Skip to main content
Log in

Liver involvement in congenital disorders of glycosylation (CDG). A systematic review of the literature

  • Review
  • Published:
Journal of Inherited Metabolic Disease

Abstract

Congenital disorders of glycosylation (CDG) are a rapidly growing family of genetic diseases caused by defects in glycosylation. Nearly 100 CDG types are known so far. Patients present a great phenotypic diversity ranging from poly- to mono-organ/system involvement and from very mild to extremely severe presentation. In this literature review, we summarize the liver involvement reported in CDG patients. Although liver involvement is present in only a minority of the reported CDG types (22 %), it can be debilitating or even life-threatening. Sixteen of the patients we collated here developed cirrhosis, 10 had liver failure. We distinguish two main groups: on the one hand, the CDG types with predominant or isolated liver involvement including MPI-CDG, TMEM199-CDG, CCDC115-CDG, and ATP6AP1-CDG, and on the other hand, the CDG types associated with liver disease but not as a striking, unique or predominant feature, including PMM2-CDG, ALG1-CDG, ALG3-CDG, ALG6-CDG, ALG8-CDG, ALG9-CDG, PGM1-CDG, and COG-CDG. This review aims to facilitate CDG patient identification and to understand CDG liver involvement, hopefully leading to earlier diagnosis, and better management and treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

Abbreviations

AF:

Alpha-fetoprotein

AP:

Alkaline phosphatase

ALT:

Alanine aminotransferase

AST:

Aspartate aminotransferase

AT:

Antithrombin

CDG:

Congenital disorder(s) of glycosylation

CK:

Creatine kinase

ER:

Endoplasmic reticulum

ERGIC:

Endoplasmic reticulum-Golgi intermediate compartment

γ-GT:

Gamma-glutamyl transferase

IEF:

Isoelectrofocusing

PT:

Prothrombin time

PTT:

Partial thromboplastin time

TA:

Transaminases

References

  • AlSubhi S, AlHashem A, AlAzami A et al (2015) Further delineation of the ALG9-CDG phenotype. JIMD Rep 27:107–112

    Article  PubMed  PubMed Central  Google Scholar 

  • Arnoux JB, Boddaert N, Valayannopoulos V et al (2008) Risk assessment of acute vascular events in congenital disorder of glycosylation type Ia. Mol Genet Metab 93:444–449

    Article  CAS  PubMed  Google Scholar 

  • Aronica E, van Kempen AAMW, van der Heide M et al (2005) Congenital disorder of glycosylation type Ia: a clinicopathological report of a newborn infant with cerebellar pathology. Acta Neuropathol 109:433–442

    Article  CAS  PubMed  Google Scholar 

  • Babovic-Vuksanovic D, Patterson MC, Schwenk WF et al (1999) Severe hypoglycemia as a presenting symptom of carbohydrate-deficient glycoprotein syndrome. J Pediatr 135:775–781

    Article  CAS  PubMed  Google Scholar 

  • Barone R, Sturiale L, Fiumara A, Uziel G, Garozzo D, Jaeken J (2007) Borderline mental development in a congenital disorder of glycosylation (CDG) type Ia patient with multisystemic involvement (intermediate phenotype). J Inherit Metab Dis 30:107

    Article  CAS  PubMed  Google Scholar 

  • Blomme B, Van Steenkiste C, Callewaert N, Van Vlierberghe H (2009) Alteration of protein glycosylation in liver diseases. J Hepatol 50:592–603

    Article  CAS  PubMed  Google Scholar 

  • Chantret I, Dancourt J, Dupre T et al (2003) A deficiency in dolichyl-P-glucose: Glc1Man9GlcNAc2-PP-dolichyl alpha3-glucosyltransferase defines a new subtype of congenital disorders of glycosylation. J Biol Chem 298:9962–9971

    Article  Google Scholar 

  • Choi R, Woo HI, Choe B-H (2015) Application of whole exome sequencing to a rare inherited metabolic disease with neurological and gastrointestinal manifestations: a congenital disorder of glycosylation mimicking glycogen storage disease. Clin Chim Acta 444:50–53

    Article  CAS  PubMed  Google Scholar 

  • Damen G, de Klerk H, Huijmans J, den Hollander J, Sinaasappel M (2004) Gastrointestinal and other clinical manifestations in 17 children with congenital disorders of glycosylation type Ia, Ib, and Ic. J Pediatr Gastroenterol Nutr 38:282–287

