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New Directions in the Development of Pharmacotherapy for Osteoarthrosis Based on Modern Concepts of the Disease Pathogenesis (A Review). Pharm Chem J 2022. [DOI: 10.1007/s11094-022-02572-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Liang H, Jiajue R, Qi W, Liu W, Chi Y, Jiang Y, Wang O, Li M, Xing X, Xia W. Clinical characteristics and the influence of rs1800470 in patients with Camurati-Engelmann disease. Front Endocrinol (Lausanne) 2022; 13:1041061. [PMID: 36339419 PMCID: PMC9631481 DOI: 10.3389/fendo.2022.1041061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 10/05/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Camurati-Engelmann disease (CED) is a sclerosing bone dysplasia caused by transforming growth factor β1 (TGFB1) gene variants. OBJECTIVE We aim to summarize the clinical characteristics and the efficacy of glucocorticoids in 14 individuals with CED, and explore the correlation between the phenotype and the SNP of rs1800470 (c.29C>T). METHODS Clinical, biochemical, radiological, and therapeutic data were collected from 14 patients. DNA was extracted for TGFB1 variants detection by Sanger sequencing. RESULTS The median onset and record age were 3.0 and 16.1 years, respectively. All patients manifested bone pain and decreased subcutaneous fat tissue. Inflammatory markers increased in over 60% of patients, and the median erythrocyte sedimentation rate (ESR) was 1.40 (0.50~3.67) of the upper limit of normal (ULN), and the median high sensitivity C reactive protein (hsCRP) was 1.71 (0.48~12.56) of ULN. There was a positive correlation between ESR and hsCRP (rs=0.806, p=0.003). Both ESR and hsCRP were negatively correlated with the levels of hemoglobin (HGB), calcium, and creatinine, but positively correlated with the level of alkaline phosphatase. Four known variants of TGFB1 were identified, including p.Tyr171Cys, p.Arg218Cys, p.Arg218His, and p.Cys225Arg. Moreover, 35.7% and 28.6% of them carried the heterozygous and homozygous SNP of c.29C>T, called C/T and T/T groups, respectively, but 35.7% of them were without c.29C>T (C/C group). The onset age, anthropometric data, percentages of different clinical manifestations, and biochemical parameters were comparable among the three groups. But there were increasing trends in levels of HGB and calcium and decreasing trends in ESR and hsCRP among C/C, C/T, and T/T groups in turn. Glucocorticoid improves the two inflammatory markers among CED patients. CONCLUSION The phenotype of CED is highly heterogeneous. There is no clear genotype-phenotype correlation, but it seems to have better trends of biochemical parameters in patients with CED carrying the T allele of rs1800470.
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Whyte MP, Aronson J, McAlister WH, Weinstein RS, Wenkert D, Clements KL, Gottesman GS, Madson KL, Stolina M, Bijanki VN, Plotkin H, Huskey M, Duan S, Mumm S. Coalescing expansile skeletal disease: Delineation of an extraordinary osteopathy involving the IFITM5 mutation of osteogenesis imperfecta type V. Bone 2021; 145:115835. [PMID: 33360005 DOI: 10.1016/j.bone.2020.115835] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/08/2020] [Accepted: 12/21/2020] [Indexed: 12/30/2022]
Abstract
In 2003, we briefly reported the remarkable osteopathy of a 12-year-old boy who at age two months began fracturing his limbs with subsequent hyperplastic callus formation and expansion and fusion of appendicular bones. By age ten years he had coalesced his lumbosacral spine, pelvis, femurs, and leg and foot bones as a single structure. Computed tomography of expanded bone revealed a thin cortical shell, diminished irregular trabeculae, and cystic areas. Histopathology featured foci of woven bone, densely packed osteocytes, cartilage, fibrovascular tissue, and massive fat deposition in the marrow space lacking hematogenous precursor cells. Bone turnover markers indicated accelerated remodeling and the few radiographically assessable appendicular bones improved during brief adherence to alendronate therapy. Following puberty, serum multiplex biomarker profiling confirmed accelerated bone turnover. At age 23 years, macrospecimens from leg amputation revealed ossification along capsular tissue together with hyaline cartilage degeneration. Concurrently, the life-long course of this same disorder was delineated in an unrelated woman until her death at age 51 years. Both patients demonstrated the radiographic hallmarks and harbored the heterozygous point mutation (c.-14C>T) in the 5'-UTR of IFITM5 associated with osteogenesis imperfecta type V (OI-V). Herein, we detail the clinical, radiological, histopathological, biochemical, and molecular findings and discuss the etiology and pathogenesis of this extraordinary osteopathy that we call coalescing expansile skeletal disease.
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Affiliation(s)
- Michael P Whyte
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children - St. Louis, St. Louis, MO 63110, USA; Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
| | - James Aronson
- Department of Pediatric Orthopaedics, University of Arkansas for Medical Sciences at Arkansas Children's Hospital, Little Rock, AR 72202, USA.
| | - William H McAlister
- Pediatric Radiology Section, Mallinckrodt Institute of Radiology at St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Robert S Weinstein
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, Department of Internal Medicine, Little Rock, AR 72201, USA.
| | - Deborah Wenkert
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children - St. Louis, St. Louis, MO 63110, USA.
| | - Karen L Clements
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children - St. Louis, St. Louis, MO 63110, USA.
| | - Gary S Gottesman
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children - St. Louis, St. Louis, MO 63110, USA.
| | - Katherine L Madson
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children - St. Louis, St. Louis, MO 63110, USA
| | - Marina Stolina
- Department of Cardiometabolic Disorders Research, Amgen Inc., Thousand Oaks, CA 91320, USA.
| | - Vinieth N Bijanki
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children - St. Louis, St. Louis, MO 63110, USA.
| | - Horacio Plotkin
- Departments of Pediatrics and Orthopedics, Children's Hospital and University of Nebraska Medical Center, Omaha, NE 68198, USA.
| | - Margaret Huskey
- Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
| | - Shenghui Duan
- Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
| | - Steven Mumm
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children - St. Louis, St. Louis, MO 63110, USA; Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
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Subchondral bone microenvironment in osteoarthritis and pain. Bone Res 2021; 9:20. [PMID: 33731688 PMCID: PMC7969608 DOI: 10.1038/s41413-021-00147-z] [Citation(s) in RCA: 188] [Impact Index Per Article: 62.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/20/2021] [Accepted: 02/01/2021] [Indexed: 01/31/2023] Open
Abstract
Osteoarthritis comprises several joint disorders characterized by articular cartilage degeneration and persistent pain, causing disability and economic burden. The incidence of osteoarthritis is rapidly increasing worldwide due to aging and obesity trends. Basic and clinical research on osteoarthritis has been carried out for decades, but many questions remain unanswered. The exact role of subchondral bone during the initiation and progression osteoarthritis remains unclear. Accumulating evidence shows that subchondral bone lesions, including bone marrow edema and angiogenesis, develop earlier than cartilage degeneration. Clinical interventions targeting subchondral bone have shown therapeutic potential, while others targeting cartilage have yielded disappointing results. Abnormal subchondral bone remodeling, angiogenesis and sensory nerve innervation contribute directly or indirectly to cartilage destruction and pain. This review is about bone-cartilage crosstalk, the subchondral microenvironment and the critical role of both in osteoarthritis progression. It also provides an update on the pathogenesis of and interventions for osteoarthritis and future research targeting subchondral bone.
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Pickering ME, Ltaief-Boudrigua A, Feurer E, Collet C, Chapurlat R. A new LRP6 variant and Camurati-Engelmann-like disease. Bone 2021; 143:115706. [PMID: 33164853 DOI: 10.1016/j.bone.2020.115706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/24/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Camurati-Engelmann disease is a rare autosomal dominant bone dysplasia belonging to the group of craniotubular hyperostoses. Genetic analysis classically shows mutation on TGFβ1 gene. CASE REPORT A young woman was hospitalized with intense pain in lower limbs, associated to radiographic hyperostosis and sclerosis of the long bones. RESULTS Mutation on LRP6 has recently been associated to high bone mass. In this case report, a rare missense variant on LRP6 gene was associated to radiographic features of Camurati-Engelmann. CONCLUSIONS More studies should be conducted to assess the pathological role of this variant in Camurati-Engelmann-like disease.
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Affiliation(s)
- Marie-Eva Pickering
- Service de Rhumatologie et Pathologie Osseuse, Hôpital Edouard Herriot, 69437 Lyon, cedex 03, France; Inserm UMR 1033, 69437 Lyon, cedex 03, France; Université de Lyon, 69437 Lyon, cedex 03, France.
