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Homocystinuria due to methylene tetrahydrofolate reductase deficiency

MedGen UID:
343470
Concept ID:
C1856061
Disease or Syndrome
Synonyms: 5,10-alpha-methylenetetrahydro-folate reductase deficiency; Homocysteinemia due to methylenetetrahydro-folate reductase deficiency; Homocysteinemia due to MTHFR deficiency; Homocysteinuria due to methylenetetrahydro-folate reductase deficiency; HOMOCYSTINURIA DUE TO DEFICIENCY OF N(5,10)-METHYLENETETRAHYDROFOLATE REDUCTASE ACTIVITY; Homocystinuria due to MTHFR deficiency; Methylenetetrahydro-folate reductase deficiency
Modes of inheritance:
Autosomal recessive inheritance
MedGen UID:
141025
Concept ID:
C0441748
Intellectual Product
Source: Orphanet
A mode of inheritance that is observed for traits related to a gene encoded on one of the autosomes (i.e., the human chromosomes 1-22) in which a trait manifests in individuals with two pathogenic alleles, either homozygotes (two copies of the same mutant allele) or compound heterozygotes (whereby each copy of a gene has a distinct mutant allele).
 
Gene (location): MTHFR (1p36.22)
 
Monarch Initiative: MONDO:0009353
OMIM®: 236250
Orphanet: ORPHA395

Definition

Methylenetetrahydrofolate reductase deficiency is a common inborn error of folate metabolism. The phenotypic spectrum ranges from severe neurologic deterioration and early death to asymptomatic adults. In the classic form, both thermostable and thermolabile enzyme variants have been identified (Rosenblatt et al., 1992). [from OMIM]

Additional description

From MedlinePlus Genetics
Less common forms of homocystinuria can cause intellectual disability, slower growth and weight gain (failure to thrive), seizures, and problems with movement. They can also cause and a blood disorder called megaloblastic anemia, which occurs when a person has a low number of red blood cells (anemia), and the remaining red blood cells are larger than normal (megaloblastic).

The signs and symptoms of homocystinuria typically develop during childhood, although some mildly affected people may not show signs and symptoms until adulthood.

The most common form of homocystinuria, called classic homocystinuria, is characterized by tall stature, nearsightedness (myopia), dislocation of the lens at the front of the eye, a higher risk of blood clotting disorders, and brittle bones that are prone to fracture (osteoporosis) or other skeletal abnormalities. Some affected individuals also have developmental delay and learning problems.

Homocystinuria is an inherited disorder in which the body is unable to process certain building blocks of proteins (amino acids) properly.   https://medlineplus.gov/genetics/condition/homocystinuria

Clinical features

From HPO
Homocystinuria
MedGen UID:
42485
Concept ID:
C0019880
Disease or Syndrome
Homocystinuria is an inherited disorder in which the body is unable to process certain building blocks of proteins (amino acids) properly. \n\nThe most common form of homocystinuria, called classic homocystinuria, is characterized by tall stature, nearsightedness (myopia), dislocation of the lens at the front of the eye, a higher risk of blood clotting disorders, and brittle bones that are prone to fracture (osteoporosis) or other skeletal abnormalities. Some affected individuals also have developmental delay and learning problems.\n\nThe signs and symptoms of homocystinuria typically develop during childhood, although some mildly affected people may not show signs and symptoms until adulthood.\n\nLess common forms of homocystinuria can cause intellectual disability, slower growth and weight gain (failure to thrive), seizures, and problems with movement. They can also cause and a blood disorder called megaloblastic anemia, which occurs when a person has a low number of red blood cells (anemia), and the remaining red blood cells are larger than normal (megaloblastic).
Stroke disorder
MedGen UID:
52522
Concept ID:
C0038454
Disease or Syndrome
Sudden impairment of blood flow to a part of the brain due to occlusion or rupture of an artery to the brain.
Paresthesia
MedGen UID:
14619
Concept ID:
C0030554
Disease or Syndrome
Abnormal sensations such as tingling, pricking, or numbness of the skin with no apparent physical cause.
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.
Atypical behavior
MedGen UID:
535345
Concept ID:
C0233514
Mental or Behavioral Dysfunction
Atypical behavior is an abnormality in a person's actions, which can be controlled or modulated by the will of the individual. While abnormal behaviors can be difficult to control, they are distinct from other abnormal actions that cannot be affected by the individual's will.
Incoordination
MedGen UID:
141714
Concept ID:
C0520966
Finding
Global developmental delay
MedGen UID:
107838
Concept ID:
C0557874
Finding
A delay in the achievement of motor or mental milestones in the domains of development of a child, including motor skills, speech and language, cognitive skills, and social and emotional skills. This term should only be used to describe children younger than five years of age.
Gait disturbance
MedGen UID:
107895
Concept ID:
C0575081
Finding
The term gait disturbance can refer to any disruption of the ability to walk. In general, this can refer to neurological diseases but also fractures or other sources of pain that is triggered upon walking. However, in the current context gait disturbance refers to difficulty walking on the basis of a neurological or muscular disease.
Muscle weakness
MedGen UID:
57735
Concept ID:
C0151786
Finding
Reduced strength of muscles.
Microcephaly
MedGen UID:
1644158
Concept ID:
C4551563
Finding
Head circumference below 2 standard deviations below the mean for age and gender.
Hyperhomocystinemia
MedGen UID:
812677
Concept ID:
C3806347
Finding
An increased concentration of homocystine in the blood.

