11; AUTS6 (609378), which maps to chromosome 17q11; AUTS7 (610676), which maps to chromosome 17q21; AUTS8 (607373), which maps to chromosome 3q25-q27; AUTS9 (611015), which maps to chromosome 7q31; AUTS10 (611016), which maps to chromosome 7q36; AUTS11 (610836), which maps to chromosome 1q41; AUTS12 (610838), which maps to chromosome 21p13-q11; AUTS13 (610908), which maps to chromosome 12q14; AUTS14A (611913), which has been found in patients with a deletion of a region of 16p11.2; AUTS14B (614671), which has been found in patients with a duplication of a region of 16p11.2; AUTS15 (612100), associated with mutation in the CNTNAP2 gene (604569) on chromosome 7q35-q36; AUTS16 (613410), associated with mutation in the SLC9A9 gene (608396) on chromosome 3q24; AUTS17 (613436), associated with mutation in the SHANK2 gene (603290) on chromosome 11q13; AUTS18 (615032), associated with mutation in the CHD8 gene (610528) on chromosome 14q11; AUTS19 (615091), associated with mutation in the EIF4E gene (133440) on chromosome 4q23; and AUTS20 (618830), associated with mutation in the NLGN1 gene (600568) on chromosome 3q26. (NOTE: the symbol 'AUTS2' has been used to refer to a gene on chromosome 7q11 (KIAA0442; 607270) and therefore is not used as a part of this autism locus series.) There are several X-linked forms of autism susceptibility: AUTSX1 (300425), associated with mutations in the NLGN3 gene (300336); AUTSX2 (300495), associated with mutations in NLGN4 (300427); AUTSX3 (300496), associated with mutations in MECP2 (300005); AUTSX4 (300830), associated with variation in the region on chromosome Xp22.11 containing the PTCHD1 gene (300828); AUTSX5 (300847), associated with mutations in the RPL10 gene (312173); and AUTSX6 (300872), associated with mutation in the TMLHE gene (300777). A locus on chromosome 2q (606053) associated with a phenotype including intellectual disability and speech deficits was formerly designated AUTS5. Folstein and Rosen-Sheidley (2001) reviewed the genetics of autism.
Lethargy
MedGen UID:
7310
Concept ID:
C0023380
Sign or Symptom
A state of disinterest, listlessness, and indifference, resulting in difficulty performing simple tasks or concentrating.
Tetraplegia
MedGen UID:
19617
Concept ID:
C0034372
Disease or Syndrome
Paralysis of all four limbs, and trunk of the body below the level of an associated injury to the spinal cord. The etiology of quadriplegia is similar to that of paraplegia except that the lesion is in the cervical spinal cord rather than in the thoracic or lumbar segments of the spinal cord.
Seizure
MedGen UID:
20693
Concept ID:
C0036572
Sign or Symptom
A seizure is an intermittent abnormality of nervous system physiology characterized by a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.
Corpus callosum, agenesis of
MedGen UID:
104498
Concept ID:
C0175754
Congenital Abnormality
The corpus callosum is the largest fiber tract in the central nervous system and the major interhemispheric fiber bundle in the brain. Formation of the corpus callosum begins as early as 6 weeks' gestation, with the first fibers crossing the midline at 11 to 12 weeks' gestation, and completion of the basic shape by age 18 to 20 weeks (Schell-Apacik et al., 2008). Agenesis of the corpus callosum (ACC) is one of the most frequent malformations in brain with a reported incidence ranging between 0.5 and 70 in 10,000 births. ACC is a clinically and genetically heterogeneous condition, which can be observed either as an isolated condition or as a manifestation in the context of a congenital syndrome (see MOLECULAR GENETICS and Dobyns, 1996). Also see mirror movements-1 and/or agenesis of the corpus callosum (MRMV1; 157600). Schell-Apacik et al. (2008) noted that there is confusion in the literature regarding radiologic terminology concerning partial absence of the corpus callosum, where various designations have been used, including hypogenesis, hypoplasia, partial agenesis, or dysgenesis.
Cerebral atrophy
MedGen UID:
116012
Concept ID:
C0235946
Disease or Syndrome
Atrophy (wasting, decrease in size of cells or tissue) affecting the cerebrum.
Hyperactivity
MedGen UID:
98406
Concept ID:
C0424295
Finding
Hyperactivity is a condition characterized by constant and unusually high levels of activity, even in situations where it is deemed inappropriate.
Delayed speech and language development
MedGen UID:
105318
Concept ID:
C0454644
Finding
A degree of language development that is significantly below the norm for a child of a specified age.
Motor delay
MedGen UID:
381392
Concept ID:
C1854301
Finding
A type of Developmental delay characterized by a delay in acquiring motor skills.
Intellectual disability
MedGen UID:
811461
Concept ID:
C3714756
Mental or Behavioral Dysfunction
Intellectual disability, previously referred to as mental retardation, is characterized by subnormal intellectual functioning that occurs during the developmental period. It is defined by an IQ score below 70.
Hypertonia
MedGen UID:
10132
Concept ID:
C0026826
Finding
A condition in which there is increased muscle tone so that arms or legs, for example, are stiff and difficult to move.
Hypotonia
MedGen UID:
10133
Concept ID:
C0026827
Finding
