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Aspartylglucosaminuria(AGU)

MedGen UID:
78649
Concept ID:
C0268225
Disease or Syndrome
Synonyms: AGA deficiency; AGU; Aspartylglucos-amidase (AGA) deficiency; Aspartylglucos-aminuria; Aspartylglycosaminuria; GLYCOASPARAGINASE; Glycosylasparaginase deficiency; High urine aspartylglucosamine levels
SNOMED CT: Aspartylglycosylaminase deficiency (54954004); Aspartylglucosaminuria (54954004); Aspartylglycosaminuria (54954004); Aspartylglucosaminidase deficiency (54954004)
Modes of inheritance:
Autosomal recessive inheritance
MedGen UID:
141025
Concept ID:
C0441748
Intellectual Product
Sources: HPO, OMIM, 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).
Autosomal recessive inheritance (HPO, OMIM, Orphanet)
 
Gene (location): AGA (4q34.3)
 
HPO: HP:0012068
Monarch Initiative: MONDO:0008830
OMIM®: 208400
Orphanet: ORPHA93

Definition

Aspartylglucosaminuria (AGU) is a severe autosomal recessive lysosomal storage disorder that involves the central nervous system and causes skeletal abnormalities as well as connective tissue lesions. The most characteristic feature is progressive mental retardation. The disorder is caused by deficient activity of the lysosomal enzyme glycosylasparaginase, which results in body fluid and tissue accumulation of a series of glycoasparagines, i.e., glycoconjugates with an aspartylglucosamine moiety at the reducing end. AGU belongs to the group of disorders commonly referred to as the Finnish disease heritage (summary by Mononen et al., 1993 and Arvio and Arvio, 2002). [from OMIM]

Additional description

From GHR
Aspartylglucosaminuria is a condition that causes a progressive decline in mental functioning.Infants with aspartylglucosaminuria appear healthy at birth, and development is typically normal throughout early childhood. The first sign of this condition, evident around the age of 2 or 3, is usually delayed speech. Mild intellectual disability then becomes apparent, and learning occurs at a slowed pace. Intellectual disability progressively worsens in adolescence. Most people with this disorder lose much of the speech they have learned, and affected adults usually have only a few words in their vocabulary. Adults with aspartylglucosaminuria may develop seizures or problems with movement.People with this condition may also have bones that become progressively weak and prone to fracture (osteoporosis), an unusually large range of joint movement (hypermobility), and loose skin. Affected individuals tend to have a characteristic facial appearance that includes widely spaced eyes (ocular hypertelorism), small ears, and full lips. The nose is short and broad and the face is usually square-shaped. Children with this condition may be tall for their age, but lack of a growth spurt in puberty typically causes adults to be short. Affected children also tend to have frequent upper respiratory infections. Individuals with aspartylglucosaminuria usually survive into mid-adulthood.  https://ghr.nlm.nih.gov/condition/aspartylglucosaminuria