| | - Aicha Ltaief-Boudrigua
- Service de Rhumatologie et Pathologie Osseuse, Hôpital Edouard Herriot, 69437 Lyon, cedex 03, France; Inserm UMR 1033, 69437 Lyon, cedex 03, France; Université de Lyon, 69437 Lyon, cedex 03, France
| | - Elodie Feurer
- Service de Rhumatologie et Pathologie Osseuse, Hôpital Edouard Herriot, 69437 Lyon, cedex 03, France; Inserm UMR 1033, 69437 Lyon, cedex 03, France; Université de Lyon, 69437 Lyon, cedex 03, France
| | - Corinne Collet
- Service de Rhumatologie et Pathologie Osseuse, Hôpital Edouard Herriot, 69437 Lyon, cedex 03, France; Inserm UMR 1033, 69437 Lyon, cedex 03, France; Université de Lyon, 69437 Lyon, cedex 03, France
| | - Roland Chapurlat
- Service de Rhumatologie et Pathologie Osseuse, Hôpital Edouard Herriot, 69437 Lyon, cedex 03, France; Inserm UMR 1033, 69437 Lyon, cedex 03, France; Université de Lyon, 69437 Lyon, cedex 03, France
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Ruan D, Zhuang Z, Ding R, Qiu Y, Zhou S, Wu J, Xu C, Hong L, Huang S, Zheng E, Cai G, Wu Z, Yang J. Weighted Single-Step GWAS Identified Candidate Genes Associated with Growth Traits in a Duroc Pig Population. Genes (Basel) 2021; 12:genes12010117. [PMID: 33477978 PMCID: PMC7835741 DOI: 10.3390/genes12010117] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 12/17/2022] Open
Abstract
Growth traits are important economic traits of pigs that are controlled by several major genes and multiple minor genes. To better understand the genetic architecture of growth traits, we performed a weighted single-step genome-wide association study (wssGWAS) to identify genomic regions and candidate genes that are associated with days to 100 kg (AGE), average daily gain (ADG), backfat thickness (BF) and lean meat percentage (LMP) in a Duroc pig population. In this study, 3945 individuals with phenotypic and genealogical information, of which 2084 pigs were genotyped with a 50 K single-nucleotide polymorphism (SNP) array, were used for association analyses. We found that the most significant regions explained 2.56–3.07% of genetic variance for four traits, and the detected significant regions (>1%) explained 17.07%, 18.59%, 23.87% and 21.94% for four traits. Finally, 21 genes that have been reported to be associated with metabolism, bone growth, and fat deposition were treated as candidate genes for growth traits in pigs. Moreover, gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses implied that the identified genes took part in bone formation, the immune system, and digestion. In conclusion, such full use of phenotypic, genotypic, and genealogical information will accelerate the genetic improvement of growth traits in pigs.
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Affiliation(s)
- Donglin Ruan
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou 510642, China; (D.R.); (Z.Z.); (R.D.); (Y.Q.); (S.Z.); (J.W.); (C.X.); (L.H.); (S.H.); (E.Z.); (G.C.)
- Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou 510642, China
| | - Zhanwei Zhuang
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou 510642, China; (D.R.); (Z.Z.); (R.D.); (Y.Q.); (S.Z.); (J.W.); (C.X.); (L.H.); (S.H.); (E.Z.); (G.C.)
- Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou 510642, China
| | - Rongrong Ding
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou 510642, China; (D.R.); (Z.Z.); (R.D.); (Y.Q.); (S.Z.); (J.W.); (C.X.); (L.H.); (S.H.); (E.Z.); (G.C.)
- Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou 510642, China
| | - Yibin Qiu
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou 510642, China; (D.R.); (Z.Z.); (R.D.); (Y.Q.); (S.Z.); (J.W.); (C.X.); (L.H.); (S.H.); (E.Z.); (G.C.)
- Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou 510642, China
| | - Shenping Zhou
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou 510642, China; (D.R.); (Z.Z.); (R.D.); (Y.Q.); (S.Z.); (J.W.); (C.X.); (L.H.); (S.H.); (E.Z.); (G.C.)
- Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou 510642, China
| | - Jie Wu
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou 510642, China; (D.R.); (Z.Z.); (R.D.); (Y.Q.); (S.Z.); (J.W.); (C.X.); (L.H.); (S.H.); (E.Z.); (G.C.)
- Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou 510642, China
| | - Cineng Xu
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou 510642, China; (D.R.); (Z.Z.); (R.D.); (Y.Q.); (S.Z.); (J.W.); (C.X.); (L.H.); (S.H.); (E.Z.); (G.C.)
- Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou 510642, China
| | - Linjun Hong
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou 510642, China; (D.R.); (Z.Z.); (R.D.); (Y.Q.); (S.Z.); (J.W.); (C.X.); (L.H.); (S.H.); (E.Z.); (G.C.)
- Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou 510642, China
| | - Sixiu Huang
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou 510642, China; (D.R.); (Z.Z.); (R.D.); (Y.Q.); (S.Z.); (J.W.); (C.X.); (L.H.); (S.H.); (E.Z.); (G.C.)
- Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou 510642, China
| | - Enqin Zheng
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou 510642, China; (D.R.); (Z.Z.); (R.D.); (Y.Q.); (S.Z.); (J.W.); (C.X.); (L.H.); (S.H.); (E.Z.); (G.C.)
- Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou 510642, China
| | - Gengyuan Cai
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou 510642, China; (D.R.); (Z.Z.); (R.D.); (Y.Q.); (S.Z.); (J.W.); (C.X.); (L.H.); (S.H.); (E.Z.); (G.C.)
| | - Zhenfang Wu
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou 510642, China; (D.R.); (Z.Z.); (R.D.); (Y.Q.); (S.Z.); (J.W.); (C.X.); (L.H.); (S.H.); (E.Z.); (G.C.)
- Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou 510642, China
- Correspondence: (Z.W.); (J.Y.)
| | - Jie Yang
- National Engineering Research Center for Breeding Swine Industry, College of Animal Science, South China Agricultural University, Guangzhou 510642, China; (D.R.); (Z.Z.); (R.D.); (Y.Q.); (S.Z.); (J.W.); (C.X.); (L.H.); (S.H.); (E.Z.); (G.C.)
- Lingnan Guangdong Laboratory of Modern Agriculture, Guangzhou 510642, China
- Correspondence: (Z.W.); (J.Y.)
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Whyte MP, Ma NS, Mumm S, Gottesman GS, McAlister WH, Nenninger AR, Bijanki VN, Ericson KL, Magnusson P. Persistent idiopathic hyperphosphatasemia from bone alkaline phosphatase in a healthy boy. Bone 2020; 138:115459. [PMID: 32474245 DOI: 10.1016/j.bone.2020.115459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/26/2020] [Accepted: 05/26/2020] [Indexed: 11/19/2022]
Abstract
Alkaline phosphatase (ALP) in humans comprises a family of four cell-surface phosphomonoester phosphohydrolase isozymes. Three genes separately encode the "tissue-specific" ALPs whereas the fourth gene encodes ubiquitous homodimeric "tissue-nonspecific" ALP (TNSALP) richly expressed in bone, liver, kidney, and developing teeth. TNSALP monomers have five putative N-linked glycosylation sites where different post-translational modifications account for this isozyme's distinctive physicochemical properties in different organs. Three bone-derived TNSALP (BALP) isoforms (B/I, B1, and B2) are present in healthy serum, whereas a fourth BALP isoform (B1x) can circulate in chronic kidney disease. Herein, we report a healthy boy with persistent hyperphosphatasemia due to BALP levels two- to threefold higher than age-appropriate reference values. High-performance liquid chromatography, electrophoresis, heat inactivation, catalysis inhibition, and polyethylene glycol precipitation revealed increased serum B/I, B1, and B2 differing from patterns found in skeletal diseases. B/I was ~23-fold elevated. Absence of mental retardation and physical stigmata excluded Mabry syndrome, the ALP-anchoring disorder causing hyperphosphatasemia. Routine biochemical studies indicated intact mineral homeostasis. Serum N-terminal propeptide of type I procollagen (P1NP) level was normal, but C-terminal cross-linking telopeptide of type I collagen (CTX) level was elevated. However, radiological studies showed no evidence for a generalized skeletal disturbance. Circulating pyridoxal 5'-phosphate, a TNSALP natural substrate, was not low despite the laboratory hyperphosphatasemia, thereby suggesting BALP phosphohydrolase activity was not elevated endogenously. Mutation analysis of the ALPL gene encoding TNSALP revealed no defect. His non-consanguineous healthy parents had serum total ALP activity and BALP protein levels that were normal. Our patient's sporadic idiopathic hyperphosphatasemia could reflect altered post-translational modification together with increased expression and/or impaired degradation of BALP.
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Affiliation(s)
- Michael P Whyte
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children, St. Louis, MO 63110, USA; Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
| | - Nina S Ma
- Division of Endocrinology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA.
| | - Steven Mumm
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children, St. Louis, MO 63110, USA; Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
| | - Gary S Gottesman
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children, St. Louis, MO 63110, USA.
| | - William H McAlister
- Mallinckrodt Institute of Radiology, Washington University School of Medicine at St. Louis Children's Hospital, St. Louis, MO 63110, USA.
| | - Angela R Nenninger
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children, St. Louis, MO 63110, USA.
| | - Vinieth N Bijanki
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children, St. Louis, MO 63110, USA.
| | - Karen L Ericson
- Department of Chemistry, Purdue University-Fort Wayne, Fort Wayne, IN 46805, USA.
| | - Per Magnusson
- Department of Clinical Chemistry and Department of Biomedical and Clinical Sciences, Linköping University, SE-58185 Linköping, Sweden.
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Owhonda RA, Wells JE, Lloyd EW, Mumm S, Kimonis V. A Case Report of a 44-Year-Old Woman With Camurati-Englemann Disease: A Case Report. JBJS Case Connect 2020; 10:e19.00400. [PMID: 32668141 DOI: 10.2106/jbjs.cc.19.00400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CASE A 44-year-old woman presented with easy fatigability, diplopia, dizziness, and a 2-year history of pelvic, hip, and lower extremity aching and pain. Radiograph, magnetic resonance imaging, computed tomography, and histopathologic imaging studies were obtained. Hypersclerosis of the affected bones led to the initiation of a sclerotic bone dysplasia workup and sequencing of the transforming growth factor beta 1 gene located on chromosome 19q13 revealed a heterozygous rare missense variant in exon-4, leading to a final diagnosis of Camurati-Engelmann disease (CED). Medical treatment thus far has had a minimal effect on her symptoms, and the patient continues to be followed. CONCLUSIONS This specific mutation has been reported only once previously in a patient with CED. This case report expands the typical phenotype associated with CED in association with the c.667T>C, p.Cys223Arg variant.
