1
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Topaloglu R. Extrarenal complications of cystinosis. Pediatr Nephrol 2024; 39:2283-2292. [PMID: 38127152 DOI: 10.1007/s00467-023-06225-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
Cystinosis is a rare autosomal recessive disease with an incidence 1 per 100,000-200,000 live births. It is caused by pathogenic variants of the cystinosin (CTNS) gene that lead to impaired cystine transport from lysosomes to cystosol, resulting in cystine accumulation in lysosomes and subsequent cellular dysfunction. The initial manifestation, cystine accumulation in proximal tubular cells (PTCs), causes renal Fanconi syndrome, which presents with proximal renal tubular acidosis and generalized dysfunction of the proximal tubule, including the presence of polyuria, glycosuria, phosphaturia, aminoaciduria, tubular proteinuria, growth retardation, and rickets. Eventually, glomerular involvement, glomerular proteinuria, focal segmental glomerulosclerosis (FSGS), and progression to kidney failure occur. Although the kidneys are the first organs affected, and play a key role in morbidity and mortality, extrarenal multiorgan involvement can occur in patients with cystinosis, which is seen not only in adults but in early ages in untreated patients, patients with insufficient treatment, and in those that don't comply with treatment. The treatment of cystinosis consists of supportive treatment for Fanconi syndrome, and specific lifelong cystine-depleting therapy using oral cysteamine. There is strong evidence that as early as possible, initiation and ongoing appropriate therapy with cysteamine are essential for delaying the progression to kidney failure, end-organ damage, and extrarenal involvement. The present review aimed to evaluate the extra renal complications of cystinosis.
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Affiliation(s)
- Rezan Topaloglu
- Hacettepe University, School of Medicine, Department of Pediatric Nephrology, Ankara, Türkiye.
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2
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Sinopoli HJ, Khouri Y. Failure to Thrive With Severe Hypokalemia Yields Cystinosis Diagnosis in a 19-Month-Old Female Child: A Case Report. Cureus 2024; 16:e63122. [PMID: 39055402 PMCID: PMC11272141 DOI: 10.7759/cureus.63122] [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: 06/10/2024] [Accepted: 06/25/2024] [Indexed: 07/27/2024] Open
Abstract
Cystinosis is a rare, genetically inherited disease that affects lysosomal storage of cysteine. It is the most common cause of Fanconi syndrome. Mutations have led to early-onset end-stage renal disease as well as other systemic organ failures. In this case, we report a 19-month-old female child who presented acutely to the outpatient clinic with nausea, vomiting, and diarrhea. The patient was previously diagnosed with unspecified renal tubular acidosis and treated with oral electrolytes. Early labs during her acute presentation showed severe hypokalemia and electrolyte imbalance, which necessitated a transfer to a pediatric ICU. Through confirmatory testing, a diagnosis of cystinosis was made. This case is an example of the recognition and treatment of a rare inherited disease.
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Affiliation(s)
- Himbert J Sinopoli
- College of Medicine, Alabama College of Osteopathic Medicine, Dothan, USA
| | - Yousef Khouri
- Pediatrics, Alabama College of Osteopathic Medicine, Dothan, USA
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3
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Regnier M, Flammier S, Boutaba M, Ndongo AA, Servais A, Schaefer F, Levtchenko E, Bacchetta J, Bertholet-Thomas A. Worldwide disparities in access to treatment and investigations for nephropathic cystinosis: a 2023 perspective. Pediatr Nephrol 2024; 39:1113-1123. [PMID: 37978055 PMCID: PMC10899370 DOI: 10.1007/s00467-023-06179-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 09/18/2023] [Accepted: 09/18/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Nephropathic cystinosis (NC) is a rare lysosomal disease, leading to early kidney failure and extra-renal comorbidities. Its prognosis strongly relies on early diagnosis and treatment by cysteamine. Developing economies (DEing) face many challenges when treating patients for rare and chronic diseases. The aim here is to evaluate the access to investigations and treatment in DEing, and to assess for potential inequalities with Developed Economies (DEed). METHODS In this international cross-sectional study, a questionnaire on access, price and reimbursement of genetic, biological analyses, and treatment was sent to nephrology centers worldwide during 2022. RESULTS A total of 109 centers responded, coming from 49 countries and managing 741 patients: 43 centers from 30 DEing and Economies in transition (TrE), and 66 from 19 DEed. In 2022, genetics availability was 63% in DEing and 100% in DEed, whereas intra leukocytes cystine levels (IL-CL) were available for 30% of DEing patients, and 94% of DEed patients, both increasing over the last decade, as has access to immediate release cysteamine and to cysteamine eye drops in DEing. However, delayed released cysteamine can be delivered to only 7% vs. 74% of patients from DEing and DEed, respectively, and is still poorly reimbursed in DEing. CONCLUSIONS Over the last decade, access to investigations (namely genetics and IL-CL) and to cysteamine have improved in DEing and TrE. However, discrepancies remain with DEed: access to delayed released cysteamine is limited, and reimbursement is still profoundly insufficient, therefore limiting their current use.
