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The biosynthetic pathway of 2-azahypoxanthine in fairy-ring forming fungus. Sci Rep 2016; 6:39087. [PMID: 27991529 PMCID: PMC5171910 DOI: 10.1038/srep39087] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 11/17/2016] [Indexed: 01/01/2023] Open
Abstract
“Fairy rings” resulting from fungus-stimulated plant growth occur all over the world. In 2010, 2-azahypoxanthine (AHX) from a fungus Lepista sordida was identified as the “fairy” that stimulates plant growth. Furthermore, 2-aza-8-oxohypoxanthine (AOH) was isolated as a common metabolite of AHX in plants, and the endogenous existence of AHX and AOH in plants was proved. The structure of AHX allowed us to hypothesize that AHX was derived from 5-aminoimidazole-4-carboxamide ribonucleotide (AICAR). Thus, we performed a feeding experiment that supplied AICAR to L. sordida. Consumption of AICAR and accumulation of AHX were observed after feeding. The mycelia extract had enzymatic activity of adenine/5-aminoimidazole-4-carboxamide phosphoribosyltransferase (APRT). APRT gene of L. sordida revealed its structural characteristics in homology modeling and showed transcriptional enhancement after feeding. These results support that AHX was synthesized from AICAR and AHX biosynthesis was transcriptionally controlled by AICAR, indicating the presence of novel purine metabolic pathway in L. sordida.
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Thorsteinsdottir M, Thorsteinsdottir UA, Eiriksson FF, Runolfsdottir HL, Agustsdottir IMS, Oddsdottir S, Sigurdsson BB, Hardarson HK, Kamble NR, Sigurdsson ST, Edvardsson VO, Palsson R. Quantitative UPLC-MS/MS assay of urinary 2,8-dihydroxyadenine for diagnosis and management of adenine phosphoribosyltransferase deficiency. J Chromatogr B Analyt Technol Biomed Life Sci 2016; 1036-1037:170-177. [PMID: 27770717 PMCID: PMC5445224 DOI: 10.1016/j.jchromb.2016.09.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 09/09/2016] [Accepted: 09/13/2016] [Indexed: 10/21/2022]
Abstract
Adenine phosphoribosyltransferase (APRT) deficiency is a hereditary disorder that leads to excessive urinary excretion of 2,8-dihydroxyadenine (DHA), causing nephrolithiasis and chronic kidney disease. Treatment with allopurinol or febuxostat reduces DHA production and attenuates the renal manifestations. Assessment of DHA crystalluria by urine microscopy is used for therapeutic monitoring, but lacks sensitivity. We report a high-throughput assay based on ultra-performance liquid chromatography coupled to tandem mass spectrometry (UPLC-MS/MS) for quantification of urinary DHA. The UPLC-MS/MS assay was optimized by a chemometric approach for absolute quantification of DHA, utilizing isotopically labeled DHA as an internal standard. Experimental screening was conducted with D-optimal design and optimization of the DHA response was performed with central composite face design and related to the peak area of DHA using partial least square regression. Acceptable precision and accuracy of the DHA concentration were obtained over a calibration range of 100 to 5000ng/mL on three different days. The intra- and inter-day accuracy and precision coefficients of variation were well within ±15% for quality control samples analyzed in replicates of six at three concentration levels. Absolute quantification of DHA in urine samples from patients with APRT deficiency was achieved wihtin 6.5min. Measurement of DHA in 24h urine samples from three patients with APRT deficiency, diluted 1:15 (v/v) with 10mM ammonium hydroxide (NH4OH), yielded a concentration of 3021, 5860 and 10563ng/mL and 24h excretion of 816, 1327 and 1649mg, respectively. A rapid and robust UPLC-MS/MS assay for absolute quantification of DHA in urine was successfully developed. We believe this method will greatly facilitate diagnosis and management of patients with APRT deficiency.
