Glycogen Storage Patients: Comparison
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Glycogen storage diseases (GSDs) are clinically and genetically heterogeneous disorders that disturb glycogen synthesis or utilization. Although it is one of the oldest inherited metabolic disorders, new genetic methods and long-time patient follow-ups provide us with unique insight into the genotype–phenotype correlations. The aim of this study was to share the phenotypic features and molecular diagnostic results that include new pathogenic variants in theour GSD cases. Twenty-six GSD patients were evaluated retrospectively. Demographic data, initial laboratory and imaging features, and current findings of the patients were recorded. Molecular analysis results were classified as novel or previously defined variants. Novel variants were analyzed with pathogenicity prediction tools according to American College of Medical Genetics and Genomics (ACGM) criteria. Twelve novel and rare variants in six different genes were associated with the disease. Hearing impairment in two patients with GSD I, early peripheral neuropathy after liver transplantation in one patient with GSD IV, epilepsy and neuromotor retardation in three patients with GSD IXA were determined. AWe characterized a heterogeneous group of all diagnosed GSDs over a 5-year period was characterized in thein our institution, and identified novel variants and new clinical findings. It is still difficult to establish a genotype–phenotype correlation in GSDs.

  • glycogen storage disease
  • genotype–phenotype
  • novel variants

[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]1. Introduction

Glycogen storage diseases [GSDs] are a large group of inherited metabolic diseases with abnormal storage or utilization of glycogen. They affect primarily the liver and muscle, followed by the nervous system, kidneys, intestine, and leukocytes [1]. The incidence of all forms of glycogen storage disease is 1/10,000 [2]. Depending on the type of enzyme deficiency in tissue, it is classified as muscle or liver glycogenosis. However, both muscle and liver can be affected in some types [3]. The diagnosis of GSDs is based on the enzyme assay and/or molecular analysis as a result of the biochemical analysis and biopsy examination of the patients with characteristic signs [4]. GSDs have broad genetic heterogeneity and phenotypical variations. Some GSDs lead to death within the first years of life, whereas some remain asymptomatic for life. Genotype–phenotype correlation has been reported for some mutations in GSD patients [5]. Patients with late-onset or atypical presentation can experience a delay in diagnosis and proper treatment. Some unexpected clinical findings may accompany classical features [6]. 

2. Demographic and Findings

Twenty-six patients diagnosed with GSD from 24 unrelated families were investigated. The initial laboratory findings are shown in Table 12. As a result of molecular analysis, 12 novel pathogenic variations were detected; GYS2 c.607A>G (p.Thr203Ala) and c.1307A>C (p.Gln436Pro), G6PC c.562+1G>A (p.), GBE1 c.1054G>C (p.Asp352His), PYGL c.1355G>T (p.Gly452Val), c.2380-1G>C p.(?), c.921_924del (p.His308Leufs*8), PHKA2 c.1978C>T (p.Leu660Phe), c.3028-2A>G (p.), c.3201G>T (p.Trp1067Cys), PHKB exon 18–21 deletion (p.), PHKA1 c.1963C>T (p.Arg655Cys) (Table 23).
Table 12. Initial laboratory and imaging features of patients.
ID Type Glycose