    Article  PubMed  Google Scholar 

  • de Koning TJ, Dorland L, van Diggelen OP et al (1998) A novel disorder of N-glycosylation due to phosphomannose isomerase deficiency. Biochem Biophys Res Commun 245:38–42

    Article  PubMed  Google Scholar 

  • de Lonlay P, Seta N (2009) The clinical spectrum of phosphomannose isomerase deficiency, with an evaluation of mannose treatment for CDG-Ib. Biochim Biophys Acta 1792:841–843

    Article  PubMed  Google Scholar 

  • de Lonlay P, Seta N, Barrot S et al (2001) A broad spectrum of clinical presentations in congenital disorders of glycosylation I: a series of 26 cases. J Med Genet 38:14–19

    Article  PubMed  PubMed Central  Google Scholar 

  • Eklund EA, Sun L, Westphal V, Northrop JL, Freeze HH, Scaglia F (2005) Congenital disorder of glycosylation (CDG)-Ih patient with a severe hepato-intestinal phenotype and evolving central nervous system pathology. J Pediatr 147:847–850

    Article  PubMed  Google Scholar 

  • Eklund EA, Sun L, Yang SP, Pasion RM, Thorland EC, Freeze HH (2006) Congenital disorder of glycosylation Ic due to a de novo deletion and an hALG-6 mutation. Biochem Biophys Res Commun 339:755–760

    Article  CAS  PubMed  Google Scholar 

  • Ferro JM, Viana P, Santos P (2016) Management of neurologic manifestations in patients with liver disease. Curr Treat Options Neurol 18:37

    Article  PubMed  Google Scholar 

  • Foulquier F, Vasile E, Schollen E et al (2006) Conserved oligomeric Golgi complex subunit 1 deficiency reveals a previously uncharacterized congenital disorder of glycosylation type II. PNAS 103:3764–3769

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Frank CG, Grubenmann CE, Eyaid W, Berger EG, Aebi M, Hennet T (2004) Identification and functional analysis of a defect in the human ALG9 Gene: definition of congenital disorder of glycosylation type IL. Am J Hum Genet 75:146–150

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Freeze HH, Chong JX, Bamshad MJ, Ng BG (2014) Solving glycosylation disorders: fundamental approaches reveal complicated pathways. Am J Hum Genet 94:161–175

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Fung CW, Matthijs G, Sturiale L et al (2012) COG5-CDG with a mild neurohepatic presentation. JIMD Rep 3:67–70

    Article  CAS  PubMed  Google Scholar 

  • Grubenmann CE, Frank CG, Hülsmeier AJ et al (2004) Deficiency of the first mannosylation step in the N-glycosylation pathway causes congenital disorder of glycosylation type Ik. Hum Mol Genet 13:535–542

    Article  CAS  PubMed  Google Scholar 

  • Grünewald S (2009) The clinical spectrum of phosphomannomutase 2 deficiency (CDG-Ia). Biochim Biophys Acta 1792:827–834

    Article  PubMed  Google Scholar 

  • Grünewald S, De Vos R, Jaeken J (2003) Abnormal lysosomal inclusions in liver hepatocytes but not in fibroblasts in congenital disorders of glycosylation (CDG). J Inherit Metab Dis 26:49–54

    Article  PubMed  Google Scholar 

  • Hendriksz CJ, McClean P, Henderson MJ et al (2001) Successful treatment of carbohydrate deficient glycoprotein syndrome type 1b with oral mannose. Arch Dis Child 85:339–340

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hernández EM, Vega Pajares AIV, González BP et al (2008) Defecto congénito de glucosilación tipo Ib. experiencia en el tratamiento con manosa. An Pediatr (Barc) 69:358–365

    Article  Google Scholar 

  • Höck M, Wegleiter K, Ralser E et al (2015) ALG8-CDG: novel patients and review of the literature. Orphanet J Rare Dis 10:73–80

    Article  PubMed  PubMed Central  Google Scholar 

  • Jaeken J, Morava E (2016) Congenital disorders of glycosylation and dolichol and glycosylphosphatidylinositol metabolism. In: Saudubray, Baumgartner, Walter (ed) Inborn metabolic diseases. diagnosis and treatment, 6th edn. Springer, Berlin, pp 607–622

