Lysosomal Storage Disorders Flashcards

(57 cards)

1
Q

How many enzymes does the lysosome contain?

A

Contains ~50 enzymes

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2
Q

What kind of environment does the lysosome contain?

A

High acidic environment (low pH) to store hydrolytic enzymes

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3
Q

What cellular processes does the lysosome do?

A

Breakdown of waste, destruction of foreign material, apoptosis, breakdown of macromolecules into smaller molecules

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4
Q

Types of lysosomes and where they are formed?

A

Primary: Formed from endolytic vesicles (Golgi)
Secondary: Primary lysosome that has fused with endosome

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5
Q

Movement of lysosomal enzymes (3 steps)

A
  1. Enzymes initially generated in ER.
  2. Enzymes are transported to Golgi where they acquire mannose-6-phosphate (M6P), where is critical for localization to lysosome.
  3. M6P receptors located on cell membrane to bind with M6P, resulting in localization to the lysosome.
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6
Q

What are lysosomal storage disorders?

A

Multiple disorders associated with the dysfunction of lysosomal enzymes and the breakdown of macromolecules

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7
Q

Three mechanism of lysosomal storage disorders?

A
  1. Failure of gene to produce adequate levels of an active enzyme or enzyme with altered kinetics.
  2. Failure to incorporate enzyme into lysosome d/t failure of lysosome transport.
  3. Mutation in primary enzyme, affecting portion of the molecule which identifies it as an enzyme destined for lysosomal uptake.
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8
Q

How do the majority of LSDs arise from?

A

Defects in sugar hydrolyses responsible for the degradation of complex carbohydrate sequences attached to certain other macromolecules

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9
Q

Glycoprotein disorder

A

Pompe disease

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10
Q

Glycolipids disorder

A

Tay Sachs Disease, Gaucher disease, Niemann Pick

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11
Q

Glucosaminoglycans disorders

A

Mucopolysaccharidosis

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12
Q

What is the inheritance of almost all LSDs

A

Autosomal recessive

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13
Q

There are two X-linked LSDs, what are they?

A

Hunter syndrome & Fabry disease

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14
Q

MPS make up about how much of all LSD cases

A

35%

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15
Q

Most common LSD

A

Gaucher disease

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16
Q

What are other names for Pompe Disease?

A

GSDII / Acid Maltase Deficiency / GAA Deficiency

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17
Q

True or false, Pompe is the only GSD which is also an LSD

A

True

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18
Q

All other GSDs are due to defects in what?

A

Cytoplasmic enzymes

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19
Q

Pompe is a deficiency in what?

A

Deficiency of alpha-1,4-glucosidase

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20
Q

What does alpha-1,4-glucosidase do?

A

Breaks down glycogen into glucose

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21
Q

What does Infantile-onset Pompe disease look like?

Etiology, symptoms, prognosis, treatment, long term complications

A
  • Significantly reduced or absent GAA
  • Massive HCM,FTT, rapidly progressing muscle weakness, respiratory failure, aspiration
  • Developmental delay
  • Death by 1-2 years of age if untreated
  • Treated patients may require mechanical ventilation, wheelchair, etc.
  • Long-term survivors develop complications (vision/hearing problems, speech issues)
  • Overall cognition can be preserved
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22
Q

What does late-onset pompe disease look like?

A
  • Some residual enzyme activity
  • Characterized by more slowly progressive muscle weakness and absence of HCM in 1st year
  • Proximal muscles (LE>UE) and trunk most affected
  • Can have cardiac rhythm disturbances
  • Respiratory dysfunction and failure can occur
  • Death usually occurs due to respiratory failure but with treatment, lifespan can be close to normal
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23
Q

Pompe Disease Gene affected

24
Q

Mechanism of disease in pompe disease
Describe activity in:
* Null alleles
* Missense and other

A

Mechanism: loss of function
Null: result in 0% enzyma activity
Missense and other may result in some normal activity.