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVHomocystinuria due to methylene tetrahydrofolate reductase deficiency

Professional guidelines

PubMed

Wasim M, Awan FR, Khan HN, Tawab A, Iqbal M, Ayesha H
Biochem Genet 2018 Apr;56(1-2):7-21. Epub 2017 Nov 1 doi: 10.1007/s10528-017-9825-6. PMID: 29094226
Huemer M, Diodato D, Schwahn B, Schiff M, Bandeira A, Benoist JF, Burlina A, Cerone R, Couce ML, Garcia-Cazorla A, la Marca G, Pasquini E, Vilarinho L, Weisfeld-Adams JD, Kožich V, Blom H, Baumgartner MR, Dionisi-Vici C
J Inherit Metab Dis 2017 Jan;40(1):21-48. Epub 2016 Nov 30 doi: 10.1007/s10545-016-9991-4. PMID: 27905001Free PMC Article
Levin BL, Varga E
J Genet Couns 2016 Oct;25(5):901-11. Epub 2016 Apr 30 doi: 10.1007/s10897-016-9956-7. PMID: 27130656

Recent clinical studies

Etiology

Zaric BL, Obradovic M, Bajic V, Haidara MA, Jovanovic M, Isenovic ER
Curr Med Chem 2019;26(16):2948-2961. doi: 10.2174/0929867325666180313105949. PMID: 29532755
Wasim M, Awan FR, Khan HN, Tawab A, Iqbal M, Ayesha H
Biochem Genet 2018 Apr;56(1-2):7-21. Epub 2017 Nov 1 doi: 10.1007/s10528-017-9825-6. PMID: 29094226
Levin BL, Varga E
J Genet Couns 2016 Oct;25(5):901-11. Epub 2016 Apr 30 doi: 10.1007/s10897-016-9956-7. PMID: 27130656
Perry DJ
Baillieres Best Pract Res Clin Haematol 1999 Sep;12(3):451-77. doi: 10.1053/beha.1999.0036. PMID: 10856981
Grieco AJ
Am J Med Sci 1977 Mar-Apr;273(2):120-32. PMID: 324277

Diagnosis

Kaur R, Correa ARE, Thakur S, Kabra M, Gupta N
Indian J Pediatr 2020 Nov;87(11):951-953. Epub 2020 May 26 doi: 10.1007/s12098-020-03290-3. PMID: 32451826
Vieira D, Florindo C, Tavares de Almeida I, Macário MC
BMJ Case Rep 2020 Mar 10;13(3) doi: 10.1136/bcr-2019-232241. PMID: 32161077Free PMC Article
Wasim M, Awan FR, Khan HN, Tawab A, Iqbal M, Ayesha H
Biochem Genet 2018 Apr;56(1-2):7-21. Epub 2017 Nov 1 doi: 10.1007/s10528-017-9825-6. PMID: 29094226
Huemer M, Diodato D, Schwahn B, Schiff M, Bandeira A, Benoist JF, Burlina A, Cerone R, Couce ML, Garcia-Cazorla A, la Marca G, Pasquini E, Vilarinho L, Weisfeld-Adams JD, Kožich V, Blom H, Baumgartner MR, Dionisi-Vici C
J Inherit Metab Dis 2017 Jan;40(1):21-48. Epub 2016 Nov 30 doi: 10.1007/s10545-016-9991-4. PMID: 27905001Free PMC Article
Przyrembel H
Ergeb Inn Med Kinderheilkd 1982;49:77-135. doi: 10.1007/978-3-642-68543-9_2. PMID: 7049692