mg/dL		 AST

U/L		 ALT

IU/L		 CPK

U/L		 LDL

mg/dL		 HDL

mg/dL		 Cholesterol

mg/dL		 Triglyceride

mg/dL		 AFP

ng/mL		 Lactate

mg/dL		 Ketone Ultrasound and/or ECHO
. Molecular and enzymatic assays of patients.
ID Type Gene Inheritence Allele 1 Allele 2
P1 GSD0 37 26 16 55 95 61 168 68 1 30 + normal
P1 GSD0 GYS2 AR c.607A>G p.Thr203Ala c.1145G>A p.(Gly382Glu) P2 GSD0 35 30 18 68 79 68 172 56 1 26 ++
P2normal
GSD0 GYS2 P3 GSD0 49 16 30 67 58 c.1307A>C p.Gln436Pro65 136 64 1 11 + normal
P4 GSDIa 12 134 73
P4 GSDIa57 126 27 323 2007 2 65 + grade 1 steatosis
G6PC AR c.247C>T p.R83C c.247C>T p.R83C P5 GSDIa 14 65 71 49 136 41 213 546 2 40
P5 GSDIa G6PC++ hepatomegaly
AR c.247C>T p.R83C P6 GSDIa 9 282 133 67 149 23 341 1158 1 53 +++ heterogeneity in liver and kidney
c.247C>T p.R83C
P6 GSDIa G6PC AR P7 GSDIa 16 257 305 97 171 13 304 1200 2 97 + heterogeneity in liver and kidney
P8 GSDIa 73 197 187 67 184 44 284 944 1.5 35 neg hepatomegaly, heterogenity
P9 GSDIb 20 62 45 76 94 AR c.1043_1044delCT p.Pro348ArgfsTer519 167 267 1.2 c.1043_1044delCT p.Pro348ArgfsTer526 neg grade 1 steatosis
P10 GSD III 34 226 327 1760
P10 GSD III AGL AR138 12 225 c.1019delA p.Gln340fs c.1019delA p.Gln340fs370 1 43 neg grade 2 steatosis hepatomegaly
P11 GSDIII
P1171 705 867 867 186 30 217 GSDIII AGL AR479 4.4 42 neg grade 1 steatosis, hepatomegaly
c.1020del p.Glu340Aspfs*9 c.1020del p.Glu340Aspfs*9 P12 GSDIII
P12 GSDIII AGL AR c.4126C>T p.Gln1376 c.4126C>T p.Gln1376 P16 GSDV 100 33 18 318 95 38 178 69 − − neg normal
P13 GSDIV GBE1 AR c.1492G>A p.Glu498Lys c.1492G>A p.Glu498Lys
P14 GSDIV GBE1 AR c.1054G>C p.Asp352His c.1054G>C p.Asp352His P17
P15 GSDVI
P21 GSDIXa PH KA2 XL c.3614C>T p.Pro1205Leu c.3614C>T p.Pro1205Leu
P22 GSDIXa PHKA2 XL c.1978C>T p.Leu660Phe
67 1 9 +++ hepatomegaly
Abbreviations: AST: Aspartate transaminase, ALT: Alanine transaminase, CPK: Creatine phosphokinase, LDL: Low-density lipoprotein-cholesterol, HDL: High-density lipoprotein-cholesterol, AFP: Alpha-fetoprotein, ECHO: echocardiography. “+” (plus) means presence of the finding, “−” (minus) means absence of the finding.
Table 23
AR
c.607A>G p.Thr203Ala c.1145G>A p.(Gly382Glu)
P3 GSD0 GYS2 AR c.1307A>C p.Gln436Pro
c.562+1G>A
c.562+1G>A
P7 GSDIa G6PC AR c.247C>T p.Arg83Cys c.247C>T p.Arg83Cys
P8 GSD1a G6PC AR c.247C>T p.Arg83cys c.247C>T p.Arg83cys
P9 GSDIb SLC37A4
23
160 123 424 145 8 234 471 41 25 + grade 1 heterogeneity, hepatomegaly
P13 GSDIV 74 317 137 54 96 28 139 75 13 12 neg nodular heterogeneous liver
P14 GSDIV 65 158 14 57 104 46 172 106 18 13 neg nodular heterogeneous in liver
P15 GSDV 86 50 29 556 78 45 139 69 0.8 15 GSDVneg normal PYGM AR c.1A>G p.Met1Val c.1A>G p.Met1Val
P16 GSDV PYGM AR
74 545 444 87 104 22 178 241 2 25 + hepatomegaly
c.772+2_772+3delTG c.772+2_772+3delTG
P17 GSDVI PYGL AR c.1355G>T p.Gly452Val c.1355G>T p.Gly452Val P18 GSDVI 48 193 78 69 72 29 124 115 1.9 26 ++ hepatomegaly
P18 GSDVI PYGL AR c.2380-1G>C IVS19_1G>C c.2380-1G>C IVS19_1G>C P19 GSDVI 39 60 64 98 94 36 158 138 2.7 31 + hepatomegaly
P19 GSDVI PYGL AR c.2380+1G>C IVS19+1G>C c.2380+1G>C IVS19+1G>C P20 GSDVI 59 74 78 89 112 39 125 67 1.7 12 + grade 1 steatosis, hepatomegaly
P20 GSDVI PYGL AR c.921_924del p.His308Leufs*8 c.921_924del p.His308Leufs*8 P21 GSDIXa 45 225 189 356 153 17 224 276 1 12 + hepatomegaly, grade 1 steatosis
P22 GSDIXa 56 199 111 525 107 33 159 c.1978C>T p.Leu660Phe98 2 38 ++ hepatomegaly
P23 GSDIXa 65
P23 GSDIXa PHKA286 98 215 164 45 198 218 1.2 15 neg hepatomagaly, heterogenity, hypertophic CMP
XL c.3028-2A>G c.3028-2A>G P24 GSDIXa 75 68 64 218 120 72 208
P2471 − GSDIXa26 neg hepatomagaly
PHKA2 XL c.3201G>T p.Trp1067Cys c.3201G>T p.Trp1067Cys P25 GSDIXb 78 74 50
P25562 89 GSDIXb61 169 76 5 11 ++ grade 1 heterogeneity
PHKB AR Exon18_21 deletion Exon18_21 deletion P26 GSDIXd
P26 GSDIXd67 80 84 PHKA1 XL c.1963C>T p.Arg655Cys292 76 48 c.1963C>T p.Arg655Cys138
Abbreviations: AR: autosomal recessive, AD: autosomal dominant, XL: X-linked. The novel variants are shown in bold.