Clinical features

From HPO
Fabry disease
MedGen UID:
8083
Concept ID:
C0002986
Disease or Syndrome
Fabry disease results from deficient activity of the enzyme alpha-galactosidase A (a-Gal A) and progressive lysosomal deposition of globotriaosylceramide (GL-3) in cells throughout the body. The classic form, occurring in males with less than 1% a-Gal A enzyme activity, usually has its onset in childhood or adolescence with periodic crises of severe pain in the extremities (acroparesthesia), the appearance of vascular cutaneous lesions (angiokeratomas), sweating abnormalities (anhidrosis, hypohidrosis, and rarely hyperhidrosis), characteristic corneal and lenticular opacities, and proteinuria. Gradual deterioration of renal function to end-stage renal disease (ESRD) usually occurs in men in the third to fifth decade. In middle age, most males successfully treated for ESRD develop cardiac and/or cerebrovascular disease, a major cause of morbidity and mortality. Heterozygous females typically have milder symptoms at a later age of onset than males. Rarely, they may be relatively asymptomatic throughout a normal life span or may have symptoms as severe as those observed in males with the classic phenotype. In contrast, males with greater than 1% a-Gal A activity may have: (1) a cardiac variant phenotype that usually presents in the sixth to eighth decade with left ventricular hypertrophy, cardiomyopathy and arrhythmia, and proteinuria, but without ESRD; or (2) a renal variant phenotype, associated with ESRD but without the skin lesions or pain; or (3) cerebrovascular disease presenting as stroke or transient ischemic attack.
Diarrhea
MedGen UID:
8360
Concept ID:
C0011991
Sign or Symptom
Abnormally increased frequency of loose or watery bowel movements.
Pathologic fracture
MedGen UID:
42095
Concept ID:
C0016663
Pathologic Function
A traumatic break in an area of bone that has been weakened by another disease process.
Hepatomegaly
MedGen UID:
42428
Concept ID:
C0019209
Finding
Abnormal enlargement of the liver.
Hernia
MedGen UID:
6816
Concept ID:
C0019270
Finding
Protrusion of tissue, structure, or part of an organ through the bone, muscular tissue, or the membrane by which it is normally contained. Hernia may involve tissues such as the ABDOMINAL WALL or the respiratory DIAPHRAGM. Hernias may be internal, external, congenital, or acquired.
Hoarse voice
MedGen UID:
5602
Concept ID:
C0019825
Sign or Symptom
An unnaturally deep or rough quality of voice.
Kyphosis
MedGen UID:
44042
Concept ID:
C0022821
Anatomical Abnormality
Abnormally increased curvature of the thoracic portion of the spine.
Macroglossia
MedGen UID:
44236
Concept ID:
C0024421
Disease or Syndrome
Macroglossia is an abnormal enlargement of the tongue. It is commonly observed with type 2 glycogen storage disease (232300), neurofibromatosis (162200), congenital hypothyroidism, and the Beckwith-Wiedemann syndrome (130650).
Wide mouth
MedGen UID:
44238
Concept ID:
C0024433
Congenital Abnormality
Distance between the oral commissures more than 2 SD above the mean. Alternatively, an apparently increased width of the oral aperture (subjective).
Mitral regurgitation
MedGen UID:
7670
Concept ID:
C0026266
Finding
Backflow of blood from the LEFT VENTRICLE into the LEFT ATRIUM due to imperfect closure of the MITRAL VALVE. This can lead to mitral valve regurgitation.
Muscular hypotonia
MedGen UID:
10133
Concept ID:
C0026827
Finding
A condition of decreased tone of the skeletal muscles and diminished resistance to passive stretching.
Spasticity
MedGen UID:
7753
Concept ID:
C0026838
Sign or Symptom
A form of muscle hypertonia associated with upper MOTOR NEURON DISEASE. Resistance to passive stretch of a spastic muscle results in minimal initial resistance (a "free interval") followed by an incremental increase in muscle tone. Tone increases in proportion to the velocity of stretch. Spasticity is usually accompanied by HYPERREFLEXIA and variable degrees of MUSCLE WEAKNESS. (From Adams et al., Principles of Neurology, 6th ed, p54)
Scoliosis
MedGen UID:
11348
Concept ID:
C0036439
Disease or Syndrome
A congenital or acquired spinal deformity characterized by lateral curvature of the spine.
Seizures
MedGen UID:
20693
Concept ID:
C0036572
Sign or Symptom
A seizure is an intermittent abnormality of nervous system physiology characterised by a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain.
Spondylolisthesis
MedGen UID:
52470
Concept ID:
C0038016
Disease or Syndrome
Spondylolisthesis is defined as forward slipping of a vertebral body on the one below it. Spondylolysis is defined as a defect in the pars interarticularis without vertebral slipping (summary by Wiltse et al., 1975).
Spondylolysis
MedGen UID:
21294
Concept ID:
C0038018
Disease or Syndrome
A defect in the pars interarticularis of a vertebral bone.
Joint laxity
MedGen UID:
39439
Concept ID:
C0086437
Finding
Lack of stability of a joint.
Cataract (disease)
MedGen UID:
39462
Concept ID:
C0086543
Acquired Abnormality
A cataract is an opacity or clouding that develops in the crystalline lens of the eye or in its capsule.
Hurler syndrome
MedGen UID:
39698
Concept ID:
C0086795
Disease or Syndrome
Mucopolysaccharidosis type I (MPS I) is a progressive multisystem disorder with features ranging over a continuum of severity. While affected individuals have traditionally been classified as having one of three MPS I syndromes (Hurler syndrome, Hurler-Scheie syndrome, or Scheie syndrome), no easily measurable biochemical differences have been identified and the clinical findings overlap; thus, affected individuals are best described as having either severe or attenuated MPS I, a distinction that influences therapeutic options. Severe MPS I. Infants appear normal at birth. Typical early manifestations are nonspecific (e.g., umbilical or inguinal hernia, frequent upper respiratory-tract infections before age 1 year). Coarsening of the facial features may not become apparent until after age one year. Gibbus deformity of the lower spine is common and often noted within the first year. Progressive skeletal dysplasia (dysostosis multiplex) involving all bones is universal. By age three years, linear growth decreases. Intellectual disability is progressive and profound. Hearing loss is common. Death, typically caused by cardiorespiratory failure, usually occurs within the first ten years of life. Attenuated MPS I. The severity and rate of disease progression range from serious life-threatening complications leading to death in the second to third decades to a normal life span complicated by significant disability from progressive joint manifestations and cardiorespiratory disease. While some individuals have no neurologic involvement and psychomotor development may be normal in early childhood, learning disabilities can be present. Clinical onset is usually between ages three and ten years. Hearing loss and cardiac valvular disease are common.
