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Bea-Mascato B, Valverde D. Genotype-phenotype associations in Alström syndrome: a systematic review and meta-analysis. J Med Genet 2023; 61:18-26. [PMID: 37321834 PMCID: PMC10803979 DOI: 10.1136/jmg-2023-109175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/29/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Alström syndrome (ALMS; #203800) is an ultrarare monogenic recessive disease. This syndrome is associated with variants in the ALMS1 gene, which encodes a centrosome-associated protein involved in the regulation of several ciliary and extraciliary processes, such as centrosome cohesion, apoptosis, cell cycle control and receptor trafficking. The type of variant associated with ALMS is mostly complete loss-of-function variants (97%) and they are mainly located in exons 8, 10 and 16 of the gene. Other studies in the literature have tried to establish a genotype-phenotype correlation in this syndrome with limited success. The difficulty in recruiting a large cohort in rare diseases is the main barrier to conducting this type of study. METHODS In this study we collected all cases of ALMS published to date. We created a database of patients who had a genetic diagnosis and an individualised clinical history. Lastly, we attempted to establish a genotype-phenotype correlation using the truncation site of the patient's longest allele as a grouping criteria. RESULTS We collected a total of 357 patients, of whom 227 had complete clinical information, complete genetic diagnosis and meta-information on sex and age. We have seen that there are five variants with high frequency, with p.(Arg2722Ter) being the most common variant, with 28 alleles. No gender differences in disease progression were detected. Finally, truncating variants in exon 10 seem to be correlated with a higher prevalence of liver disorders in patients with ALMS. CONCLUSION Pathogenic variants in exon 10 of the ALMS1 gene were associated with a higher prevalence of liver disease. However, the location of the variant in the ALMS1 gene does not have a major impact on the phenotype developed by the patient.
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Affiliation(s)
- Brais Bea-Mascato
- CINBIO, Universidad de Vigo, 36310 Vigo, Spain
- Grupo de Investigación en Enfermedades Raras y Medicina Pediátrica, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Diana Valverde
- CINBIO, Universidad de Vigo, 36310 Vigo, Spain
- Grupo de Investigación en Enfermedades Raras y Medicina Pediátrica, Instituto de Investigación Sanitaria Galicia Sur (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
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Marozio L, Dassie F, Bertschy G, Canuto EM, Milan G, Cosma S, Maffei P, Benedetto C. Case Report:Pregnancy and birth in a mild phenotype of Alström syndrome. Front Genet 2022; 13:995947. [PMID: 36263420 PMCID: PMC9573963 DOI: 10.3389/fgene.2022.995947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Alström syndrome (AS) is an ultrarare multisystemic progressive disease caused by autosomal recessive variations of the ALMS1 gene (2p13). AS is characterized by double sensory impairment, cardiomyopathy, childhood obesity, extreme insulin resistance, early nonalcoholic fatty liver disease, renal dysfunction, respiratory disease, endocrine and urologic disorders. In female AS patients, hyperandrogenism has been described but fertility issues and conception have not been investigated so far. Case: This case report describes the spontaneous conception, pregnancy, and birth in a 27-year-old woman with AS, characterized by a mild phenotype with late onset of visual impairment, residual perception of light, and hypertension. Before pregnancy, menses were regular with increased levels of dihydrotestosterone and androstanediol glucuronide in the follicular phase, and the ovaries and endometrium were normal during vaginal ultrasound. A thorough clinical follow-up of the maternal and fetal conditions was carried out. A weight gain of 10 kg during pregnancy was recorded, and serial blood and urine tests were all within the normal range, except for mild anemia. The course of pregnancy was uneventful up to 34 weeks of gestation when preeclampsia developed with an abnormally high level of blood pressure and edema in the lower limbs. At 35 weeks + 3 days of gestation, an urgent cesarean section was performed, and a healthy male weighing 1,950 g was born. Histological examination of the placenta showed partial signs of flow obstruction, limited abruption areas, congested fetal vessels and villi, and a small single infarcted area. Conclusion: The present case demonstrates for the first time that conceiving is possible for patients with ALMS. Particular attention should be given to the management of AS systemic comorbidities through the course of pregnancy.
