1
|
Chen X, Cai C, Lun S, Ye Q, Pan W, Chen Y, Wu Y, Feng T, Su F, Ma C, Luo J, Liu M, Ma G. The contribution of a novel PHEX gene mutation to X-linked hypophosphatemic rickets: a case report and an analysis of the gene mutation dosage effect in a rat model. Front Endocrinol (Lausanne) 2023; 14:1251718. [PMID: 38116308 PMCID: PMC10728720 DOI: 10.3389/fendo.2023.1251718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023] Open
Abstract
A Chinese family was identified to have two patients with rickets, an adult female and a male child (proband), both exhibiting signs related to X-linked hypophosphatemic rickets (XLH). Gene sequencing analysis revealed a deletion of adenine at position 1985 (c.1985delA) in the PHEX-encoding gene. To investigate the relationship between this mutation and the pathogenicity of XLH, as well as analyze the effects of different dosages of PHEX gene mutations on clinical phenotypes, we developed a rat model carrying the PHEX deletion mutation. The CRISPR/Cas9 gene editing technology was employed to construct the rat model with the PHEX gene mutation (c.1985delA). Through reproductive procedures, five genotypes of rats were obtained: female wild type (X/X), female heterozygous (-/X), female homozygous wild type (-/-), male wild type (X/Y), and male hemizygous (-/Y). The rats with different genotypes underwent analysis of growth, serum biochemical parameters, and bone microstructure. The results demonstrated the successful generation of a stable rat model inheriting the PHEX gene mutation. Compared to the wild-type rats, the mutant rats displayed delayed growth, shorter femurs, and significantly reduced bone mass. Among the female rats, the homozygous individuals exhibited the smallest body size, decreased bone mass, shortest femur length, and severe deformities. Moreover, the mutant rats showed significantly lower blood phosphorus concentration, elevated levels of FGF23 and alkaline phosphatase, and increased expression of phosphorus regulators. In conclusion, the XLH rat model with the PHEX gene mutation dosage demonstrated its impact on growth and development, serum biochemical parameters, and femoral morphology.
Collapse
Affiliation(s)
- Xiaoming Chen
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Faculty of Chinese Medicine, Macau University of Science and Technology, Avenida Wai Long, Taipa, Macau, China
| | - Cijing Cai
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
- Maternal and Children’s Health Research Institute, Shunde Women and Children’s Hospital, Guangdong Medical University, Foshan, China
| | - Shaocong Lun
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Qiuli Ye
- Department of Traditional Chinese Medicine, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Weiyuan Pan
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yushi Chen
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yuexuan Wu
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Taoshan Feng
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Faming Su
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Choudi Ma
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jiaxin Luo
- Department of Endocrinology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Meilian Liu
- Department of Pulmonary Oncology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Guoda Ma
- Maternal and Children’s Health Research Institute, Shunde Women and Children’s Hospital, Guangdong Medical University, Foshan, China
- Key Laboratory of Research in Maternal and Child Medicine and Birth Defects, Guangdong Medical University, Foshan, China
| |
Collapse
|
2
|
Kocijan R, Mindler GT, Hartmann MA, Kraus DA, Raimann A, Zwerina J. Dissociation of clinical, laboratory, and bone biopsy findings in adult X-linked hypophosphatemia: a case report. Wien Med Wochenschr 2023; 173:339-345. [PMID: 36695943 DOI: 10.1007/s10354-022-01000-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/15/2022] [Indexed: 01/26/2023]
Abstract
X‑linked hypophosphatemia (XLH) is a phosphate wasting disorder. Typical serum constellations include low serum phosphate as well as high alkaline phosphatase (ALP) and fibroblast growth factor 23 (FGF-23 ) levels. Adult XLH patients usually suffer from (pseudo)fractures, enthesopathies, impaired mobility, and osteoarthritis. We report the case of a middle-aged woman with clinically mild disease, relatively balanced laboratory values, but bone non-healing of the femur post-surgery. Transiliac bone biopsy revealed pronounced osteomalacia and severe deterioration of bone microstructure. Due to the lack of XLH-typical symptoms, the patient was not substituted with calcitriol and phosphate in adulthood. Thus, laboratory findings and radiological examinations do not necessarily reflect bone metabolism in XLH. Bone biopsies should be considered in unclear cases or prior to surgery in adults with XLH.
Collapse
Affiliation(s)
- Roland Kocijan
- 1st Medical Department Hanusch Hospital, Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA; Trauma Centre Meidling, Heinrich-Collin-Straße 30, 1140, Vienna, Austria.
- Vienna Bone and Growth Center, Vienna, Austria.