25
Diagnostics for Pompe
* Gene sequencing and del/dup * GAA enzyme deficient in blood/skin/muscle * Muscle biopsy to assess glycogen content and structure
26
Direct treatment for Pompe and timing for IOPD & LOPD
* ERT via IV infusion * IOPD treatment needs to start ASAP * LOPD treatment needs to start depending on age of dx and symptom onset
27
Gaucher Disease: also known as
Glucocerebrocidase (GCase) Deficiency
28
What is GCase involved in?
Involved in the breakdown in the breakdown of glycolipiids
29
Gaucher Disease primarily impacts:
Bone, liver and spleen
30
What are the three types of Gaucher Disease?
* Type 1- Non-Neuronpathic (chronic) * Type 2- Neuronpathic (acute) - extremely rare - infantile * Type 3 - Neuronpathic (sub-acute/chronic) - Juvenile
31
Most prevalent form of Gaucher
Type 1
32
AOE for Type one Gaucher
Childhood - adulthood
33
Clinical manifestations for Type 1 Gaucher (6 points)
* Visceromegaly * Thrombocytopenia and/or anemia * Increased risk for multiple myeloma * Growth Restriction * Bone/joint pain and risk for AVN and bone crises * No CNS involvement
34
Clinical manifestation of type 2 and prognosis
* Rapidly progressive CNS degeneration beginning at 4-6 mos. * Some progress to hydrops fetalis * Death from pulmonary and neurologic disease occuring by 2 years. * Hepatosplenomegaly present
35
Gacher Type 2 Earlier onset
3-6 Mos.
36
Gaucher Type 3 Clinical Characteristics
* Often presents first with hepatosplenomegaly * CNS deterioration more slowly progressive than Type 2 * CNS involvement may include oculomotor apraxia, horizontal eye saccades * Skeletal involvement may be debilitating
37
Gaucher Type 3 AOE
AOE variable -- many live into young adulthood.
38
Gaucher disease affected gene
GBA gene
39
Gaucher disease diagnostics
* GCase deficient in various tissues * Bone marrow aspirate - Gaucher cells
40
Fabry Disease: AKA
Alpha-Galactosidase A deficiency
41
Fabry: MOI & Gene affected
X-Linked GLA
42
Fabry Diagnostics
* GLA sequencing and del/dup * Measurement of alpha-gal in blood * Measurement of lyso-globotriasylceramide biomarker
43
Fabry Childhood Symptoms:
* Pain crises * Hypohidrosis * Corneal opacities * Recurrent fever * Hot and cold intolerance
44
Fabry Adolescent onset symptoms
* Angiokeratomas * Fatigue
45
Fabry Adult onset Symptoms
* Renal dysfunction * Neurological complications * Cerebrovascular disease * Cardiac dysfunction * Hearing loss and tinnitus
46
Krabbe Disease: AKA
Globoid Cell Leukodystrophy
47
What is Krabbe Disease?
Deficient beta galactosidase causing accumulation of galactocerebroside
48
Krabbe Disease: Gene affected
GALC
49
What does the toxic accumulation result in in Krabbe disease?
Results in destruction of myelin
50
Krabbe disease diagnostics
Enyzyme assay in blood or fibroblasts, chorionic villi prenatally GALC sequencing and del/dupe
51
Krabbe: infantile form, symptoms and prognosis
Usually fatal in first few months of life -- rapid neurologic deterioration, paralysis, seizures, blindness, deafness
52
Krabbe disease: Later onset
Neurologic features appear by 10-12 years of age Vision loss, hypertonia, difficulty walking, cognitive impairment, shortened life-span
53
What conditions are GM2 Gangliosidoses?
Tay sachs and Sandhoff disease
54
What enzyme is affected in Tay Sachs?
Deficiency of hex A
55
What enzymes are affected in Sandhoff disease?
HexA & HexB
56
Characteristics of infantile form of GM2 Gangliosidoses
* Affected child normal at birth * Rapid, progressive CNS degeneration * Infants usually never walk and have marked feeding problems, blindness, deafness, and convulsions * Macular Red cherry spot
57
GM2 Gangliosidoses prognosis
Death at 2-3 years.