Hypotonia is an abnormally low muscle tone (the amount of tension or resistance to movement in a muscle). Even when relaxed, muscles have a continuous and passive partial contraction which provides some resistance to passive stretching. Hypotonia thus manifests as diminished resistance to passive stretching. Hypotonia is not the same as muscle weakness, although the two conditions can co-exist.
Microcephaly
MedGen UID:
1644158
Concept ID:
C4551563
Finding
Head circumference below 2 standard deviations below the mean for age and gender.
Reduced dihydropyrimidine dehydrogenase level
MedGen UID:
892350
Concept ID:
C4025582
Finding
An abnormal reduction in dihydropyrimidine dehydrogenase (NADP+) level.
Congenital ocular coloboma
MedGen UID:
1046
Concept ID:
C0009363
Congenital Abnormality
Coloboma is an eye abnormality that occurs before birth. Colobomas are missing pieces of tissue in structures that form the eye. They may appear as notches or gaps in one of several parts of the eye, including the colored part of the eye called the iris; the retina, which is the specialized light-sensitive tissue that lines the back of the eye; the blood vessel layer under the retina called the choroid; or the optic nerves, which carry information from the eyes to the brain.\n\nColobomas may be present in one or both eyes and, depending on their size and location, can affect a person's vision. Colobomas affecting the iris, which result in a "keyhole" appearance of the pupil, generally do not lead to vision loss. Colobomas involving the retina result in vision loss in specific parts of the visual field. Large retinal colobomas or those affecting the optic nerve can cause low vision, which means vision loss that cannot be completely corrected with glasses or contact lenses.\n\nSome people with coloboma also have a condition called microphthalmia. In this condition, one or both eyeballs are abnormally small. In some affected individuals, the eyeball may appear to be completely missing; however, even in these cases some remaining eye tissue is generally present. Such severe microphthalmia should be distinguished from another condition called anophthalmia, in which no eyeball forms at all. However, the terms anophthalmia and severe microphthalmia are often used interchangeably. Microphthalmia may or may not result in significant vision loss.\n\nPeople with coloboma may also have other eye abnormalities, including clouding of the lens of the eye (cataract), increased pressure inside the eye (glaucoma) that can damage the optic nerve, vision problems such as nearsightedness (myopia), involuntary back-and-forth eye movements (nystagmus), or separation of the retina from the back of the eye (retinal detachment).\n\nColobomas involving the eyeball should be distinguished from gaps that occur in the eyelids. While these eyelid gaps are also called colobomas, they arise from abnormalities in different structures during early development.\n\nSome individuals have coloboma as part of a syndrome that affects other organs and tissues in the body. These forms of the condition are described as syndromic. When coloboma occurs by itself, it is described as nonsyndromic or isolated.
Microphthalmia
MedGen UID:
10033
Concept ID:
C0026010
Congenital Abnormality
Microphthalmia is an eye abnormality that arises before birth. In this condition, one or both eyeballs are abnormally small. In some affected individuals, the eyeball may appear to be completely missing; however, even in these cases some remaining eye tissue is generally present. Such severe microphthalmia should be distinguished from another condition called anophthalmia, in which no eyeball forms at all. However, the terms anophthalmia and severe microphthalmia are often used interchangeably. Microphthalmia may or may not result in significant vision loss.\n\nPeople with microphthalmia may also have a condition called coloboma. Colobomas are missing pieces of tissue in structures that form the eye. They may appear as notches or gaps in the colored part of the eye called the iris; the retina, which is the specialized light-sensitive tissue that lines the back of the eye; the blood vessel layer under the retina called the choroid; or in the optic nerves, which carry information from the eyes to the brain. Colobomas may be present in one or both eyes and, depending on their size and location, can affect a person's vision.\n\nPeople with microphthalmia may also have other eye abnormalities, including clouding of the lens of the eye (cataract) and a narrowed opening of the eye (narrowed palpebral fissure). Additionally, affected individuals may have an abnormality called microcornea, in which the clear front covering of the eye (cornea) is small and abnormally curved.\n\nBetween one-third and one-half of affected individuals have microphthalmia as part of a syndrome that affects other organs and tissues in the body. These forms of the condition are described as syndromic. When microphthalmia occurs by itself, it is described as nonsyndromic or isolated.
Nystagmus
MedGen UID:
45166
Concept ID:
C0028738
Disease or Syndrome
Rhythmic, involuntary oscillations of one or both eyes related to abnormality in fixation, conjugate gaze, or vestibular mechanisms.
Optic atrophy
MedGen UID:
18180
Concept ID:
C0029124
Disease or Syndrome
Atrophy of the optic nerve. Optic atrophy results from the death of the retinal ganglion cell axons that comprise the optic nerve and manifesting as a pale optic nerve on fundoscopy.