3. The phenotypic features and molecular diagnostic results of GSD

Another novel mutation of G6PC associated with GSDIa was detected in a patient; c.562+1G>A (P7, homozygous). The most striking finding was the bilateral sensorineural hearing impairment that was detected in two of the patients with different mutations (one with common, previously defined; c.247C>T and one with novel; c.562+1G>A, P6, P7, respectively) [7][8][9,10]. Iwanicka-Pronicka et al. [9][11] reported hearing impairment “at birth” in four (2 GSDIa; 2 GSDIb) out of 40 GSDI cases (20 patients with each subtype). The underlying mechanism has not been yet determined. Hearing impairment was determined when P6 was 6 months old and P7 was 18 months old; both of them passed newborn hearing screening tests and have normal brain MRI (magnetic resonance imaging), EEG (electroencephalogram), and neurocognitive development; they had a cochlear implant at the age of 1 and 2, respectively. Both have mild disarticulation and speech disturbance. As their hearing was normal at birth, auditory dysfunction gene panel or whole exome sequencing (WES) was not performed. For this reason, it would be appropriate to perform hearing evaluation in order to detect hearing loss early in GSD type 1 patients. Short stature and osteoporosis are remarkable findings among patients at any age, and may be due to inappropriate metabolic control, poor nutrition, the effects of lactic acidosis, or accompanying endocrinological problems (hypogonadism) [10][11][12][12,13,14]. The occurrence of osteoporosis in all of the patients, except the younger (P5), can be attributed to the above-mentioned factors.

Two missense mutations were identified in GBE1-related GSDIV (one previously defined; c.1492G>A p.E498K and one novel; c.1054G>C p.Asp352His, P13, P14, respectively). P14 typically presented with hypotonia, myopathy, and hepatopathy. There is no treatment for this case other than liver transplantation [13][17]. Apart from that, it also causes a complex neurological condition called “Adult Polyglucosan Body Disease” (APBD), which shows symptoms after the fifth decade of life. It presents a variable combination of cognitive impairment, pyramidal tetraparesis, peripheral neuropathy, cerebellar dysfunction, and extrapyramidal signs [14][15][18,19]. There is no reported case in the literature that has both severe hepatic and neuromuscular involvement at this age. Performing neurological follow-up of patients with GBE1 mutation from an earlier age will provide a chance for early detection of neurological findings.

GSDVI may present with different combinations of findings including hepatomegaly, mild-to-moderate hypoglycemia, hyperlactatemia, hyper-transaminasemia, and short stature [16][17][20,21]. Short stature with normal neuromotor development should be a warning sign for GSD type VI.

GSDIX is a group of glycogenoses caused by hepatic phosphorylase kinase deficiency, a hexadecameric enzyme comprising four copies each of four unique subunits encoded by four different genes; PHKA1, PHKA2, PHKB, and PHKG2 [16][18] [20,22]. Five out of six patients had novel mutated genes as follows; in PHKA2 c.1978C>T (p.Leu660Phe) (P22, homozygous) c.3028-2A>G (p.) (P23, homozygous), c.3201G>T (p.Trp1067Cys) (P24, homozygous), in PHKB exon 18_21 deletion (p.) (P25, homozygous), in PHKA1 c.1963C>T (p.Arg655Cys) (P26, homozygous). The most common findings are hepatomegaly, short stature, delay in motor development, the elevation of transaminases, cholesterol, and triglyceride, fasting hyperketosis, and hypoglycemia. 