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Affiliation(s)
- Rebisi A Owhonda
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas
| | - Joel E Wells
- Department of Orthopaedic Surgery, University of Texas Southwestern, Dallas, Texas
| | - Eric W Lloyd
- Boca Raton Orthopedics Group, Boca Raton, Florida
| | - Steven Mumm
- Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital and Center for Metabolic Bone Disease and Molecular Research, Shriners Hospitals for Children-St. Louis, St. Louis, Missouri
| | - Virginia Kimonis
- Division of Genetics and Genomic Medicine, Department of Pediatrics, University of California, Irvine, California
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Hughes P, Hassan I, Que L, Mead P, Lee JH, Love DR, Prosser DO, Cundy T. Observations on the Natural History of Camurati-Engelmann Disease. J Bone Miner Res 2019; 34:875-882. [PMID: 30690794 DOI: 10.1002/jbmr.3670] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/05/2018] [Indexed: 11/07/2022]
Abstract
Camurati-Engelmann disease (OMIM 31300) is a rare cranio-tubular bone dysplasia characterized by osteosclerosis of the long bones and skull caused by dominantly-inherited mutations in the transforming growth factor beta 1 (TGFB1) gene. A wide variation in phenotype has been recognized, even within families carrying the same mutation. In addition, aspects of the natural history of the disorder, in particular whether it is always progressive or can remit spontaneously, remain uncertain. In a large kindred carrying a TGFB1 gene mutation (c.653G > A; p.R218H) we have attempted to clarify the extent of phenotypic variability and the natural history of the disease through detailed individual histories of symptoms, and skeletal imaging by both radiography and scintigraphy. Only one subject had the classical childhood onset with bone pain in the legs and gait disturbance. Eight subjects reported the onset of leg pain in their teenage years that, by their early 20s, had either resolved or persisted at a low level. Two of these eight later developed cranial nerve palsies. There was a wide variation in the radiographic appearance in adults, but disease extent and activity in long bones, as assessed by scintigraphy, was inversely correlated with age (p < 0.025). In younger subjects the radiographic and scintigraphic appearances were concordant, but in older subjects the scintigram could be quiescent despite florid radiographic changes. Sequential scintigrams in two subjects showed reduced activity in the later scan. One subject had suffered meningoencephalitis in early childhood that resulted in paresis of one arm. The affected arm showed markedly less disease involvement, implicating mechanical or growth factors in its etiology. Our data suggest that the natural history of Camurati-Engelmann disease can be benign, and that disease activity commonly attenuates in adulthood. Severe cases of childhood onset and/or with cranial nerve involvement, may occur only in a minority of mutation carriers. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Peter Hughes
- Radiology, Auckland City Hospital, Auckland, New Zealand
| | - Ibrahim Hassan
- Nuclear Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Lorna Que
- Nuclear Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Patricia Mead
- Nuclear Medicine, Auckland City Hospital, Auckland, New Zealand
| | | | - Donald R Love
- Diagnostic Genetics, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Debra O Prosser
- Diagnostic Genetics, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Tim Cundy
- Endocrinology, Auckland City Hospital, Auckland, New Zealand
- Department of Medicine, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
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Van Hul W, Boudin E, Vanhoenacker FM, Mortier G. Camurati-Engelmann Disease. Calcif Tissue Int 2019; 104:554-560. [PMID: 30721323 DOI: 10.1007/s00223-019-00532-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 01/28/2019] [Indexed: 12/12/2022]
Abstract
Camurati-Engelmann disease or progressive diaphyseal dysplasia is a rare autosomal dominant sclerosing bone dysplasia. Mainly the skull and the diaphyses of the long tubular bones are affected. Clinically, the patients suffer from bone pain, easy fatigability, and decreased muscle mass and weakness in the proximal parts of the lower limbs resulting in gait disturbances. The disease-causing mutations are located within the TGFβ-1 gene and expected to or thought to disrupt the binding between TGFβ1 and its latency-associated peptide resulting in an increased signaling of the pathway and subsequently accelerated bone turnover. In preclinical studies, it was shown that targeting the type I receptor ameliorates the high bone turnover. In patients, treatment options are currently mostly limited to corticosteroids that may relieve the pain, and improve the muscle weakness and fatigue. In this review, the clinical and radiological characteristics as well as the molecular genetics of this condition are discussed.
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Affiliation(s)
- Wim Van Hul
- Department of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium.
- Department of Medical Genetics, University of Antwerp, Prins Boudewijnlaan 43, 2650, Edegem, Belgium.
| | - Eveline Boudin
- Department of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
| | - Filip M Vanhoenacker
- AZ Sint-Maarten, Antwerp University Hospital and Ghent University, Mechelen, Belgium
| | - Geert Mortier
- Department of Medical Genetics, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium
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11
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Mwasamwaja AO, Mkwizu EW, Shao ER, Kalambo CF, Lyaruu I, Hamel BC. Camurati-Engelmann disease: a case report from sub-Saharan Africa. Oxf Med Case Reports 2018; 2018:omy036. [PMID: 30034812 PMCID: PMC6049015 DOI: 10.1093/omcr/omy036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/27/2018] [Accepted: 05/07/2018] [Indexed: 12/02/2022] Open
Abstract
Camurati–Engelmann disease is a rare autosomal dominant inherited condition belonging to the group of craniotubular hyperostosis with characteristic radiological features of the diaphyses of the long bones and the skull. A 35-year-old female is reported presenting with bone pain and waddling gait, since the age of 20 years. Motor activities were limited since the age of 10 years. Palpable bones, muscle weakness and protrusion of eyes were noted. Radiologically, hyperostosis of long bones was seen. Based on history, clinical and radiological features Camurati–Engelmann disease was diagnosed. Sequence analysis of the transforming growth factor β1 (TGFB1) gene revealed a missense mutation (c.652C>T; p.Arg218Cys). She is the first molecularly confirmed case in sub-Saharan Africa. It is emphasized that Camurati–Engelmann disease is included in the differential diagnosis of persistent bone pain, but also of abnormal childhood motor development in order to avoid unnecessary investigations and inadequate management.
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Affiliation(s)
- Amos O Mwasamwaja
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Elifuraha W Mkwizu
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Elichilia R Shao
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Clement F Kalambo
- Department of Diagnostic Radiology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Department of Diagnostic Radiology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Isaack Lyaruu
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Ben C Hamel
- Postgraduate Office, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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12
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Abstract
PURPOSE OF REVIEW The group of sclerosing bone disorders encompasses a variety of disorders all marked by increased bone mass. In this review, we give an overview of the genetic causes of this heterogeneous group of disorders and briefly touch upon the value of these findings for the development of novel therapeutic agents. RECENT FINDINGS Advances in the next-generation sequencing technologies are accelerating the molecular dissection of the pathogenic mechanisms underlying skeletal dysplasias. Throughout the years, the genetic cause of these disorders has been extensively studied which resulted in the identification of a variety of disease-causing genes and pathways that are involved in bone formation by osteoblasts, bone resorption by osteoclasts, or both processes. Due to this rapidly increasing knowledge, the insights into the regulatory mechanisms of bone metabolism are continuously improving resulting in the identification of novel therapeutic targets for disorders with reduced bone mass and increased bone fragility.
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Affiliation(s)
- Raphaël De Ridder
- Centre of Medical Genetics, University of Antwerp & University Hospital Antwerp, Antwerp, Belgium
| | - Eveline Boudin
- Centre of Medical Genetics, University of Antwerp & University Hospital Antwerp, Antwerp, Belgium
| | - Geert Mortier
- Centre of Medical Genetics, University of Antwerp & University Hospital Antwerp, Antwerp, Belgium
| | - Wim Van Hul
- Centre of Medical Genetics, University of Antwerp & University Hospital Antwerp, Antwerp, Belgium.
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13
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Xu X, Zheng L, Yuan Q, Zhen G, Crane JL, Zhou X, Cao X. Transforming growth factor-β in stem cells and tissue homeostasis. Bone Res 2018; 6:2. [PMID: 29423331 PMCID: PMC5802812 DOI: 10.1038/s41413-017-0005-4] [Citation(s) in RCA: 239] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/12/2017] [Accepted: 11/15/2017] [Indexed: 02/05/2023] Open
Abstract
TGF-β 1-3 are unique multi-functional growth factors that are only expressed in mammals, and mainly secreted and stored as a latent complex in the extracellular matrix (ECM). The biological functions of TGF-β in adults can only be delivered after ligand activation, mostly in response to environmental perturbations. Although involved in multiple biological and pathological processes of the human body, the exact roles of TGF-β in maintaining stem cells and tissue homeostasis have not been well-documented until recent advances, which delineate their functions in a given context. Our recent findings, along with data reported by others, have clearly shown that temporal and spatial activation of TGF-β is involved in the recruitment of stem/progenitor cell participation in tissue regeneration/remodeling process, whereas sustained abnormalities in TGF-β ligand activation, regardless of genetic or environmental origin, will inevitably disrupt the normal physiology and lead to pathobiology of major diseases. Modulation of TGF-β signaling with different approaches has proven effective pre-clinically in the treatment of multiple pathologies such as sclerosis/fibrosis, tumor metastasis, osteoarthritis, and immune disorders. Thus, further elucidation of the mechanisms by which TGF-β is activated in different tissues/organs and how targeted cells respond in a context-dependent way can likely be translated with clinical benefits in the management of a broad range of diseases with the involvement of TGF-β.