Brachycephaly
MedGen UID:
113165
Concept ID:
C0221356
Congenital Abnormality
An abnormality of skull shape characterized by a decreased anterior-posterior diameter. That is, a cephalic index greater than 81%. Alternatively, an apparently shortened anteroposterior dimension (length) of the head compared to width.
Cerebral atrophy
MedGen UID:
116012
Concept ID:
C0235946
Disease or Syndrome
Atrophy (wasting, decrease in size of cells or tissue) affecting the cerebrum.
Aspartylglucosaminuria
MedGen UID:
78649
Concept ID:
C0268225
Disease or Syndrome
Aspartylglucosaminuria (AGU) is a severe autosomal recessive lysosomal storage disorder that involves the central nervous system and causes skeletal abnormalities as well as connective tissue lesions. The most characteristic feature is progressive mental retardation. The disorder is caused by deficient activity of the lysosomal enzyme glycosylasparaginase, which results in body fluid and tissue accumulation of a series of glycoasparagines, i.e., glycoconjugates with an aspartylglucosamine moiety at the reducing end. AGU belongs to the group of disorders commonly referred to as the Finnish disease heritage (summary by Mononen et al., 1993 and Arvio and Arvio, 2002).
Short stature
MedGen UID:
87607
Concept ID:
C0349588
Finding
A height below that which is expected according to age and gender norms. Although there is no universally accepted definition of short stature, many refer to "short stature" as height more than 2 standard deviations below the mean for age and gender (or below the 3rd percentile for age and gender dependent norms).
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.
Delayed skeletal maturation
MedGen UID:
108148
Concept ID:
C0541764
Finding
A decreased rate of skeletal maturation. Delayed skeletal maturation can be diagnosed on the basis of an estimation of the bone age from radiographs of specific bones in the human body.
Decreased prothrombin time
MedGen UID:
154375
Concept ID:
C0580413
Finding
Abnormally short time to coagulation in the prothrombin time test, which is a measure of the extrinsic pathway of coagulation. The results of the prothrombin time test are often expressed in terms of the International normalized ratio (INR), which is calculated as a ratio of the patient's prothrombin time (PT) to a control PT standardized for the potency of the thromboplastin reagent developed by the World Health Organization (WHO) using the formula: INR is equal to Patient PT divided by Control PT.
Acne
MedGen UID:
152379
Concept ID:
C0702166
Disease or Syndrome
A skin condition in which there is an increase in sebum secretion by the pilosebaceous apparatus associated with open comedones (blackheads), closed comedones (whiteheads), and pustular nodules (papules, pustules, and cysts).
Neutropenia
MedGen UID:
163121
Concept ID:
C0853697
Finding
A decrease in the number of neutrophils in the peripheral blood.
Macroorchidism
MedGen UID:
224727
Concept ID:
C1263023
Finding
The presence of abnormally large testes.
Depressed nasal bridge
MedGen UID:
373112
Concept ID:
C1836542
Finding
Posterior positioning of the nasal root in relation to the overall facial profile for age.
Developmental regression
MedGen UID:
324613
Concept ID:
C1836830
Disease or Syndrome
Loss of developmental skills, as manifested by loss of developmental milestones.
Vacuolated lymphocytes
MedGen UID:
332307
Concept ID:
C1836855
Finding
The presence of clear, sharply defined vacuoles in the lymphocyte cytoplasm.
Thick lower lip vermilion
MedGen UID:
326567
Concept ID:
C1839739
Finding
Increased thickness of the lower lip, leading to a prominent appearance of the lower lip. The height of the vermilion of the lower lip in the midline is more than 2 SD above the mean. Alternatively, an apparently increased height of the vermilion of the lower lip in the frontal view (subjective).
Anteverted nares
MedGen UID:
326648
Concept ID:
C1840077
Finding
Anteriorly-facing nostrils viewed with the head in the Frankfurt horizontal and the eyes of the observer level with the eyes of the subject. This gives the appearance of an upturned nose (upturned nasal tip).
Intellectual disability
MedGen UID:
334384
Concept ID:
C1843367
Finding
Subnormal intellectual functioning which originates during the developmental period. Intellectual disability, previously referred to as mental retardation, has been defined as an IQ score below 70.
Platyspondyly
MedGen UID:
335010
Concept ID:
C1844704
Finding
A flattened vertebral body shape with reduced distance between the vertebral endplates.
Coarse facial features
MedGen UID:
335284
Concept ID:
C1845847
Finding
Absence of fine and sharp appearance of brows, nose, lips, mouth, and chin, usually because of rounded and heavy features or thickened skin with or without thickening of subcutaneous and bony tissues.
Beaking of vertebral bodies
MedGen UID:
341588
Concept ID:
C1856599
Finding
Anterior tongue-like protrusions of the vertebral bodies.
Generalized hypotonia
MedGen UID:
346841
Concept ID:
C1858120
Finding
Generalized muscular hypotonia (abnormally low muscle tone).
Thickened calvaria
MedGen UID:
346823
Concept ID:
C1858452
Finding
The presence of an abnormally thick calvaria.
Broad face
MedGen UID:
349223
Concept ID:
C1859680
Finding
Bizygomatic (upper face) and bigonial (lower face) width greater than 2 standard deviations above the mean (objective); or an apparent increase in the width of the face (subjective).
Hypoplastic frontal sinuses
MedGen UID:
349225
Concept ID:
C1859682
Finding
Underdevelopment of frontal sinus.
Recurrent respiratory infections
MedGen UID:
812812
Concept ID:
C3806482
Finding
An increased susceptibility to respiratory infections as manifested by a history of recurrent respiratory infections.
Abnormality of metabolism/homeostasis
MedGen UID:
867398
Concept ID:
C4021768
Finding
Microcephaly
MedGen UID:
1644158
Concept ID:
C4551563
Finding
Head circumference below 2 standard deviations below the mean for age and gender.

