Enzyme replacement therapy in two patients with classic Fabry disease from the same family tree: Two case reports

BACKGROUND

The pathophysiology of Fabry disease (FD)-induced progressive vital organ damage is irreversible. Disease progression can be delayed using enzyme replacement therapy (ERT). In patients with classic FD, sporadic accumulation of globotriaosylceramide (GL-3) in the heart and kidney begins in utero; however, until childhood, GL-3 accumulation is mild and reversible and can be restored by ERT. The current consensus is that ERT initiation during early childhood is paramount. Nonetheless, complete recovery of organs in patients with advanced FD is challenging.

CASE SUMMARY

Two related male patients, an uncle (patient 1) and nephew (patient 2), presented with classic FD. Both patients were treated by us. Patient 1 was in his 50s, and ERT was initiated following end-organ damage; this was subsequently ineffective. He developed cerebral infarction and died of sudden cardiac arrest. Patient 2 was in his mid-30s, and ERT was initiated when the patient was diagnosed with FD, during which the damage to vital organs was not overtly apparent. Although he had left ventricular hypertrophy at the beginning of this treatment, the degree of hypertrophy progression was limited to a minimal range after > 18 years of ERT.

CONCLUSION

We obtained discouraging ERT outcomes for older patients but encouraging outcomes for younger adults with classic FD.

237 EFFECT OF A PTEN INHIBITOR ON OVARIAN CONTENTS OF APOPTOSIS-RELATED PROTEINS AND ANTI-MÜLLERIAN HORMONE (AMH) IN A/J MICE

Strain/individual differences in superovulation efficiency with gonadotropins constitute a serious problem in mouse reproduction (Suzuki et al. 1996 Reprod. Fertil. Dev. 8, 975–980). Because PI3K/Akt signalling pathway is involved in ovarian folliculogenesis and phosphatase and tensin homologue deleted from chromosome 10 (PTEN) negatively regulates the process, I have been studying the effect of PTEN inhibitors on ovarian folliculogenesis and ovulation in mice to improve superovulation efficiency. In the present study, I compared ovarian contents of apoptosis-related proteins and anti-Müllerian hormone (AMH, an activity/number indicator of preantral and early-antral follicles) in A/J mice to examine the possibilities of an exogenous PTEN inhibitor to suppress follicular atresia and to promote folliculogenesis. At PMSG injections, 0 (control, n = 5) or 2 mg kg–1 B.W. (treated, n = 5) of a PTEN inhibitor, dipotassium bisperoxo (picolinato) oxovanadate (V), dissolved in Ringer solution were also injected to 28-day-old A/J female mice. Ovaries were collected 24 h after the injections. Ovarian protein contents of six proteins (shown in results) were measured by quantitative Western blots with β-actin as an internal control using whole ovary homogenates. Quantitativity of the Western blots were confirmed by calibration curves produced using a dilution series of sample mix (see Suzuki et al. 2011 Exp. Anim. 60, 193–196, for method details). Observed values were compared between control and treated groups by ANOVA. No significant difference in ovarian protein contents of apoptosis-related proteins (cleaved caspase-3, cleaved caspase-9, cleaved PARP, BAX, and BCL-2) was found between the 2 groups (P = 0.951, 0.548, 0.095, 0.226, and 0.363, respectively; n = 5). On the other hand, ovarian AMH protein was more abundant in the treated group than that in the control group (P = 0.009). Although these results should be confirmed by more precise quantification methods such ELISA or RIA to eliminate possible lack of difference in apoptosis-related proteins due to methodology, they suggest that PTEN inhibitors can promote ovarian folliculogenesis but not suppress follicular atresia. This work was supported by a grant from the Ministry of Health, Labour and Welfare of Japan.