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Affiliation(s)
- Xin Xu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Liwei Zheng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Quan Yuan
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Implantology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Gehua Zhen
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Janet L. Crane
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD USA
| | - Xuedong Zhou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cariology and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Xu Cao
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
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14
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Butscheidt S, Rolvien T, Kornak U, Schmidt FN, Schinke T, Amling M, Oheim R. Clinical Significance of DXA and HR-pQCT in Autosomal Dominant Osteopetrosis (ADO II). Calcif Tissue Int 2018; 102:41-52. [PMID: 29018903 DOI: 10.1007/s00223-017-0332-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/21/2017] [Indexed: 12/29/2022]
Abstract
The main hallmark of high bone mass (HBM) disorders is increased bone mineral density, potentially visible in conventional radiographs and quantifiable by other radiographic methods. While one of the most common forms of HBM is CLCN7-related autosomal dominant osteopetrosis type II (ADO II), there is no consensus on diagnostic thresholds. We therefore wanted to assess whether CLCN7-osteopetrosis patients differ from benign HBM cases in terms of (1) bone mineral density, (2) bone structure, and (3) microarchitectural abnormalities. 16 patients meeting the criteria of HBM (DXA T/Z-score ≥ 2.5 at all sites) were included in this retrospective study. Osteologic assessment using dual-energy X-ray absorptiometry (DXA), high-resolution peripheral quantitative computed tomography (HR-pQCT), and serum analyses was performed. The presence of CLCN7 and/or other HBM gene mutations affecting bone mass were tested using a custom designed bone panel. While a DXA threshold for ADO II could be implemented (DXA Z-score ≥ + 6.0), the differences in bone microarchitecture were of lesser extent compared to the benign HBM group. All adult patients with ADO II suffered from elevated fracture rates independent from Z-score. In HR-pQCT, structural alterations, such as bone islets were found only inconsistently. In cases of HBM, a DXA Z-score ≥ 6 may be indicative for an inheritable HBM disorder, such as ADO II. Microarchitectural bone alterations might represent local microfracture repair or accumulation of cartilage remnants due to impaired osteoclast function, but seem not to be correlated with fracture risk.
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Affiliation(s)
- Sebastian Butscheidt
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany
| | - Tim Rolvien
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany
| | - Uwe Kornak
- Institute of Medical Genetics and Human Genetics, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Charité Universitätsmedizin Berlin, Berlin, Germany
- Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Felix N Schmidt
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany
| | - Thorsten Schinke
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany.
| | - Ralf Oheim
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529, Hamburg, Germany
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15
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Herrera S, Soriano R, Nogués X, Güerri-Fernandez R, Grinberg D, García-Giralt N, Martínez-Gil N, Castejón S, González-Lizarán A, Balcells S, Diez-Perez A. Discrepancy between bone density and bone material strength index in three siblings with Camurati-Engelmann disease. Osteoporos Int 2017; 28:3489-3493. [PMID: 28842728 DOI: 10.1007/s00198-017-4198-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED Camurati-Engelmann (CE) is a very rare disease affecting one in every million persons worldwide. It is characterized by an enlargement of long bones. We aimed to assess bone characteristics in three siblings with different tools. Even if there was an excess of bone density, quality seemed to be deteriorated. INTRODUCTION CE disease is a rare monogenic disorder affecting approximately one in every million persons worldwide. It is mainly characterized by a progressive hyperostosis of the periosteum and endosteum of the diaphysis of long bones. Limited data are available about bone characteristics in these patients. In three siblings with CE disease, we aimed to assess bone mineral density (BMD) and trabecular bone score (TBS) by dual-energy X-ray absorptiometry (DXA) and material characteristics at tissue level using bone impact reference point indentation. METHODS Clinical data were collected and a general laboratory workup was performed. At the lumbar spine and hip, BMD and TBS were measured using DXA imaging. Bone material strength index (BMSi) was measured by bone impact microindentation using an Osteoprobe instrument. RESULTS All three cases had densitometric values consistent with high bone mass (sum of Z-score at the lumbar spine and hip > 4). Hip BMD was extremely high in all three siblings at both total hip and femoral neck, while at the lumbar spine, two of them had normal values but the third again had very high BMD. TBS values were in the normal range. In contrast, BMSi measurements were at low or very low levels, compared with normal controls. CONCLUSION Despite strikingly increased BMD and normal microarchitecture, BMSi is affected in patients with CE. Microindentation could be an appropriate tool for assessing bone fragility in these patients. Bone disease in this group of patients requires further study to better understand the underlying regulatory mechanisms and their alterations.
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Affiliation(s)
- S Herrera
- Hospital del Mar Institute of Medical Research, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - R Soriano
- Hospital del Mar Institute of Medical Research, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - X Nogués
- Hospital del Mar Institute of Medical Research, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - R Güerri-Fernandez
- Hospital del Mar Institute of Medical Research, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - D Grinberg
- Department of Genetics, Microbiology and Statistics, University of Barcelona, IBUB, IDSJD, and CIBERER, Instituto Carlos III, Barcelona, Spain
| | - N García-Giralt
- Hospital del Mar Institute of Medical Research, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - N Martínez-Gil
- Department of Genetics, Microbiology and Statistics, University of Barcelona, IBUB, IDSJD, and CIBERER, Instituto Carlos III, Barcelona, Spain
| | - S Castejón
- Hospital del Mar Institute of Medical Research, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - A González-Lizarán
- Hospital del Mar Institute of Medical Research, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain
| | - S Balcells
- Department of Genetics, Microbiology and Statistics, University of Barcelona, IBUB, IDSJD, and CIBERER, Instituto Carlos III, Barcelona, Spain
| | - A Diez-Perez
- Hospital del Mar Institute of Medical Research, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Barcelona, Spain.
- Department of Internal Medicine, Hospital del Mar, P. Maritim 25-29, 08003, Barcelona, Spain.
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16
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Krela-Kaźmierczak I, Michalak M, Wawrzyniak A, Szymczak A, Eder P, Łykowska-Szuber L, Kaczmarek-Ryś M, Drwęska-Matelska N, Skrzypczak-Zielińska M, Linke K, Słomski R. The c.29T>C polymorphism of the transforming growth factor beta-1 (TGFB1) gene, bone mineral density and the occurrence of low-energy fractures in patients with inflammatory bowel disease. Mol Biol Rep 2017; 44:455-461. [PMID: 28993955 DOI: 10.1007/s11033-017-4131-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 09/19/2017] [Indexed: 01/12/2023]
Abstract
Gastrointestinal tract conditions are frequently associated with low bone mineral density and increased risk of fractures due to osteoporosis, the latter concerning particularly inflammatory bowel disease (IBD) patients. One of the candidate genes involved in osteoporosis is the transforming growth factor beta-1 (TGFB1) whose polymorphisms may be responsible for the development of this disease. The aim of this study was to analyse the frequency of TGFB1 polymorphic variants and determine the association between the c.29T>C TGFB1 polymorphism, and bone mineral density and fractures in IBD patients. The study subjects included 198 IBD patients [100 suffering from Crohn's disease (CD) and 98 from ulcerative colitis (UC)] and 41 healthy volunteers as a control group. Densitometric bone measurements were obtained using dual energy X-ray absorptiometry. The TGFB1 genotyping was conducted using restriction fragments length polymorphism. We conducted an analysis of genotype distribution's concordance with Hardy-Weinberg equilibrium. We found statistically significant differences in lumbar spine (L2-L4) and femoral neck BMD and T-scores between CD, UC and control subgroups. The distribution of TGFB1 polymorphic variants among CD and UC patients was concordant with Hardy-Weinberg equilibrium. There were no statistically significant differences in densitometric parameters (lumbar spine and femoral neck BMD, T-score, and Z-score) between carriers of different TGFB1 polymorphisms among IBD (CD and UC) patients nor among controls. We have found no statistically significant differences in the prevalence of low-energy fractures between groups of different TGFB1 polymorphic variant carriers. The allele dose effect, recessive effect and dominant effect analysis did not show an association between low-energy fractures and the TGFB1 polymorphisms among CD and UC patients. We have not observed an association between the c.29T>C TGFB1 polymorphic variant and the bone mineral density within the cancellous and cortical bones (L2-L4 and femoral neck, respectively), or the occurrence of fractures among the IBD patients and their family members.
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Affiliation(s)
- I Krela-Kaźmierczak
- Department of Gastroenterology, Human Nutrition and Internal Diseases, University of Medical Sciences, Przybyszewskiego Street 49, 60-355, Poznan, Poland.