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Affiliation(s)
| | | | - Finnur F Eiriksson
- University of Iceland, Reykjavik, Iceland; ArcticMass, Reykjavik, Iceland.
| | | | - Inger M Sch Agustsdottir
- Childreńs Medical Center, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
| | - Steinunn Oddsdottir
- Department of Clinical Biochemistry, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
| | - Baldur B Sigurdsson
- ArcticMass, Reykjavik, Iceland; Center for Biomedicine, European Academy of Bolzano/Bozen, Bolzano, Italy.
| | | | | | | | - Vidar O Edvardsson
- University of Iceland, Reykjavik, Iceland; Childreńs Medical Center, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
| | - Runolfur Palsson
- University of Iceland, Reykjavik, Iceland; Division of Nephrology, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland.
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Doré B, Meria P. A great contributor to the French urological science: Michel Daudon. CR CHIM 2016. [DOI: 10.1016/j.crci.2014.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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54
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Biomineralization versus microcrystalline pathologies: Beauty and the beast. CR CHIM 2016. [DOI: 10.1016/j.crci.2015.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Nephrolithiasis (NL) is one of the most prevalent nontransmissible diseases in western countries. It is being associated with other frequent diseases, including osteoporosis, cardiovascular disease, hypertension, diabetes mellitus, through a putative common link with metabolic syndrome and insulin resistance or altered mineral metabolism. This review will focus on classification, physicochemical basis, risk factors, laboratory and imaging investigations, medical management.Classification as to stone composition includes calcium, uric acid (UA), cystine (Cys), infected, 2-8 dihydroxyadenine and rare NL. According to pathophysiology, NL is classified as primary, secondary to systemic diseases or drugs, caused by renal or metabolic hereditary disorders.A stone can only form in supersaturated environment, and this is sufficient in UA, Cys and infected NL, but not in Ca-NL, which results from the imbalance between supersaturation and inhibition. All types are characterized by derangements of peculiar risk factors. Laboratory investigations aim at identifying type of NL, underlying risk factors and state of saturation, and pathophysiology. This justifies a rationale therapy able to dissolve some types of stones and/or produce reduction in recurrence rate in others.Medical management includes alkali and allopurinol for UA nephrolithiasis (UA-NL), thiols and alkali in Cys-NL, dietary and pharmacological intervention for Ca-NL. Thiazides and alkaline citrate salts are the most widely used drugs in Ca-NL, where they proved efficient to prevent new stones. Other drugs have only been used in particular subsets.Proper medical management and modern urological approaches have already notably improved clinical outcomes. Future studies will further clarify mechanisms of NL with expected new and targeted therapeutic options.
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[Nephrolithiasis of adult: From mechanisms to preventive medical treatment]. Rev Med Interne 2016; 38:44-52. [PMID: 27349612 DOI: 10.1016/j.revmed.2016.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 05/23/2016] [Indexed: 01/06/2023]
Abstract
Nephrolithiasis is a very common (prevalence around 10 to 12% in France) and recurrent disorder. Nephrolithiasis is associated to chronic kidney disease and is responsible for 2 to 3% of cases of end-stage renal disease, mainly if it is associated to nephrocalcinosis or to a monogenic disorder (1.6% of nephrolithiasis in adults, among them 1% of cystinuria). To understand the underlying pathophysiological processes, stone analysis (morphology and using infrared spectrophotometry) as well as minimal biological assessment including urine crystal research are required. The calcic nephrolithiasis is the more frequent subtype (>80%). Its medical treatment relies on simple dietary rules: non-alkaline hyperdiuresis>2 liters/day, calcium intake normalization (1 gram per day divided between the three principal meals), normalization of sodium (6 to 7 grams per day) and protein intake (1g/kg of theoretical body weight/day), and eviction of foods rich in oxalate. In case of persistent hypercalciuria (>0.1mmol/kg of theoretical body weight/day on free diet), a thiazide diuretic can be started while being aware to correct iatrogenic decrease in plasma potassium and urine citrate excretion. Measurement of bone mineral density must systematically be performed in patients with high 24 h-urinary calcium excretion. The medical treatment of uric acid nephrolithiasis relies on alkaline hyperdiuresis (goal of urine pH: 6.2 to 6.8). The use of allopurinol is justified only if urine uric acid is over 4mmol/day. Thanks to a well-managed preventive medical treatment, one can expect to stop the activity of nephrolithiasis in more than 80% of cases, making it one of the most accessible renal pathologies to preventive medical treatment.