354 COMPARISON OF OVARIAN CONTENTS OF AKT ISOFORMS AMONG 4 STRAINS OF MICE

Strain/individual differences in superovulation efficiency with gonadotropins constitute a serious problem in mouse reproduction (Suzuki et al. 1996 Reprod. Fertil. Dev. 8, 975–980). Because the PI3K/Akt signalling pathway is involved in ovarian folliculogenesis, quantitative difference of protein components in the PI3K/Akt signalling pathway among mouse strains may explain the strain difference in superovulation efficiency. The present study compared ovarian contents of AKT isoforms among 4 strains to examine the involvement of the PI3K/Akt signalling pathway in superovulation. Ovarian protein contents of AKT1, AKT2, and AKT3 isoforms in 4-week-old females of 4 mouse strains were measured by quantitative Western blots with GAPDH as an internal control using whole ovary homogenates (see Suzuki et al. 2011 Exp. Anim. 60, 193–196, for method details). Observed values were compared among strains by 1-way ANOVA after normality (Shapiro-Wilk) and equal variance (Levene) were confirmed. Ovarian protein contents of all 3 AKT isoforms in A/J, C57BL/6N, DBA/2, and C3H/He (arbitrary unit, mean ± s.e.m., n = 4) were significantly different among strains by 1-way ANOVA (P < 0.05). Ovarian AKT1 contents were 1.01 ± 0.10a, 0.98 ± 0.07, 0.89 ± 0.03, and 0.84 ± 0.02b, respectively. Ovarian AKT2 contents were 1.39 ± 0.13a, 0.74 ± 0.10b, 1.03 ± 0.07c, and 0.91 ± 0.19bc, respectively. Ovarian AKT3 contents were 1.24 ± 0.38, 1.55 ± 0.24a, 1.11 ± 0.09, and 0.67 ± 0.18b, respectively. a–cValues with different superscripts in each isoform are significantly different by Tukey test (P < 0.05). Thus, significant quantitative differences in ovarian AKT isoforms among strains suggest that the ovarian PI3K/Akt signalling pathway acts differently among strains. This activity difference of the pathway may explain the strain difference in superovulation efficiency in mice.This work was supported by a grant from the Ministry of Health, Labour and Welfare of Japan.

214 SUPEROVULATION IN A/J MICE USING A COMBINATION OF GONADOTROPINS AND THE PTEN INHIBITOR bpV(pic)

Strain and individual differences in superovulation constitute a serious problem in mice. Gonadotropins stimulate the maturation of developing ovarian follicles, but not primordial follicle activation (PFA), which is negatively controlled by the Phosphatase and Tensin Homologue Deleted from Chromosome 10 (PTEN). PTEN inhibitors may increase the number of developing follicles by promoting PFA. If so, subsequent gonadotropin injections may make more follicles ovulate. This study tested whether PTEN inhibitors promote superovulation by gonadotropins and examined the fertilizability of ovulated oocytes in vitro. Method: Immature females of the low responder A/J mouse strain were used. Based on preliminary results regarding peaks in the daily changes in the ovary weight/body weight ratio and ovarian anti-Müllerian hormone protein content after injections of the PTEN inhibitor, dipotassium bisperoxo (picolinato) oxovanadate (V) [bpV(pic)], the number of ovulated oocytes was examined using four combinations of the bpV(pic) dose and interval between the bpV(pic) and pregnant mare serum gonadotropin (PMSG) injections: 1) 3 μg and PMSG on Day 3; 2) 3 μg and PMSG on Day 4; 3) 30 μg and PMSG on Day 1; and 4) 30 μg and PMSG on Day 2. Ovulation was induced by hCG 48 h after PMSG injection. In vitro fertilization of the obtained oocytes was performed using TYH medium and epididymal sperm from adult ICR male mice (Day 1). Subsequently, the oocytes were cultured in KSOMaa+0.1% bovine serum albumin for 4 days. The numbers of two-cell embryos and blastocysts were recorded on Days 2 and 5, respectively. Results: The average number of oocytes collected in treatments 1 to 4 was 1) 7.2 ± 0.7 v. 9.4 ± 1.6 [control v. bpV(pic), mean ± s.e.m., n = 5]; 2) 7.8 ± 0.7 v. 9.0 ± 1.4; 3) 9.8 ± 1.6 v. 11.2 ± 1.0; and 4) 9.4 ± 1.0 v. 7.4 ± 1.9. More oocytes tended to be collected in the bpV(pic) groups in treatments 1 to 3, but the differences were not significant on ANOVA. The corresponding percentages of two-cell embryos on Day 2 after insemination were 1) 78.7 ± 7.7% v. 83.7 ± 5.6%; 2) 76.0 ± 4.2% v. 65.2 ± 4.2%; 3) 53.5 ± 13.0% v. 68.6 ± 9.1%; and 4) 78.2 ± 9.7% v. 55.2 ± 5.7%. The respective percentages of blastocysts on Day 5 after insemination were 1) 62.7 ± 6.5% v. 69.5 ± 8.1%; 2) 67.9 ± 7.7% v. 41.6 ± 5.6%; 3) 74.9 ± 11.3% v. 79.2 ± 7.8%; and 4) 78.0 ± 3.8% v. 60.5 ± 4.3%. On weighted ANOVA with angular transformations, the two-cell embryo and blastocyst rates were significantly lower in bpV(pic) groups than in control groups for treatments 2 and 4. Discussion: More oocytes tended to be collected in the bpV(pic) groups in 3 of the 4 experimental treatments. Different injection intervals between bpV(pic) and PMSG influenced both the superovulation efficiency and fertilizability of the oocytes. This new method using both PTEN inhibitors and gonadotropins is a promising method for improving superovulation efficiency, although the optimal injection scheme should be determined. This work was supported by a grant from the Ministry of Health, Labour, and Welfare of Japan.