- School of medicine, Metabolic bone diseases unit, Sigmund Freud University Vienna, Vienna, Austria.
| | - Gabriel Tilmann Mindler
- Vienna Bone and Growth Center, Vienna, Austria
- Department of Pediatric Orthopaedics, Orthopaedic Hospital Speising, Vienna, Austria
| | - Markus Alexander Hartmann
- 1st Medical Department Hanusch Hospital, Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA; Trauma Centre Meidling, Heinrich-Collin-Straße 30, 1140, Vienna, Austria
| | - Danial Arian Kraus
- 1st Medical Department Hanusch Hospital, Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA; Trauma Centre Meidling, Heinrich-Collin-Straße 30, 1140, Vienna, Austria
- Vienna Bone and Growth Center, Vienna, Austria
| | - Adalbert Raimann
- Vienna Bone and Growth Center, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Medical University Vienna, Vienna, Austria
| | - Jochen Zwerina
- 1st Medical Department Hanusch Hospital, Ludwig Boltzmann Institute of Osteology at Hanusch Hospital of OEGK and AUVA; Trauma Centre Meidling, Heinrich-Collin-Straße 30, 1140, Vienna, Austria
- Vienna Bone and Growth Center, Vienna, Austria
| |
Collapse
|
3
|
Kara JAS, Zange J, Hoffman F, Tank J, Jordan J, Semler O, Schönau E, Rittweger J, Seefried L. Impaired Physical Performance in X-linked Hypophosphatemia Is not Caused by Depleted Muscular Phosphate Stores. J Clin Endocrinol Metab 2023; 108:1634-1645. [PMID: 37043477 DOI: 10.1210/clinem/dgad210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/19/2023] [Accepted: 04/10/2023] [Indexed: 04/13/2023]
Abstract
CONTEXT X-linked hypophosphatemia (XLH) is a rare genetic disease, characterized by renal phosphate wasting and complex musculoskeletal manifestations including decreased physical performance. OBJECTIVE To characterize muscular deficits in patients with XLH and investigate phosphate stores in muscles. METHODS Case-control study (Muscle fatigability in X-linked Hypophosphatemia [MuXLiH]) with a 1-time assessment at the German Aerospace Center (DLR), Cologne, from May to December 2019, including patients with XLH cared for at the Osteology Department, University of Wuerzburg. Thirteen patients with XLH and 13 age/sex/body weight-matched controls aged 18-65 years were included. The main outcome measure was 31P-magnetic resonance spectroscopy (31P-MRS)-based assessment of phosphate metabolites in the soleus muscle at rest. Further analyses included magnetic resonance imaging-based muscle volume measurement, laboratory testing, isokinetic maximum voluntary contraction (MVC), fatigue testing, and jumping mechanography. RESULTS By means of 31P-MRS, no significant differences were observed between XLH and controls regarding phosphate metabolites except for a slightly increased phosphocreatine to inorganic phosphate (PCr/Pi) ratio (XLH: 13.44 ± 3.22, control: 11.01 ± 2.62, P = .023). Quadriceps muscle volume was reduced in XLH (XLH: 812.1 ± 309.0 mL, control: 1391.1 ± 306.2 mv, P < .001). No significant differences were observed regarding isokinetic maximum torque (MVC) adjusted to quadriceps muscle volume. Jumping peak power and jump height were significantly reduced in XLH vs controls (both P < .001). CONCLUSION The content of phosphoric compounds within the musculature of patients with XLH was not observed to be different from controls. Volume-adjusted muscle strength and fatiguability were not different either. Reduced physical performance in patients with XLH may result from long-term adaptation to reduced physical activity due to skeletal impairment.
Collapse
Affiliation(s)
| | - Jochen Zange
- German Aerospace Center, Institute of Aerospace Medicine, 51147 Cologne, Germany
| | - Fabian Hoffman
- German Aerospace Center, Institute of Aerospace Medicine, 51147 Cologne, Germany
| | - Jens Tank
- German Aerospace Center, Institute of Aerospace Medicine, 51147 Cologne, Germany
| | - Jens Jordan
- German Aerospace Center, Institute of Aerospace Medicine, 51147 Cologne, Germany
| | - Oliver Semler
- Department of Pediatrics and Adolescent Medicine, University of Cologne, University Hospital Cologne, 50937 Cologne, Germany
| | - Eckhard Schönau
- Department of Pediatrics and Adolescent Medicine, University of Cologne, University Hospital Cologne, 50937 Cologne, Germany
| | - Jörn Rittweger
- German Aerospace Center, Institute of Aerospace Medicine, 51147 Cologne, Germany
- Department of Pediatrics and Adolescent Medicine, University of Cologne, University Hospital Cologne, 50937 Cologne, Germany
| | - Lothar Seefried
- Osteology and Clinical Trial Unit, Orthopedic Department, Julius Maximillian University Würzburg, 97074 Würzburg, Germany
| |
Collapse
|
4
|
Scorcelletti M, Zange J, Böcker J, Sies W, Lau P, Mittag U, Reeves ND, Ireland A, Rittweger J. Associations between long-term exercise participation and lower limb joint and whole-bone geometry in young and older adults. Front Physiol 2023; 14:1150562. [PMID: 37250122 PMCID: PMC10211427 DOI: 10.3389/fphys.2023.1150562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction: Features of lower limb bone geometry are associated with movement kinematics and clinical outcomes including fractures and osteoarthritis. Therefore, it is important to identify their determinants. Lower limb geometry changes dramatically during development, partly due to adaptation to the forces experienced during physical activity. However, the effects of adulthood physical activity on lower limb geometry, and subsequent associations with muscle function are relatively unexplored. Methods: 43 adult males were recruited; 10 young (20-35 years) trained i.e., regional to world-class athletes, 12 young sedentary, 10 older (60-75 years) trained and 11 older sedentary. Skeletal hip and lower limb geometry including acetabular coverage and version angle, total and regional femoral torsion, femoral and tibial lateral and frontal bowing, and frontal plane lower limb alignment were assessed using magnetic resonance imaging. Muscle function was assessed recording peak power and force of jumping and hopping using mechanography. Associations between age, training status and geometry were assessed using multiple linear regression, whilst associations between geometry and muscle function were assessed by linear mixed effects models with adjustment for age and training. Results: Trained individuals had 2° (95% CI:0.6°-3.8°; p = 0.009) higher femoral frontal bowing and older individuals had 2.2° (95% CI:0.8°-3.7°; p = 0.005) greater lateral bowing. An age-by-training interaction indicated 4° (95% CI:1.4°-7.1°; p = 0.005) greater acetabular version angle in younger trained individuals only. Lower limb geometry was not associated with muscle function (p > 0.05). Discussion: The ability to alter skeletal geometry via exercise in adulthood appears limited, especially in epiphyseal regions. Furthermore, lower limb geometry does not appear to be associated with muscle function.