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Affiliation(s)
- Luca Marozio
- Department of Obstetrics and Gynecology, University of Turin, Turin, Italy
| | - Francesca Dassie
- Department of Medicine, University of Padua, Padua, Italy
- *Correspondence: Francesca Dassie,
| | - Gianluca Bertschy
- Department of Obstetrics and Gynecology, University of Turin, Turin, Italy
| | - Emilie M. Canuto
- Department of Obstetrics and Gynecology, University of Turin, Turin, Italy
| | | | - Stefano Cosma
- Department of Obstetrics and Gynecology, University of Turin, Turin, Italy
| | - Pietro Maffei
- Department of Medicine, University of Padua, Padua, Italy
| | - Chiara Benedetto
- Department of Obstetrics and Gynecology, University of Turin, Turin, Italy
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Cheng WY, Ma MJ, Yuan SQ, Qi XL, Rong WN, Sheng XL. New pathogenic variants of ALMS1 gene in two Chinese families with Alström Syndrome. BMC Ophthalmol 2022; 22:386. [PMID: 36162988 PMCID: PMC9511775 DOI: 10.1186/s12886-022-02597-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 09/07/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Alström Syndrome (AS) is an autosomal recessive hereditary disease with the characteristics of multiorgan dysfunction. Due to the heterogeneity of clinical manifestations of AS, genetic testing is crucial for the diagnosis of AS. Herein, we used whole-exome sequencing (WES) to determine the genetic causes and characterize the clinical features of three affected patients in two Chinese families with Alström Syndrome. Materials and methods Three affected patients (initially diagnosed as achromatopsia). and five asymptomatic members were recruited for both genetic and clinical tests. The complete ophthalmic examinations and systemic examinations were performed on all participants. Whole exome sequencing (WES) was performed for mutation detection. The silico analysis was also applied to predict the pathogenesis of identified pathogenic variants. Results In family 1, the proband showed low vision, hyperopia, photophobia, nystagmus, and total color blindness. DNA analysis revealed that she carried a compound heterozygote with two novel pathogenic variants in the ALMS1 gene NM_015120.4:c.10379del (NP_055935.4:p.(Asp2252Tyr)) and NM_015120.4:c.11641_11642del (NP_055935.4:p.(Val3881ThrfsTer11)). Further systemic examinations showed short stature, acanthosis nigricans, and sensorineural hearing loss. In family 2, two affected siblings presented the low vision, hyperopia, photophobia, nystagmus, and total color blindness. DNA analysis revealed that they carried a same compound heterozygote with two novel pathogenic variants in the ALMS1 gene NM_015120.4:c.10379del (NP_055935.4:p.(Asn3460IlefsTer49)), NM_015120.4:c.10819C > T (NP_055935.4:p.(Arg3607Trp)). Further systemic examinations showed obesity and mild abnormalities of lipid metabolism. According to the genetic testing results and further systemic analysis, the three affected patients were finally diagnosed as Alström Syndrome (AS). Conclusions We found two new compound heterozygous pathogenic variants of the ALMS1 gene and determined the diagnosis as Alström Syndrome in three patients of two Chinese families. Our study extends the genotypic and phenotypic spectrums for ALMS1 -AS and emphasizes the importance of gene testing in assisting the clinical diagnosis for cases with phenotypic diversities, which would help the AS patients with early diagnosis and treatment to reduce future systemic damage.
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Affiliation(s)
- Wan-Yu Cheng
- Third Clinical Medical College of Ningxia Medical University, Ningxia Eye Hospital, People's Hospital of Ningxia Hui Autonomous Region, No 936, Huanghe East Road, Jinfeng District, Yinchuan, 750001, Ningxia, China
| | - Mei-Jiao Ma
- Gansu Aier Ophthalmology and Optometry Hospital, 1228-437, Guazhou Road, Qilihe District, Lanzhou City, 730050, Gansu, China
| | - Shi-Qin Yuan
- Third Clinical Medical College of Ningxia Medical University, Ningxia Eye Hospital, People's Hospital of Ningxia Hui Autonomous Region, No 936, Huanghe East Road, Jinfeng District, Yinchuan, 750001, Ningxia, China
| | - Xiao-Long Qi
- Third Clinical Medical College of Ningxia Medical University, Ningxia Eye Hospital, People's Hospital of Ningxia Hui Autonomous Region, No 936, Huanghe East Road, Jinfeng District, Yinchuan, 750001, Ningxia, China
| | - Wei-Ning Rong
- Third Clinical Medical College of Ningxia Medical University, Ningxia Eye Hospital, People's Hospital of Ningxia Hui Autonomous Region, No 936, Huanghe East Road, Jinfeng District, Yinchuan, 750001, Ningxia, China.