319 REDUCED SUPEROVULATION EFFICIENCY BY HIGH-DOSE TREATMENT OF DEHYDROEPIANDROSTERONE IN MICE

Strain differences in in vitro fertilizability still constitute a serious problem in mouse reproduction. To improve the in vitro fertilizability of mouse oocytes, we examined the effect of implanting time-release pellets of dehydroepiandrosterone (DHEA), a testosterone precursor, in female mice on oocyte fertilizability. The DHEA pellets (0.25, 1.5, or 5 mg pellet–1, 21-day release form, Innovative Research of America, Sarasota, FL, USA) or corresponding placebo pellets were implanted subcutaneously in 9-week-old female 129X1/SvJJmsSlc mice. On Day 18 of implantation, superovulation was induced in these females by injections of pregnant mare serum gonadotropin (PMSG) and hCG 48 h apart. On Day 21, IVF was conducted using oocytes collected from the oviducal ampullae of these females and epididymal sperm from Slc : ICR male mice using TYH medium. Then, the embryos were cultured in vitro in Whitten’s medium for 96 h. Plasma steroid levels and expression of 5 ovarian proteins (PTEN and receptors for FSH, androgen, oestrogen, and progesterone) at oocyte collection were measured by enzyme immunoassay and quantitative Western blots, respectively. Embryo development into 2-cell and blastocyst stages at each dose at 24 h and 96 h after insemination, respectively, were compared between DHEA and placebo groups using weighted ANOVA with angular transformations. Other observed values were compared using Student’s t-test. Treatment with DHEA suppressed the numbers of ovulated oocytes in the 1.5 and 5 mg groups (DHEA v. placebo: 21.0 ± 2.6 v. 32.5 ± 2.8 and 19.9 ± 1.4 v. 27.1 ± 1.6, respectively, n = 10; P < 0.05), but not in the 0.25 mg group (26.6 ± 3.2 v. 24.8 ± 2.4). Treatment with DHEA did not affect the percentages of 2-cell embryo formation at any dose, ranging 50 to 60%. In the 0.25 mg group, DHEA treatment tended to increase blastocyst formation rate (1.8 ± 0.8% v. 0.4 ± 0.4%; not significant). However, the treatment at 1.5 mg suppressed the rate (0.0 ± 0.0% v. 3.1 ± 0.7%; P < 0.05) and treatment at 5 mg did not affect the rate (1.3 ± 0.9% v. 0.8 ± 0.6%). Plasma testosterone levels were increased by DHEA at 1.5 and 5 mg (338.2 ± 39.8 v. 197.0 ± 8.9 pg mL–1 and 534.9 ± 111.4 v. 241.8 ± 34.4 pg mL–1, respectively, n = 6; P < 0.05), but not at 0.25 mg (247.4 ± 22.0 v. 252.5 ± 35.6 pg mL–1, n = 6). No significant difference was induced by DHEA in plasma DHEA, progesterone, or oestradiol at any doses. Ovarian PTEN protein was more abundant in DHEA group than in placebo group at 5 mg (P < 0.05), tended to be more abundant at 1.5 mg (P ≈ 0.14), and was not different at 0.25 mg (P ≈ 0.35). The amounts of the 4 receptor proteins were not significantly changed by DHEA at any dose. These results suggest that DHEA at a low dose (e.g. 0.25 mg pellets for 21 days) might have a potential to improve in vitro fertilizability of mouse oocytes. Higher doses of DHEA reduced superovulation efficiency, perhaps because of the high testosterone level induced by the high-dose treatment of DHEA. The high testosterone level might upregulate ovarian PTEN expression, which might suppress ovarian primordial follicle activation. A more detailed study is needed to determine the optimal dose, timing, and duration of DHEA treatment for the improvement of female fertilizability.