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Becker GJ, Garigali G, Fogazzi GB. Advances in Urine Microscopy. Am J Kidney Dis 2016; 67:954-64. [DOI: 10.1053/j.ajkd.2015.11.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 11/03/2015] [Indexed: 11/11/2022]
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Chong SL, Ng YH. Obstructive uropathy and severe acute kidney injury from renal calculi due to adenine phosphoribosyltransferase deficiency. World J Pediatr 2016; 12:243-5. [PMID: 26684317 DOI: 10.1007/s12519-015-0073-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 12/09/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adenine phosphoribosyltransferase (APRT) deficiency is an uncommon genetic cause of chronic kidney disease due to crystalline nephropathy. METHODS A case of a Chinese boy with APRT deficiency presenting with severe acute kidney injury secondary to obstructive uropathy from multiple renal calculi was reviewed. RESULTS The patient underwent staged removal of the calculi. Infrared spectrometry of the renal calculi showed 2,8-dihydroxyadenine. APRT deficiency was confirmed with abolished APRT enzyme activity in red blood cells. He was started on allopurinol and low purine diet with complete resolution of the residual calculi. CONCLUSION APRT deficiency should be considered in patients with multiple radiolucent renal calculi.
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Affiliation(s)
- Siew Le Chong
- Department of Pediatrics (Nephrology Service), KK Women's and Children's Hospital, Singapore, Singapore
| | - Yong Hong Ng
- Department of Pediatrics (Nephrology Service), KK Women's and Children's Hospital, Singapore, Singapore.
- , 100 Bukit Timah Road, Singapore, 229899, Singapore.
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Amin R, Eid L, Edvardsson VO, Fairbanks L, Moudgil A. An unusual cause of "pink diaper" in an infant: Answers. Pediatr Nephrol 2016; 31:577-80. [PMID: 25823988 PMCID: PMC4591240 DOI: 10.1007/s00467-015-3073-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 02/11/2015] [Accepted: 02/12/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Rasheda Amin
- Division of Pediatric Nephrology, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, 20010, USA
| | - Loai Eid
- Division of Pediatrics, Latifa Hospital, Dubai, United Arab Emirates
| | - Vidar O Edvardsson
- Children's Medical Center, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
- School of Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Lynette Fairbanks
- Purine Research Laboratory, Viapath, St Thomas' Hospital, London, UK
| | - Asha Moudgil
- Division of Pediatric Nephrology, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, 20010, USA.
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Bollée G, Cochat P, Daudon M. Recurrence of crystalline nephropathy after kidney transplantation in APRT deficiency and primary hyperoxaluria. Can J Kidney Health Dis 2015; 2:31. [PMID: 26380104 PMCID: PMC4570695 DOI: 10.1186/s40697-015-0069-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 07/24/2015] [Indexed: 01/25/2023] Open
Abstract
Purpose of review To provide transplant physicians with a summary of the pathogenesis and diagnosis of adenine phosphoribosyl transferase (APRT) deficiency and primary hyperoxaluria and, focussed on kidney transplantation, and to discuss interventions aimed at preventing and treating the recurrence of crystalline nephropathy in renal transplant recipients. Source of information Pubmed literature search. Setting Primary hyperoxaluria and APRT deficiency are rare inborn errors of human metabolism. The hallmark of these diseases is the overproduction and urinary excretion of compounds (2,8 dihydroxyadenine in APRT deficiency, oxalate in primary hyperoxaluria) that form urinary crystals. Although recurrent urolithiasis represents the main clinical feature of these diseases, kidney injury can occur as a result of crystal precipitation within the tubules and interstitium, a condition referred to as crystalline nephropathy. Some patients develop end-stage renal disease (ESRD) and may become candidates for kidney transplantation. Since kidney transplantation does not correct the underlying metabolic defect, transplant recipients have a high risk of recurrence of crystalline nephropathy, which can lead to graft loss. In some instances, the disease remains undiagnosed until after the occurrence of ESRD or even after kidney transplantation. Key messages Patients with APRT deficiency or primary hyperoxaluria may develop ESRD as a result of crystalline nephropathy. In the absence of diagnosis and adequate management, the disease is likely to recur after kidney transplantation, which often leads to rapid loss of renal allograft function. Primary