Classical homocystinuria

General Information (adopted from Orphanet):

Synonyms, Signs: HOMOCYSTINURIA WITH OR WITHOUT RESPONSE TO PYRIDOXINE
CBS DEFICIENCY HYPERHOMOCYSTEINEMIA, THROMBOTIC, CBS-RELATED, INCLUDED
cystathionine beta-synthase deficiency
Homocystinuria due to cystathionine beta-synthase deficiency
Number of Symptoms 71
OrphanetNr: 394
OMIM Id: 236200
ICD-10: E72.1
UMLs:
MeSH:
MedDRA:
Snomed:

Prevalence, inheritance and age of onset:

Prevalence: 1.65 [Orphanet]
Inheritance: Autosomal recessive
[Orphanet]
Age of onset: Childhood
[Orphanet]

Disease classification (adopted from Orphanet):

Parent Diseases: AARSKOG SYNDROME, AUTOSOMAL DOMINANT
 -AARSKOG SYNDROME, AUTOSOMAL DOMINANT
Amino acid or protein metabolism disease with epilepsy
 -Rare neurologic disease
Developmental anomaly of metabolic origin
 -Rare developmental defect during embryogenesis
 -Rare genetic disease
Disorder of methionine cycle and sulfur amino acid metabolism
 -Rare genetic disease
 -Rare neurologic disease
Lens position anomaly
 -Rare eye disease
 -Rare genetic disease
Metabolic disease with cataract
 -Rare eye disease
 -Rare genetic disease
Neurometabolic disease
 -Rare genetic disease
 -Rare neurologic disease
Rare disease with glaucoma as a major feature
 -Rare eye disease
 -Rare genetic disease
Syndromic developmental defect of the eye
 -Rare developmental defect during embryogenesis
 -Rare eye disease
 -Rare genetic disease

Symptom Information: Sort by abundance 

1
(HPO:0002156) Homocystinuria 12 / 7739
2
(HPO:0000164) Abnormality of the teeth Very frequent [Orphanet] 291 / 7739
3
(HPO:0000678) Dental crowding 65 / 7739
4
(HPO:0000218) High palate 356 / 7739
5
(HPO:0002705) High, narrow palate Occasional [Orphanet] 308 / 7739
6
(HPO:0001083) Ectopia lentis Very frequent [Orphanet] 45 / 7739
7
(HPO:0000510) Rod-cone dystrophy Occasional [Orphanet] 266 / 7739
8
(HPO:0000541) Retinal detachment Occasional [Orphanet] 87 / 7739
9
(HPO:0000501) Glaucoma Occasional [Orphanet] 180 / 7739
10
(HPO:0000572) Visual loss Frequent [Orphanet] 272 / 7739
11
(HPO:0000545) Myopia Frequent [Orphanet] 286 / 7739
12
(HPO:0000518) Cataract Occasional [Orphanet] 454 / 7739
13
(HPO:0004374) Hemiplegia/hemiparesis Occasional [Orphanet] 158 / 7739
14
(HPO:0001250) Seizures Occasional [Orphanet] 1245 / 7739
15
(HPO:0012075) Personality disorder 4 / 7739
16
(HPO:0001249) Intellectual disability 1089 / 7739
17
(HPO:0000716) Depression 99 / 7739
18
(HPO:0000708) Behavioral abnormality Occasional [Orphanet] 212 / 7739
19
(HPO:0000768) Pectus carinatum Frequent [Orphanet] 136 / 7739
20
(HPO:0000939) Osteoporosis 129 / 7739
21
(HPO:0002751) Kyphoscoliosis 131 / 7739
22
(HPO:0011302) Long palm Very frequent [Orphanet] 70 / 7739
23
(HPO:0004586) Biconcave vertebral bodies 15 / 7739
24
(HPO:0002808) Kyphosis Frequent [Orphanet] 289 / 7739
25
(HPO:0002857) Genu valgum Frequent [Orphanet] 144 / 7739
26
(HPO:0000767) Pectus excavatum Frequent [Orphanet] 244 / 7739
27
(HPO:0001376) Limitation of joint mobility 27 / 7739
28
(HPO:0002650) Scoliosis Frequent [Orphanet] 705 / 7739
29
(HPO:0001166) Arachnodactyly 62 / 7739
30
(HPO:0002659) Increased susceptibility to fractures Very frequent [Orphanet] 110 / 7739
31
(HPO:0001387) Joint stiffness Frequent [Orphanet] 322 / 7739
32
(HPO:0004349) Reduced bone mineral density Very frequent [Orphanet] 165 / 7739
33
(HPO:0002239) Gastrointestinal hemorrhage Occasional [Orphanet] 97 / 7739
34
(HPO:0001397) Hepatic steatosis 75 / 7739
35
(HPO:0002039) Anorexia Occasional [Orphanet] 62 / 7739
36
(HPO:0004299) Hernia of the abdominal wall Occasional [Orphanet] 176 / 7739
37
(HPO:0002910) Elevated hepatic transaminases Occasional [Orphanet] 158 / 7739
38
(HPO:0002040) Esophageal varix Occasional [Orphanet] 23 / 7739
39
(HPO:0002240) Hepatomegaly Occasional [Orphanet] 467 / 7739
40
(HPO:0001733) Pancreatitis 46 / 7739
41
(HPO:0000023) Inguinal hernia 181 / 7739
42
(HPO:0001519) Disproportionate tall stature Frequent [Orphanet] 39 / 7739
43
(HPO:0001508) Failure to thrive Occasional [HPO:probinson] 454 / 7739
44
(HPO:0001933) Subcutaneous hemorrhage Occasional [Orphanet] 50 / 7739
45
(HPO:0000965) Cutis marmorata 46 / 7739
46
(HPO:0001025) Urticaria Occasional [Orphanet] 73 / 7739
47
(HPO:0002299) Brittle hair 52 / 7739
48
(HPO:0001006) Hypotrichosis Frequent [Orphanet] 219 / 7739
49
(HPO:0001010) Hypopigmentation of the skin 46 / 7739
50
(HPO:0002170) Intracranial hemorrhage Occasional [Orphanet] 40 / 7739
51
(HPO:0001297) Stroke 44 / 7739
52
(HPO:0000822) Hypertension Frequent [Orphanet] 224 / 7739
53
(HPO:0001634) Mitral valve prolapse 69 / 7739
54
(HPO:0002140) Ischemic stroke Frequent [Orphanet] 70 / 7739
55
(HPO:0100026) Arteriovenous malformation Frequent [Orphanet] 38 / 7739
56
(HPO:0001658) Myocardial infarction 30 / 7739
57
(HPO:0004420) Arterial thrombosis Frequent [Orphanet] 20 / 7739
58
(HPO:0001907) Thromboembolism 15 / 7739
59
(HPO:0004936) Venous thrombosis Frequent [Orphanet] 41 / 7739
60
(HPO:0002204) Pulmonary embolism Frequent [Orphanet] 26 / 7739
61
(HPO:0000007) Autosomal recessive inheritance 2538 / 7739
62
(HPO:0012795) Abnormality of the optic disc Occasional [Orphanet] 187 / 7739
63
(OMIM) Occasional failure to thrive in infancy 1 / 7739
64
(OMIM) Malar flush 1 / 7739
65
(OMIM) Fine, brittle hair 2 / 7739
66
(HPO:0012758) Neurodevelopmental delay Frequent [Orphanet] 949 / 7739
67
(HPO:0040160) Generalized osteoporosis 7 / 7739
68
(OMIM) Normal to tall stature 3 / 7739
69
(MedDRA:10071093) Cystathionine beta-synthase deficiency 1 / 7739
70
(OMIM) Fatty changes in liver 1 / 7739
71
(OMIM) Methioninuria 1 / 7739