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
Follow this link to review classifications for Dihydropyrimidine dehydrogenase deficiency in Orphanet.

Professional guidelines

PubMed

Etienne-Grimaldi MC, Pallet N, Boige V, Ciccolini J, Chouchana L, Barin-Le Guellec C, Zaanan A, Narjoz C, Taieb J, Thomas F, Loriot MA; Francophone Network of Pharmacogenetics (RNPGx) and the French Clinical Oncopharmacology Group (GPCO)-UNICANCER
Eur J Cancer 2023 Mar;181:3-17. Epub 2022 Dec 9 doi: 10.1016/j.ejca.2022.11.028. PMID: 36621118
Lee A, Ezzeldin H, Fourie J, Diasio R
Clin Adv Hematol Oncol 2004 Aug;2(8):527-32. PMID: 16163233
Van Kuilenburg AB, Vreken P, Abeling NG, Bakker HD, Meinsma R, Van Lenthe H, De Abreu RA, Smeitink JA, Kayserili H, Apak MY, Christensen E, Holopainen I, Pulkki K, Riva D, Botteon G, Holme E, Tulinius M, Kleijer WJ, Beemer FA, Duran M, Niezen-Koning KE, Smit GP, Jakobs C, Smit LM, Van Gennip AH
Hum Genet 1999 Jan;104(1):1-9. doi: 10.1007/pl00008711. PMID: 10071185