hyperoxaluria, but not APRT deficiency, becomes a systemic disease at low GFR with oxalate deposition leading to malfunction in non-renal organs (systemic oxalosis). We suggest that these diagnoses should be considered in patients with low glomerular filtration rate (GFR) and a history of kidney stones. In APRT deficiency, stones may be confused with uric acid stones, unless specialized techniques are used (infrared spectroscopy or X-ray crystallography for urinary crystals or stone analysis; Fourier transform infrared microscopy for crystals in kidney biopsy). Where these are unavailable, and for confirmation, the diagnosis can be made by measurement of enzyme activity in red blood cell lysates or by genetic testing. In patients with primary hyperoxaluria, levels of urinary and plasma oxalate; and the presence of nearly pure calcium oxalate monohydrate in stones, which often also have an unusually pale colour and unorganized structure, increase diagnostic suspicion. Molecular genetic testing is the criterion measure. Lifelong allopurinol therapy, with high fluid intake if appropriate, may stabilize kidney function in APRT deficiency; if ESRD has occurred or is near, results with kidney transplantation after initiation of allopurinol are excellent. In primary hyperoxaluria recognized before ESRD, pyridoxine treatment and high fluid intake may lead to a substantial decrease in urinary calcium oxalate supersaturation and prevent renal failure. In non-responsive patients or those recognized later in their disease, liver transplantation cures the underlying defect and should be considered when the GFR falls below 30 ml/min/1.73 m2; in those which or near ESRD, liver transplantation and intensive dialysis before kidney transplantation may be considered to reduce the total body oxalate burden before kidney transplantation. Limitations The availability of diagnostic tests varies between countries and centres. Data on long term outcomes after kidney transplantation are limited, especially for APRT deficiency patients. Implications Increasing transplant physicians knowledge of APRT deficiency and primary hyperoxaluria should enable them to implement adequate diagnostic and therapeutic interventions, thereby achieving good outcomes after kidney transplantation.
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Affiliation(s)
- Guillaume Bollée
- Division of Nephrology and Research Centre of the Centre Hospitalier de l'Université de Montréal and Université de Montréal, Montréal, Québec Canada ; Division of Nephrology, Hôpital Notre Dame, 1560 Sherbrooke Street East, Montreal, QC H2L 4 M1 Canada
| | - Pierre Cochat
- Centre de Référence des Maladies Rénales Rares, Hospices Civils de Lyon and Université Claude-Bernard Lyon 1, Lyon, France
| | - Michel Daudon
- Service d'Explorations Fonctionnelles, AP-HP, Hôpital Tenon, Paris, France
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George SA, Al-Rushaidan S, Francis I, Soonowala D, Nampoory MRN. 2,8-Dihydroxyadenine Nephropathy Identified as Cause of End-Stage Renal Disease After Renal Transplant. EXP CLIN TRANSPLANT 2015; 15:574-577. [PMID: 27447713 DOI: 10.6002/ect.2015.0096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Adenine phosphoribosyltransferase deficiency is a rare autosomal recessive disorder of uric acid metabolism that leads to formation and excretion of 2,8-dihydroxyadenine into urine. The low solubility of 2,8-dihydroxyadenine results in precipitation and formation of urinary crystals and renal stones. Patients with this disorder usually have recurrent nephrolithiasis and can develop nephropathy secondary to crystal precipitation in the renal parenchyma. The disease is most often underdiagnosed and can recur in renal transplant, causing graft failure. Lack of specific clinical manifestations, chemical and radiologic features identical to those shown with uric acid stones, and lack of awareness among clinicians are among the causes for the underdiagnoses of this treatable disease. Allopurinol, a xanthine dehydrogenase inhibitor, is the mainstay of treatment, supported by high fluid intake and dietary modifications. The possibility of adenine phosphoribosyl transferase deficiency should be considered in all cases of urolithiasis in children, patients with recurrent urolithiasis, and patients with urolithiasis associated with renal failure of unknown cause, including patients with end-stage renal disease and renal transplant recipients. Here, we report a case of a 41-year-old female patient who had a late diagnosis of 2,8-dihydroxyadenine nephropathy-induced end-stage renal disease, made on the native nephrectomy that accompanied the renal transplant, and who had a timely intervention that prevented recurrence in the graft.