| | - M Michalak
- Department of Computer Science and Statistics, University of Medical Sciences, Poznan, Poland
| | - A Wawrzyniak
- Department of Family Medicine, University of Medical Sciences, Poznan, Poland
| | - A Szymczak
- Department of Gastroenterology, Human Nutrition and Internal Diseases, University of Medical Sciences, Przybyszewskiego Street 49, 60-355, Poznan, Poland
| | - P Eder
- Department of Gastroenterology, Human Nutrition and Internal Diseases, University of Medical Sciences, Przybyszewskiego Street 49, 60-355, Poznan, Poland
| | - L Łykowska-Szuber
- Department of Gastroenterology, Human Nutrition and Internal Diseases, University of Medical Sciences, Przybyszewskiego Street 49, 60-355, Poznan, Poland
| | - M Kaczmarek-Ryś
- Department of Biochemistry and Biotechnology, Poznan University of Life Sciences, Poznan, Poland
| | | | - M Skrzypczak-Zielińska
- Department of Biochemistry and Biotechnology, Poznan University of Life Sciences, Poznan, Poland
| | - K Linke
- Department of Gastroenterology, Human Nutrition and Internal Diseases, University of Medical Sciences, Przybyszewskiego Street 49, 60-355, Poznan, Poland
| | - R Słomski
- Department of Biochemistry and Biotechnology, Poznan University of Life Sciences, Poznan, Poland
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17
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Tucci JR, Whitford GM, McAlister WH, Novack D, Mumm S, Keaveny TM, Whyte MP. Skeletal Fluorosis Due To Inhalation Abuse of a Difluoroethane-Containing Computer Cleaner. J Bone Miner Res 2017; 32:188-195. [PMID: 27449958 PMCID: PMC5977397 DOI: 10.1002/jbmr.2923] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/07/2016] [Accepted: 07/14/2016] [Indexed: 12/13/2022]
Abstract
Skeletal fluorosis (SF) is endemic in many countries and millions of people are affected worldwide, whereas in the United States SF is rare with occasional descriptions of unique cases. We report a 28-year-old American man who was healthy until 2 years earlier when he gradually experienced difficulty walking and an abnormal gait, left hip pain, loss of mobility in his right wrist and forearm, and progressive deformities including enlargement of the digits of both hands. Dual-energy X-ray absorptiometry (DXA) of his lumbar spine, femoral neck, total hip, and the one-third forearm revealed bone mineral density (BMD) Z-scores of +6.2, +4.8, +3.0, and -0.2, respectively. Serum, urine, and bone fluoride levels were all elevated and ultimately explained by chronic sniffing abuse of a computer cleaner containing 1,1-difluoroethane. Our findings reflect SF due to the unusual cause of inhalation abuse of difluoroethane. Because this practice seems widespread, particularly in the young, there may be many more such cases. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Joseph R. Tucci
- Department of Medicine, Roger Williams Medical Center, Providence, RI, USA 02908; Boston University School of Medicine; Boston, MA, USA, 02118
| | - Gary M. Whitford
- Department of Oral Biology, School of Dental Medicine, George Regents University; Augusta, Georgia, USA, 30912
| | - William H. McAlister
- Department of Pediatric Radiology, Mallinckrodt Institute of Radiology at St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, MO, USA, 63110
| | - Deborah Novack
- Division of Bone and Mineral Diseases, Department of Internal Medicine, and Department of Pathology, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA, 63110
| | - Steven Mumm
- Division of Bone and Mineral Diseases, Department of Internal Medicine, and Department of Pathology, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA, 63110
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO, USA, 63110
| | - Tony M. Keaveny
- Departments of Mechanical Engineering and Bioengineering, University of California; Berkeley, CA, USA, 94720
| | - Michael P. Whyte
- Division of Bone and Mineral Diseases, Department of Internal Medicine, and Department of Pathology, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA, 63110
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO, USA, 63110
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18
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Lhaneche L, Hald JD, Domingues A, Hannouche D, Delepine M, Zelenika D, Boland A, Ostertag A, Cohen-Solal M, Langdahl BL, Harsløf T, de Vernejoul MC, Geoffroy V, Jehan F. Variations of SOST mRNA expression in human bone are associated with DNA polymorphism and DNA methylation in the SOST gene. Bone 2016; 92:107-115. [PMID: 27519970 DOI: 10.1016/j.bone.2016.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/12/2016] [Accepted: 08/08/2016] [Indexed: 11/24/2022]
Abstract
SOST encodes sclerostin, an inhibitor of bone formation that antagonizes canonical Wnt signaling. Variations of SOST expression have an impact on bone mineral density (BMD) and bone strength. We hypothesized that genetic and epigenetic DNA modifications have an impact on SOST gene expression. By analyzing 43 bone samples from women, we found that rs851054 (G/A) is associated with SOST mRNA expression, donors with one or two G allele(s) displaying higher SOST expression (p<0.05). Beside this polymorphism, we also investigated the role of CpG methylation in SOST mRNA expression, and analyzed methylation variation at 13 CpG sites on the 1st exon of SOST in 14 human bone samples. Principal component analysis identified three groups of CpG sites that explained most of the methylation variation. We calculated the percentage of methylation in the main group of CpGs, and showed that higher rates of methylated CpGs are associated with higher SOST mRNA expression. To demonstrate that change in SOST expression might be related to human bone disease, we analyzed 131 patients with osteogenesis imperfecta (OI), a rare disease characterized by low BMD, bone fragility, and marked intra-familial variability of bone phenotypes. We found an association between rs851054 of the SOST promoter and the fracture rate only during childhood (p<0.01). In conclusion, genetic and epigenetic changes contribute to variation in SOST expression in human bone. Our data also indicate that these variations may be related to the severity of OI.
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Affiliation(s)
- Leila Lhaneche
- INSERM U1132 BIOSCAR, Hôpital Lariboisière, 75010 Paris, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Jannie D Hald
- Department of Endocrinology and Internal Medicine, THG, Aarhus University Hospital, DK-8000 Aarhus, Denmark
| | - Aline Domingues
- INSERM U1132 BIOSCAR, Hôpital Lariboisière, 75010 Paris, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Didier Hannouche
- Department of Orthopaedic Surgery, Hôpital Lariboisière, AP-HP, 75010 Paris, France
| | - Marc Delepine
- Centre National de Genotypage, Institut Génomique, Commissariat à l'énergie Atomique, 2 rue Gaston Crémieux, CP5721 91057 Evry Cedex, France
| | - Diana Zelenika
- Centre National de Genotypage, Institut Génomique, Commissariat à l'énergie Atomique, 2 rue Gaston Crémieux, CP5721 91057 Evry Cedex, France
| | - Anne Boland
- Centre National de Genotypage, Institut Génomique, Commissariat à l'énergie Atomique, 2 rue Gaston Crémieux, CP5721 91057 Evry Cedex, France
| | - Agnes Ostertag
- INSERM U1132 BIOSCAR, Hôpital Lariboisière, 75010 Paris, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Martine Cohen-Solal
- INSERM U1132 BIOSCAR, Hôpital Lariboisière, 75010 Paris, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; Service de Rhumatologie, GH Saint-Louis Lariboisière Fernand Widal, 75010 Paris, France
| | - Bente L Langdahl
- Department of Endocrinology and Internal Medicine, THG, Aarhus University Hospital, DK-8000 Aarhus, Denmark
| | - Torben Harsløf
- Department of Endocrinology and Internal Medicine, THG, Aarhus University Hospital, DK-8000 Aarhus, Denmark
| | - Marie-Christine de Vernejoul
- INSERM U1132 BIOSCAR, Hôpital Lariboisière, 75010 Paris, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; Service de Rhumatologie, GH Saint-Louis Lariboisière Fernand Widal, 75010 Paris, France
| | - Valérie Geoffroy
- INSERM U1132 BIOSCAR, Hôpital Lariboisière, 75010 Paris, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Frédéric Jehan
- INSERM U1132 BIOSCAR, Hôpital Lariboisière, 75010 Paris, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France.
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19
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Di Carlo M, Silveri F, Tardella M, Carotti M, Salaffi F. Multiple diaphyseal sclerosis (Ribbing disease): what about neridronate? Osteoporos Int 2016; 27:3127-31. [PMID: 27105644 DOI: 10.1007/s00198-016-3604-9] [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: 02/24/2016] [Accepted: 04/12/2016] [Indexed: 01/15/2023]
Abstract
Sclerosing bone disorders are uncommon diseases and represent a diagnostic challenge. Osteocondensation is a bone alteration, involving both acquired and hereditary conditions. Multiple diaphyseal sclerosis (Ribbing disease) is an inherited condition. It is characterized by excessive proliferation of endosteal and periosteal osseous tissue at the diaphyses of long bones, especially of tibias and femurs. The conventional radiology depicts cortical thickening of diaphyses of long bones while bone scintigraphy shows characteristically an abnormal tracer concentration in the involved diaphyses. The magnetic resonance imaging (MRI) examination confirms the presence of sclerosis and reveals bone marrow edema in the diaphyses of the afflicted bones. Due to the lack of knowledge of the pathophysiology, the treatment is empirical with glucocorticoids or bisphosphonates. Concerning bisphosphonates, the literature reports are conflicting. We report the case of a patient that showed lack of response to intravenous neridronate within 1 year of treatment, both in terms of pain and persistence of bone marrow edema at MRI.
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Affiliation(s)
- M Di Carlo
- Rheumatology Department, Polytechnic University of the Marche, c/o Ospedale "Carlo Urbani", Via Aldo Moro, 25, 60035, Jesi (AN), Italy.
| | - F Silveri
- Rheumatology Department, Polytechnic University of the Marche, c/o Ospedale "Carlo Urbani", Via Aldo Moro, 25, 60035, Jesi (AN), Italy
| | - M Tardella
- Rheumatology Department, Polytechnic University of the Marche, c/o Ospedale "Carlo Urbani", Via Aldo Moro, 25, 60035, Jesi (AN), Italy
- Internal Medicine Department, "C. and G. Mazzoni" Hospital, Area Vasta 5, Ascoli Piceno, Italy
| | - M Carotti
- Radiology Department, Polytechnic University of the Marche, Ancona, Italy
| | - F Salaffi
- Rheumatology Department, Polytechnic University of the Marche, c/o Ospedale "Carlo Urbani", Via Aldo Moro, 25, 60035, Jesi (AN), Italy
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Faraji A, Abtahi S, Ghaderi A, Samsami Dehaghani A. Transforming Growth Factor β1 (TGF-β1) in the Sera of Postmenopausal Osteoporotic Females. Int J Endocrinol Metab 2016; 14:e36511. [PMID: 28123435 PMCID: PMC5237297 DOI: 10.5812/ijem.36511] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 09/26/2016] [Accepted: 10/16/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Postmenopausal osteoporosis is a major cause of morbidity in postmenopausal females. Transforming growth factor β1 (TGF-β1) and interleukin 18 (IL-18) play complex roles in normal bone metabolism, and in pathophysiology of postmenopausal osteoporosis. OBJECTIVES The aim of this study was to design an analytic cross sectional study in order to further clarify the role of TGF-β1 and IL-18 in osteoporosis of postmenopausal females. METHODS A cross sectional study including 65 postmenopausal osteoporotic females as cases and 69 postmenopausal females of similar age without osteoporosis as controls was conducted. Dual energy X-ray absorptiometry (DXA) was used to determine bone mass density (BMD) of participants and T-scoring was applied to establish whether the patient has osteoporosis or not. Serum TGF-β1 and IL-18 levels were measured by quantitative sandwich Enzyme linked immunosorbent assay (ELISA). RESULTS Serum TGF-β1 levels were significantly higher in osteoporotic postmenopausal females than non-osteoporotic individuals (23.8 vs. 15.8 ng/mL; P = 0.009). There was no difference between IL-18 levels in the sera of osteoporotic and non-osteoporotic postmenopausal females in this study. There was a positive correlation between body mass index (BMI) and serum level of TGF-β1 (P = 0.04). CONCLUSIONS Our study demonstrated that TGF-β1 serum levels is higher in osteoporotic postmenopausal females than non-osteoporotic ones, and probably aberrant increase in TGF-β1 in postmenopausal females can result in uncoupled bone resorption and formation, which leads to osteoporosis.