Curated

DailyMed Drug Label, FLUOROURACIL, 2020

Recent clinical studies

Etiology

de With M, Sadlon A, Cecchin E, Haufroid V, Thomas F, Joerger M, van Schaik RHN, Mathijssen RHJ, Largiadèr CR; ‘The Working Group on the Implementation of DPD-deficiency Testing in Europe’
ESMO Open 2023 Apr;8(2):101197. Epub 2023 Mar 28 doi: 10.1016/j.esmoop.2023.101197. PMID: 36989883Free PMC Article
Arrivé C, Fonrose X, Thomas F, Roth G, Jacquet E, Brice A, Chirica C, Farneti D, Frenoux C, Stanke-Labesque F, Gautier-Veyret E
Br J Clin Pharmacol 2023 Aug;89(8):2446-2457. Epub 2023 Mar 30 doi: 10.1111/bcp.15715. PMID: 36918744
Etienne-Grimaldi MC, Pallet N, Boige V, Ciccolini J, Chouchana L, Barin-Le Guellec C, Zaanan A, Narjoz C, Taieb J, Thomas F, Loriot MA; Francophone Network of Pharmacogenetics (RNPGx) and the French Clinical Oncopharmacology Group (GPCO)-UNICANCER
Eur J Cancer 2023 Mar;181:3-17. Epub 2022 Dec 9 doi: 10.1016/j.ejca.2022.11.028. PMID: 36621118
White C, Scott RJ, Paul C, Ziolkowski A, Mossman D, Fox SB, Michael M, Ackland S
Clin Pharmacol Ther 2022 Oct;112(4):791-802. Epub 2022 Jun 12 doi: 10.1002/cpt.2667. PMID: 35607723
Depetris I, Marino D, Bonzano A, Cagnazzo C, Filippi R, Aglietta M, Leone F
Crit Rev Oncol Hematol 2018 Apr;124:1-10. Epub 2018 Feb 7 doi: 10.1016/j.critrevonc.2018.02.002. PMID: 29548480

Diagnosis

de With M, Sadlon A, Cecchin E, Haufroid V, Thomas F, Joerger M, van Schaik RHN, Mathijssen RHJ, Largiadèr CR; ‘The Working Group on the Implementation of DPD-deficiency Testing in Europe’
ESMO Open 2023 Apr;8(2):101197. Epub 2023 Mar 28 doi: 10.1016/j.esmoop.2023.101197. PMID: 36989883Free PMC Article
Arrivé C, Fonrose X, Thomas F, Roth G, Jacquet E, Brice A, Chirica C, Farneti D, Frenoux C, Stanke-Labesque F, Gautier-Veyret E
Br J Clin Pharmacol 2023 Aug;89(8):2446-2457. Epub 2023 Mar 30 doi: 10.1111/bcp.15715. PMID: 36918744
Sukkarieh HH, AlSagoor T, Alnuhait M, Bustami R, Bryson S, Adem FMK, Abdalla H, Karbani G
Cancer Rep (Hoboken) 2023 Feb;6(2):e1704. Epub 2022 Aug 14 doi: 10.1002/cnr2.1704. PMID: 36806724Free PMC Article
Etienne-Grimaldi MC, Pallet N, Boige V, Ciccolini J, Chouchana L, Barin-Le Guellec C, Zaanan A, Narjoz C, Taieb J, Thomas F, Loriot MA; Francophone Network of Pharmacogenetics (RNPGx) and the French Clinical Oncopharmacology Group (GPCO)-UNICANCER
Eur J Cancer 2023 Mar;181:3-17. Epub 2022 Dec 9 doi: 10.1016/j.ejca.2022.11.028. PMID: 36621118
Depetris I, Marino D, Bonzano A, Cagnazzo C, Filippi R, Aglietta M, Leone F
Crit Rev Oncol Hematol 2018 Apr;124:1-10. Epub 2018 Feb 7 doi: 10.1016/j.critrevonc.2018.02.002. PMID: 29548480