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Affiliation(s)
- Maitena Regnier
- Centre de Référence Des Maladies Rénales Rares Néphrogones, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon & Université Claude-Bernard, Lyon 1, Lyon, France
- Service de Néphrologie, Rhumatologie Et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Boulevard Pinel, 69677, Bron Cedex, France
- Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon 1, Lyon, France
| | - Sacha Flammier
- Centre de Référence Des Maladies Rénales Rares Néphrogones, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon & Université Claude-Bernard, Lyon 1, Lyon, France
- Service de Néphrologie, Rhumatologie Et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Boulevard Pinel, 69677, Bron Cedex, France
| | - Mounia Boutaba
- Department of Pediatrics A, Hussein Dey University Hospital Center, University of Algiers 1, Algiers, Algeria
| | - Aliou Abdoulaye Ndongo
- Pediatric Unit, Aristide Le Dantec Hospital Cheikh Anta Diop University of Dakar, Dakar, Senegal
| | - Aude Servais
- Service de Néphrologie Et Maladies Métaboliques Adulte Hôpital Necker 149, Paris, France
| | - Franz Schaefer
- Division of Pediatric Nephrology, University Children's Hospital Heidelberg, Heidelberg, Germany
- International Pediatric Nephrology Association (IPNA), C/o Nationwide Children's Center for Faculty Development (ED-5081), 700 Children's Drive, Columbus, OH 43205, USA
- European Rare Kidney Disease Reference Network (ERK-Net) Project Office, Im Neuenheimer Feld 130.3, D-69120 Heidelberg, Germany
| | - Elena Levtchenko
- Division of Pediatric Nephrology, Department of Pediatrics, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Justine Bacchetta
- Centre de Référence Des Maladies Rénales Rares Néphrogones, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon & Université Claude-Bernard, Lyon 1, Lyon, France
- Service de Néphrologie, Rhumatologie Et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Boulevard Pinel, 69677, Bron Cedex, France
- Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon 1, Lyon, France
- European Rare Kidney Disease Reference Network (ERK-Net) Project Office, Im Neuenheimer Feld 130.3, D-69120 Heidelberg, Germany
- ORKID : Filière Orphan Kidney Diseases, Montpellier, France
- Diagnostic Et Traitements Des Maladies Osseuses, INSERM 1033 Physiopathologie, Paris, France
| | - Aurélia Bertholet-Thomas
- Centre de Référence Des Maladies Rénales Rares Néphrogones, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon & Université Claude-Bernard, Lyon 1, Lyon, France.
- Service de Néphrologie, Rhumatologie Et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Boulevard Pinel, 69677, Bron Cedex, France.
- Faculté de Médecine Lyon Est, Université Claude Bernard, Lyon 1, Lyon, France.
- European Rare Kidney Disease Reference Network (ERK-Net) Project Office, Im Neuenheimer Feld 130.3, D-69120 Heidelberg, Germany.
- ORKID : Filière Orphan Kidney Diseases, Montpellier, France.