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Affiliation(s)
- Smiley Annie George
- From the Department of Histopathology, Mubarak Al Kabir Hospital, Jabriya, Kuwait
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62
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Brilland B, Augusto JF, Croue A, Subra JF, Sayegh J. A rare case of primary non-function of renal allograft due to adenine phosphoribosyltransferase deficiency. Int Urol Nephrol 2015; 47:1589-91. [PMID: 26253830 DOI: 10.1007/s11255-015-1077-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 07/30/2015] [Indexed: 11/28/2022]
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Agrawal V, Gibson PC, Sahota A, Nasr SH. Quiz page May 2015: crystalline nephropathy in an identical twin. Am J Kidney Dis 2015; 65:A17-9. [PMID: 25919501 DOI: 10.1053/j.ajkd.2014.12.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/15/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Varun Agrawal
- Division of Nephrology and Hypertension, University of Vermont, Burlington, VT.
| | - Pamela C Gibson
- Department of Pathology, University of Vermont, Burlington, VT
| | - Amrik Sahota
- Department of Genetics, Rutgers University, Piscataway, NJ
| | - Samih H Nasr
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN
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Abstract
Primary disease recurrence after renal transplantation is mainly diagnosed by examination of biopsy samples, but can also be associated with clinical symptoms. In some patients, recurrence can lead to graft loss (7-8% of all graft losses). Primary disease recurrence is generally associated with a high risk of graft loss in patients with focal segmental glomerulosclerosis, membranous proliferative glomerulonephritis, primary hyperoxaluria or atypical haemolytic uraemic syndrome. By contrast, disease recurrence is associated with a limited risk of graft loss in patients with IgA nephropathy, renal involvement associated with Henoch-Schönlein purpura, antineutrophil cytoplasmic antibody-associated glomerulonephritis or lupus nephritis. The presence of systemic diseases that affect the kidneys, such as sickle cell anaemia and diabetes mellitus, also increases the risk of delayed graft loss. This Review provides an overview of the epidemiology, pathophysiology and management of primary disease recurrence in paediatric renal graft recipients, and describes the overall effect on graft survival of each of the primary diseases listed above. With appropriate management, few paediatric patients should be excluded from renal transplantation programmes because of an increased risk of recurrence.
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65
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Ceballos-Picot I, Daudon M, Harambat J, Bensman A, Knebelmann B, Bollée G. 2,8-Dihydroxyadenine urolithiasis: a not so rare inborn error of purine metabolism. NUCLEOSIDES NUCLEOTIDES & NUCLEIC ACIDS 2015; 33:241-52. [PMID: 24940675 DOI: 10.1080/15257770.2013.853780] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Adenine phosphoribosyltransferase (APRT) deficiency is a rare inherited metabolic disorder that leads to the formation and hyperexcretion of 2,8-dihydroxyadenine (DHA) into urine. The low solubility of DHA results in precipitation and formation of urinary crystals and kidney stones. The disease can be present as recurrent urolithiasis or nephropathy secondary to crystal precipitation into renal parenchyma (DHA nephropathy). The diagnostic tools available, including stone analysis, crystalluria, and APRT activity in red blood cells, make the diagnosis easy to confirm when APRT deficiency is suspected. However, the lack of recognition of this metabolic disorder frequently resulted in a delay in diagnosis and treatment with grave consequences. The early recognition and treatment of APRT deficiency are of crucial importance to prevent irreversible loss of renal function. This review summarizes the genetic and metabolic mechanisms underlying DHA stones formation and chronic kidney disease, along with the issues of diagnosis and management of APRT deficiency. Moreover, we report the mutations in the APRT gene responsible for APRT deficiency in 51 French patients (43 families) including 22 pediatric cases (18 families) among the 64 patients identified in the biochemistry laboratories of Necker Hospital, Paris (1978-2013).
