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Rodríguez Gutiérrez PG, González García JR, Castillo De León YA, Zárate Guerrero JR, Magaña Torres MT. A novel p.Gly417Valfs*12 mutation in the MTTP gene causing abetalipoproteinemia: Presentation of the first patient in Mexico and analysis of the previously reported cases. J Clin Lab Anal 2020; 35:e23672. [PMID: 33258201 PMCID: PMC7957982 DOI: 10.1002/jcla.23672] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 12/26/2022] Open
Abstract
Background Our aims were to describe the first Mexican patient with abetalipoproteinemia and to perform a comparative analysis of biochemical, clinical, and genetic characteristics of 100 cases reported in the literature. Methods We performed biochemical and molecular screenings in a Mexican girl with extremely low lipid levels and in her family. Further, we integrated and evaluated the characteristics of the cases with abetalipoproteinemia described in the literature. Results Our patient is a six‐year‐old girl who presented vomiting, chronic diarrhea, failure to thrive, malabsorption, acanthocytosis, anemia, transaminases elevation, and extremely low lipid levels. MTTP gene sequencing revealed homozygosity for a novel mutation p.Gly417Valfs*12 (G deletion c.1250). With the analysis of the reported cases, 60 clinical features (14 classical and 46 non‐classical) were observed, being the most common acanthocytosis (57.5%), malabsorption (43.7%), and diarrhea (42.5%); 48.8% of the patients presented only classic clinical features, while the remaining 51.2% developed secondary effects due to a fat‐soluble vitamin deficiency. An odds ratio analysis disclosed that patients diagnosed after 10 years of age have an increased risk for presenting clinical complications (OR = 18.0; 95% CI 6.0‐54.1, p < 0.0001). A great diversity of mutations in MTTP has been observed (n = 76, being the most common p.G865X and p.N139_E140) and some of them with possible residual activity. Conclusion The first Mexican patient with abetalipoproteinemia presents a novel MTTP mutation p.Gly417Valfs*12. Three factors that could modulate the phenotype in abetalipoproteinemia were identified: age at diagnosis, treatment, and the causal mutation.
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Affiliation(s)
- Perla Graciela Rodríguez Gutiérrez
- División de Genética, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México.,Doctorado en Genética Humana, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Juan Ramón González García
- División de Genética, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | | | | | - María Teresa Magaña Torres
- División de Genética, Centro de Investigación Biomédica de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
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Di Filippo M, Moulin P, Roy P, Samson-Bouma ME, Collardeau-Frachon S, Chebel-Dumont S, Peretti N, Dumortier J, Zoulim F, Fontanges T, Parini R, Rigoldi M, Furlan F, Mancini G, Bonnefont-Rousselot D, Bruckert E, Schmitz J, Scoazec JY, Charrière S, Villar-Fimbel S, Gottrand F, Dubern B, Doummar D, Joly F, Liard-Meillon ME, Lachaux A, Sassolas A. Homozygous MTTP and APOB mutations may lead to hepatic steatosis and fibrosis despite metabolic differences in congenital hypocholesterolemia. J Hepatol 2014; 61:891-902. [PMID: 24842304 DOI: 10.1016/j.jhep.2014.05.023] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 04/16/2014] [Accepted: 05/06/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Non-alcoholic steatohepatitis leading to fibrosis occurs in patients with abetalipoproteinemia (ABL) and homozygous or compound heterozygous familial hypobetalipoproteinemia (Ho-FHBL). We wanted to establish if liver alterations were more frequent in one of both diseases and were influenced by comorbidities. METHODS We report genetic, clinical, histological and biological characteristics of new cases of ABL (n =7) and Ho-FHBL (n = 7), and compare them with all published ABL (51) and Ho-FHBL (22) probands. RESULTS ABL patients, diagnosed during infancy, presented mainly with diarrhea, neurological and ophthalmological impairments and remained lean, whereas Ho-FHBL were diagnosed later, with milder symptoms often becoming overweight in adulthood. Despite subtle differences in lipid phenotype, liver steatosis was observed in both groups with a high prevalence of severe fibrosis (5/27 for Ho-FHBL vs. 4/58 for ABL (n.s.)). Serum triglycerides concentration was higher in Ho-FHBL whereas total and HDL-cholesterol were similar in both groups. In Ho-FHBL liver alterations were found to be independent from the apoB truncation size and apoB concentrations. CONCLUSIONS Our findings provide evidence for major liver abnormalities in both diseases. While ABL and Ho-FHBL patients have subtle differences in lipid phenotype, carriers of APOB mutations are more frequently obese. These results raise the question of a complex causal link between apoB metabolism and obesity. They suggest that the genetic defect in VLDL assembly is critical for the occurrence of liver steatosis leading to fibrosis and shows that obesity and insulin resistance might contribute by increasing lipogenesis.