4. Conclusions

It seems difficult to establish phenotype–genotype correlations in all types of GSDIX. Hearing impairment in GSD I, early peripheral neuropathy after liver transplantation in GSD IV, and psychomotor retardation, seizure, autism signs and hypertrophic cardiomyopathy in GSD IXa can be considered as newly determined, rare and unexcepted findings.

References

  1. Özen, H. Glycogen storage diseases: New perspectives. World J. Gastroenterol. 2007, 13, 2541–2553. Özen, H. Glycogen storage diseases: New perspectives. World J. Gastroenterol. 2007, 13, 2541–2553. [Google Scholar] [CrossRef] [PubMed]
  2. Priya, S.; Kishnani, D.K.; Yuan-Tsong, C. Glycogen Storage Diseases. Online Metabolic and Molecular Bases of Inherited Diseasel; McGraw-Hill: New York, NY, USA, 2001; Chapter 17. Priya, S.; Kishnani, D.K.; Yuan-Tsong, C. Glycogen Storage Diseases. Online Metabolic and Molecular Bases of Inherited Diseasel; McGraw-Hill: New York, NY, USA, 2001; Chapter 17. [Google Scholar]
  3. DiMauro, S.; Bruno, C. Glycogen storage diseases of muscle. Curr. Opin. Neurol. 1998, 11, 477–484. DiMauro, S.; Bruno, C. Glycogen storage diseases of muscle. Curr. Opin. Neurol. 1998, 11, 477–484. [Google Scholar] [CrossRef] [PubMed]
  4. Wolsdorf, J.I.; Holm, I.A.; Weinstein, D.A. Glycogen storage disease: Phenotypic, genetic, and biochemical characteristics, and therapy. Endocrinol. Metab. Clin. 1999, 28, 802–824. Wolsdorf, J.I.; Holm, I.A.; Weinstein, D.A. Glycogen storage disease: Phenotypic, genetic, and biochemical characteristics, and therapy. Endocrinol. Metab. Clin. 1999, 28, 802–824. [Google Scholar]
  5. Ley-Martos, M.; Salado-Reyes, M.J.; Espinosa-Rosso, R.; Solera-García, J.; Jiménez-Jiménez, L. Variability in the clinical presentation of Pompe disease: Development following enzyme replacement therapy. Rev. De Neurol. 2015, 61, 416–420. Ley-Martos, M.; Salado-Reyes, M.J.; Espinosa-Rosso, R.; Solera-García, J.; Jiménez-Jiménez, L. Variability in the clinical presentation of Pompe disease: Development following enzyme replacement therapy. Rev. De Neurol. 2015, 61, 416–420. [Google Scholar]
  6. Smith, C.; Care4Rare Canada Consortium; Dicaire, M.-J.; Brais, B.; La Piana, R. Neurological Involvement in Glycogen Storage Disease Type IXa due to PHKA2 Mutation. Can. J. Neurol. Sci. J. Can. Des. Sci. Neurol. 2020, 47, 400–403. Smith, C.; Care4Rare Canada Consortium; Dicaire, M.-J.; Brais, B.; La Piana, R. Neurological Involvement in Glycogen Storage Disease Type IXa due to PHKA2 Mutation. Can. J. Neurol. Sci. J. Can. Des. Sci. Neurol. 2020, 47, 400–403. [Google Scholar] [CrossRef]
  7. Stenson, P.D.; Mort, M.; Ball, E.V.; Shaw, K.; Philips, A.; Cooper, D.N. The Human Gene Mutation Database: Building a comprehensive mutation repository for clinical and molecular genetics, diagnostic testing and personalized genomic medicine. Hum. Genet. 2014, 133, 1–9. Laberge, A.M.; Mitchell, G.A.; Van De Werve, G.; Lambert, M. Long-term follow-up of a new case of liver glycogen synthase deficiency. Am. J. Med. Genet. 2003, 120A, 19–22. [Google Scholar] [CrossRef]