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Affiliation(s)
- Irène Ceballos-Picot
- a Université Paris Descartes, Assistance Publique Hôpitaux de Paris, Laboratoire de Biochimie Métabolomique et protéomique, Hôpital Necker-Enfants Malades , Paris , France
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Cloutier J, Villa L, Traxer O, Daudon M. Kidney stone analysis: "Give me your stone, I will tell you who you are!". World J Urol 2014; 33:157-69. [PMID: 25465911 PMCID: PMC4308647 DOI: 10.1007/s00345-014-1444-9] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 11/10/2014] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Stone analysis is an important part in the evaluation of patients having stone disease. This could orientate the physician toward particular etiologies. MATERIAL AND METHODS Chemical and physical methods are both used for analysis. Unfortunately, chemical methods often are inadequate to analyze accurately urinary calculi and could fail to detect some elements into the stone. Physical methods, in counterpart, are becoming more and more used in high-volume laboratories. The present manuscript will provide a review on analytic methods, and review all the information that should be included into an appropriate morpho-constitutional analysis. CONCLUSION This report can supply an excellent summarization of the stone morphology and give the opportunity to find specific metabolic disorders and different lithogenic process into the same stone. Here, specific chemical types with their different crystalline phases are shown in connection with their different etiologies involved.
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Affiliation(s)
- Jonathan Cloutier
- Urology Department, Tenon University Hospital, 4 rue de la Chine, 75970, Paris Cedex 20, France
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67
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Bollée G, Daudon M, Ceballos-Picot I. Adenine phosphoribosyltransferase deficiency: Leave no stone unturned. World J Clin Urol 2014; 3:218-226. [DOI: 10.5410/wjcu.v3.i3.218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 06/04/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
Adenine phosphoribosyltransferase (APRT) deficiency is a rare autosomal recessive disease leading to generation of large amounts of 2,8-dihydroxyadenine (DHA). DHA is excreted in urine, where it precipitates into crystals due to its low solubility. DHA crystals can aggregate into stones or cause injury to the renal parenchyma (DHA nephropathy). Recurrent urolithiasis and DHA nephropathy are the two clinical manifestations of APRT deficiency. Diagnosis of APRT deficiency can be made during childhood as well as adulthood. Diagnosis mainly relies on the recognition of DHA in stones or urine crystals. Measurement of APRT activity and genetic testing are useful for confirmation of diagnosis, for family screening and should be considered in difficult cases of urolithiasis or crystalline nephropathy. Allopurinol therapy is the cornerstone of treatment and is highly effective in preventing recurrence of stones and kidney disease. High fluid intake and dietary modifications are also recommended. Early diagnosis and treatment are of paramount importance to prevent renal damage. Unfortunately, diagnosis of APRT deficiency is often overlooked and irreversible renal failure still occurs in a substantial proportion of patients. Clinicians must be alert to the possibility of APRT deficiency and consider the appropriate diagnostic tests in certain cases. This review discusses the genetic and biochemical mechanisms of APRT deficiency, and the issues of diagnosis and management.
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68
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Zaidan M, Palsson R, Gall ECL, Garstka A, Maggiore U, Deteix P, Battista M, Gagné ER, Ceballos-Picot I, Van Huyen JPD, Legendre C, Daudon M, Edvardsson VO, Knebelmann B, Knebelmann B. Recurrent 2,8-dihydroxyadenine nephropathy: a rare but preventable cause of renal allograft failure. Am J Transplant 2014; 14:2623-32. [PMID: 25307253 PMCID: PMC4560835 DOI: 10.1111/ajt.12926] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/16/2014] [Accepted: 07/01/2014] [Indexed: 01/25/2023]
Abstract
Adenine phosphoribosyltransferase (APRT) deficiency is a rare autosomal recessive enzyme defect of purine metabolism that usually manifests as 2,8-dihydroxyadenine (2,8-DHA) nephrolithiasis and more rarely chronic kidney disease. The disease is most often misdiagnosed and can recur in the renal allograft. We analyzed nine patients with recurrent 2,8-DHA crystalline nephropathy, in all of whom the diagnosis had been missed prior to renal transplantation. The diagnosis was established at a median of 5 (range 1.5-312) weeks following the transplant procedure. Patients had delayed graft function (n=2), acute-on-chronic (n=5) or acute (n=1) allograft dysfunction, whereas one patient had normal graft function at the time of diagnosis. Analysis of allograft biopsies showed birefringent 2,8-DHA crystals in renal tubular lumens, within tubular epithelial cells and interstitium. Fourier transformed infrared microscopy confirmed the diagnosis in all cases, which was further supported by 2,8-DHA crystalluria, undetectable erythrocyte APRT enzyme activity, and genetic testing. With allopurinol therapy, the allograft function improved (n=7), remained stable (n=1) or worsened (n=1). At last follow-up, two patients had experienced allograft loss and five had persistent chronic allograft dysfunction. 2,8-DHA nephropathy is a rare but underdiagnosed and preventable disorder that can recur in the renal allograft and may lead to allograft loss.