Therapy

Mütze U, Gleich F, Garbade SF, Plisson C, Aldámiz-Echevarría L, Arrieta F, Ballhausen D, Zielonka M, Petković Ramadža D, Baumgartner MR, Cano A, García Jiménez MC, Dionisi-Vici C, Ješina P, Blom HJ, Couce ML, Meavilla Olivas S, Mention K, Mochel F, Morris AAM, Mundy H, Redonnet-Vernhet I, Santra S, Schiff M, Servais A, Vitoria I, Huemer M, Kožich V, Kölker S
J Inherit Metab Dis 2022 Jul;45(4):719-733. Epub 2022 Apr 6 doi: 10.1002/jimd.12499. PMID: 35358327
Zaric BL, Obradovic M, Bajic V, Haidara MA, Jovanovic M, Isenovic ER
Curr Med Chem 2019;26(16):2948-2961. doi: 10.2174/0929867325666180313105949. PMID: 29532755
Huemer M, Diodato D, Schwahn B, Schiff M, Bandeira A, Benoist JF, Burlina A, Cerone R, Couce ML, Garcia-Cazorla A, la Marca G, Pasquini E, Vilarinho L, Weisfeld-Adams JD, Kožich V, Blom H, Baumgartner MR, Dionisi-Vici C
J Inherit Metab Dis 2017 Jan;40(1):21-48. Epub 2016 Nov 30 doi: 10.1007/s10545-016-9991-4. PMID: 27905001Free PMC Article
Perry DJ
Baillieres Best Pract Res Clin Haematol 1999 Sep;12(3):451-77. doi: 10.1053/beha.1999.0036. PMID: 10856981
Grieco AJ
Am J Med Sci 1977 Mar-Apr;273(2):120-32. PMID: 324277

Prognosis

Savojardo C, Babbi G, Baldazzi D, Martelli PL, Casadio R
Int J Mol Sci 2021 Dec 23;23(1) doi: 10.3390/ijms23010167. PMID: 35008593Free PMC Article
Sørensen JT, Gaustadnes M, Stabler SP, Allen RH, Mudd SH, Hvas AM
Mol Genet Metab 2016 Mar;117(3):344-50. Epub 2015 Dec 23 doi: 10.1016/j.ymgme.2015.12.010. PMID: 26750749
Diekman EF, de Koning TJ, Verhoeven-Duif NM, Rovers MM, van Hasselt PM
JAMA Neurol 2014 Feb;71(2):188-94. doi: 10.1001/jamaneurol.2013.4915. PMID: 24323041
Dragani A, Falco A, Santilli F, Basili S, Rolandi G, Cerasa L, Lattanzio S, Ciabattoni G, Patrono C, Davì G
Thromb Haemost 2012 Sep;108(3):533-42. Epub 2012 Jul 10 doi: 10.1160/TH11-12-0899. PMID: 22782530
Morel CF, Scott P, Christensen E, Rosenblatt DS, Rozen R
Mol Genet Metab 2005 Jun;85(2):115-20. Epub 2005 Apr 1 doi: 10.1016/j.ymgme.2005.03.001. PMID: 15896655

Clinical prediction guides

Savojardo C, Babbi G, Baldazzi D, Martelli PL, Casadio R
Int J Mol Sci 2021 Dec 23;23(1) doi: 10.3390/ijms23010167. PMID: 35008593Free PMC Article
Weile J, Kishore N, Sun S, Maaieh R, Verby M, Li R, Fotiadou I, Kitaygorodsky J, Wu Y, Holenstein A, Bürer C, Blomgren L, Yang S, Nussbaum R, Rozen R, Watkins D, Gebbia M, Kozich V, Garton M, Froese DS, Roth FP
Am J Hum Genet 2021 Jul 1;108(7):1283-1300. doi: 10.1016/j.ajhg.2021.05.009. PMID: 34214447Free PMC Article
To-Figueras J, Wijngaard R, García-Villoria J, Aarsand AK, Aguilera P, Deulofeu R, Brunet M, Gómez-Gómez À, Pozo OJ, Sandberg S
J Inherit Metab Dis 2021 Jul;44(4):961-971. Epub 2021 May 4 doi: 10.1002/jimd.12391. PMID: 33861472
Morel CF, Scott P, Christensen E, Rosenblatt DS, Rozen R
Mol Genet Metab 2005 Jun;85(2):115-20. Epub 2005 Apr 1 doi: 10.1016/j.ymgme.2005.03.001. PMID: 15896655
Bakker RC, Brandjes DP
Pharm World Sci 1997 Jun;19(3):126-32. doi: 10.1023/a:1008634632501. PMID: 9259028

Recent systematic reviews

Zeng H, He D, Zhao Y, Liu NG, Xie H
Arch Gynecol Obstet 2021 Apr;303(4):1089-1098. Epub 2020 Oct 31 doi: 10.1007/s00404-020-05851-5. PMID: 33128585
Chen F, Wen T, Lv Q, Liu F
Nutr Cancer 2020;72(7):1211-1218. Epub 2019 Oct 29 doi: 10.1080/01635581.2019.1677924. PMID: 31661627
Huemer M, Kožich V, Rinaldo P, Baumgartner MR, Merinero B, Pasquini E, Ribes A, Blom HJ
J Inherit Metab Dis 2015 Nov;38(6):1007-19. Epub 2015 Mar 12 doi: 10.1007/s10545-015-9830-z. PMID: 25762406Free PMC Article

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