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      A proposed nosology of inborn errors of metabolism

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          Abstract

          Purpose

          We propose a nosology for inborn errors of metabolism that builds on their recent redefinition.

          Methods

          We established a strict definition of criteria in order to develop a self-consistent schema for inclusion of a disorder into the nosology.

          Results

          We identified 1,015 well-characterized inborn errors of metabolism described in the literature. In addition, there are 111 less well-characterized conditions that may be inborn errors but do not meet strict criteria for inclusion in the current nosology.

          Conclusion

          We provide a master list of all currently recognized inborn errors of metabolism grouped according to their pathophysiological basis, with the hope of setting a standard against which new errors should be defined, as well as to promote awareness and foster collaboration in the area. With the rapid advances in the field of genetics in recent years, it is likely that this nosology will need to be updated in the near future, a process that will benefit from broader input and collaboration of experts in the field in order to improve future versions of the proposed classification.

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          Most cited references22

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          THE INCIDENCE OF ALKAPTONURIA : A STUDY IN CHEMICAL INDIVIDUALITY.

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            Inheritance of most X-linked traits is not dominant or recessive, just X-linked.

            The existence of X-linked disorders in humans has been recognized for many centuries, based on lessons in religious texts and observations of specific human families (e.g., color blindness or Daltonism). Our modern concepts of Mendelian (including X-linked) inheritance originated just after the turn of the last century. Early concepts of dominance and recessiveness were first used in conjunction with autosomal traits, and then applied to "sex"-linked traits to distinguish X-linked recessive and X-linked dominant inheritance. The former was defined as vertical transmission in which carrier women pass the disorder to affected sons, while the latter was defined as vertical transmission in which daughters of affected males are always affected, transmitting the disorder to offspring of both sexes. However, many X-linked disorders such as adrenoleukodystrophy, fragile X syndrome, and ornithine transcarbamylase deficiency do not fit these rules. We reviewed the literature on 32 X-linked disorders and recorded information on penetrance and expressivity in both sexes. As expected, penetrance and an index of severity of the phenotype (defined in our Methods) were both high in males, while the severity index was low in females. Contrary to standard presentations of X-linked inheritance, penetrance was highly variable in females. Our analysis classified penetrance as high in 28% of the disorders studied, intermediate in 31%, and low in 40%. The high proportion of X-linked disorders with intermediate penetrance is difficult to reconcile with standard definitions of X-linked recessive and dominant inheritance. They do not capture the extraordinarily variable expressivity of X-linked disorders or take into account the multiple mechanisms that can result in disease expression in females, which include cell autonomous expression, skewed X-inactivation, clonal expansion, and somatic mosaicism. We recommend that use of the terms X-linked recessive and dominant be discontinued, and that all such disorders be simply described as following "X-linked" inheritance. Copyright 2004 Wiley-Liss, Inc.
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              The Croonian Lectures ON INBORN ERRORS OF METABOLISM.

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                Author and article information

                Journal
                9815831
                22061
                Genet Med
                Genet. Med.
                Genetics in medicine : official journal of the American College of Medical Genetics
                1098-3600
                1530-0366
                21 March 2018
                08 June 2018
                09 December 2018
                : 10.1038/s41436-018-0022-8
                Affiliations
                [1 ]National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
                [2 ]Division of Genetics and Metabolism, Children's National Health System, Washington, DC, USA
                [3 ]Departments of Pediatrics and Clinical Genetics, Academic Medical Centre, Amsterdam, The Netherlands
                [4 ]Department of Pediatrics, Centre for Molecular Medicine and Therapeutics, University of British Columbia, Vancouver, Canada
                [5 ]Department of Pediatrics, University of Pittsburgh School of Medicine, Department of Human Genetics, Graduate School of Public Health, Pittsburgh, PA, USA
                [6 ]Dietmar-Hopp Metabolic Center, University Children's Hospital, Heidelberg, Germany
                Author notes
                Corresponding author: Carlos R. Ferreira, 10 Center Drive, Building 10, Room 9N248B, Bethesda, MD 20892-1851
                Article
                NIHMS953428
                10.1038/s41436-018-0022-8
                6286709
                29884839
                c40a1ea0-ba93-42a6-8e75-a8c5b558e48e

                Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use: http://www.nature.com/authors/editorial_policies/license.html#terms

                History
                Categories
                Article

                Genetics
                nosology,inborn errors of metabolism,inherited metabolic disorders,classification
                Genetics
                nosology, inborn errors of metabolism, inherited metabolic disorders, classification

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