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4
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Mohammadi Chermahini Z, Salehi M, Gheissari A, Ahmadi Beni F, Khosravian F, Kazemi M. CTNS Mutations Causing Autosomal Recessive Cystinosis in a Subset of Iranian Population: Report of Two New Variants. Adv Biomed Res 2024; 13:2. [PMID: 38525388 PMCID: PMC10958734 DOI: 10.4103/abr.abr_149_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/25/2023] [Accepted: 07/29/2023] [Indexed: 03/26/2024] Open
Abstract
Background Nephropathic cystinosis (NC) is an uncommon autosomal recessive disease with abnormality in lysosomal storage that appearances in patients with mutations in the CTNS gene encoding a lysosomal transporter cystinosin. Disrupted function of this transporter is followed by accumulation of cysteine crystals in cells of many various organs. This study aimed to investigate the mutations of the CTNS gene in 20 Iranian patients suffering from NC. Materials and Methods Twenty Iranian cystinosis patients referring to Imam Hossein Hospital of Isfahan were employed in this case-series study. After extraction of genomic DNA, the promoter and entire coding regions of CTNS were analysed using sanger sequencing in all patients. Gap-Polymerase Chain Reaction was used to detect 57 kb deletion in the CTNS gene. In silico study was performed to analyse variants. Results The large deletion was not seen in any NC patients. Molecular analysis which conducted to screen the CTNS gene of patients, identified eight different mutations, including two new mutations, c.971_972insC and c.956_956delA, which have not been reported before, and c.681G>A mutation, which was identified as a frequently founded mutation in the Middle East and was observed in 35% of patients. In this study, five other mutations including c.1015G>A, c.922G>A, c.323_323delA, c.433C>T, and c.18_21delGACT were also observed, which have been reported in previous studies. Conclusion The mutational spectrum in the Iranian patients is the same as previously reported mutations except that two new mutations were found. The present findings will present suggestions for regular molecular diagnosis of cystinosis in Iran.
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Affiliation(s)
- Zahra Mohammadi Chermahini
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Reproductive Sciences and Sexual Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Cellular, Molecular and Genetics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mansoor Salehi
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Cellular, Molecular and Genetics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alaleh Gheissari
- Department of Pediatrics, School of Medicine, Kidney Diseases Research Center, Imam Hossein Children’s Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Faeze Ahmadi Beni
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farinaz Khosravian
- Cellular, Molecular and Genetics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Kazemi
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Reproductive Sciences and Sexual Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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5
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Münch J, Goodyer PR, Wagner CA. Tubular Diseases and Stones Seen From Pediatric and Adult Nephrology Perspectives. Semin Nephrol 2023; 43:151437. [PMID: 37968178 DOI: 10.1016/j.semnephrol.2023.151437] [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] [Indexed: 11/17/2023]
Abstract
The tubular system of the kidneys is a complex series of morphologic and functional units orchestrating the content of tubular fluid as it flows along the nephron and collecting ducts. Renal tubules maintain body water, regulate electrolytes and acid-base balance, reabsorb precious organic solutes, and eliminate specific metabolites, toxins, and drugs. In addition, decisive mechanisms to adjust blood pressure are governed by the renal tubules. Genetic as well as acquired disorders of these tubular functions may cause serious diseases that manifest both in childhood and adulthood. This article addresses a selection of tubulopathies and the underlying pathomechanisms, while highlighting the important differences in pediatric and adult nephrology care. These range from rare monogenic conditions such as nephrogenic diabetes insipidus, cystinosis, and Bartter syndrome that present in childhood, to the genetic and acquired tubular pathologies causing hypertension or nephrolithiasis that are more prevalent in adults. Both pediatric and adult nephrologists must be aware of these conditions and the age-dependent manifestations that warrant close interaction between the two subspecialties.
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Affiliation(s)
- Johannes Münch
- Institute of Physiology, University of Zurich, Zurich, Switzerland; Institute of Human Genetics, University of Zurich, Zurich, Switzerland; National Center of Competence in Research, NCCR Kidney.CH, Switzerland
| | - Paul R Goodyer
- McGill University Health Centre, Montreal, Quebec, Canada
| | - Carsten A Wagner
- Institute of Physiology, University of Zurich, Zurich, Switzerland; National Center of Competence in Research, NCCR Kidney.CH, Switzerland.