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Affiliation(s)
- Aazam Faraji
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz, Iran
| | - Shabnam Abtahi
- Shiraz Institute for Cancer Research, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Ghaderi
- Shiraz Institute for Cancer Research, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alamtaj Samsami Dehaghani
- Department of Obstetrics and Gynecology, School of Medicine, Shiraz, Iran
- Corresponding author: Alamtaj Samsami Dehaghani, Department of Obstetrics and Gynecology, School of Medicine, Shiraz, Iran. E-mail:
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How rare bone diseases have informed our knowledge of complex diseases. BONEKEY REPORTS 2016; 5:839. [PMID: 27688878 DOI: 10.1038/bonekey.2016.69] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 07/22/2016] [Indexed: 02/07/2023]
Abstract
Rare bone diseases, generally defined as monogenic traits with either autosomal recessive or dominant patterns of inheritance, have provided a rich database of genes and associated pathways over the past 2-3 decades. The molecular genetic dissection of these bone diseases has yielded some major surprises in terms of the causal genes and/or involved pathways. The discovery of genes/pathways involved in diseases such as osteopetrosis, osteosclerosis, osteogenesis imperfecta and many other rare bone diseases have all accelerated our understanding of complex traits. Importantly these discoveries have provided either direct validation for a specific gene embedded in a group of genes within an interval identified through a complex trait genome-wide association study (GWAS) or based upon the pathway associated with a monogenic trait gene, provided a means to prioritize a large number of genes for functional validation studies. In some instances GWAS studies have yielded candidate genes that fall within linkage intervals associated with monogenic traits and resulted in the identification of causal mutations in those rare diseases. Driving all of this discovery is a complement of technologies such as genome sequencing, bioinformatics and advanced statistical analysis methods that have accelerated genetic dissection and greatly reduced the cost. Thus, rare bone disorders in partnership with GWAS have brought us to the brink of a new era of personalized genomic medicine in which the prevention and management of complex diseases will be driven by the molecular understanding of each individuals contributing genetic risks for disease.
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Guañabens N, Mumm S, Gifre L, Ruiz-Gaspà S, Demertzis JL, Stolina M, Novack DV, Whyte MP. Idiopathic Acquired Osteosclerosis in a Middle-Aged Woman With Systemic Lupus Erythematosus. J Bone Miner Res 2016; 31:1774-82. [PMID: 27005479 PMCID: PMC5010446 DOI: 10.1002/jbmr.2842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 03/17/2016] [Accepted: 03/20/2016] [Indexed: 02/06/2023]
Abstract
Widely distributed osteosclerosis is an unusual radiographic finding with multiple causes. A 42-year-old premenopausal Spanish woman gradually acquired dense bone diffusely affecting her axial skeleton and focally affecting her proximal long bones. Systemic lupus erythematosus (SLE) diagnosed in adolescence had been well controlled. She had not fractured or received antiresorptive therapy, and she was hepatitis C virus antibody negative. Family members had low bone mass. Lumbar spine bone mineral density (BMD) measured by dual-photon absorptiometry (DPA) at age 17 years, while receiving glucocorticoids, was 79% the average value of age-matched controls. From ages 30 to 37 years, dual-energy X-ray absorptiometry (DXA) BMD Z-scores steadily increased in her lumbar spine from +3.8 to +7.9, and in her femoral neck from -1.4 to -0.7. Serum calcium and phosphorus levels were consistently normal, 25-hydroxyvitamin D (25OHD) <20 ng/mL, and parathyroid hormone (PTH) sometimes slightly increased. Her reduced estimated glomerular filtration rate (eGFR) was 38 to 55 mL/min. Hypocalciuria likely reflected positive mineral balance. During increasing BMD, turnover markers (serum bone-specific alkaline phosphatase [ALP], procollagen type 1 N propeptide [P1NP], osteocalcin [OCN], and carboxy-terminal cross-linking telopeptide of type 1 collagen [CTx], and urinary amino-terminal cross-linking telopeptide of type 1 collagen [NTx and CTx]) were 1.6- to 2.8-fold above the reference limits. Those of bone formation seemed increased more than those of resorption. FGF-23 was slightly elevated, perhaps from kidney disease. Serum osteoprotegerin (OPG) and TGFβ1 levels were normal, but sclerostin (SOST) and receptor activator of nuclear factor kappa-B ligand (RANKL) were elevated. Serum multiplex biomarker profiling confirmed a high level of SOST and RANKL, whereas Dickkopf-1 (DKK-1) seemed low. Matrix metalloproteinases-3 (MMP-3) and -7 (MMP-7) were elevated. Iliac crest biopsy revealed tetracycline labels, no distinction between thick trabeculae and cortical bone, absence of peritrabecular fibrosis, few osteoclasts, and no mastocytosis. Then, for the past 3 years, BMD Z-scores steadily decreased. Skeletal fluorosis, mastocytosis, myelofibrosis, hepatitis C-associated osteosclerosis, multiple myeloma, and aberrant phosphate homeostasis did not explain her osteosclerosis. Mutation analysis of the LRP5, LRP4, SOST, and osteopetrosis genes was negative. Microarray showed no notable copy number variation. Perhaps her osteosclerosis reflected an interval of autoimmune-mediated resistance to SOST and/or RANKL. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Núria Guañabens
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Steven Mumm
- Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA.,Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO, USA
| | - Laia Gifre
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Silvia Ruiz-Gaspà
- Metabolic Bone Diseases Unit, Department of Rheumatology, Hospital Clinic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jennifer L Demertzis
- Musculoskeletal Disease Section, Mallinckrodt Institute of Radiology at Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Marina Stolina
- Department of Metabolic Disorders, Amgen Inc., Thousand Oaks, CA, USA
| | - Deborah V Novack
- Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA.,Department of Pathology, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Michael P Whyte
- Division of Bone and Mineral Diseases, Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, MO, USA.,Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St. Louis, MO, USA
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Jiajue R, Wu B, Jiang Y, Wang O, Li M, Xing X, Xia W. Mild Camurati‑Engelamann disease presenting with exophthalmos as the first and only manifestation: A case report. Mol Med Rep 2016; 14:2710-6. [PMID: 27484238 DOI: 10.3892/mmr.2016.5548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 04/07/2016] [Indexed: 11/06/2022] Open
Abstract
Camurati-Engelmann disease (CED; MIM 131300), or progressive diaphyseal dysplasia, is a rare autosomal dominant bone disease, which is caused by mutations in the transforming growth factor‑β1 (TGFβ1) gene on chromosome 19q13.1‑13.3. Extremely variable penetrance has been reported to be associated with CED, the most common features of which are limb pain, waddling gait and muscle weakness. The present study reported on a consanguineous Chinese family with one affected individual that initially presented with exophthalmos, which has not previously been reported as an initial manifestation of CED. The proband was a 22-year-old woman that presented with progressive proptosis. Except for increased serum levels of alkaline phosphatase and C‑terminal telopeptide of type I collagen, no other biochemical abnormalities were detected. Whole‑body radiological and bone scintigraphic investigations revealed that hyperostosis and sclerosis predominantly affected the cranial bones, including the skull base, and only mildly affected the long bones. A heterozygous mutation involving a G to A transition at the cDNA position +653 of TGFβ1 was detected in the patient only, but not in her family members, by automated DNA sequencing using an ABI DNA sequencer (Model 377). Based on the clinical, biochemical, radiological and genetic findings, a diagnosis of CED was confirmed. Considering the phenotypic variability associated with CED and the unique manifestations of the patient described in the present study, CED should be taken into account regarding the differential diagnosis of exophthalmos.
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Affiliation(s)
- Ruizhi Jiajue
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Bo Wu
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Yan Jiang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Ou Wang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Mei Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Xiaoping Xing
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
| | - Weibo Xia
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
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Whyte MP, Madson KL, Mumm S, McAlister WH, Novack DV, Blair JC, Helliwell TR, Stolina M, Abernethy LJ, Shaw NJ. Rapid skeletal turnover in a radiographic mimic of osteopetrosis. J Bone Miner Res 2014; 29:2601-9. [PMID: 24919763 PMCID: PMC4391634 DOI: 10.1002/jbmr.2289] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/30/2014] [Accepted: 05/26/2014] [Indexed: 12/13/2022]
Abstract
Among the high bone mass disorders, the osteopetroses reflect osteoclast failure that prevents skeletal resorption and turnover, leading to reduced bone growth and modeling and characteristic histopathological and radiographic findings. We report an 11-year-old boy with a new syndrome that radiographically mimics osteopetrosis (OPT), but features rapid skeletal turnover. He presented at age 21 months with a parasellar, osteoclast-rich giant cell granuloma. Radiographs showed a dense skull, generalized osteosclerosis and cortical thickening, medullary cavity narrowing, and diminished modeling of tubular bones. His serum alkaline phosphatase was >5000 IU/L (normal <850 IU/L). After partial resection, the granuloma re-grew but then regressed and stabilized during 3 years of uncomplicated pamidronate treatment. His hyperphosphatasemia transiently diminished, but all bone turnover markers, especially those of apposition, remained elevated. Two years after pamidronate therapy stopped, bone mineral density (BMD) Z-scores reached +9.1 and +5.8 in the lumbar spine and hip, respectively, and iliac crest histopathology confirmed rapid bone remodeling. Serum multiplex biomarker profiling was striking for low sclerostin. Mutation analysis was negative for activation of lipoprotein receptor-related protein 4 (LRP4), LRP5, or TGFβ1, and for defective sclerostin (SOST), osteoprotegerin (OPG), RANKL, RANK, SQSTM1, or sFRP1. Microarray showed no notable copy number variation. Studies of his nonconsanguineous parents were unremarkable. The etiology and pathogenesis of this unique syndrome are unknown.