Therapy

de With M, Sadlon A, Cecchin E, Haufroid V, Thomas F, Joerger M, van Schaik RHN, Mathijssen RHJ, Largiadèr CR; ‘The Working Group on the Implementation of DPD-deficiency Testing in Europe’
ESMO Open 2023 Apr;8(2):101197. Epub 2023 Mar 28 doi: 10.1016/j.esmoop.2023.101197. PMID: 36989883Free PMC Article
Lešnjaković L, Ganoci L, Bilić I, Šimičević L, Mucalo I, Pleština S, Božina N
Pharmacogenomics 2023 Jan;24(2):93-106. Epub 2023 Jan 13 doi: 10.2217/pgs-2022-0135. PMID: 36636997
Etienne-Grimaldi MC, Pallet N, Boige V, Ciccolini J, Chouchana L, Barin-Le Guellec C, Zaanan A, Narjoz C, Taieb J, Thomas F, Loriot MA; Francophone Network of Pharmacogenetics (RNPGx) and the French Clinical Oncopharmacology Group (GPCO)-UNICANCER
Eur J Cancer 2023 Mar;181:3-17. Epub 2022 Dec 9 doi: 10.1016/j.ejca.2022.11.028. PMID: 36621118
White C, Scott RJ, Paul C, Ziolkowski A, Mossman D, Fox SB, Michael M, Ackland S
Clin Pharmacol Ther 2022 Oct;112(4):791-802. Epub 2022 Jun 12 doi: 10.1002/cpt.2667. PMID: 35607723
Depetris I, Marino D, Bonzano A, Cagnazzo C, Filippi R, Aglietta M, Leone F
Crit Rev Oncol Hematol 2018 Apr;124:1-10. Epub 2018 Feb 7 doi: 10.1016/j.critrevonc.2018.02.002. PMID: 29548480

Prognosis

Lešnjaković L, Ganoci L, Bilić I, Šimičević L, Mucalo I, Pleština S, Božina N
Pharmacogenomics 2023 Jan;24(2):93-106. Epub 2023 Jan 13 doi: 10.2217/pgs-2022-0135. PMID: 36636997
Taieb J, Karoui M, Basile D
ESMO Open 2021 Aug;6(4):100184. Epub 2021 Jul 5 doi: 10.1016/j.esmoop.2021.100184. PMID: 34237612Free PMC Article
Depetris I, Marino D, Bonzano A, Cagnazzo C, Filippi R, Aglietta M, Leone F
Crit Rev Oncol Hematol 2018 Apr;124:1-10. Epub 2018 Feb 7 doi: 10.1016/j.critrevonc.2018.02.002. PMID: 29548480
van Kuilenburg AB
Eur J Cancer 2004 May;40(7):939-50. doi: 10.1016/j.ejca.2003.12.004. PMID: 15093568
Gardiner SJ, Begg EJ, Robinson BA
Adverse Drug React Toxicol Rev 2002;21(1-2):1-16. doi: 10.1007/BF03256180. PMID: 12140902

Clinical prediction guides

Sukkarieh HH, AlSagoor T, Alnuhait M, Bustami R, Bryson S, Adem FMK, Abdalla H, Karbani G
Cancer Rep (Hoboken) 2023 Feb;6(2):e1704. Epub 2022 Aug 14 doi: 10.1002/cnr2.1704. PMID: 36806724Free PMC Article
Lešnjaković L, Ganoci L, Bilić I, Šimičević L, Mucalo I, Pleština S, Božina N
Pharmacogenomics 2023 Jan;24(2):93-106. Epub 2023 Jan 13 doi: 10.2217/pgs-2022-0135. PMID: 36636997
Depetris I, Marino D, Bonzano A, Cagnazzo C, Filippi R, Aglietta M, Leone F
Crit Rev Oncol Hematol 2018 Apr;124:1-10. Epub 2018 Feb 7 doi: 10.1016/j.critrevonc.2018.02.002. PMID: 29548480
Kuilenburg ABPV, Meijer J, Tanck MWT, Dobritzsch D, Zoetekouw L, Dekkers LL, Roelofsen J, Meinsma R, Wymenga M, Kulik W, Büchel B, Hennekam RCM, Largiadèr CR
Biochim Biophys Acta 2016 Apr;1862(4):754-762. Epub 2016 Jan 12 doi: 10.1016/j.bbadis.2016.01.009. PMID: 26804652
Van Kuilenburg AB, Vreken P, Abeling NG, Bakker HD, Meinsma R, Van Lenthe H, De Abreu RA, Smeitink JA, Kayserili H, Apak MY, Christensen E, Holopainen I, Pulkki K, Riva D, Botteon G, Holme E, Tulinius M, Kleijer WJ, Beemer FA, Duran M, Niezen-Koning KE, Smit GP, Jakobs C, Smit LM, Van Gennip AH
Hum Genet 1999 Jan;104(1):1-9. doi: 10.1007/pl00008711. PMID: 10071185

Recent systematic reviews

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