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6
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El Younsi M, Trabelsi M, Ben Youssef S, Ouertani I, Hammi Y, Achour A, Maazoul F, Kharrat M, Gargah T, M'rad R. Clinical and genetic characteristics of Tunisian children with infantile nephropathic cystinosis. Pediatr Nephrol 2023; 38:119-129. [PMID: 35445972 DOI: 10.1007/s00467-022-05525-1] [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: 09/28/2021] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Nephropathic cystinosis is an autosomal recessive disease caused by a mutation in the CTNS gene which encodes cystinosin, a lysosomal cystine transporter. The spectrum of mutations in the CTNS gene is not well defined in the North African population. Here, we investigated twelve patients with nephropathic cystinosis belonging to eight Tunisian families in order to analyze the clinical and genetic characteristics of Tunisian children with infantile nephropathic cystinosis. METHODS Clinical data were collected retrospectively. Molecular analysis of the CTNS gene was performed by Sanger sequencing. RESULTS We describe a new splicing mutation c.971-1G > C in the homozygous state in 6/12 patients which seems to be a founder mutation. The reported deletion of 23nt c.771_793 Del (p.Gly258Serfs*30) was detected in a homozygous state in one patient and in a heterozygous compound state with the c.971-1G > C mutation in 3/12 patients. Two of 12 patients have a deletion of exons 4 and 5 of the CTNS gene. None of our patients had the most common 57-kb deletion. CONCLUSIONS The mutational spectrum in the Tunisian population is different from previously described populations. Thus, a molecular diagnostic strategy must be implemented in Tunisia, by targeting as a priority the common mutations described in this country. Such a strategy will allow a cost-effective diagnosis confirmation as well as early administration of treatment with oral cysteamine. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Mariem El Younsi
- Laboratoire de Génétique Humaine, LR99ES10, Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
| | - Médiha Trabelsi
- Service des Maladies Congénitales et Héréditaires, Hôpital Charles Nicolle, Bab Souika, 1006, Tunis, Tunisia
| | - Sandra Ben Youssef
- Service de Pédiatrie Néphrologique Hôpital Charles Nicolle, Bab Souika, 1006, Tunis, Tunisia
| | - Inès Ouertani
- Service des Maladies Congénitales et Héréditaires, Hôpital Charles Nicolle, Bab Souika, 1006, Tunis, Tunisia
| | - Yousra Hammi
- Service de Pédiatrie Néphrologique Hôpital Charles Nicolle, Bab Souika, 1006, Tunis, Tunisia
| | - Ahlem Achour
- Service des Maladies Congénitales et Héréditaires, Hôpital Charles Nicolle, Bab Souika, 1006, Tunis, Tunisia
| | - Faouzi Maazoul
- Service des Maladies Congénitales et Héréditaires, Hôpital Charles Nicolle, Bab Souika, 1006, Tunis, Tunisia
| | - Maher Kharrat
- Laboratoire de Génétique Humaine, LR99ES10, Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia
| | - Tahar Gargah
- Service de Pédiatrie Néphrologique Hôpital Charles Nicolle, Bab Souika, 1006, Tunis, Tunisia
| | - Ridha M'rad
- Laboratoire de Génétique Humaine, LR99ES10, Faculté de Médecine de Tunis, Université de Tunis El Manar, 1007, Tunis, Tunisia. .,Service des Maladies Congénitales et Héréditaires, Hôpital Charles Nicolle, Bab Souika, 1006, Tunis, Tunisia.
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7
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Gaudioso Á, Silva TP, Ledesma MD. Models to study basic and applied aspects of lysosomal storage disorders. Adv Drug Deliv Rev 2022; 190:114532. [PMID: 36122863 DOI: 10.1016/j.addr.2022.114532] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 08/05/2022] [Accepted: 09/04/2022] [Indexed: 01/24/2023]
Abstract
The lack of available treatments and fatal outcome in most lysosomal storage disorders (LSDs) have spurred research on pathological mechanisms and novel therapies in recent years. In this effort, experimental methodology in cellular and animal models have been developed, with aims to address major challenges in many LSDs such as patient-to-patient variability and brain condition. These techniques and models have advanced knowledge not only of LSDs but also for other lysosomal disorders and have provided fundamental insights into the biological roles of lysosomes. They can also serve to assess the efficacy of classical therapies and modern drug delivery systems. Here, we summarize the techniques and models used in LSD research, which include both established and recently developed in vitro methods, with general utility or specifically addressing lysosomal features. We also review animal models of LSDs together with cutting-edge technology that may reduce the need for animals in the study of these devastating diseases.