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Affiliation(s)
- Michael P. Whyte
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children; St. Louis, MO, USA, 63131
- Division of Bone and Mineral Diseases, Washington University School of Medicine at Barnes-Jewish Hospital; St. Louis, MO, USA, 63110
| | - Katherine L. Madson
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children; St. Louis, MO, USA, 63131
| | - Steven Mumm
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children; St. Louis, MO, USA, 63131
- Division of Bone and Mineral Diseases, Washington University School of Medicine at Barnes-Jewish Hospital; St. Louis, MO, USA, 63110
| | - William H. McAlister
- Department of Pediatric Radiology, Mallinckrodt Institute of Radiology at St. Louis Children’s Hospital, Washington University School of Medicine; St. Louis, MO, USA, 63110
| | - Deborah V. Novack
- Division of Bone and Mineral Diseases, Washington University School of Medicine at Barnes-Jewish Hospital; St. Louis, MO, USA, 63110
- Department of Pathology, Washington University School of Medicine at Barnes-Jewish Hospital; St. Louis, MO, USA, 63110
| | - Jo C. Blair
- Department of Endocrinology, Alder Hey Children’s National Health Service Foundation Trust; Liverpool, UK, L12 2AP
| | - Timothy R. Helliwell
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool; Liverpool, UK, L69 3GA
| | | | - Laurence J. Abernethy
- Department of Radiology, Alder Hey Children’s National Health Service Foundation Trust; Liverpool, UK, L12 2AP
| | - Nicholas J. Shaw
- Department of Endocrinology and Diabetes, Birmingham Children’s Hospital; Birmingham, UK, B4 6NH
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Low SF, Abu Bakar N, Ngiu CS. Camurati-engelmann disease association with hypogonadism and primary hypothyroidism. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e9481. [PMID: 25389497 PMCID: PMC4222023 DOI: 10.5812/ircmj.9481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 07/29/2013] [Accepted: 11/19/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Camurati-Engelmann disease (CED) is a rare autosomal dominant disease with various phenotypic expressions. The symptoms usually develop during childhood. The hallmark of the disease is bilateral symmetric diaphyseal hyperostosis of the long bones with progressive involvement of the metaphysis. The epiphysis is strictly spared. The common clinical symptoms are pain of the extremities, muscle wasting, waddling gait, and lethargy. CED is rarely seen in conjunction with hypogonadism. CED-associated hypothyroidism has not been reported yet. Clinical assessment and skeletal survey are important to make the diagnosis. CASE PRESENTATION Hereby we reported a case of CED with concomitant hypogonadism and hypothyroidism. Serial plain radiographs of the patient showed classic and progressive diaphyseal cortical hyperostosis of the long bone. CONCLUSIONS Hyperostosis of the skull was observed in the present case. The characteristic osseous changes of CED were highlighted and the differential diagnoses were discussed.
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Affiliation(s)
- Soo Fin Low
- Department of Radiology, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Norzailin Abu Bakar
- Department of Radiology, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Chai Soon Ngiu
- Department of Medicine, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Abstract
Osteoarthritis (OA) is a common joint degenerative disease affecting the whole joint structure, including articular cartilage, subchondral bone and synovial tissue. Although extensive work has been done in recent years to explore the molecular mechanism underlying this disease, the pathogenesis of OA is still poorly understood and currently, there is no effective disease-modifying treatment for OA. Recently, both in vitro and in vivo studies suggest that confirmed (TGF-β)/SMAD pathway plays a critical role during OA development. This short review will focus on the function and signaling mechanisms of TGF-β/SMAD pathway in articular chondrocytes, mesenchymal progenitor cells of subchondral bone and synovial lining cells during OA development.
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Affiliation(s)
- Jie Shen
- Department of Orthopaedics and Rehabilitation, Center for Musculoskeletal Research, University of Rochester School of Medicine, Rochester, NY 14642, USA
| | - Shan Li
- Department of Biochemistry, Rush University Medical Center, Chicago, IL 60612, USA
| | - Di Chen
- Department of Biochemistry, Rush University Medical Center, Chicago, IL 60612, USA
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Kobayashi H, Higashiura Y, Koike N, Akasaka J, Uekuri C, Iwai K, Niiro E, Morioka S, Yamada Y. Genes Downregulated in Endometriosis Are Located Near the Known Imprinting Genes. Reprod Sci 2014; 21:966-972. [PMID: 24615936 DOI: 10.1177/1933719114526473] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
There is now accumulating evidence that endometriosis is a disease associated with an epigenetic disorder. Genomic imprinting is an epigenetic phenomenon known to regulate DNA methylation of either maternal or paternal alleles. We hypothesize that hypermethylated endometriosis-associated genes may be enriched at imprinted gene loci. We sought to determine whether downregulated genes associated with endometriosis susceptibility are associated with chromosomal location of the known paternally and maternally expressed imprinting genes. Gene information has been gathered from National Center for Biotechnology Information database geneimprint.com. Several researchers have identified specific loci with strong DNA methylation in eutopic endometrium and ectopic lesion with endometriosis. Of the 29 hypermethylated genes in endometriosis, 19 genes were located near 45 known imprinted foci. There may be an association of the genomic location between genes specifically downregulated in endometriosis and epigenetically imprinted genes.
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Affiliation(s)
- Hiroshi Kobayashi
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Yumi Higashiura
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Natsuki Koike
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Juria Akasaka
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Chiharu Uekuri
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Kana Iwai
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Emiko Niiro
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Sachiko Morioka
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
| | - Yuki Yamada
- Department of Obstetrics and Gynecology, Nara Medical University, Nara, Japan
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Crane JL, Cao X. Bone marrow mesenchymal stem cells and TGF-β signaling in bone remodeling. J Clin Invest 2014; 124:466-72. [PMID: 24487640 DOI: 10.1172/jci70050] [Citation(s) in RCA: 303] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
During bone resorption, abundant factors previously buried in the bone matrix are released into the bone marrow microenvironment, which results in recruitment and differentiation of bone marrow mesenchymal stem cells (MSCs) for subsequent bone formation, temporally and spatially coupling bone remodeling. Parathyroid hormone (PTH) orchestrates the signaling of many pathways that direct MSC fate. The spatiotemporal release and activation of matrix TGF-β during osteoclast bone resorption recruits MSCs to bone-resorptive sites. Dysregulation of TGF-β alters MSC fate, uncoupling bone remodeling and causing skeletal disorders. Modulation of TGF-β or PTH signaling may reestablish coupled bone remodeling and be a potential therapy.
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Liu S, Song W, Boulanger JH, Tang W, Sabbagh Y, Kelley B, Gotschall R, Ryan S, Phillips L, Malley K, Cao X, Xia TH, Zhen G, Cao X, Ling H, Dechow PC, Bellido TM, Ledbetter SR, Schiavi SC. Role of TGF-β in a mouse model of high turnover renal osteodystrophy. J Bone Miner Res 2014; 29:1141-57. [PMID: 24166835 PMCID: PMC4076799 DOI: 10.1002/jbmr.2120] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 09/24/2013] [Accepted: 09/30/2013] [Indexed: 12/12/2022]
Abstract
Altered bone turnover is a key pathologic feature of chronic kidney disease-mineral and bone disorder (CKD-MBD). Expression of TGF-β1, a known regulator of bone turnover, is increased in bone biopsies from individuals with CKD. Similarly, TGF-β1 mRNA and downstream signaling is increased in bones from jck mice, a model of high-turnover renal osteodystrophy. A neutralizing anti-TGF-β antibody (1D11) was used to explore TGF-β's role in renal osteodystrophy. 1D11 administration to jck significantly attenuated elevated serum osteocalcin and type I collagen C-telopeptides. Histomorphometric analysis indicated that 1D11 administration increased bone volume and suppressed the elevated bone turnover in a dose-dependent manner. These effects were associated with reductions in osteoblast and osteoclast surface areas. Micro-computed tomography (µCT) confirmed the observed increase in trabecular bone volume and demonstrated improvements in trabecular architecture and increased cortical thickness. 1D11 administration was associated with significant reductions in expression of osteoblast marker genes (Runx2, alkaline phosphatase, osteocalcin) and the osteoclast marker gene, Trap5. Importantly, in this model, 1D11 did not improve kidney function or reduce serum parathyroid hormone (PTH) levels, indicating that 1D11 effects on bone are independent of changes in renal or parathyroid function. 1D11 also significantly attenuated high-turnover bone disease in the adenine-induced uremic rat model. Antibody administration was associated with a reduction in pSMAD2/SMAD2 in bone but not bone marrow as assessed by quantitative immunoblot analysis. Immunostaining revealed pSMAD staining in osteoblasts and osteocytes but not osteoclasts, suggesting 1D11 effects on osteoclasts may be indirect. Immunoblot and whole genome mRNA expression analysis confirmed our previous observation that repression of Wnt/β-catenin expression in bone is correlated with increased osteoclast activity in jck mice and bone biopsies from CKD patients. Furthermore, our data suggest that elevated TGF-β may contribute to the pathogenesis of high-turnover disease partially through inhibition of β-catenin signaling.
