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Citrin deficiency (CD) is an autosomal recessive disease caused by mutations in the SLC25A13 gene. This study aimed to expand the current body of data on Chinese patients with neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) by analyzing their clinical characteristics, genetic mutation spectrum, and long-term follow-up outcomes. From May 2013 to April 2025, 60 children diagnosed with NICCD were enrolled in this retrospective study. Related data were obtained from medical records. Among 60 patients, common presentations included elevated aspartate aminotransferase (100%), infantile cholestasis (95.0%), elevated citrulline (96.7%), hyperlactatemia (93.3%), hypoproteinemia (81.7%), coagulation dysfunction (60.0%), hyperammonemia (48.3%) and chubby face (36.7%). Twenty-eight SLC25A13 variants were detected, with c.852_855delTATG (42.7%), IVS16ins3kb (15.4%) and c.615+5G>A (10.3%) being the most frequent. All patients were fed lactose-free milk powder enriched with medium-chain triglycerides (MCT) after diagnosis or suspected diagnosis. Ten patients were lost to follow-up. Among 50 followed patients, 30 were followed for > 5 years. Twenty-four patients showed typical dietary features. After discharge, 11 had hypoglycemic episodes, 5 had growth retardation, 11 had dyslipidemia and 3 progressed to failure to thrive and dyslipidemia caused by citrin deficiency (FTTDCD). All patients remained in stable condition. Patients with neonatal intrahepatic cholestasis caused by citrin deficiency present with a variety of clinical manifestations. c.852_855delTATG, IVS16ins3kb and c.615+5G>A are the mutation hotspots of the SLC25A13 gene in Zhejiang, China. Early intervention leads to a good prognosis.

Mitochondrial carriers catalyse the translocation of numerous metabolites across the inner mitochondrial membrane, playing a key role in different cell functions. For this reason, mitochondrial carrier gene expression needs tight regulation. The human SLC25A13 gene, encoding for the mitochondrial aspartate/glutamate carrier isoform 2 (AGC2), catalyses the electrogenic exchange of aspartate for glutamate plus a proton, thus taking part in many metabolic processes including the malate-aspartate shuttle. By the luciferase (LUC) activity of promoter deletion constructs we identified the putative promoter region, comprising the proximal promoter (−442 bp/−19 bp), as well as an enhancer region (−968 bp/−768 bp). Furthermore, with different approaches, such as in silico promoter analysis, gene silencing and chromatin immunoprecipitation, we identified two transcription factors responsible for SLC25A13 transcriptional regulation: FOXA2 and USF1. USF1 acts as a positive transcription factor which binds to the basal promoter thus ensuring SLC25A13 gene expression in a wide range of tissues. The role of FOXA2 is different, working as an activator in hepatic cells. As a tumour suppressor, FOXA2 could be responsible for SLC25A13 high expression levels in liver and its downregulation in hepatocellular carcinoma (HCC).

Backgroud The mitochondrial Aspartate/Glutamate Carrier 2 (AGC2), encoded by the SLC25A13 gene, plays a critical role in cellular metabolism and redox balance through the malate/aspartate shuttle. Dysregulation of AGC2 is implicated in rare genetic diseases and tumorigenesis, making it a promising therapeutic target. Methods In this study, we developed the first integrative platform for the discovery and validation of high-affinity AGC2 modulators, combining in silico screening with biophysical and functional assays. Docking-based virtual screening of chemical libraries was employed to identify candidate inhibitors. Their binding and inhibitory activity were validated via a combination of thermal shift assays and isothermal titration calorimetry (ITC) performed on n -dodecyl-β- d -maltoside (DDM)-based vesicles reconstituted with AGC2, alongside functional transport assays using AGC2-containing proteoliposomes. Results We identified two previously unreported AGC2 inhibitors, suramin and taurolithocholic acid 3-sulfate. Remarkably, we report the first successful application of ITC to AGC2, overcoming major experimental challenges associated with ITC assays on the SLC25A family members, and achieving greater stability and reproducibility compared to similar assays performed on other family members, such as the ADP/ATP carrier and uncoupling proteins. Additionally, we present the first transmission electron microscopy (TEM) characterization of proteoliposomes and DDM-based vesicles reconstituted with AGC2, providing direct structural insights into the systems used for biophysical analysis. Conclusions This study establishes a reproducible, and scalable workflow that bridges high-throughput ligand identification with high-resolution kinetic characterization for targeting mitochondrial carriers. Graphical abstract