| | - Xun-Lun Sheng
- Gansu Aier Ophthalmology and Optometry Hospital, 1228-437, Guazhou Road, Qilihe District, Lanzhou City, 730050, Gansu, China.
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Bettini S, Bombonato G, Dassie F, Favaretto F, Piffer L, Bizzotto P, Busetto L, Chemello L, Senzolo M, Merkel C, Angeli P, Vettor R, Milan G, Maffei P. Liver Fibrosis and Steatosis in Alström Syndrome: A Genetic Model for Metabolic Syndrome. Diagnostics (Basel) 2021; 11:diagnostics11050797. [PMID: 33924909 PMCID: PMC8170882 DOI: 10.3390/diagnostics11050797] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/18/2021] [Accepted: 04/24/2021] [Indexed: 12/27/2022] Open
Abstract
Alström syndrome (ALMS) is an ultra-rare monogenic disease characterized by insulin resistance, multi-organ fibrosis, obesity, type 2 diabetes mellitus (T2DM), and hypertriglyceridemia with high and early incidence of non-alcoholic fatty liver disease (NAFLD). We evaluated liver fibrosis quantifying liver stiffness (LS) by shear wave elastography (SWE) and steatosis using ultrasound sonographic (US) liver/kidney ratios (L/K) in 18 patients with ALMS and 25 controls, and analyzed the contribution of metabolic and genetic alterations in NAFLD progression. We also genetically characterized patients. LS and L/K values were significantly higher in patients compared with in controls (p < 0.001 versus p = 0.013). In patients, LS correlated with the Fibrosis-4 Index and age, while L/K was associated with triglyceride levels. LS showed an increasing trend in patients with metabolic comorbidities and displayed a significant correlation with waist circumference, the homeostasis model assessment, and glycated hemoglobin A1c. SWE and US represent promising tools to accurately evaluate early liver fibrosis and steatosis in adults and children with ALMS during follow-up. We described a new pathogenic variant of exon 8 in ALMS1. Patients with ALMS displayed enhanced steatosis, an early increased age-dependent LS that is associated with obesity and T2DM but also linked to genetic alterations, suggesting that ALMS1 could be involved in liver fibrogenesis.
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Affiliation(s)
- Silvia Bettini
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (F.F.); (L.B.); (R.V.); (G.M.); (P.M.)
- Correspondence: (S.B.); (F.D.); Tel.: +39-333-204-6896 (S.B.); Tel.: +39-049-821-7021 (F.D.)
| | - Giancarlo Bombonato
- Internal Medicine 5, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (G.B.); (L.P.); (P.B.); (L.C.); (C.M.); (P.A.)
| | - Francesca Dassie
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (F.F.); (L.B.); (R.V.); (G.M.); (P.M.)
- Correspondence: (S.B.); (F.D.); Tel.: +39-333-204-6896 (S.B.); Tel.: +39-049-821-7021 (F.D.)
| | - Francesca Favaretto
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (F.F.); (L.B.); (R.V.); (G.M.); (P.M.)
| | - Luca Piffer
- Internal Medicine 5, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (G.B.); (L.P.); (P.B.); (L.C.); (C.M.); (P.A.)
| | - Paola Bizzotto
- Internal Medicine 5, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (G.B.); (L.P.); (P.B.); (L.C.); (C.M.); (P.A.)
| | - Luca Busetto
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (F.F.); (L.B.); (R.V.); (G.M.); (P.M.)
| | - Liliana Chemello
- Internal Medicine 5, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (G.B.); (L.P.); (P.B.); (L.C.); (C.M.); (P.A.)
