Hyperornithinemia-hyperammonemia-homocitrullinuria

General Information (adopted from Orphanet):

Synonyms, Signs: HHH
HHHS
ORNT1 deficiency
Ornithine carrier deficiency
Ornithine translocase deficiency
Triple H syndrome
hhh syndrome
Number of Symptoms 82
OrphanetNr: 415
OMIM Id: 238970
ICD-10: E72.4
UMLs:
MeSH:
MedDRA:
Snomed:

Prevalence, inheritance and age of onset:

Prevalence: No data available.
Inheritance: Autosomal recessive
25874378 [IBIS]
Age of onset: Neonatal
Infancy
Childhood
25874378 [IBIS]

Disease classification (adopted from Orphanet):

Parent Diseases: Disorder of urea cycle metabolism and ammonia detoxification
 -Rare genetic disease

Comment:

Hyperornithinemia-hyperammonemia-homocitrullinuria belongs to the class of urea cycle disorders and is caused by mutations in the gene SLC25A15 (ORNT1) encoding the ornthine/citrulline transporter. HHH syndrome is characterized by high clinical variability (PMID:25874378). Most of the patients with ORNT1-deficiencies have a later onset and milder clinical course when compared to patients with ornithine transcarbamylase deficiency since additional transporters with overlapping function exist (PMID:19287344).