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Affiliation(s)
- Ángel Gaudioso
- Centro Biología Molecular Severo Ochoa (CSIC-UAM), Madrid, Spain
| | - Teresa P Silva
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Portugal
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8
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Temporary hemiepiphysiodesis for correction of genu valgum due to cystinosis: a preliminary interventional study in children. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Alonzi T, Aiello A, Repele F, Falasca L, Francalancia M, Garbuglia AR, Delogu G, Nicastri E, Piacentini M, Goletti D. Cysteamine exerts in vitro antiviral activity against the SARS-CoV-2 Delta and Omicron variants. Cell Death Dis 2022; 8:288. [PMID: 35705564 PMCID: PMC9199336 DOI: 10.1038/s41420-022-01080-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 11/28/2022]
Abstract
The novel SARS-CoV-2 variants of concern (VOC) represent a considerable global alarm because their mutations are known to affect transmissibility and cause immune escape. While preventing severe disease and deaths, the available vaccines do not avoid infection; therefore, COVID-19 disease management still requires effective therapies. We have recently reported that the aminothiol cysteamine, a drug already applied to humans, exerts direct antiviral activity against SARS-CoV-2 and has in vitro immunomodulatory effect. To evaluate whether this compound exerts antiviral effects also against SARS-CoV-2 variants, we performed different infected cell-based assays using Wild type, Delta, or Omicron VOC. We found that cysteamine significantly reduces the cytopathic effect induced by SARS-CoV-2 Wild type strain and Delta variant in Vero E6 cells. On the other hand, cysteamine had no effects on the survival of cells infected with the Omicron variant, due to the lack of cytotoxicity on Vero E6 cells, at least when infected at MOI = 0.001 for 72 h. Moreover, cysteamine significantly reduced the production of Wild type, Delta, and Omicron variants as measured by the virus released in the culture media (Vero E6 and Calu-3 cells) and by transmission electron microscopy analysis (Vero E6 cells). Notably, cysteamine is more effective in inhibiting the Omicron rather than Delta or Wild type viruses, with an 80% inhibition of Omicron production compared to 40% of Wild type and Delta variant. Overall, our findings demonstrate that cysteamine exerts direct antiviral actions against SARS-CoV-2 Delta and Omicron variants, in addition to the Wild type virus. Our data further demonstrate that cysteamine is a good candidate as repurposing drug for the treatment of SARS-CoV-2 infection for the present and, likely, the future VOC and, therefore, it would be important to investigate its clinical relevance in randomized clinical trials.
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Affiliation(s)
- Tonino Alonzi
- National Institute for Infectious Diseases "L. Spallanzani"-IRCCS, Rome, Italy
| | - Alessandra Aiello
- National Institute for Infectious Diseases "L. Spallanzani"-IRCCS, Rome, Italy
| | - Federica Repele
- National Institute for Infectious Diseases "L. Spallanzani"-IRCCS, Rome, Italy
| | - Laura Falasca
- National Institute for Infectious Diseases "L. Spallanzani"-IRCCS, Rome, Italy
| | | | - Anna Rosa Garbuglia
- National Institute for Infectious Diseases "L. Spallanzani"-IRCCS, Rome, Italy
| | - Giovanni Delogu
- Institute of Microbiology, Università Cattolica del Sacro Cuore - Fondazione Policlinico Gemelli, Rome, Italy.,Mater Olbia Hospital, Olbia, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases "L. Spallanzani"-IRCCS, Rome, Italy
| | - Mauro Piacentini
- National Institute for Infectious Diseases "L. Spallanzani"-IRCCS, Rome, Italy. .,Department of Biology, University of Rome "Tor Vergata", Rome, Italy.
| | - Delia Goletti
- National Institute for Infectious Diseases "L. Spallanzani"-IRCCS, Rome, Italy
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10
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Emma F, Montini G, Pennesi M, Peruzzi L, Verrina E, Goffredo BM, Canalini F, Cassiman D, Rossi S, Levtchenko E. Biomarkers in Nephropathic Cystinosis: Current and Future Perspectives. Cells 2022; 11:cells11111839. [PMID: 35681534 PMCID: PMC9180050 DOI: 10.3390/cells11111839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/23/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022] Open
Abstract
Early diagnosis and effective therapy are essential for improving the overall prognosis and quality of life of patients with nephropathic cystinosis. The severity of kidney dysfunction and the multi-organ involvement as a consequence of the increased intracellular concentration of cystine highlight the necessity of accurate monitoring of intracellular cystine to guarantee effective treatment of the disease. Cystine depletion is the only available treatment, which should begin immediately after diagnosis, and not discontinued, to significantly slow progression of renal and extra-renal organ damage. This review aims to discuss the importance of the close monitoring of intracellular cystine concentration to optimize cystine depletion therapy. In addition, the role of new biomarkers in the management of the disease, from timely diagnosis to implementing treatment during follow-up, is overviewed.
