Glycogen Storage Diseases

Korlimarla, Aditi; Gibson, Rebecca; Kishnani, Priya S.

doi:10.1007/978-3-030-94510-7_25

Cited by 1 publication

(1 citation statement)

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“…Glycogen storage disease type I (GSD1), or von Gierke's disease, was the first form of glycogenosis to be described and also the first one for which the enzyme deficiency-glucose-6-phosphatase deficiency-was elucidated soon after the discovery of this enzyme [1]. The symptoms of this disease (reviewed in [2]), principally hepatomegaly (and nephromegaly), due to glycogen accumulation in the liver and the kidneys, together with hypoglycemia and lactic acidosis, are an obvious consequence of a lack of glycogen degradation and the conversion of gluconeogenic precursors to glucose in the two organs that are by far the most important ones for the production of glucose during fasting.…”

Section: Introductionmentioning

confidence: 99%

Treatment of the Neutropenia Associated with GSD1b and G6PC3 Deficiency with SGLT2 Inhibitors

et al. 2023

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Glycogen storage disease type Ib (GSD1b) is due to a defect in the glucose-6-phosphate transporter (G6PT) of the endoplasmic reticulum, which is encoded by the SLC37A4 gene. This transporter allows the glucose-6-phosphate that is made in the cytosol to cross the endoplasmic reticulum (ER) membrane and be hydrolyzed by glucose-6-phosphatase (G6PC1), a membrane enzyme whose catalytic site faces the lumen of the ER. Logically, G6PT deficiency causes the same metabolic symptoms (hepatorenal glycogenosis, lactic acidosis, hypoglycemia) as deficiency in G6PC1 (GSD1a). Unlike GSD1a, GSD1b is accompanied by low neutrophil counts and impaired neutrophil function, which is also observed, independently of any metabolic problem, in G6PC3 deficiency. Neutrophil dysfunction is, in both diseases, due to the accumulation of 1,5-anhydroglucitol-6-phosphate (1,5-AG6P), a potent inhibitor of hexokinases, which is slowly formed in the cells from 1,5-anhydroglucitol (1,5-AG), a glucose analog that is normally present in blood. Healthy neutrophils prevent the accumulation of 1,5-AG6P due to its hydrolysis by G6PC3 following transport into the ER by G6PT. An understanding of this mechanism has led to a treatment aimed at lowering the concentration of 1,5-AG in blood by treating patients with inhibitors of SGLT2, which inhibits renal glucose reabsorption. The enhanced urinary excretion of glucose inhibits the 1,5-AG transporter, SGLT5, causing a substantial decrease in the concentration of this polyol in blood, an increase in neutrophil counts and function and a remarkable improvement in neutropenia-associated clinical signs and symptoms.

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Section: Introductionmentioning

confidence: 99%