  8. Chou, J.Y.; Jun, H.S.; Mansfield, B. Type I glycogen storage diseases: Disorders of the glucose-6-phosphatase/glucose-6-phosphate transporter complexes. J. Inherit. Metab. Dis. 2015, 38, 511–519. Gitzelmann, R.; Spycher, M.A.; Feil, G.; Müller, J.; Seilnacht, B.; Stahl, M.; Bosshard, N.U. Liver glycogen synthase deficiency: A rarely diagnosed entity. Eur. J. Pediatr. 1996, 155, 561. [Google Scholar] [CrossRef] [PubMed]
  9. Iwanicka-Pronicka, K.; Trubicka, J.; Pronicki, M.; Szymanska, E.; Ciara, E.; Rokicki, R.; Wortmann, S. Hearing loss as a newly recognized symptom of GSD type I. A clinical report of four unrelated Polish patients. Res. Sq. 2020. Stenson, P.D.; Mort, M.; Ball, E.V.; Shaw, K.; Philips, A.; Cooper, D.N. The Human Gene Mutation Database: Building a comprehensive mutation repository for clinical and molecular genetics, diagnostic testing and personalized genomic medicine. Hum. Genet. 2014, 133, 1–9. [Google Scholar] [CrossRef]
  10. Smit, G.P.A. The long-term outcome of patients with glycogen storage disease type Ia. Eur. J. Nucl. Med. Mol. Imaging 1993, 152, 52–55. Chou, J.Y.; Jun, H.S.; Mansfield, B. Type I glycogen storage diseases: Disorders of the glucose-6-phosphatase/glucose-6-phosphate transporter complexes. J. Inherit. Metab. Dis. 2015, 38, 511–519. [Google Scholar] [CrossRef]
  11. Talente, G.M.; Coleman, R.A.; Alter, C.; Baker, L.; Brown, B.I.; Cannon, R.A.; Chen, Y.-T.; Crigler, J.F.; Ferreira, P.; Haworth, J.C.; et al. Glycogen Storage Disease in Adults. Ann. Intern. Med. 1994, 120, 218–226. Iwanicka-Pronicka, K.; Trubicka, J.; Pronicki, M.; Szymanska, E.; Ciara, E.; Rokicki, R.; Wortmann, S. Hearing loss as a newly recognized symptom of GSD type I. A clinical report of four unrelated Polish patients. Res. Sq. 2020. [Google Scholar] [CrossRef]
  12. Cabrera-Abreu, J.; Crabtree, N.J.; Elias, E.; Fraser, W.; Cramb, R.; Alger, S. Bone mineral density and markers of bone turnover in patients with glycogen storage disease types I, III and IX. J. Inherit. Metab. Dis. 2004, 27, 1–9. Smit, G.P.A. The long-term outcome of patients with glycogen storage disease type Ia. Eur. J. Nucl. Med. Mol. Imaging 1993, 152, 52–55. [Google Scholar] [CrossRef] [PubMed]
  13. Schene, I.F.; Korenke, C.G.; Huidekoper, H.H.; van der Pol, L.; Dooijes, D.; Breur, J.M.P.J.; Biskup, S.; Fuchs, S.A.; Visser, G. Glycogen Storage Disease Type IV: A Rare Cause for Neuromuscular Disorders or Often Missed? JIMD Rep. 2019, 45, 99–104. Talente, G.M.; Coleman, R.A.; Alter, C.; Baker, L.; Brown, B.I.; Cannon, R.A.; Chen, Y.-T.; Crigler, J.F.; Ferreira, P.; Haworth, J.C.; et al. Glycogen Storage Disease in Adults. Ann. Intern. Med. 1994, 120, 218–226. [Google Scholar] [CrossRef] [PubMed]
  14. Naddaf, E.; Kassardjıan, C.D.; Kurt, Y.G.; Akman, H.O.; Windebank, A.J. Adult polyglucosan body disease presenting as a unilateral progressive plexopathy. Muscle Nerve 2016, 53, 976–981. Cabrera-Abreu, J.; Crabtree, N.J.; Elias, E.; Fraser, W.; Cramb, R.; Alger, S. Bone mineral density and markers of bone turnover in patients with glycogen storage disease types I, III and IX. J. Inherit. Metab. Dis. 2004, 27, 1–9. [Google Scholar] [CrossRef]