Background/Objectives: Glioblastoma (GBM) is the most aggressive primary brain tumor in adults and remains associated with poor prognosis despite multimodal therapy. Metabolic reprogramming, particularly increased dependence on glutamine, supports GBM bioenergetic, biosynthetic, and redox demands. This study aimed to systematically identify glutamine-associated metabolic regulators with prognostic relevance and biological plausibility in GBM. Methods: Transcriptomic data from TCGA and GTEx were analyzed using GEPIA2, with survival validation performed using the CGGA. Functional pathway enrichment, protein expression assessment, protein–protein interaction network analysis, tumor microenvironment evaluation, epigenetic profiling, and single-cell RNA sequencing validation were integrated to contextualize candidate genes. Pharmacogenomic correlation analysis and structure-based molecular docking were applied as supportive validation layers. Results: Ceruloplasmin (CP), Solute Carrier Family 25 Member 13 (SLC25A13), and Solute Carrier Family 38 Member 2 (SLC38A2) were selectively dysregulated and associated with poor clinical outcomes in GBM. CP was linked to redox regulation and stress-adaptive survival programs, SLC25A13 to mitochondrial metabolite exchange and glutamine-coupled nucleotide biosynthesis, and SLC38A2 to glutamine uptake, nutrient sensing, and mTORC1-MYC-associated growth signaling. Conclusions: CP, SLC25A13, and SLC38A2 emerge as clinically relevant glutamine-associated metabolic regulators in GBM, linking redox regulation, mitochondrial metabolite exchange, and glutamine-driven growth signaling. These findings highlight transport- and exchange-centered metabolic nodes as potential biomarkers and candidates for future metabolic targeting in GBM.

Aims Diabetic retinopathy (DR) is a major complication of diabetes that leads to vision impairment. The aim of this study was to investigate the regulatory role of miR-509-3p in DR, focusing on its interaction with SLC25A13 and its impact on retinal endothelial cell function, oxidative stress, apoptosis, and ferroptosis. Methods HRVECs were cultured in high-glucose (HG) conditions to establish an in vitro DR model. miR-509-3p mimics and inhibitors were transfected into HRVECs to assess their effects on SLC25A13 expression, cell viability, apoptosis, reactive oxygen species (ROS) levels, and ferroptosis markers. A luciferase reporter assay and RNA immunoprecipitation were used to confirm the binding of miR-509-3p to SLC25A13 mRNA. For in vivo validation, agomiR-509-3p was injected into the vitreous of DR mice, and retinal thickness, pathological damage, and apoptosis were evaluated. Ferroptosis-related markers (GPX4, TlR4, ASCL4) were analyzed in HRVECs to explore the mechanism of miR-509-3p in regulating ferroptosis. Results In vitro, miR-509-3p significantly decreased SLC25A13 expression, resulting in enhanced HRVEC viability, reduced apoptosis, and lower ROS levels under HG conditions. Overexpression of SLC25A13 reversed these protective effects, while miR-509-3p knockdown exacerbated oxidative stress and apoptosis. In vivo, agomiR-509-3p increased retinal thickness, reduced pathological damage, and decreased apoptosis in DR mice. Ferroptosis marker analysis revealed that miR-509-3p upregulated GPX4 expression and downregulated TlR4 and ASCL4, whereas SLC25A13 overexpression reversed these effects, further linking miR-509-3p to the regulation of ferroptosis. Conclusions miR-509-3p exerts a protective effect in DR by targeting SLC25A13, reducing oxidative stress, apoptosis, and ferroptosis in retinal endothelial cells. These findings highlight the potential of miR-509-3p as a therapeutic target for DR management.

Purpose To enhance the detection rate of Neonatal Intrahepatic Cholestasis caused by Citrin Deficiency (NICCD) through newborn screening (NBS), we analyzed the metabolic profiles of missed patients and proposed a more reliable method for early diagnosis. Methods In this retrospective study, NICCD patients were classified into “Newborn Screening” (64 individuals) and “Missed Screening” (52 individuals) groups. Metabolic profiles were analyzed using the non-derivatized MS/MS Kit, and genetic mutations were identified via next-generation sequencing and confirmed by Sanger sequencing. Receiver Operating Characteristic (ROC) analysis evaluated the predictive value of amino acids and acylcarnitines in dried blood spots (DBS) for identifying missed patients including 40 missed patients and 17,269 healthy individuals, with additional validation using 12 missed patients and 454 healthy controls. Results The age of diagnosis was significantly higher in the “Missed Screening” group compared to the “Newborn Screening” group (74.50 vs. 18.00 days, P  < 0.001). ROC analysis revealed that citrulline had excellent diagnostic accuracy for missed patients, with an AUC of 0.970 and a cut-off value of 17.57 µmol/L. Additionally, glycine, phenylalanine, ornithine, and C8 were significant markers, each with an AUC greater than 0.70. A combination of these markers achieved an AUC of 0.996 with a cut-off value of 0.00195. Validation demonstrated a true positive rate of 91.67% and a true negative rate of 96.48%. Common SLC25A13 mutations in both groups were c.852_855del, IVS16ins3kb, and c.615 + 5G > A. Conclusions Combining multiple metabolic markers during NBS significantly improves sensitivity and specificity for detecting missed NICCD cases. However, the relationship between genetic mutations and missed cases remains unclear.