Associated genes:

CBS;

ClinVar (via SNiPA)

Gene symbol Variation Clinical significance Reference

Additional Information:

Description: (OMIM) Classic homocystinuria is an autosomal recessive metabolic disorder of sulfur metabolism. The clinical features of untreated homocystinuria due to CBS deficiency usually manifest in the first or second decade of life and include myopia, ectopia lentis, mental retardation, skeletal ...
Diagnosis OMIM Spaeth and Barber (1967) described a silver-nitroprusside test that was almost completely specific for homocystine. Wadman et al. (1983) referred to the cyanide-nitroprusside reaction used in the detection of cystinuria and homocystinuria as the Brand reaction.

Uhlendorf ...

Clinical Description OMIM Homocystinuria was discovered independently by Gerritsen et al. (1962) in Madison, Wisconsin, and by Carson and Neill (1962) in Belfast, Northern Ireland. The patients of both groups were studied because of mental retardation.

Mudd et al. (1985) ...

Genotype-Phenotype Correlations OMIM Kluijtmans et al. (1999) investigated the molecular basis of CBS deficiency in 29 Dutch patients from 21 unrelated pedigrees and studied the possibility of a genotype-phenotype relationship with regard to biochemical and clinical expression and response to homocysteine-lowering treatment. ...
Molecular genetics OMIM With a rabbit antiserum against human hepatic CBS, Skovby et al. (1984) studied the enzyme in cultured fibroblasts derived from 17 homocystinuric patients. In 15 of the 17 lines, the enzyme had subunits indistinguishable in size from the normal ...
Population genetics OMIM Homocystinuria has been observed in Japan (Tada et al., 1967) and in persons of many different ethnic extractions living in the United States (Schimke et al., 1965).

Carey et al. (1968) pointed out that 27 cases had ...

Diagnosis GeneReviews Classic homocystinuria discussed in this GeneReview is caused by deficiency of cystathionine β-synthase (CBS), a pyridoxine (vitamin B6)-dependent enzyme. Because homocysteine is at the branch point between transsulfuration and methionine remethylation in the methionine metabolic cycle, a block at CBS limits transsulfuration and results in both increased homocysteine and increased methionine, the latter caused by enhanced remethylation (Figure 1)....
Clinical Description GeneReviews Homocystinuria is characterized by involvement of the eye, skeletal system, vascular system, and CNS. All four, or only one, of the systems can be involved. Expressivity is variable for all of the clinical signs. It is not unusual for a previously asymptomatic individual to present in adult years with only a thromboembolic event that is often cerebrovascular [Yap 2003, Skovby et al 2010]....
Differential Diagnosis GeneReviews The clinical condition that most closely mimics classic homocystinuria is Marfan syndrome, which shares the features of long thin body habitus, arachnodactyly, and predisposition for ectopia lentis and myopia. Although ectopia lentis can also occur early in sulfite oxidase deficiency, this condition is clinically distinct from homocystinuria. Individuals with sulfite oxidase deficiency and Marfan syndrome have normal concentrations of plasma homocystine, total homocysteine, and methionine....
Management GeneReviews To establish the extent of disease in all individuals diagnosed with homocystinuria caused by cystathionine beta synthase deficiency, a pyridoxine (vitamin B6) challenge should be conducted before treatment is begun (see Testing, Pyridoxine (B6) challenge test)....
Molecular genetics GeneReviews Information in the Molecular Genetics and OMIM tables may differ from that elsewhere in the GeneReview: tables may contain more recent information. —ED....