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Affiliation(s)
- Mohamad Zaidan
- Department of Nephrology-Transplantation, Necker Hospital, APHP, Paris, France,Paris Descartes University, Sorbonne Paris Cité, Paris, France,INSERM U1151, Institut Necker Enfants Malades, Département « Biologie cellulaire », Paris, France
| | - Runolfur Palsson
- Division of Nephrology, Internal Medicine Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland,Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Antoine Garstka
- Department of Nephrology, Huriez Hospital, CHRU de Lille, Lille, France
| | - Umberto Maggiore
- Department of Nephrology, Parma University Hospital, Parma, Italy
| | - Patrice Deteix
- Department of Nephrology, Gabriel-Montpied Hospital, CHU de Clermont-Ferrand, France
| | - Michele Battista
- Departments of Clinical and Experimental Medicine, Nephrology and Transplantation and International Research Centre Autoimmune Diseases (IRCAD) of the Amedeo Avogadro University, Maggiore Hospital, Novara, Italy
| | - Eve-Reine Gagné
- Division of Nephrology, CHUS, FMSS, Sherbrooke University, Québec, Canada
| | - Irène Ceballos-Picot
- Paris Descartes University, Sorbonne Paris Cité, Paris, France,Department of Metabolic Biochemistry, Necker Hospital, APHP, Paris, France
| | - Jean-Paul Duong Van Huyen
- Paris Descartes University, Sorbonne Paris Cité, Paris, France,Department of Pathology, Necker Hospital, APHP, Paris, France
| | - Christophe Legendre
- Department of Nephrology-Transplantation, Necker Hospital, APHP, Paris, France,Paris Descartes University, Sorbonne Paris Cité, Paris, France,INSERM U1151, Institut Necker Enfants Malades, Département « Biologie cellulaire », Paris, France
| | - Michel Daudon
- Department of Clinical Physiology, Tenon Hospital, APHP, Paris, France
| | - Vidar O. Edvardsson
- Division of Nephrology, Internal Medicine Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland,Division of Pediatric Nephrology, Children's Medical Center, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland
| | - Bertrand Knebelmann
- Department of Nephrology-Transplantation, Necker Hospital, APHP, Paris, France,Paris Descartes University, Sorbonne Paris Cité, Paris, France,INSERM U1151, Institut Necker Enfants Malades, Département « Biologie cellulaire », Paris, France
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Quaglia M, Musetti C, Ghiggeri GM, Fogazzi GB, Settanni F, Boldorini RL, Lazzarich E, Airoldi A, Izzo C, Giordano M, Stratta P. Unexpectedly high prevalence of rare genetic disorders in kidney transplant recipients with an unknown causal nephropathy. Clin Transplant 2014; 28:995-1003. [PMID: 24961278 DOI: 10.1111/ctr.12408] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with a rare genetic disease may receive renal transplantation (KTx) without a correct diagnosis of causal nephropathy and therefore develop unexpected and even severe complications. The aim of the study was to describe the cases of rare genetic disorders diagnosed after KTx, in order to draw clinical lessons for the transplant physician. METHODS We retrospectively assessed all patients who had received a diagnosis of a rare genetic disorder after KTx. RESULTS In our center, more than 30% (278/911) of kidney transplant (KTx) recipients were diagnosed with a causal nephropathy: Prevalence of rare genetic disorders in this group was 4.32% (12/278), including 2,8-dihydroxyadeninuria (2,8-DHA) disease (n = 2), HNF-1B-associated nephropathy (n = 2), UMOD-related nephropathy (n = 5), Fabry disease (n = 1), INF2 focal segmental glomerulosclerosis (n = 1), and Senior-Løken syndrome (n = 1). 2,8-DHA nephropathy relapsed in both patients causing an acute renal failure and jeopardizing the graft. CONCLUSIONS Kidney transplant recipients without a diagnosis of causal nephropathy appear to be a selected population in which rare genetic diseases might be more common than expected. As even a belated diagnosis after KTx can have a significant impact on graft and patient survival and on other family members, this possibility should be evaluated in KTx recipients without a known causal nephropathy.