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVAspartylglucosaminuria

Conditions with this feature

Aspartylglucosaminuria
MedGen UID:
78649
Concept ID:
C0268225
Disease or Syndrome
Aspartylglucosaminuria (AGU) is a severe autosomal recessive lysosomal storage disorder that involves the central nervous system and causes skeletal abnormalities as well as connective tissue lesions. The most characteristic feature is progressive mental retardation. The disorder is caused by deficient activity of the lysosomal enzyme glycosylasparaginase, which results in body fluid and tissue accumulation of a series of glycoasparagines, i.e., glycoconjugates with an aspartylglucosamine moiety at the reducing end. AGU belongs to the group of disorders commonly referred to as the Finnish disease heritage (summary by Mononen et al., 1993 and Arvio and Arvio, 2002).

Recent clinical studies

Etiology

Tokola AM, Åberg LE, Autti TH
J Neuroradiol 2015 Dec;42(6):345-57. Epub 2015 May 27 doi: 10.1016/j.neurad.2015.03.003. PMID: 26026191
Saito S, Ohno K, Sugawara K, Suzuki T, Togawa T, Sakuraba H
Biochem Biophys Res Commun 2008 Dec 26;377(4):1168-72. Epub 2008 Nov 4 doi: 10.1016/j.bbrc.2008.10.142. PMID: 18992224
Autti T, Lönnqvist T, Joensuu R
Acta Radiol 2008 Jul;49(6):687-92. doi: 10.1080/02841850802065000. PMID: 18568562
Arvio M, Arvio P, Hurmerinta K, Pirinen S, Sillanpää M
Acta Neurol Scand 2005 Nov;112(5):335-7. doi: 10.1111/j.1600-0404.2005.00492.x. PMID: 16218917
Arvio P, Arvio M, Wolf J, Lukinmaa PL, Saxen L, Pirinen S
Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998 Nov;86(5):562-8. doi: 10.1016/s1079-2104(98)90346-8. PMID: 9830648