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Affiliation(s)
- Mathilde Di Filippo
- UF Dyslipidémies Cardiobiologie, Département de Biochimie et de Biologie Moléculaire du GHE, Laboratoire de Biologie Médicale Multi Sites, Hospices Civils de Lyon, Lyon, France; INSERM U1060, INSA de Lyon, INRA U1235, Univ Lyon-1, Université de Lyon, Villeurbanne, Oullins, France.
| | - Philippe Moulin
- INSERM U1060, INSA de Lyon, INRA U1235, Univ Lyon-1, Université de Lyon, Villeurbanne, Oullins, France; Fédération d'Endocrinologie, Maladies métaboliques, Diabète et Nutrition, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Pascal Roy
- Service de Biostatistique, Hospices Civils de Lyon, Lyon, France; Centre National de la Recherche Scientifique UMR5558, Univ Lyon-1, Villeurbanne, France
| | | | | | - Sabrina Chebel-Dumont
- UF Dyslipidémies Cardiobiologie, Département de Biochimie et de Biologie Moléculaire du GHE, Laboratoire de Biologie Médicale Multi Sites, Hospices Civils de Lyon, Lyon, France
| | - Noël Peretti
- Service de Gastroentérologie Hépatologie et Nutrition Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
| | - Jérôme Dumortier
- Fédération des Spécialités Digestives, Hôpital Edouard Herriot, Hospices Civils, Lyon, France
| | - Fabien Zoulim
- Service d'Hépato-Gastro-Entérologie, Hôpital de la Croix Rousse, Hospices Civils, Lyon, France
| | - Thierry Fontanges
- Service d'Hépato-Gastro-Entérologie, Centre Hospitalier Pierre Oudot, Bourgoin Jallieu, France
| | - Rossella Parini
- Rare Metabolic Disease Unit, Department of Pediatrics, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | - Miriam Rigoldi
- Rare Metabolic Disease Unit, Department of Pediatrics, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | - Francesca Furlan
- Rare Metabolic Disease Unit, Department of Pediatrics, Fondazione MBBM, San Gerardo Hospital, Monza, Italy
| | - Grazia Mancini
- Department of Clinical Genetics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dominique Bonnefont-Rousselot
- Unité pédagogique de Biochimie, Faculté des Sciences Pharmaceutiques et Biologiques, Paris, France; UPMC University Paris 6, UMR_S1166 Inserm ICAN, Paris, France; Service de Biochimie métabolique, Groupe hospitalier Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Eric Bruckert
- Service d'Endocrinologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Jacques Schmitz
- Service de Gastroentérologie Pédiatrique, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Jean Yves Scoazec
- Service d'anatomie pathologique, Hôpital Edouard Herriot, Hospices Civils, Lyon, France
| | - Sybil Charrière
- INSERM U1060, INSA de Lyon, INRA U1235, Univ Lyon-1, Université de Lyon, Villeurbanne, Oullins, France; Fédération d'Endocrinologie, Maladies métaboliques, Diabète et Nutrition, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Sylvie Villar-Fimbel
- Fédération d'Endocrinologie, Maladies métaboliques, Diabète et Nutrition, Hôpital Louis Pradel, Hospices Civils de Lyon, Bron, France
| | - Frederic Gottrand
- Department of Pediatric Gastroenterology Hepatology and Nutrition, Jeanne de Flandre university hospital, Lille, France
| | - Béatrice Dubern
- Nutrition et Gastroentérologie Pédiatriques, Hôpital Trousseau, AP-HP, Paris, France; Institut de Cardiométabolisme et Nutrition (ICAN), INSERM UMRS U872 (Eq7) Nutriomique, Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Diane Doummar
- Service de Neuropédiatrie, Hôpital Trousseau, Paris, France
| | - Francesca Joly
- Service de Gastroentérologie et d'Assistance Nutritive, Hôpital Beaujon, Clichy, France
| | | | - Alain Lachaux
- Service de Gastroentérologie Hépatologie et Nutrition Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France; INSERM U 1111, Faculté de médecine Lyon Est, Université Lyon 1, Lyon, France
| | - Agnès Sassolas
- UF Dyslipidémies Cardiobiologie, Département de Biochimie et de Biologie Moléculaire du GHE, Laboratoire de Biologie Médicale Multi Sites, Hospices Civils de Lyon, Lyon, France; INSERM U1060, INSA de Lyon, INRA U1235, Univ Lyon-1, Université de Lyon, Villeurbanne, Oullins, France
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Zamel R, Khan R, Pollex RL, Hegele RA. Abetalipoproteinemia: two case reports and literature review. Orphanet J Rare Dis 2008; 3:19. [PMID: 18611256 PMCID: PMC2467409 DOI: 10.1186/1750-1172-3-19] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Accepted: 07/08/2008] [Indexed: 01/23/2023] Open
Abstract
Abetalipoproteinemia (ABL, OMIM 200100) is a rare, autosomal recessive disorder, characterized by fat malabsorption, acanthocytosis and hypocholesterolemia in infancy. Later in life, deficiency of fat-soluble vitamins is associated with development of atypical retinitis pigmentosa, coagulopathy, posterior column neuropathy and myopathy. ABL results from mutations in the gene encoding the large subunit of microsomal triglyceride transfer protein (MTP; OMIM 157147). To date at least 33 MTP mutations have been identified in 43 ABL patients. We describe the clinical progress of two patients, both currently in the fifth decade of life, who were diagnosed with ABL as children and were treated with high oral doses of fat soluble vitamins, including vitamin E over the last three decades. Treatment appears to have been associated with arrest of the neuropathy and other complications in both patients. Because pharmacologic inhibition of MTP is being developed as a novel approach to reduce plasma cholesterol for prevention of cardiovascular disease, defining the long-term clinical features of patients with a natural deficiency in MTP might provide some insight into the possible effects of such treatments. We review the range of clinical, biochemical and molecular perturbations in ABL.
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Affiliation(s)
- Rola Zamel
- Department of Medicine and Biochemistry, University of Western Ontario, London, Ontario, Canada.
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