Adenylosuccinase deficiency: An unusual cause of early-onset epilepsy associated with acquired microcephaly

Service de Radiologie Pédiatrique, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, B-1200 Bruxelles, Belgium
Brain and Development (Impact Factor: 1.88). 10/2000; 22(6):383-386. DOI: 10.1016/S0387-7604(00)00154-6


Adenylosuccinase deficiency, an autosomal recessive inborn error of purine synthesis, was first described in 1984 by Jaeken and Van den Berghe (reviewed in J Inher Metab Dis 20;1997:193). The cardinal features are variable psychomotor delay often accompanied by epilepsy and autistic features. Diagnosis is made by detection of abnormal purine metabolites in body fluids. We report a girl who presented with early onset epilepsy, associated with acquired microcephaly and severe psychomotor retardation, as the most prominent symptoms.

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    • "These are mostly case reports or small series of cases with different phenotypes, and correlation with clinical symptoms is ambiguous. Reported findings on brain MRI in ADSL deficiency include atrophy of the cerebral cortex, corpus callosum, cerebellar vermis (Van den Berghe et al 1997; Edery et al 2003; Jurecka et al 2012a, b), lack of myelination (Kohler et al 1999; Jurecka et al 2012a, b), delayed myelination (Jurkiewicz et al 2007; Lundy et al 2010; Jurecka et al 2012a, b), anomalies of the white matter (Valik et al 1997; Nassogne et al 2000; Edery et al 2003; Marinaki et al 2004; Lundy et al 2010) and lissencephaly (Stathis et al 2000) (Figs. 2, 3 and 4). "
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    ABSTRACT: Adenylosuccinate lyase ADSL) deficiency is a defect of purine metabolism affecting purinosome assembly and reducing metabolite fluxes through purine de novo synthesis and purine nucleotide recycling pathways. Biochemically this defect manifests by the presence in the biologic fluids of two dephosphorylated substrates of ADSL enzyme: succinylaminoimidazole carboxamide riboside (SAICAr) and succinyladenosine (S-Ado). More than 80 individuals with ADSL deficiency have been identified, but incidence of the disease remains unknown. The disorder shows a wide spectrum of symptoms from slowly to rapidly progressing forms. The fatal neonatal form has onset from birth and presents with fatal neonatal encephalopathy with a lack of spontaneous movement, respiratory failure, and intractable seizures resulting in early death within the first weeks of life. Patients with type I (severe form) present with a purely neurologic clinical picture characterized by severe psychomotor retardation, microcephaly, early onset of seizures, and autistic features. A more slowly progressing form has also been described (type II, moderate or mild form), as having later onset, usually within the first years of life, slight to moderate psychomotor retardation and transient contact disturbances. Diagnosis is facilitated by demonstration of SAICAr and S-Ado in extracellular fluids such as plasma, cerebrospinal fluid and/or followed by genomic and/or cDNA sequencing and characterization of mutant proteins. Over 50 ADSL mutations have been identified and their effects on protein biogenesis, structural stability and activity as well as on purinosome assembly were characterized. To date there is no specific and effective therapy for ADSL deficiency.
    Journal of Inherited Metabolic Disease 08/2014; 38(2). DOI:10.1007/s10545-014-9755-y · 3.37 Impact Factor
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    • "Diagnosis was based on the detection of SAICAriboside and S-Ado by HPLC analysis of cerebrospinal fluid and/or urine. The clinical features of patient 1, an Italian American girl, have been published elsewhere (Nassogne et al. 2000). Patients 2 and 3 are from Norway and Australia, respectively. "
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    ABSTRACT: Adenylosuccinate lyase (ADSL; also called "adenylosuccinase") catalyzes two steps in the synthesis of purine nucleotides: (1) the conversion of succinylaminoimidazolecarboxamide ribotide into aminoimidazolecarboxamide ribotide and (2) the conversion of adenylosuccinate into adenosine monophosphate. ADSL deficiency, a recessively inherited disorder, causes variable-but most often severe-mental retardation, frequently accompanied by epilepsy and/or autism. It is characterized by the accumulation, in body fluids, of succinylaminoimidazolecarboxamide riboside and succinyladenosine, the dephosphorylated derivatives of the two substrates of the enzyme. Analysis of the ADSL gene of three unrelated patients with ADSL deficiency, in whom one of the ADSL alleles displayed a normal coding sequence, revealed a -49T-->C mutation in the 5' untranslated region of this allele. Measurements of the amount of mRNA transcribed from the latter allele showed that it was reduced to approximately 33% of that transcribed from the alleles mutated in their coding sequence. Further investigations showed that the -49T-->C mutation provokes a reduction to 25% of wild-type control of promoter function, as evaluated by luciferase activity and mRNA level in transfection experiments. The mutation also affects the binding of nuclear respiratory factor 2 (NRF-2), a known activator of transcription, as assessed by gel-shift studies. Our findings indicate that a mutation of a regulatory region of the ADSL gene might be an unusually frequent cause of ADSL deficiency, and they suggest a role for NRF-2 in the gene regulation of the purine biosynthetic pathway.
    The American Journal of Human Genetics 07/2002; 71(1):14-21. DOI:10.1086/341036 · 10.93 Impact Factor
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    Journal of Medical Genetics 06/2002; 39(6):440-442. DOI:10.1136/jmg.39.6.440 · 6.34 Impact Factor
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