Symptom Information: Sort by abundance 

1
(HPO:0002574) Episodic abdominal pain 23247599 IBIS 10 / 7739
2
(HPO:0002014) Diarrhea 23430880 IBIS 225 / 7739
3
(HPO:0011968) Feeding difficulties 22649802 IBIS 240 / 7739
4
(HPO:0002013) Vomiting Frequent [IBIS] 3116497 IBIS 191 / 7739
5
(HPO:0002572) Episodic vomiting Frequent [IBIS] 25874378 IBIS 12 / 7739
6
(HPO:0002038) Protein avoidance 18978333; 25874378 IBIS 7 / 7739
7
(HPO:0007648) Punctate cataract Rare [IBIS] 25411929 IBIS 2 / 7739
8
(HPO:0000533) Chorioretinal atrophy 25411929 IBIS 24 / 7739
9
(HPO:0012152) Foveoschisis Rare [IBIS] 25411929 IBIS 3 / 7739
10
(HPO:0000639) Nystagmus 23247599 IBIS 555 / 7739
11
(HPO:0000662) Nyctalopia Rare [IBIS] 25411929 IBIS 92 / 7739
12
(HPO:0000529) Progressive visual loss Occasional [IBIS] 25411929 IBIS 54 / 7739
13
(HPO:0003218) Oroticaciduria 2222247 IBIS 10 / 7739
14
(HPO:0001508) Failure to thrive 24473688 IBIS 454 / 7739
15
(HPO:0004324) Increased body weight 23430880 IBIS 4 / 7739
16
(HPO:0003235) Hypermethioninemia 24473688 IBIS 8 / 7739
17
(HPO:0003217) Hyperglutaminemia 2222247 IBIS 9 / 7739
18
(HPO:0012026) Hyperornithinemia Very frequent [IBIS] 3670619 IBIS 1 / 7739
19
(HPO:0003348) Hyperalaninemia 2222247 IBIS 19 / 7739
20
(HPO:0001928) Abnormality of coagulation 18978333 IBIS 44 / 7739
21
(HPO:0005560) Imbalanced hemoglobin synthesis 24473688 IBIS 2 / 7739
22
(MedDRA:10043396) Thalassaemia trait 24473688 IBIS 1 / 7739
23
(HPO:0001987) Hyperammonemia Frequent [IBIS] 75% (n=16) 18978333 IBIS 50 / 7739
24
(HPO:0001252) Muscular hypotonia 24473688 IBIS 990 / 7739
25
(HPO:0001336) Myoclonus 3670619 IBIS 115 / 7739
26
(HPO:0002169) Clonus Frequent [IBIS] 69% (n=16) 18978333 IBIS 37 / 7739
27
(HPO:0011448) Ankle clonus 23247599 IBIS 31 / 7739
28
(HPO:0001324) Muscle weakness 3670619 IBIS 859 / 7739
29
(HPO:0007340) Lower limb muscle weakness 3670619 IBIS 61 / 7739
30
(HPO:0001298) Encephalopathy 18978333 IBIS 72 / 7739
31
(HPO:0006846) Acute encephalopathy 18978333 IBIS 3 / 7739
32
(HPO:0002495) Impaired vibratory sensation 1432421 IBIS 26 / 7739
33
(HPO:0001251) Ataxia 3116497 IBIS 413 / 7739
34
(HPO:0002075) Dysdiadochokinesis 23247599 IBIS 40 / 7739
35
(HPO:0002066) Gait ataxia 24473688 IBIS 327 / 7739
36
(HPO:0002141) Gait imbalance 23430880 IBIS 55 / 7739
37
(HPO:0002312) Clumsiness 24473688 IBIS 28 / 7739
38
(HPO:0002370) Poor coordination Frequent [IBIS] 56% (n=16) 18978333 IBIS 15 / 7739
39
(HPO:0001350) Slurred speech 23430880 IBIS 16 / 7739
40
(HPO:0007256) Abnormal pyramidal signs 11552031 IBIS 116 / 7739
41
(HPO:0001347) Hyperreflexia Very frequent [IBIS] 94% (n=16) 18978333 IBIS 363 / 7739
42
(HPO:0006801) Hyperactive deep tendon reflexes 23247599 IBIS 21 / 7739
43
(HPO:0001257) Spasticity Frequent [IBIS] 75% (n=16) 18978333 IBIS 251 / 7739
44
(HPO:0002061) Lower limb spasticity 18978333 IBIS 56 / 7739
45
(HPO:0002313) Spastic paraparesis Frequent [IBIS] 50% (n=16) 18978333 IBIS 33 / 7739
46
(HPO:0011098) Speech apraxia 1432421 IBIS 9 / 7739
47
(HPO:0001332) Dystonia 23247599 IBIS 197 / 7739
48
(MedDRA:10033666) Panic disorder 23247599 IBIS 2 / 7739
49
(HPO:0001328) Specific learning disability Frequent [IBIS] 81% (n=16) 18978333 IBIS 114 / 7739
50
(HPO:0001289) Confusion Frequent [IBIS] 2222247 IBIS 36 / 7739
51
(HPO:0001263) Global developmental delay 18978333 IBIS 853 / 7739
52
(HPO:0001249) Intellectual disability Occasional [IBIS] 25% (n=16) 18978333 IBIS 1089 / 7739
53
(HPO:0001270) Motor delay Very frequent [IBIS] 94% (n=16) 18978333 IBIS 322 / 7739
54
(HPO:0001254) Lethargy 3116497 IBIS 104 / 7739
55
(HPO:0001259) Coma Frequent [IBIS] 25874378 IBIS 65 / 7739
56
(HPO:0100543) Cognitive impairment Occasional [IBIS] 25% (n=16) 18978333 IBIS 230 / 7739
57
(HPO:0001288) Gait disturbance 23430880 IBIS 318 / 7739
58
(HPO:0001250) Seizures Occasional [IBIS] 31% (n=16) 18978333 IBIS 1245 / 7739
59
(HPO:0002121) Absence seizures 18978333 IBIS 62 / 7739
60
(HPO:0002123) Generalized myoclonic seizures 5782534 IBIS 62 / 7739
61
(HPO:0012127) Uraciluria 24473688 IBIS 2 / 7739
62
(HPO:0006579) Prolonged neonatal jaundice 24473688 IBIS 25 / 7739
63
(HPO:0001410) Decreased liver function Frequent [IBIS] 38% (n=16) 18978333 IBIS 59 / 7739
64
(HPO:0002910) Elevated hepatic transaminases Frequent [IBIS] 44% (n=16) 18978333 IBIS 158 / 7739
65
(HPO:0012115) Hepatitis 18978333 IBIS 24 / 7739
66
(HPO:0200119) Acute hepatitis 18978333 IBIS 2 / 7739
67
(HPO:0002240) Hepatomegaly 18978333 IBIS 467 / 7739
68
(HPO:0002401) Stroke-like episodes 24473688 IBIS 10 / 7739
69
(HPO:0002789) Tachypnea 22649802 IBIS 48 / 7739
70
(HPO:0001510) Growth delay 22465082 IBIS 295 / 7739
71
(HPO:0002904) Hyperbilirubinemia 24473688 IBIS 32 / 7739
72
(HPO:0011400) Abnormal CNS myelination 17825324 IBIS 10 / 7739
73
(HPO:0002500) Abnormality of the cerebral white matter 3407856; 11552031 IBIS 73 / 7739
74
(HPO:0002062) Morphological abnormality of the pyramidal tract 11552031 IBIS 24 / 7739
75
(HPO:0002120) Cerebral cortical atrophy Occasional [IBIS] 25% (n=16) 18978333 IBIS 187 / 7739
76
(HPO:0030051) Tip-toe gait Frequent [IBIS] 75% (n=16) 18978333 IBIS 10 / 7739
77
(OMIM) Buccolingofacial dyspraxia Occasional [IBIS] 31% (n=16) 18978333 IBIS 1 / 7739
78
(OMIM) Coagulopathy due to liver dysfunction 18978333 IBIS 1 / 7739
79
(OMIM) Deficits in abstraction 23247599 IBIS 2 / 7739
80
(OMIM) Homocitrullinuria Very frequent [IBIS] 3670619 IBIS 2 / 7739
81
(OMIM) Hyperarginemia Very frequent [IBIS] 24473688 IBIS 3 / 7739
82
(OMIM) Stuporous catatonia 3670619 IBIS 2 / 7739