    Chapter  Google Scholar 

  • Jaeken J, Stibler H, Hagberg B (1991) The carbohydrate-deficient glycoprotein syndrome. a new inherited multisystemic disease with severe nervous system involvement. Acta Paediatr Scand Suppl 375:1–71

    CAS  PubMed  Google Scholar 

  • Jaeken J, Matthijs G, Saudubray J-M et al (1998) Phosphomannose isomerase deficiency: a carbohydrate-deficient glycoprotein syndrome with hepatic-intestinal presentation. Am J Hum Genet 62:1535–1539

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Jaeken J, Lefeber D, Matthijs G (2014) Clinical utility gene card for: phosphomannose isomerase deficiency. Eur J Hum Genet. doi:10.1038/ejhg.2014.29

    Google Scholar 

  • Jaeken J, Lefeber D, Matthijs G (2015a) Clinical utility gene card for: ALG1 defective congenital disorder of glycosylation. Eur J Hum Genet. doi:10.1038/ejhg.2015.9

    Google Scholar 

  • Jaeken J, Lefeber D, Matthijs G (2015b) Clinical utility gene card for: ALG6 defective congenital disorder of glycosylation. Eur J Hum Genet. doi:10.1038/ejhg.2014.146

    Google Scholar 

  • Jansen JC, Timal S, van Scherpenzeel M et al (2016a) TMEM199 deficiency is a disorder of Golgi homeostasis characterized by elevated aminotransferases, alkaline phosphatase, and cholesterol and abnormal glycosylation. Am J Hum Genet 98:322–330

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Jansen JC, Cirak S, van Scherpenzeel M et al (2016b) CCDC115 deficiency causes a disorder of golgi homeostasis with abnormal protein glycosylation. Am J Hum Genet 98:310–321

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Jansen EJR, Timal S, Ryan M et al (2016c) ATP6AP1 deficiency causes an immunodeficiency with hepatopathy, cognitive impairment and abnormal protein glycosylation. Nat Commun 7:11600

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Janssen MCH, de Kleine RH, van den Berg AP et al (2014) Successful liver transplantation and long-term follow-up in a patient with MPI-CDG. Pediatrics 134:e279–e283

    Article  PubMed  Google Scholar 

  • Kelly DF, Boneh A, Pitsch S et al (2001) Carbohydrate-deficient glycoprotein syndrome 1b: a new answer to an old diagnostic dilemma. J Paediatr Child Health 37:510–512

    Article  CAS  PubMed  Google Scholar 

  • Kjaergaard S, Schwartz M, Skovby F (2001) Congenital disorder of glycosylation type Ia (CDG-Ia): phenotypic spectrum of the R141H/F119L genotype. Arch Dis Child 85:236–239

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kodera H, Ando N, Yuasa I et al (2015) Mutations in COG2 encoding a subunit of the conserved oligomeric golgi complex cause a congenital disorder of glycosylation. Clin Genet 87:455–460

    Article  CAS  PubMed  Google Scholar 

  • Kornak U, Reynders E, Dimopoulou A et al (2008) Impaired glycosylation and cutis laxa caused by mutations in the vesicular H+-ATPase subunit ATP6V0A2. Nat Genet 40:32–34

    Article  CAS  PubMed  Google Scholar 

  • Lepais L, Cheillan D, Frachon SC et al (2015) ALG3-CDG: report of two siblings with antenatal features carrying homozygous p.Gly96Arg Mutation. Am J Med Genet 167A:2748–2754

    Article  PubMed  Google Scholar 

  • Liem YS, Bode L, Freeze HH, Leebeek FWG, Zandbergen AAM, Wilson JHP (2008) Using heparin therapy to reverse protein-losing enteropathy in a patient with CDG-Ib. Nat Clin Pract Gastroenterol Hepatol 5:220–224

    Article  PubMed  Google Scholar 

  • Mention K, Lacaille F, Valayannopoulos V et al (2008) Development of liver disease despite mannose treatment in two patients with CDG-Ib. Mol Genet Metabol 93:40–43

    Article  CAS  Google Scholar 

  • Miura Y, Tay SKH, Aw MM, Eklund E, Freeze HH (2005) Clinical and biochemical characterization of a patient with congenital disorder of glycosylation (CDG) IIX. J Pediatr 147:851–853

    Article  PubMed  Google Scholar 

  • Monin ML, Mignot C, De Lonlay P et al (2014) 29 French adult patients with PMM2-congenital disorder of glycosylation: outcome of the classical pediatric phenotype and depiction of a late-onset phenotype. Orphanet J Rare Dis 9:207