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Affiliation(s)
- Francesco Emma
- Department of Pediatric Subspecialties, Division of Nephrology, Bambino Gesù Children’s Hospital-IRCCS, 00165 Rome, Italy;
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Ca’ Grande IRRCS Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Marco Pennesi
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, 34137 Trieste, Italy;
| | - Licia Peruzzi
- Pediatric Nephrology Unit, Regina Margherita Children’s Hospital, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy;
| | - Enrico Verrina
- Dialysis Unit, Department of Pediatrics, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Bianca Maria Goffredo
- Department of Pediatric Subspecialties, Division of Metabolic Diseases, Bambino Gesù Children’s Hospital-IRCCS, 00165 Rome, Italy;
| | - Fabrizio Canalini
- Medical Department, Chiesi Pharmaceutics, 43100 Parma, Italy; (F.C.); (S.R.)
| | - David Cassiman
- Department of Metabolic Diseases, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Silvia Rossi
- Medical Department, Chiesi Pharmaceutics, 43100 Parma, Italy; (F.C.); (S.R.)
| | - Elena Levtchenko
- Department of Pediatric Nephrology and Development and Regeneration, University Hospitals Leuven, University of Leuven, 3000 Leuven, Belgium
- Correspondence:
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11
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Alhasan K, D'Alessandri-Silva C, Mongia A, Topaloglu R, Tasic V, Filler G. Young Adults With Hereditary Tubular Diseases: Practical Aspects for Adult-Focused Colleagues. Adv Chronic Kidney Dis 2022; 29:292-307. [PMID: 36084976 DOI: 10.1053/j.ackd.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/07/2021] [Accepted: 11/15/2021] [Indexed: 11/11/2022]
Abstract
Recent advances in the management of kidney tubular diseases have resulted in a significant cohort of adolescents and young adults transitioning from pediatric- to adult-focused care. Most of the patients under adult-focused care have glomerular diseases, whereas rarer tubular diseases form a considerable proportion of pediatric patients. The purpose of this review is to highlight the clinical signs and symptoms of tubular disorders, as well as their diagnostic workup, including laboratory findings and imaging, during young adulthood. We will then discuss more common disorders such as cystinosis, cystinuria, distal kidney tubular acidosis, congenital nephrogenic diabetes insipidus, Dent disease, rickets, hypercalciuria, and syndromes such as Bartter, Fanconi, Gitelman, Liddle, and Lowe. This review is a practical guide on the diagnostic and therapeutic approach of tubular conditions affecting young adults who are transitioning to adult-focused care.
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Affiliation(s)
- Khalid Alhasan
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Cynthia D'Alessandri-Silva
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, and Nephrology, Connecticut Children's Medical Center, Hartford, CT
| | - Anil Mongia
- Department of Pediatrics, SUNY Downstate Medical Center, Brooklyn, NY
| | - Rezan Topaloglu
- Department of Paediatrics, Division of Pediatric Nephrology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Velibor Tasic
- University Children's Hospital, Medical School, Skopje, North Macedonia
| | - Guido Filler
- Department of Paediatrics, Division of Pediatric Nephrology, Western University, London, ON, Canada; Department of Medicine, Western University, London, ON, Canada; Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada.