  15. Schröder, J.M.; May, R.; Shin, Y.S.; Sigmund, M.; Nase-Hüppmeier, S. Juvenile hereditary polyglucosan body disease with complete branching enzyme deficiency (type IV glycogenosis). Acta Neuropath. 1993, 85, 419–430. Shen, J.; Bao, Y.; Liu, H.M.; Lee, P.; Leonard, J.V.; Chen, Y.T. Mutations in exon 3 of the glycogen debranching enzyme gene are associated with glycogen storage disease type III that is differentially expressed in liver and muscle. J. Clin. Investig. 1996, 98, 352–357. [Google Scholar] [CrossRef]
  16. Kishnani, P.S.; on behalf of the ACMG Work Group on Diagnosis and Management of Glycogen Storage Diseases Type VI and IX; Goldstein, J.; Austin, S.L.; Arn, P.; Bachrach, B.; Bali, D.S.; Chung, W.K.; El-Gharbawy, A.; Brown, L.M.; et al. Diagnosis and management of glycogen storage diseases type VI and IX: A clinical practice resource of the American College of Medical Genetics and Genomics (ACMG). Genet. Med. 2019, 21, 772–789. Parvari, R.; Moses, S.; Shen, J.; Hershkovitz, E.; Lerner, A.; Chen, Y.-T. A Single-Base Deletion in the 3’-Coding Region of Glycogen-Debranching Enzyme Is Prevalent in Glycogen Storage Disease Type IIIA in a Population of North African Jewish Patients. Eur. J. Hum. Genet. 1997, 5, 266–270. [Google Scholar] [CrossRef]
  17. Aeppli, T.R.; Rymen, D.; Allegri, G.; Bode, P.K.; Häberle, J. Glycogen storage disease type VI: Clinical course and molecular background. Eur. J. Nucl. Med. Mol. Imaging 2019, 179, 405–413. Schene, I.F.; Korenke, C.G.; Huidekoper, H.H.; van der Pol, L.; Dooijes, D.; Breur, J.M.P.J.; Biskup, S.; Fuchs, S.A.; Visser, G. Glycogen Storage Disease Type IV: A Rare Cause for Neuromuscular Disorders or Often Missed? JIMD Rep. 2019, 45, 99–104. [Google Scholar]
  18. Hidaka, F.; Sawada, H.; Matsuyama, M.; Nunoi, H. A novel mutation of the PHKA2 gene in a patient with X-linked liver glycogenosis type 1. Pediatr. Int. 2005, 47, 687–690. Naddaf, E.; Kassardjıan, C.D.; Kurt, Y.G.; Akman, H.O.; Windebank, A.J. Adult polyglucosan body disease presenting as a unilateral progressive plexopathy. Muscle Nerve 2016, 53, 976–981. [Google Scholar] [CrossRef] [PubMed]
  19. Schröder, J.M.; May, R.; Shin, Y.S.; Sigmund, M.; Nase-Hüppmeier, S. Juvenile hereditary polyglucosan body disease with complete branching enzyme deficiency (type IV glycogenosis). Acta Neuropath. 1993, 85, 419–430. [Google Scholar] [CrossRef]
  20. Kishnani, P.S.; on behalf of the ACMG Work Group on Diagnosis and Management of Glycogen Storage Diseases Type VI and IX; Goldstein, J.; Austin, S.L.; Arn, P.; Bachrach, B.; Bali, D.S.; Chung, W.K.; El-Gharbawy, A.; Brown, L.M.; et al. Diagnosis and management of glycogen storage diseases type VI and IX: A clinical practice resource of the American College of Medical Genetics and Genomics (ACMG). Genet. Med. 2019, 21, 772–789. [Google Scholar] [CrossRef] [PubMed]
  21. Aeppli, T.R.; Rymen, D.; Allegri, G.; Bode, P.K.; Häberle, J. Glycogen storage disease type VI: Clinical course and molecular background. Eur. J. Nucl. Med. Mol. Imaging 2019, 179, 405–413. [Google Scholar] [CrossRef] [PubMed]
  22. Hidaka, F.; Sawada, H.; Matsuyama, M.; Nunoi, H. A novel mutation of the PHKA2 gene in a patient with X-linked liver glycogenosis type 1. Pediatr. Int. 2005, 47, 687–690. [Google Scholar] [CrossRef] [PubMed]
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