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Contreras JL, Ladino MA, Aránguiz K, Mendez GP, Coban-Akdemir Z, Yuan B, Gibbs RA, Burrage LC, Lupski JR, Chinn IK, Vogel TP, Orange JS, Poli MC. Immune Dysregulation Mimicking Systemic Lupus Erythematosus in a Patient With Lysinuric Protein Intolerance: Case Report and Review of the Literature. Front Pediatr 2021; 9:673957. [PMID: 34095032 PMCID: PMC8172984 DOI: 10.3389/fped.2021.673957] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/14/2021] [Indexed: 12/14/2022] Open
Abstract
Lysinuric protein intolerance (LPI) is an inborn error of metabolism caused by defective transport of cationic amino acids in epithelial cells of intestines, kidneys and other tissues as well as non-epithelial cells including macrophages. LPI is caused by biallelic, pathogenic variants in SLC7A7. The clinical phenotype of LPI includes failure to thrive and multi-system disease including hematologic, neurologic, pulmonary and renal manifestations. Individual presentations are extremely variable, often leading to misdiagnosis or delayed diagnosis. Here we describe a patient that clinically presented with immune dysregulation in the setting of early-onset systemic lupus erythematosus (SLE), including renal involvement, in whom an LPI diagnosis was suspected post-mortem based on exome sequencing analysis. A review of the literature was performed to provide an overview of the clinical spectrum and immune mechanisms involved in this disease. The precise mechanism by which ineffective amino acid transport triggers systemic inflammatory features is not yet understood. However, LPI should be considered in the differential diagnosis of early-onset SLE, particularly in the absence of response to immunosuppressive therapy.
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Affiliation(s)
| | - Mabel A. Ladino
- Universidad de Chile, Reumatóloga Pediátrica Hospital San Juan de Dios, Santiago, Chile
| | - Katherine Aránguiz
- Unidad de Inmunología y Reumatología Hospital Luis Calvo Mackenna, Providencia, Chile
| | - Gonzalo P. Mendez
- Patológo Renal, Departamento de Anatomía Patológica, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Zeynep Coban-Akdemir
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, United States
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Bo Yuan
- Department of Laboratories, Seattle Children's Hospital, Seattle, WA, United States
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, United States
| | - Richard A. Gibbs
- Sequencing Center, Baylor College of Medicine, Houston, TX, United States
| | - Lindsay C. Burrage
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, United States
- Texas Children's Hospital, Houston, TX, United States
| | - James R. Lupski
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, United States
- Sequencing Center, Baylor College of Medicine, Houston, TX, United States
- Texas Children's Hospital, Houston, TX, United States
| | - Ivan K. Chinn
- Texas Children's Hospital, Houston, TX, United States
- Department of Pediatrics, Division of Allergy, Immunology and Retrovirology, Baylor College of Medicine, Houston, TX, United States
| | - Tiphanie P. Vogel
- Texas Children's Hospital, Houston, TX, United States
- Department of Pediatrics, Division of Rheumatology, Baylor College of Medicine, Houston, TX, United States
| | - Jordan S. Orange
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University, New York, NY, United States
| | - M. Cecilia Poli
- Facultad de Medicina Universidad del Desarrollo-Clínica Alemana, Santiago, Chile
- Department of Pediatrics, Division of Allergy, Immunology and Retrovirology, Baylor College of Medicine, Houston, TX, United States
- Unidad de Inmunología y Reumatología, Hospital Roberto del Río, Santiago, Chile
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Dimitriou C, Saliba S, Peyrassol X, Ben Abbou W, Nassogne MC, Neugroschl C, Wiame E, De Leener A, Cassart M. Heterogeneous colonic content: A prenatal sonographic manifestation of lysinuric protein intolerance. Clin Case Rep 2020; 8:1010-1014. [PMID: 32577254 PMCID: PMC7303845 DOI: 10.1002/ccr3.2780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 02/03/2020] [Accepted: 02/12/2020] [Indexed: 11/21/2022] Open
Abstract
We report a fetus with heterogeneous colonic content, an isolated sonographic prenatal sign of lysinuric protein intolerance, a very rare metabolic disease. Familial genetic enquiries confirmed heterozygote mutation in the implicated gene in parents. The prenatal diagnosis led to neonatal dietary adaptation and avoided acute complications.
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Affiliation(s)
| | - Souha Saliba
- Department of RadiologyIris Hospitals SouthBrusselsBelgium
| | | | - Wafa Ben Abbou
- Department of Fetal MedicineIris Hospitals SouthBrusselsBelgium
| | - Marie Cécile Nassogne
- Department of Pediatric Neurology and hereditary metabolic diseasesCHU Saint‐ LucBrusselsBelgium
| | | | - Elsa Wiame
- Laboratory of Biochemistryde Duve InstituteBrusselsBelgium
| | | | - Marie Cassart
- Department of RadiologyIris Hospitals SouthBrusselsBelgium
- Department of Fetal MedicineIris Hospitals SouthBrusselsBelgium
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Noguchi A, Takahashi T. Overview of symptoms and treatment for lysinuric protein intolerance. J Hum Genet 2019; 64:849-858. [PMID: 31213652 DOI: 10.1038/s10038-019-0620-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 12/30/2022]
Abstract
Lysinuric protein intolerance (LPI) is caused by dysfunction of the dibasic amino acid membrane transport owing to the functional abnormality of y+L amino acid transporter-1 (y+ LAT-1). LPI is associated with autosomal recessive inheritance and pathological variants in the responsible gene SLC7A7 are also observed. The pathophysiology of this disease had earlier been understood as a transport defect in polarized cells (e.g., intestinal or renal tubular epithelium); however, in recent years, transport defects in non-polarized cells such as lymphocytes and macrophages have also been recognized as important. Although the former can cause death, malnutrition, and urea cycle dysfunction (hyperammonemia), the latter can induce renal, pulmonary, and immune disorders. Furthermore, although therapeutic interventions can prevent hyperammonemic episodes to some extent, progression of pulmonary and renal complications cannot be prevented, thereby influencing prognosis. Such pathological conditions are currently being explored and further investigation would prove beneficial. In this study, we have summarized the basic pathology as revealed in recent years, along with the clinical aspects and genetic features.
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Affiliation(s)
- Atsuko Noguchi
- Akita University Graduate School of Medicine, Pediatrics, Akita, Akita, Japan.
| | - Tsutomu Takahashi
- Akita University Graduate School of Medicine, Pediatrics, Akita, Akita, Japan
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