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Erfidan G, Alaygut D, Özdemir Şimşek Ö, Arslansoyu Çamlar S, Mutlubaş F, Kasap Demir B. A Bartter syndrome patient presenting with severe growth retardation: Answers. Pediatr Nephrol 2022; 37:1043-1047. [PMID: 34999984 DOI: 10.1007/s00467-021-05384-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Gökçen Erfidan
- Department of Pediatric Nephrology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Gaziler Street No-1 35180, Yenişehir, Konak, Izmir, Turkey.
| | - Demet Alaygut
- Department of Pediatric Nephrology, Izmir Faculty of Medicine, University of Health Sciences, Izmir, Turkey
| | - Özgür Özdemir Şimşek
- Department of Pediatric Nephrology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Gaziler Street No-1 35180, Yenişehir, Konak, Izmir, Turkey
| | - Seçil Arslansoyu Çamlar
- Department of Pediatric Nephrology, Izmir Faculty of Medicine, University of Health Sciences, Izmir, Turkey
| | - Fatma Mutlubaş
- Department of Pediatric Nephrology, Izmir Faculty of Medicine, University of Health Sciences, Izmir, Turkey
| | - Belde Kasap Demir
- Department of Pediatric Nephrology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Gaziler Street No-1 35180, Yenişehir, Konak, Izmir, Turkey
- Department of Pediatric Nephrology and Rheumatology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
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Atmis B, K Bayazit A, Cevizli D, Kor D, Fidan HB, Bisgin A, Kilavuz S, Unal I, Erdogan KE, Melek E, Gonlusen G, Anarat A, Onenli Mungan N. More than tubular dysfunction: cystinosis and kidney outcomes. J Nephrol 2021; 35:831-840. [PMID: 34097292 DOI: 10.1007/s40620-021-01078-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cystinosis is a lysosomal storage disease that affects many tissues. Its prognosis depends predominantly on kidney involvement. Cystinosis has three clinical forms: nephropathic infantile, nephropathic juvenile and non-nephropathic adult. Proximal tubular dysfunction is prominent in the infantile form, whereas a combination of glomerular and tubular alterations are observed in the juvenile form. METHODS Thirty-six children with nephropathic cystinosis were included in the study. Clinical features, molecular genetic diagnoses, and kidney outcomes of the patients were evaluated. RESULTS Twenty-one children (58.3%) were male. The median age at diagnosis was 18.5 months. Twenty-eight patients (77.8%) had infantile nephropathic cystinosis, while eight (22.2%) had juvenile nephropathic cystinosis. An acute rapid deterioration of the kidney function with proteinuria, hypoalbuminemia, and nephrotic syndrome, was observed in 37.5% of patients with the juvenile form. The mean estimated glomerular filtration rate (eGFR) was 82.31 ± 37.45 ml/min/1.73m2 at diagnosis and 63.10 ± 54.60 ml/min/1.73m2 at the last visit (p = 0.01). Six patients (16.6%) had kidney replacement therapy (KRT) at the last visit. The median age of patients with kidney failure was 122 months. Patients with a spot urine protein/creatinine ratio < 6 mg/mg at the time of diagnosis had better kidney outcomes (p = 0.01). The most common allele was c.451A>G (32.6%). The patients with the most common mutation tended to have higher mean eGFR and lower leukocyte cystine levels than patients with other mutations. CONCLUSION Glomerulonephritis may be a frequent finding in addition to the well-known tubular dysfunction in patients with cystinosis. Furthermore, our results highlight that the presence of severe proteinuria at the time of diagnosis is a relevant prognostic factor for kidney survival.
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Affiliation(s)
- Bahriye Atmis
- Department of Pediatric Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey.
| | - Aysun K Bayazit
- Department of Pediatric Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Derya Cevizli
- Department of Pediatric Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Deniz Kor
- Department of Pediatric Metabolism and Nutrition, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Hatice Busra Fidan
- Department of Pediatrics, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Atil Bisgin
- Department of Medical Genetics, Cukurova University Faculty of Medicine, Adana, Turkey.,Cukurova University AGENTEM (Adana Genetic Diseases Diagnosis and Treatment Center), Adana, Turkey.,Medical Genetics Department of Balcali Clinics and Hospital, Faculty of Medicine, Adana, Turkey
| | - Sebile Kilavuz
- Department of Pediatric Metabolism and Nutrition, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ilker Unal
- Department of Biostatistics, Cukurova University Faculty of Medicine, Adana, Turkey
| | | | - Engin Melek
- Department of Pediatric Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Gulfiliz Gonlusen
- Department of Pathology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ali Anarat
- Department of Pediatric Nephrology, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Neslihan Onenli Mungan
- Department of Pediatric Metabolism and Nutrition, Cukurova University Faculty of Medicine, Adana, Turkey
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