    Article  PubMed  PubMed Central  Google Scholar 

  • Monticelli M, Ferro T, Jaeken J, Dos Reis Ferreira V, Videira PA (2016) Immunological aspects of congenital disorders of glycosylation (CDG): a review. J Inherit Metab Dis 39:765–780

    Article  CAS  PubMed  Google Scholar 

  • Morava E (2014) Galactose supplementation in phosphoglucomutase-1 deficiency; review and outlook for a novel treatable CDG. Mol Genet Metab 112:275–279

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Morava E, Zeevaert R, Korsch E et al (2007) A common mutation in the COG7 gene with a consistent phenotype including microcephaly, adducted thumbs, growth retardation, VSD and episodes of hyperthermia. Eur J Hum Genet 15:638–665

    Article  CAS  PubMed  Google Scholar 

  • Morava E, Vodopiutz J, Lefeber DJ et al (2012) Defining the phenotype in congenital disorder of glycosylation due to ALG1 mutations. Pediatrics 130:e1034–e1039

    Article  PubMed  Google Scholar 

  • Morava E, Tiemes V, Thiel C et al (2016) ALG6-CDG: a recognizable phenotype with epilepsy, proximal muscle weakness, ataxia and behavior and limb anomalies. J Inherit Metab Dis 39:713–723

    Article  CAS  PubMed  Google Scholar 

  • Ng BG, Kranz C, Hagebeuk EEO et al (2007) Molecular and clinical characterization of a Moroccan Cog7 deficient patient. Mol Genet Metab 91:201–204

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ng BG, Sharma V, Sun L et al (2011) Identification of the first COG-CDG patient of Indian origin. Mol Genet Metab 102:364–367

    Article  CAS  PubMed  Google Scholar 

  • Ng BG, Shiryaev SA, Rymen D et al (2016) ALG1-CDG: clinical and molecular characterization of 39 unreported patients. Hum Mutat 37:653–660

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Niehues R, Hasilik M, Alton G et al (1998) Carbohydrate-deficient glycoprotein syndrome type Ib. phosphomannose isomerase deficiency and mannose therapy. J Clin Invest 101:1414–1420

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ono H, Sakura N, Yamashita K, Yuasa I, Ohno K (2003) Novel nonsense mutation (R194X) in the PMM2 gene in a Japanese patient with congenital disorder of glycosylation type Ia. Brain Dev 27:525–528

    Article  Google Scholar 

  • Panneerselvam K, Freeze HH (1996) Mannose enters mammalian cells using a specific transporter that is insensitive to glucose. J Biol Chem 271:9417–9421

    Article  CAS  PubMed  Google Scholar 

  • Reynders E, Foulquier F, Leão Teles E et al (2009) Golgi function and dysfunction in the first COG4-deficient CDG type II patient. Hum Mol Genet 18:3244–3256

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Rohlfing A-K, Rust S, Reunert J et al (2014) ALG1-CDG: a new case with early fatal outcome. Gene 534:345–351

    Article  CAS  PubMed  Google Scholar 

  • Rymen D, Winter J, Van Hasselt PM et al (2015) Key features and clinical variability of COG6-CDG. Mol Genet Metabol 116:163–170

    Article  CAS  Google Scholar 

  • Schollen E, Frank CG, Keldermans L et al (2004) Clinical and molecular features of three patients with congenital disorders of glycosylation type Ih (CDG-Ih) (ALG8 deficiency). J Med Genet 41:550–556

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Serrano M, de Diego V, Muchart J et al (2015) Phosphomannomutase deficiency (PMM2-CDG): ataxia and cerebellar assessment. Orphanet J Rare Dis 10:138

    Article  PubMed  PubMed Central  Google Scholar 

  • Shanti B, Silink M, Bhattacharya K et al (2009) Congenital disorder of glycosylation type Ia: heterogeneity in the clinical presentation from multivisceral failure to hyperinsulinaemic hypoglycaemia as leading symptoms in three infants with phosphomannomutase deficiency. J Inherit Metab Dis 32:S241–S251

    Article  PubMed  Google Scholar 

  • Sorte H, Mørkrid L, Rødningen O et al (2012) Severe ALG8-CDG (CDG-Ih) associated with homozygosity for two novel missense mutations detected by exome sequencing of candidate genes. Eur J Med Genet 55:196–202