Diagnosis

Yamamoto T, Shimojima K, Matsufuji M, Mashima R, Sakai E, Okuyama T
Brain Dev 2017 May;39(5):422-425. Epub 2017 Jan 4 doi: 10.1016/j.braindev.2016.12.004. PMID: 28063748
Arvio M, Mononen I
Orphanet J Rare Dis 2016 Dec 1;11(1):162. doi: 10.1186/s13023-016-0544-6. PMID: 27906067Free PMC Article
Opladen T, Ebinger F, Zschocke J, Sengupta D, Ben-Omran T, Shahbeck N, Moog U, Fischer C, Bürger F, Haas D, Ruef P, Harting I, Al-Rifai H, Hoffmann GF
J Child Neurol 2014 Jan;29(1):36-42. Epub 2012 Dec 26 doi: 10.1177/0883073812469049. PMID: 23271757
Ambrosetto G, Santucci M
Epilepsia 2009 Jun;50(6):1638-40. Epub 2009 Jan 21 doi: 10.1111/j.1528-1167.2008.01991.x. PMID: 19175389
Arvio M, Arvio P, Hurmerinta K, Pirinen S, Sillanpää M
Acta Neurol Scand 2005 Nov;112(5):335-7. doi: 10.1111/j.1600-0404.2005.00492.x. PMID: 16218917

Therapy

Banning A, Schiff M, Tikkanen R
Biochim Biophys Acta Mol Basis Dis 2018 Mar;1864(3):668-675. Epub 2017 Dec 13 doi: 10.1016/j.bbadis.2017.12.014. PMID: 29247835
Banning A, Gülec C, Rouvinen J, Gray SJ, Tikkanen R
Sci Rep 2016 Nov 23;6:37583. doi: 10.1038/srep37583. PMID: 27876883Free PMC Article
Dunder U, Valtonen P, Kelo E, Mononen I
J Inherit Metab Dis 2010 Oct;33(5):611-7. Epub 2010 Jul 6 doi: 10.1007/s10545-010-9158-7. PMID: 20607610
Labate A, Barone R, Gambardella A, Civitelli D, Fiumara A, Annesi G, Zappia M, Pavone L, Quattrone A
Brain Dev 2004 Mar;26(2):130-3. doi: 10.1016/S0387-7604(03)00069-X. PMID: 15036433
Arvio M, Sauna-Aho O, Peippo M
J Pediatr 2001 Feb;138(2):288-90. doi: 10.1067/mpd.2001.110119. PMID: 11174635

Prognosis

Arvio M, Arvio P, Hurmerinta K, Pirinen S, Sillanpää M
Acta Neurol Scand 2005 Nov;112(5):335-7. doi: 10.1111/j.1600-0404.2005.00492.x. PMID: 16218917
Malm G, Månsson JE, Winiarski J, Mosskin M, Ringdén O
Transplantation 2004 Aug 15;78(3):415-9. doi: 10.1097/00007890-200408150-00015. PMID: 15316370
Vargas-Díez E, Chabás A, Coll MJ, Sánchez-Pérez J, García-Díez A, Fernández-Herrera JM
Br J Dermatol 2002 Oct;147(4):760-4. doi: 10.1046/j.1365-2133.2002.04827.x. PMID: 12366426
Arvio P, Arvio M
Acta Paediatr 2002;91(3):255-7. doi: 10.1080/08035250252833842. PMID: 12022293
Arvio M, Sauna-Aho O, Peippo M
J Pediatr 2001 Feb;138(2):288-90. doi: 10.1067/mpd.2001.110119. PMID: 11174635

Clinical prediction guides

Opladen T, Ebinger F, Zschocke J, Sengupta D, Ben-Omran T, Shahbeck N, Moog U, Fischer C, Bürger F, Haas D, Ruef P, Harting I, Al-Rifai H, Hoffmann GF
J Child Neurol 2014 Jan;29(1):36-42. Epub 2012 Dec 26 doi: 10.1177/0883073812469049. PMID: 23271757
Autti T, Lönnqvist T, Joensuu R
Acta Radiol 2008 Jul;49(6):687-92. doi: 10.1080/02841850802065000. PMID: 18568562
Saarela J, von Schantz C, Peltonen L, Jalanko A
Hum Mutat 2004 Oct;24(4):350-1. doi: 10.1002/humu.9276. PMID: 15365992
Malm G, Månsson JE, Winiarski J, Mosskin M, Ringdén O
Transplantation 2004 Aug 15;78(3):415-9. doi: 10.1097/00007890-200408150-00015. PMID: 15316370
Saarela J, Laine M, Oinonen C, von Schantz C, Jalanko A, Rouvinen J, Peltonen L
Hum Mol Genet 2001 Apr 15;10(9):983-95. doi: 10.1093/hmg/10.9.983. PMID: 11309371

Recent systematic reviews

Autti T, Joensuu R, Aberg L
Neuroradiology 2007 Jul;49(7):571-8. Epub 2007 Mar 3 doi: 10.1007/s00234-007-0220-6. PMID: 17334752

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