Associated genes:

SLC25A15;

ClinVar (via SNiPA)

Gene symbol Variation Clinical significance Reference

Additional Information:

Diagnosis OMIM - Prenatal Diagnosis

Chadefaux et al. (1989) suggested that the first-trimester diagnosis of HHHS can be achieved by study of the incorporation of (14)C-ornithine into proteins of chorionic villi. They referred to a case of untreated ...

Clinical Description OMIM Shih et al. (1969) reported a child with mental retardation and myoclonic seizures associated with hyperornithinemia, hyperammonemia, and homocitrullinemia. The findings were consistent with an inherited disorder of amino acid metabolism.

Rodes et al. (1987) reported ...

Molecular genetics OMIM Among 11 patients with the HHH syndrome, Camacho et al. (1999) identified 2 mutations in the ORNT1 gene (see, e.g., F188del; 603861.0001 and E180K; 603861.0002), and a larger deletion. The F188del mutation accounted for 19 of 20 possible ...
Diagnosis GeneReviews Hyperornithinemia-hyperammonemia-homocitrullinuria (HHH) syndrome is caused by mutations in SLC25A15, the gene that encodes ORNT1 (mitochondrial ornithine transporter 1), which is involved in the urea cycle and the ornithine degradation pathway. ...
Clinical Description GeneReviews In general, the age of onset and clinical presentation of individuals with hyperornithinemia-hyperammonemia-homocitrullinuria (HHH) syndrome vary....
Genotype-Phenotype Correlations GeneReviews The SLC25A15 (ORNT1) genotype does not correlate with the clinical or biochemical phenotype of HHH syndrome. Functional studies of SLC25A15 mutations using in vitro cell culture and liposome reconstitution studies revealed no genotype-phenotype correlation [Fiermonte et al 2003, Camacho et al 2006]: some SLC25A15 missense and nonsense mutations (p.Phe188del, p.Thr32Arg, and p.Gly190Asp) had mild residual function and others (p.Gly220Arg, p.Arg179*, p.Gly27Arg, p.Arg275Gln, and p.Arg275*) had no function. Individuals with completely nonfunctional SLC25A15 mutations did not have neonatal hyperammonemia....
Differential Diagnosis GeneReviews Hyperammonemia. Most commonly, neonates with hyperammonemia and neonatal onset HHH syndrome are initially suspected of having sepsis....
Management GeneReviews To establish the extent of disease and needs of an individual diagnosed with the hyperornithinemia-hyperammonemia-homocitrullinuria (HHH) syndrome, the following evaluations are recommended:...
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....