| | - Marco Senzolo
- Gastroenterology Department of Oncological and Gastroenterological Surgical Sciences, DiSCOG, University of Padua, 35128 Padua, Italy;
| | - Carlo Merkel
- Internal Medicine 5, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (G.B.); (L.P.); (P.B.); (L.C.); (C.M.); (P.A.)
| | - Paolo Angeli
- Internal Medicine 5, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (G.B.); (L.P.); (P.B.); (L.C.); (C.M.); (P.A.)
| | - Roberto Vettor
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (F.F.); (L.B.); (R.V.); (G.M.); (P.M.)
| | - Gabriella Milan
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (F.F.); (L.B.); (R.V.); (G.M.); (P.M.)
| | - Pietro Maffei
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (F.F.); (L.B.); (R.V.); (G.M.); (P.M.)
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Dassie F, Favaretto F, Bettini S, Parolin M, Valenti M, Reschke F, Danne T, Vettor R, Milan G, Maffei P. Alström syndrome: an ultra-rare monogenic disorder as a model for insulin resistance, type 2 diabetes mellitus and obesity. Endocrine 2021; 71:618-625. [PMID: 33566311 DOI: 10.1007/s12020-021-02643-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/19/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Alström syndrome (ALMS) is a monogenic ultra-rare disorder with a prevalence of one per million inhabitants caused by pathogenic variants of ALMS1 gene. ALMS1 is located on chromosome 2p13, spans 23 exons and encodes a predicted 461.2-kDa protein of 4169 amino acids. The infantile cone-rod dystrophy with nystagmus and severe visual impairment is the earliest and most consistent clinical manifestation of ALMS. In addition, infantile transient cardiomyopathy, early childhood obesity with hyperphagia, deafness, insulin resistance (IR), type 2 diabetes mellitus (T2DM), systemic fibrosis and progressive renal or liver dysfunction are common findings. ALMS1 encodes a large ubiquitously expressed protein that is associated with the centrosome and the basal body of primary cilium. CURRENT RESEARCH The localisation of ALMS1 to the ciliary basal body suggests its contribution to ciliogenesis and/or normal ciliary function, or centriolar stability. ALMS1 regulate glucose transport through the actin cytoskeleton, which plays an important role in insulin-stimulated GLUT4 transport. Both extreme IR and β-cell failure are the two determinant factors responsible for the development of glucose metabolism alterations in ALMS. TREATMENT Currently, there is no known cure for ALMS other than managing the underlying systemic diseases. When possible, individuals with ALMS and families should be referred to a centre of expertise and followed by a multidisciplinary team. Lifestyle modification, aerobic exercise and dietary induced weight loss are highly recommended as primary treatment for ALMS patients with T2DM and obesity. CONCLUSION Managing a rare disease requires not only medical care but also a support network including patient associations.
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Affiliation(s)
- Francesca Dassie
- Department of Medicine (DIMED), Clinica Medica 3, Padua University Hospital, Padua, Italy
| | - Francesca Favaretto
- Department of Medicine (DIMED), Clinica Medica 3, Padua University Hospital, Padua, Italy
| | - Silvia Bettini
- Department of Medicine (DIMED), Clinica Medica 3, Padua University Hospital, Padua, Italy
| | - Matteo Parolin
- Department of Medicine (DIMED), Clinica Medica 3, Padua University Hospital, Padua, Italy
| | - Marina Valenti
- Italian Association of Alström Syndrome Patients-ASS.A.I., Endo-ERN ePAG, Padua, Italy
| | - Felix Reschke
- Department of General Pediatrics, Endocrinology/Diabetology and Clinical Research, Children's Hospital Auf der Bult, Hannover, Germany
| | - Thomas Danne
- Department of General Pediatrics, Endocrinology/Diabetology and Clinical Research, Children's Hospital Auf der Bult, Hannover, Germany
| | - Roberto Vettor
- Department of Medicine (DIMED), Clinica Medica 3, Padua University Hospital, Padua, Italy
| | - Gabriella Milan
- Department of Medicine (DIMED), Clinica Medica 3, Padua University Hospital, Padua, Italy
| | - Pietro Maffei
- Department of Medicine (DIMED), Clinica Medica 3, Padua University Hospital, Padua, Italy.
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