Guidelines for the diagnosis and management of cystathionine beta-synthase deficiency.

Morris AA; Kožich V; Santra S; Andria G; Ben-Omran TI; Chakrapani AB; Crushell E; Henderson MJ; Hochuli M; Huemer M; Janssen MC; Maillot F; Mayne PD; McNulty J; Morrison TM; Ogier H; O'Sullivan S; Pavlíková M; de Almeida IT; Terry A; Yap S; Blom HJ; Chapman KA

doi:10.1007/s10545-016-9979-0

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Journal article

Guidelines for the diagnosis and management of cystathionine beta-synthase deficiency.

Morris AA Institute of Human Development, University of Manchester, Manchester, UK. Andrew.morris@cmft.nhs.uk.
Kožich V Institute of Inherited Metabolic Disorders, Charles University in Prague-First Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic.
Santra S Clinical IMD, Birmingham Children's Hospital, Birmingham, UK.
Andria G Department of translational medicine, Federico II University, Naples, Italy.
Ben-Omran TI Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar.
Chakrapani AB Department of Metabolic Medicine, Great Ormond Street Hospital, London, UK.
Crushell E National Centre for Inherited Metabolic Disorders, Temple Street Children's University Hospital, Dublin, Ireland.
Henderson MJ Willink Unit, Manchester Centre for Genomic Medicine, Central Manchester University Hospitals, St Mary's Hospital, Oxford Road, Manchester, M13 9WL, UK.
Hochuli M Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Zürich, Zurich, Switzerland.
Huemer M Division of Metabolism and Children's Research Center, University Children's Hospital Zürich, Zurich, Switzerland.
Janssen MC Department of Internal medicine, Radboud University Medical Center, Nijmegen, Netherlands.
Maillot F CHRU de Tours, Université François Rabelais, Tours, France.
Mayne PD Newborn Bloodspot Screening Laboratory, Temple Street Children's University Hospital, Dublin, Ireland.
McNulty J National Centre for Inherited Metabolic Disorders, Temple Street Children's University Hospital, Dublin, Ireland.
Morrison TM HCU Network, Baulkham Hills, Australia.
Ogier H Service de Neurologie Pédiatrique et des Maladies Métaboliques, Hôpital Robert Debré, Paris, France.
O'Sullivan S Royal Belfast Hospital for Sick Children, Belfast, UK.
Pavlíková M Institute of Inherited Metabolic Disorders, Charles University in Prague-First Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic.
de Almeida IT Metabolism & Genetics Group, Faculty of Pharmacy at University of Lisboa, Lisboa, Portugal.
Terry A Institute of Human Development, University of Manchester, Manchester, UK.
Yap S Dept of Inherited Metabolic Diseases, Sheffield Children's Hospital, Sheffield, UK.
Blom HJ Laboratory of Clinical Biochemistry and Metabolism, Department of General Pediatrics, Adolescent Medicine and Neonatology, University Medical Centre Freiburg, Freiburg im Breisgau, Germany.
Chapman KA Division of Genetic and Metabolism, Children's National Health System, Washington, DC, USA.

2016-10-26

Published in:

Journal of inherited metabolic disease. - 2017

English Cystathionine beta-synthase (CBS) deficiency is a rare inherited disorder in the methionine catabolic pathway, in which the impaired synthesis of cystathionine leads to accumulation of homocysteine. Patients can present to many different specialists and diagnosis is often delayed. Severely affected patients usually present in childhood with ectopia lentis, learning difficulties and skeletal abnormalities. These patients generally require treatment with a low-methionine diet and/or betaine. In contrast, mildly affected patients are likely to present as adults with thromboembolism and to respond to treatment with pyridoxine. In this article, we present recommendations for the diagnosis and management of CBS deficiency, based on a systematic review of the literature. Unfortunately, the quality of the evidence is poor, as it often is for rare diseases. We strongly recommend measuring the plasma total homocysteine concentrations in any patient whose clinical features suggest the diagnosis. Our recommendations may help to standardise testing for pyridoxine responsiveness. Current evidence suggests that patients are unlikely to develop complications if the plasma total homocysteine concentration is maintained below 120 μmol/L. Nevertheless, we recommend keeping the concentration below 100 μmol/L because levels fluctuate and the complications associated with high levels are so serious.

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