    Article  PubMed  Google Scholar 

  • Spaapen LJM, Bakker JA, Van Der Meer SB et al (2005) Clinical and biochemical presentation of siblings with COG-7 deficiency, a lethal multiple O- and N-glycosylation disorder. J Inherit Metab Dis 28:707–714

    Article  CAS  PubMed  Google Scholar 

  • Sparks SE, Krasnewich DM (2014) Congenital disorders of N-linked glycosylation. pathway overview. In: Pagon RA, Adam MP, Ardinger HH, Wallace SE, Amemiya A, Bean LJH, Bird TD, Fong CT, Mefford HC, Smith RJH, Stephens K (eds) eneReviews®. University of Washington, Seattle, pp 1993–2016

    Google Scholar 

  • Sun L, Eklund EA, Chung WK, Wang C, Cohen J, Freeze HH (2005) Congenital disorder of glycosylation Id presenting with hyperinsulinemic hypoglycemia and islet cell hyperplasia. J Clin Endocrinol Metab 90:4371–4375

    Article  CAS  PubMed  Google Scholar 

  • Tegtmeyer LC, Rust S, van Scherpenzeel M et al (2014) Multiple phenotypes in phosphoglucomutase 1 deficiency. N Eng J Med 370:533–542

    Article  CAS  Google Scholar 

  • Vesela K, Honzik T, Hansikova H et al (2009) A new case of ALG8 deficiency (CDG Ih). J Inherit Metab Dis 32:259–264

    Article  CAS  Google Scholar 

  • Vleugels W, Keldermans L, Jaeken J et al (2009) Quality control of glycoproteins bearing truncated glycans in an ALG9-defective (CDG-IL) patient. Glycobiology 19:910–917

    Article  CAS  PubMed  Google Scholar 

  • Weinstein M, Schollen, Matthijs G et al (2005) CDG-IL: an infant with a novel mutation in the ALG9 gene and additional phenotypic features. Am J Med Genet 136A:194–197

    Article  Google Scholar 

  • Westphal V, Kjaergaard S, Davis JÁ, Peterson SM, Skovby F, Freeze HH (2001) Genetic and metabolic analysis of the first adult with congenital disorder of glycosylation type Ib: long-term outcome and effects of mannose supplementation. Mol Genet Metabol 73:77–85

    Article  CAS  Google Scholar 

  • Wong SY, Beamer LJ, Gadomski T et al (2016) Defining the phenotype and assessing severity in phosphoglucomutase-1 deficiency. J Pediatr 175:130–136

    Article  CAS  PubMed  Google Scholar 

  • Wu X, Steet RA, Bohorov O et al (2004) Mutation of the COG complex subunit gene COG7 causes a lethal congenital disorder. Nat Med 10:518–523

    Article  CAS  PubMed  Google Scholar 

  • Zeevaert R, Foulquier F, Cheillan D et al (2009) A new mutation in COG7 extends the spectrum of COG subunit deficiencies. Eur J Med Genet 52:303–305

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Dorinda Marques da Silva acknowledges support from the “Second Liliana Scientific Scholarship 2016”. We also thank the CDG & Allies – Professionals and Patient Associations International Network (CDG & Allies PPAIN), whose network expertise greatly helped this manuscript. We are grateful to Diogo Sampaio (http://www.diogosampaio.pt/), who helped design Fig. 1 of this publication.

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to J. Jaeken or D. Cassiman.

Ethics declarations

Conflict of interests

Vanessa dos Reis Ferreira is President and founder of the Portuguese Association for CDG and other Rare Metabolic Diseases (APCDG-DMR). All other authors declare no competing financial interests.

Funding

This work was supported by the CDG Professionals and Patient Associations International Network(CDG & Allies – PPAIN) and Liliana Fellowships from APCDG attributed to Marques-da-Silva D. and Monticelli M. The authors confirmed independence from the sponsors, the content of the article has not been influenced by sponsors.

Additional information

Communicated by: Eva Morava

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 69 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Marques-da-Silva, D., dos Reis Ferreira, V., Monticelli, M. et al. Liver involvement in congenital disorders of glycosylation (CDG). A systematic review of the literature. J Inherit Metab Dis 40, 195–207 (2017). https://doi.org/10.1007/s10545-016-0012-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10545-016-0012-4

Keywords

Navigation