Octacalcium phosphate collagen composites with titanium mesh facilitate alveolar augmentation in canine mandibular bone defects

This study was designed to investigate whether bone regeneration by implantation of octacalcium phosphate and porcine atelocollagen composite (OCP/Col) would be enhanced if mechanical stress to the implanted OCP/Col were alleviated. OCP/Col discs were implanted into an arc-shaped mandibular defect in male adult beagle dogs divided into untreated, OCP/Col, and OCP/Col/Mesh groups. In the OCP/Col/Mesh group, mechanical stress towards the implanted OCP/Col was alleviated by a titanium mesh. Bone regeneration in the three groups was compared after 6 months. Macroscopically, the alveolus in the OCP/Col/Mesh group was augmented vertically more than in the other two groups. Morphometric analysis by micro-CT showed the bone volume in the OCP/Col/Mesh group was significantly greater than in the other two groups. The augmented alveolus in the OCP/Col/Mesh group consisted of outer cortical and inner cancellous structure. Histologically, the OCP/Col/Mesh-treated alveolus was augmented by matured bone tissue along the inside of the titanium mesh. The implanted OCP/Col in the OCP/Col/Mesh and OCP/Col groups had almost disappeared. These results indicated that vertical bone regeneration by OCP/Col was efficient and successful when the mechanical stress to the implanted OCP/Col was alleviated. OCP/Col should be a useful bone substitute with active structural reconstitution.

179 EFFECTS OF DEHYDROEPIANDROSTERONE ON SPERM FERTILIZABILITY IN VITRO AND TESTICULAR GENE EXPRESSION

Strain differences of in vitro fertilizability still constitute a serious problem in mouse reproduction. To improve the in vitro fertilizability of mouse sperm, we examined the effects of implanting time-release pellets of dehydroepiandrosterone (DHEA), a testosterone precursor, on sperm fertilizability and testicular gene expression. DHEA pellets (5 mg pellet–1, 21-day release form; Innovative Research of America) or placebo pellets were implanted subcutaneously in 9-week-old male mice from 2 strains: C57BL/6CrNSlc (B6) and 129X1/SvJJmsSlc (129X1). After 21 days, in vitro fertilization was conducted using epididymal sperm from these males and oocytes from superovulated 4-week-old Slc:ICR females. The percentages of 2-cell embryo formation in the placebo and DHEA groups were 78.2 ± 14.2% vs 89.3 ± 2.5%, respectively (mean ± standard error of the mean, n = 4 per group) using B6 sperm and 40.9 ± 8.8% vs 41.3 ± 3.1%, respectively (n = 4 per group) using 129X1 sperm, indicating no significant effect of DHEA treatment (P > 0.05 by 2-way ANOVA). However, a strain difference was quite evident (P < 0.05 by 2-way ANOVA). Quantitative Western blotting using testicular protein extracts with glyceraldehyde-3-phosphate dehydrogenase as an internal control showed that the expression of androgen receptor protein (AR) was significantly higher in B6 than in 129X1 males (P < 0.05 by 2-way ANOVA), whereas there was no significant effect of DHEA on the amount of AR in either strain (P > 0.05 by 2-way ANOVA). In B6 testes, 2-dimensional electrophoresis indicated that 1 protein spot was denser in DHEA-treated males than in placebo-treated males. In 129X1 testes, DHEA did not change the density of the corresponding spot. Mass spectrometry of the spot suggested that it was Cu/Zn superoxide dismutase (SOD1). Thus, 21-day-release pellets of 5 mg DHEA had no significant effect on sperm fertilizability in vitro in 2 strains, but the DHEA pellets induced a strain-dependent testicular protein expression, which might be because of the differential AR expression. Although DHEA treatment of male mice has the potential to improve sperm fertilizability in vitro, a more detailed study is needed to determine the optimal dose, age and duration of DHEA treatment. This work was supported by a grant from the Ministry of Health, Labour and Welfare, Japan.

Effects of an angiotensin 2 receptor blocker plus diuretic combination drug in chronic heart failure complicated by hypertension

The effects of 24 weeks' treatment with an angiotensin 2 receptor blocker (ARB)/diuretic combination drug were investigated in an open-label study of 61 patients with stabilized chronic heart failure. Renin-angiotensin-aldosterone system inhibitors were replaced with a tablet containing hydrochlorothiazide 6.25 mg plus candesartan 8 mg, administered orally, once daily, in patients with systolic blood pressure (SBP) ≥ 140 mmHg or diastolic blood pressure (DBP) ≥ 90 mmHg while under optimal treatment. Both SBP and DBP declined significantly during the ARB/diuretic combination treatment. Diuretics administered previously were discontinued during the study period in 15 patients, decreasing the number of drugs being taken. During ARB/diuretic combination treatment, the blood urea nitrogen level worsened but no significant changes were noted in potassium or estimated glomerular filtration rate, which had been a matter of concern. Additionally, the level of brain natriuretic peptide, an indicator of the severity of heart failure, was improved, indicating effectiveness and safety of the ARB/diuretic combination drug.