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Affiliation(s)
- Shiguang Liu
- Genzyme, Sanofi-Genzyme R&D Center, Framingham, MA, USA
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30
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Affiliation(s)
- Jason R Bush
- Department of Physiology and Pharmacology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
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Zhen G, Wen C, Jia X, Li Y, Crane JL, Mears SC, Askin FB, Frassica FJ, Chang W, Yao J, Carrino JA, Cosgarea A, Artemov D, Chen Q, Zhao Z, Zhou X, Riley L, Sponseller P, Wan M, Lu WW, Cao X. Inhibition of TGF-β signaling in mesenchymal stem cells of subchondral bone attenuates osteoarthritis. Nat Med 2013; 19:704-12. [PMID: 23685840 PMCID: PMC3676689 DOI: 10.1038/nm.3143] [Citation(s) in RCA: 722] [Impact Index Per Article: 65.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 02/21/2013] [Indexed: 02/07/2023]
Abstract
Osteoarthritis is a highly prevalent and debilitating joint disorder. There is no effective medical therapy for osteoarthritis due to limited understanding of osteoarthritis pathogenesis. We show that TGF–β1 is activated in the subchondral bone in response to altered mechanical loading in an anterior cruciate ligament transection (ACLT) osteoarthritis mouse model. TGF–β1 concentrations also increased in human osteoarthritis subchondral bone. High concentrations of TGF–β1 induced formation of nestin+ mesenchymal stem cell (MSC) clusters leading to aberrant bone formation accompanied by increased angiogenesis. Transgenic expression of active TGF–β1 in osteoblastic cells induced osteoarthritis. Inhibition of TGF–β activity in subchondral bone attenuated degeneration of osteoarthritis articular cartilage. Notably, knockout of the TGF–β type II receptor (TβRII) in nestin+ MSCs reduced development of osteoarthritis in ACLT mice. Thus, high concentrations of active TGF–β1 in the subchondral bone initiated the pathological changes of osteoarthritis, inhibition of which could be a potential therapeutic approach.
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Affiliation(s)
- Gehua Zhen
- Department of Orthopaedic Surgery, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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Weitzmann MN. The Role of Inflammatory Cytokines, the RANKL/OPG Axis, and the Immunoskeletal Interface in Physiological Bone Turnover and Osteoporosis. SCIENTIFICA 2013; 2013:125705. [PMID: 24278766 PMCID: PMC3820310 DOI: 10.1155/2013/125705] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 12/24/2012] [Indexed: 05/30/2023]
Abstract
Although it has long been recognized that inflammation, a consequence of immune-driven processes, significantly impacts bone turnover, the degree of centralization of skeletal and immune functions has begun to be dissected only recently. It is now recognized that formation of osteoclasts, the bone resorbing cells of the body, is centered on the key osteoclastogenic cytokine, receptor activator of NF- κ B ligand (RANKL). Although numerous inflammatory cytokines are now recognized to promote osteoclast formation and skeletal degradation, with just a few exceptions, RANKL is now considered to be the final downstream effector cytokine that drives osteoclastogenesis and regulates osteoclastic bone resorption. The biological activity of RANKL is moderated by its physiological decoy receptor, osteoprotegerin (OPG). New discoveries concerning the sources and regulation of RANKL and OPG in physiological bone turnover as well as under pathological (osteoporotic) conditions continue to be made, opening a window to the complex regulatory processes that control skeletal integrity and the depth of integration of the skeleton within the immune response. This paper will examine the interconnection between bone turnover and the immune system and the implications thereof for physiological and pathological bone turnover.
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Affiliation(s)
- M. Neale Weitzmann
- Atlanta Department of Veterans Affairs Medical Center, Decatur, GA 30033, USA
- Division of Endocrinology and Metabolism and Lipids, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, 1305 WMRB, Atlanta, GA 30322, USA
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Toumba M, Neocleous V, Shammas C, Anastasiadou V, Allgrove J, Phylactou LA, Skordis N. A family with Camurati-Engelman disease: the role of the missense p.R218C mutation in TGFbeta1 in bones and endocrine glands. J Pediatr Endocrinol Metab 2013; 26:1189-95. [PMID: 23846138 DOI: 10.1515/jpem-2013-0150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 06/12/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Camurati-Engelmann disease (CED) is a rare form of progressive diaphyseal dysplasia as a result of mutations in the transforming growth factor gene TGFbeta1 on chromosome 19q13.1-q13.3. Endocrine complications such as osteoporosis, vitamin D deficiency, delayed puberty, and hypogonadotrophic hypogonadism may be present. METHODS Genetic analysis of the TGFbeta1 gene revealed a heterozygous missense mutation p.R218C in exon 4 of chromosome 19q13.1-q13.3 in a 14-year-old girl who presented with typical symptoms of CED, hyperprolactinaemia, and menstrual irregularity. RESULTS The patient responded well to prednisone 5 mg/kg/day, as well as calcium and vitamin D supplements. CONCLUSIONS The role of p.R218C in TGFbeta1 on the mechanism of the disease, and the complications of it in bones and endocrine glands, remains unclear. Early recognition as well as a detailed understanding of the pathogenesis of the disease are important for future treatment options and a better quality of life of such patients.
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Toumba M, Neocleous V, Shammas C, Anastasiadou V, Allgrove J, Phylactou LA, Skordis N. A family with Camurati-Engelman disease. The role of the missense p.R218C mutation in TGFB1 in bones and endocrine glands. J Pediatr Endocrinol Metab 2013; 26:987-93. [PMID: 23729546 DOI: 10.1515/jpem-2013-0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 04/18/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Camurati-Engelmann disease (CED) is a rare form of progressive bone dysplasia due to mutations in the transforming factor gene TGFB1 on chromosome 19q13.1-q13.3. Endocrine complications such as osteoporosis, vitamin D deficiency, delayed puberty and hypogonadotrophic hypogonadism may be present. METHODS AND RESULTS Genetic analysis of the TGFB1 gene revealed a heterozygous missense mutation p.R218C in exon 4 of chromosome 19q13.1-q13.3 in a 14-year-old girl who presented with typical symptoms of CED, hyperprolactinaemia and menstrual irregularity. The patient responded well to prednisone 5 mg/kg per day as well as calcium and vitamin D supplements. CONCLUSIONS The role of p.R218C in TGFB1 on the mechanism of the disease itself and the complications of it in bones and endocrine glands remain unclear. Early recognition as well as a detailed understanding of the pathogenesis of the disease is important for future treatment options and better quality of life of such patients.
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Van Hul W. Identification of genetic modifiers of monogenic (bone) diseases: new tools available, but with limitations. J Bone Miner Res 2011; 26:918-9. [PMID: 21541993 DOI: 10.1002/jbmr.391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Wim Van Hul
- Department of Medical Genetics, University of Antwerp, Antwerp, Belgium.
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Whyte MP, Wenkert D, McAlister WH, Novack DV, Nenninger AR, Zhang X, Huskey M, Mumm S. Dysosteosclerosis presents as an "osteoclast-poor" form of osteopetrosis: comprehensive investigation of a 3-year-old girl and literature review. J Bone Miner Res 2010; 25:2527-39. [PMID: 20499338 PMCID: PMC3179286 DOI: 10.1002/jbmr.131] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 04/12/2010] [Accepted: 05/05/2010] [Indexed: 12/03/2022]
Abstract
Dysosteosclerosis (DSS), an extremely rare dense bone disease, features short stature and fractures and sometimes optic atrophy, cranial nerve palsy, developmental delay, and failure of tooth eruption in infancy or early childhood consistent with osteopetrosis (OPT). Bone histology during childhood shows unresorbed primary spongiosa from deficient osteoclast action. Additionally, there is remarkable progressive flattening of all vertebrae and, by adolescence, paradoxical metaphyseal osteopenia with thin cortical bone. Reports of consanguinity indicate autosomal recessive inheritance, yet more affected males than females suggest X-linked recessive inheritance. We investigated a nonconsanguineous girl with DSS. Osteosclerosis was discovered at age 7 months. Our studies, spanning ages 11 to 44 months, showed weight at approximately 50th percentile, and length diminishing from approximately 30th percentile to -2.3 SD. Head circumference was +4 SD. The patient had frontal bossing, blue sclera, normal teeth, genu valgum, and unremarkable joints. Radiographs showed orbital and facial sclerosis, basilar thickening, bone-in-bone appearance of the pelvis, sclerotic long bone ends, and fractures of ribs and extremities. Progressive metaphyseal widening occurred as vertebrae changed from ovoid to flattened and became beaked anteriorly. A hemogram was normal. Consistent with OPT, serum parathyroid hormone (PTH) concentrations reflected dietary calcium levels. Serum bone alkaline phosphatase, osteocalcin, and TRACP-5b were subnormal. The iliac crest contained excessive primary spongiosa and no osteoclasts. No mutations were identified in the splice sites or exons for the genes encoding chloride channel 7, T-cell immune regulator 1, OPT-associated transmembrane protein 1, and monocyte colony-stimulating factor (M-CSF) and its receptor C-FMS, ANKH, OPG, RANK, and RANKL. Genomic copy-number microarray was unrevealing. Hence, DSS is a distinctive OPT of unknown etiology featuring osteoclast deficiency during early childhood. How osteopenia follows is an enigma of human skeletal pathobiology.
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Affiliation(s)
- Michael P Whyte
- Center for Metabolic Bone Disease and Molecular Research, Shriners Hospital for Children, St Louis, MO 63131, USA.
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