Collapse
Affiliation(s)
- Matteo Scorcelletti
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
- Manchester Metropolitan University Institute of Sport, Manchester, United Kingdom
- Werner Siemens-Endowed Chair for Innovative Implant Development (Fracture Healing), Division of Surgery, Saarland University, Homburg, Germany
| | - Jochen Zange
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Jonas Böcker
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Wolfram Sies
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Patrick Lau
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Uwe Mittag
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Neil D. Reeves
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
- Manchester Metropolitan University Institute of Sport, Manchester, United Kingdom
| | - Alex Ireland
- Research Centre for Musculoskeletal Science and Sports Medicine, Department of Life Sciences, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, United Kingdom
- Manchester Metropolitan University Institute of Sport, Manchester, United Kingdom
| | - Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
- Department of Paediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
| |
Collapse
|
5
|
Nguyen-Khac V, Bonnet-Lebrun A, Skalli W, Adamsbaum C, Linglart A, Wicart P. Changes in adipose bone marrow and bone morphology in X-linked hypophosphatemic rickets. Orthop Traumatol Surg Res 2022; 109:103529. [PMID: 36565743 DOI: 10.1016/j.otsr.2022.103529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 08/01/2022] [Accepted: 08/26/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION X-linked hypophosphatemic (XLH) rickets causes significant bone deformities in the lower limbs resulting from a bone mineralization defect. According to Frost's Mechanostat theory, compensatory modeling of the bones takes place during increased mechanical loads. In addition, mechanical stimuli modulate the differentiation of mesenchymal stem cells; common precursors to bone marrow adipocytes and osteoblasts. HYPOTHESIS Bone deformities of the lower limbs lead to increased femoral bone mass and decreased fatty infiltration of the bone marrow (FIBM) in children with XLH rickets compared to a control group. PATIENTS AND METHODS Eleven children (10.3years [6-17]) with XLH rickets and 22 healthy children (10.2years [5-15.5]) underwent lower limb Magnetic Resonance Imaging. A calculation of FIBM was performed at the mid-femur, as well as a calculation of the total bone cross-sectional area (CSA), the cortical CSA, the anteroposterior and mediolateral axes of the femur, bone marrow and the thickness of the femoral cortices. RESULTS Total bone CSA, total cortical CSA and bone marrow CSA were higher in the XLH group than in the control group (p<0.05). The mid-lateral diameters of the femur and bone marrow were more elongated than those of the control group (p<0.001). Only the anterior cortex was thinned in the XLH group (p=0.001), while there was no difference with the control group for the posterior, medial and lateral cortices. The total percentage of FIBM was 72.81% [±3.95] and 77.4% [±5.52] for the XLH and control groups respectively (p<0.001). DISCUSSION The increase in bone mass in the XLH population reflects an adaptation of bone tissue to the bone deformities present in this pathology. The decrease in FIBM indicates a lower risk of osteoporosis in the XLH population and may constitute a new monitoring parameter in this pathology. LEVEL OF STUDY III; Case-control study.
Collapse
Affiliation(s)
| | - Aurore Bonnet-Lebrun
- ENSAM, Institut de Biomécanique Humaine G.-Charpark, 151, Boulevard de l'Hôpital, 75013 Paris, France
| | - Wafa Skalli
- ENSAM, Institut de Biomécanique Humaine G.-Charpark, 151, Boulevard de l'Hôpital, 75013 Paris, France
| | - Catherine Adamsbaum
- Hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Agnès Linglart
- Hôpital Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Philippe Wicart
- Hospital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvre, 75015 Paris, France
| |
Collapse
|