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Affiliation(s)
- Marco Quaglia
- Department of Translational Medicine and IRCAD, Nephrology and Kidney Transplantation, University of Eastern Piedmont, Novara, Italy
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70
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Arnadóttir M. Febuxostat in adenosine phosphoribosyltransferase deficiency. Am J Kidney Dis 2014; 64:316. [PMID: 24932691 DOI: 10.1053/j.ajkd.2014.04.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 04/16/2014] [Indexed: 11/11/2022]
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Kaartinen K, Hemmilä U, Salmela K, Räisänen-Sokolowski A, Kouri T, Mäkelä S. Adenine phosphoribosyltransferase deficiency as a rare cause of renal allograft dysfunction. J Am Soc Nephrol 2014; 25:671-4. [PMID: 24459232 DOI: 10.1681/asn.2013090960] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Adenine phosphoribosyltransferase deficiency is a rare autosomal recessive disorder manifesting as urolithiasis or crystalline nephropathy. It leads to the generation of large amounts of poorly soluble 2,8-dihydroxyadenine excreted in urine, yielding kidney injury and in some patients, kidney failure. Early recognition of the disease, institution of xanthine analog therapy to block the formation of 2,8-dihydroxyadenine, high fluid intake, and low purine diet prevent CKD. Because of symptom variability and lack of awareness, however, the diagnosis is sometimes extremely deferred. We describe a patient with adenine phosphoribosyltransferase deficiency who was diagnosed during evaluation of a poorly functioning second kidney allograft. This report highlights the risk of renal allograft loss in patients with undiagnosed adenine phosphoribosyltransferase deficiency and the need for improved early detection of this disease.
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Pospisilova J, Vit O, Lorkova L, Klanova M, Zivny J, Klener P, Petrak J. Resistance to TRAIL in mantle cell lymphoma cells is associated with the decreased expression of purine metabolism enzymes. Int J Mol Med 2013; 31:1273-9. [PMID: 23503700 DOI: 10.3892/ijmm.2013.1302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 03/01/2013] [Indexed: 11/05/2022] Open
Abstract
Mantle cell lymphoma (MCL) is a rare aggressive type of B-cell non-Hodgkin's lymphoma. Response to chemotherapy tends to be short and virtually all patients sooner or later relapse. The prognosis of relapsed patients is extremely poor. The tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is considered one of the novel experimental molecules with strong antitumor effects. TRAIL triggers extrinsic apoptotis in tumor cells by binding to TRAIL 'death receptors' on the cell surface. Recombinant TRAIL has shown promising pro-apoptotic effects in a variety of malignancies including lymphoma. However, as with other drugs, lymphoma cells can develop resistance to TRAIL. Therefore, the aim of this study was to identify the molecular mechanisms responsible for, and associated with TRAIL resistance in MCL cells. If identified, these features may be used as molecular targets for the effective elimination of TRAIL-resistant lymphoma cells. From an established TRAIL-sensitive mantle cell lymphoma cell line (HBL-2) we derived a TRAIL-resistant HBL-2/R subclone. By TRAIL receptor analysis and differential proteomic analysis of HBL-2 and HBL-2/R cells we revealed a marked downregulation of all TRAIL receptors and, among others, the decreased expression of 3 key enzymes of purine nucleotide metabolism, namely purine nucleoside phosphorylase, adenine phosphoribosyltransferase and inosine-5'-monophosphate dehydrogenase 2, in the resistant HBL-2/R cells. The downregulation of the 3 key enzymes of purine metabolism can have profound effects on nucleotide homeostasis in TRAIL-resistant lymphoma cells and can render such cells vulnerable to any further disruption of purine nucleotide metabolism. This pathway represents a 'weakness' of the TRAIL-resistant MCL cells and has potential as a therapeutic target for the selective elimination of such cells.
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Affiliation(s)
- Jana Pospisilova
- Institute of Pathological Physiology, First Faculty of Medicine, Charles University in Prague, 128 53 Prague, Czech Republic.
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