SLC25A13, a pivotal component of the mitochondrial aspartate-glutamate carrier, is integral to cellular metabolism and has been linked to various diseases. However, its role in cancer biology remains largely unexplored. In this study, we employed multi-omics data to elucidate the genetic landscape, expression profile, and prognostic value of SLC25A13 in a pan-cancer context. Additionally, we examined the correlation between SLC25A13 and the immune microenvironment across various cancers. By applying multiple machine learning methods, we identified seven core SLC25A13 co-expressed genes and developed a nomogram to predict the prognosis of glioma patients, validating its efficacy across multiple independent datasets. Furthermore, in vitro and in vivo experiments demonstrated that SLC25A13 is significantly overexpressed in glioblastoma tissues compared to paraneoplastic tissues, promoting glioblastoma cell proliferation and migration while inhibiting apoptosis. Collectively, our study positions SLC25A13 as a promising biomarker for cancer prognosis and a potential therapeutic target, particularly in glioma, thereby laying the groundwork for future research into its therapeutic exploitation in cancer.

Background. Citrin deficiency (CD), caused by mutations in the SLC25A13 gene, is a rare autosomal recessive urea cycle disorder with variable clinical presentations depending on age. These include neonatal intrahepatic cholestasis (NICCD), failure to thrive with dyslipidemia, and adult-onset type II citrullinemia. Patients with NICCD typically present with transient intrahepatic cholestasis in infancy, which often resolves spontaneously by one year of age; however, some may progress to severe complications later in life. Case Presentation. Four cases diagnosed with NICCD phenotype are presented. All patients presented with neonatal cholestasis, hypertransaminasemia, galactosuria, and elevated citrulline levels. Molecular analysis identified three disease-causing variants: two previously reported variants, c.955C>T (p.Arg319*) and c.74C>A (p.Ala25Glu), and a novel variant, c.1359G>T (p.Lys453Asn). Treatment included a galactose-free formula, medium-chain triglycerides, and nutritional supplementation, resulting in biochemical and clinical improvement. All patients in our series exhibited a milder clinical course, with no episodes of hyperammonemia or hypoglycemia, no progression to liver failure, and favorable long-term outcomes with dietary management. During a long-term follow-up period ranging from 7 to 11 years, no severe complications were observed. Notably, one patient developed a recurrence of cataract, emphasizing the importance of lifelong dietary adherence and regular eye examinations. Conclusions. The findings in this paper further expand the genotypic spectrum and genotype-phenotype correlations of CD. Lifelong follow-up is recommended, including ocular examination.

Background Neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD) is an autosomal recessive disorder with heterogeneous clinical manifestations. This study aimed to characterize the clinical, biochemical, and genetic spectrum of NICCD and evaluate treatment outcomes. Methods This retrospective cohort study analyzed molecularly confirmed cases of NICCD admitted to Shenzhen Children’s Hospital between March 2019 and April 2023. Comprehensive clinical data were extracted from electronic records and analyzed using descriptive statistical methods. Results The cohort ( n  = 15) demonstrated universal jaundice (100%) and hyperammonemia (93.3%), with the predominant c.851_854del variant (52%) associated with earliest onset (median 3 days) and most severe cholestatic features (100% jaundice, 60% hepatomegaly). Key metabolic abnormalities included universal citrulline elevation (100%) and frequent methionine increase (93.3%), while threonine/tyrosine disturbances showed genotype-dependent patterns. All patients achieved complete symptom resolution (median 32 days) and significant growth improvement with lactose-free MCT formula and ursodeoxycholic acid therapy, though rare variants (compound heterozygous c.1399 C > T/c.1638_1660dup) exhibited markedly prolonged recovery (88 days vs. cohort median 32 days). Conclusions This study delineates the clinical-genetic spectrum of NICCD and confirms the efficacy of MCT-based therapy. Genotype-phenotype correlations suggest variant-specific disease severity, warranting multicenter validation for rare mutations.

Citrin deficiency is characterized by a wide range of symptoms from infancy through adulthood and presents a distinct preference for a diet composed of high protein, high fat, and low carbohydrate. The present study elucidates the important criteria by patients with citrin deficiency for food selection through detailed analysis of their food preferences. The survey was conducted in 70 citrin-deficient patients aged 2–63 years and 55 control subjects aged 2–74 years and inquired about their preference for 435 food items using a scale of 1–4 (the higher, the more favored). The results showed that the foods marked as “dislike” accounted for 36.5% in the patient group, significantly higher than the 16.0% in the controls. The results also showed that patients clearly disliked foods with 20–24 (% of energy) or less protein, 45–54% (of energy) or less fat, and 30–39% (of energy) or more carbohydrate. Multiple regression analysis showed carbohydrates had the strongest influence on patients’ food preference (β = −0.503). It also showed female patients had a stronger aversion to foods with high carbohydrates than males. The protein, fat, and carbohydrate energy ratio (PFC) of highly favored foods among patients was almost the same as the average PFC ratio of their daily diet (protein 20–22: fat 47–51: carbohydrates 28–32). The data strongly suggest that from early infancy, patients start aspiring to a nutritional balance that can compensate for the metabolism dissonance caused by citrin deficiency in every food.