1
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Menon JC, Singh P, Archana A, Singh P, Mittal M, Kanga U, Mandal K, Seth A, Bhatia V, Dabadghao P, Sudhanshu S, Garg A, Vishwakarma R, Sarangi AN, Verma S, Singh SK, Bhatia E. High Frequency of Recessive WFS1 Mutations Among Indian Children With Islet Antibody-negative Type 1 Diabetes. J Clin Endocrinol Metab 2024; 109:e1072-e1082. [PMID: 37931151 DOI: 10.1210/clinem/dgad644] [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: 08/23/2023] [Revised: 10/06/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND While the frequency of islet antibody-negative (idiopathic) type 1 diabetes mellitus (T1DM) is reported to be increased in Indian children, its aetiology has not been studied. We investigated the role of monogenic diabetes in the causation of islet antibody-negative T1DM. METHODS We conducted a multicenter, prospective, observational study of 169 Indian children (age 1-18 years) with recent-onset T1DM. All were tested for antibodies against GAD65, islet antigen-2, and zinc transporter 8 using validated ELISA. Thirty-four islet antibody-negative children underwent targeted next-generation sequencing for 31 genes implicated in monogenic diabetes using the Illumina platform. All mutations were confirmed by Sanger sequencing. RESULTS Thirty-five (21%) children were negative for all islet antibodies. Twelve patients (7% of entire cohort, 34% of patients with islet antibody-negative T1DM) were detected to have pathogenic or likely pathogenic genetic variants. The most frequently affected locus was WFS1, with 9 patients (5% of entire cohort, 26% of islet antibody-negative). These included 7 children with homozygous and 1 patient each with a compound heterozygous and heterozygous mutation. Children with Wolfram syndrome 1 (WS) presented with severe insulin-requiring diabetes (including 3 patients with ketoacidosis), but other syndromic manifestations were not detected. In 3 patients, heterozygous mutations in HNF4A, ABCC8, and PTF1A loci were detected. CONCLUSION Nearly one-quarter of Indian children with islet antibody-negative T1DM had recessive mutations in the WFS1 gene. These patients did not exhibit other features of WS at the time of diagnosis. Testing for monogenic diabetes, especially WS, should be considered in Indian children with antibody-negative T1DM.
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Affiliation(s)
- Jayakrishnan C Menon
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Pratibha Singh
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Archana Archana
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Preeti Singh
- Department of Paediatrics, Lady Hardinge Medical College, Delhi 110001, India
| | - Medha Mittal
- Department of Paediatrics, Chacha Nehru Bal Chikitsalay, Delhi 110031, India
| | - Uma Kanga
- Department of Immunogenetics and Transplant Immunology, All India Institute of Medical Sciences, Delhi 110029, India
| | - Kausik Mandal
- Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Anju Seth
- Department of Paediatrics, Lady Hardinge Medical College, Delhi 110001, India
| | - Vijayalakshmi Bhatia
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Siddhnath Sudhanshu
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Atul Garg
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Ruchira Vishwakarma
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
| | - Aditya Narayan Sarangi
- Department of Genome Analytics, BaseSolve Informatics Pvt Ltd, Ahmedabad, Gujrat 380006, India
| | - Shivendra Verma
- Department of General Medicine, GSVM Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Surya Kumar Singh
- Department of Endocrinology, Banaras Hindu University, Varanasi, Uttar Pradesh 221005, India
| | - Eesh Bhatia
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
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2
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Li Y, Gong S, Li M, Cai X, Liu W, Zhang S, Ma Y, Luo Y, Zhou L, Zhang X, Huang X, Gao X, Hu M, Li Y, Ren Q, Wang Y, Zhou X, Han X, Ji L. The genetic and clinical characteristics of WFS1 related diabetes in Chinese early onset type 2 diabetes. Sci Rep 2023; 13:9127. [PMID: 37277527 DOI: 10.1038/s41598-023-36334-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 06/01/2023] [Indexed: 06/07/2023] Open
Abstract
Diabetes is one of the most common phenotypes of Wolfram syndrome owing to the presence of the variants of the WFS1 gene and is often misdiagnosed as other types of diabetes. We aimed to explore the prevalence of WFS1-related diabetes (WFS1-DM) and its clinical characteristics in a Chinese population with early-onset type 2 diabetes (EOD). We sequenced all exons of the WFS1 gene in 690 patients with EOD (age at diagnosis ≤ 40 years) for rare variants. Pathogenicity was defined according to the standards and guidelines of the American College of Medical Genetics and Genomics. We identified 33 rare variants predicted to be deleterious in 39 patients. The fasting [1.57(1.06-2.22) ng/ml] and postprandial C-peptide levels [2.8(1.75-4.46) ng/ml] of the patients with such WFS1 variations were lower than those of the patients without WFS1 variation [2.09(1.43-3.05) and 4.29(2.76-6.07) respectively, ng/ml]. Six (0.9%) patients carried pathogenic or likely pathogenic variants; they met the diagnostic criteria for WFS1-DM according to the latest guidelines, but typical phenotypes of Wolfram syndrome were seldom observed. They were diagnosed at an earlier age and usually presented with an absence of obesity, impaired beta cell function, and the need for insulin treatment. WFS1-DM is usually mistakenly diagnosed as type 2 diabetes, and genetic testing is helpful for individualized treatment.
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Affiliation(s)
- Yating Li
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, No 11, Xizhimen South Street, Beijing, 100044, China
| | - Siqian Gong
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, No 11, Xizhimen South Street, Beijing, 100044, China
| | - Meng Li
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, No 11, Xizhimen South Street, Beijing, 100044, China
| | - Xiaoling Cai
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, No 11, Xizhimen South Street, Beijing, 100044, China
| | - Wei Liu
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, No 11, Xizhimen South Street, Beijing, 100044, China
| | - Simin Zhang
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, No 11, Xizhimen South Street, Beijing, 100044, China
| | - Yumin Ma
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, No 11, Xizhimen South Street, Beijing, 100044, China
| | - Yingying Luo
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, No 11, Xizhimen South Street, Beijing, 100044, China
| | - Lingli Zhou
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, No 11, Xizhimen South Street, Beijing, 100044, China
| | - Xiuying Zhang
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, No 11, Xizhimen South Street, Beijing, 100044, China
| | - Xiuting Huang
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, No 11, Xizhimen South Street, Beijing, 100044, China
| | - Xueying Gao
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, No 11, Xizhimen South Street, Beijing, 100044, China
| | - Mengdie Hu
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, No 11, Xizhimen South Street, Beijing, 100044, China
| | - Yufeng Li
- Beijing Pinggu Hospital, No·59, Xinping North Street, Beijing, 101200, China
| | - Qian Ren
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, No 11, Xizhimen South Street, Beijing, 100044, China
| | - Yanai Wang
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, No 11, Xizhimen South Street, Beijing, 100044, China
| | - Xianghai Zhou
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, No 11, Xizhimen South Street, Beijing, 100044, China
| | - Xueyao Han
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, No 11, Xizhimen South Street, Beijing, 100044, China.
| | - Linong Ji
- Departments of Endocrinology and Metabolism, Peking University People's Hospital, Peking University Diabetes Center, No 11, Xizhimen South Street, Beijing, 100044, China.
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3
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Serbis A, Rallis D, Giapros V, Galli-Tsinopoulou A, Siomou E. Wolfram Syndrome 1: A Pediatrician's and Pediatric Endocrinologist's Perspective. Int J Mol Sci 2023; 24:ijms24043690. [PMID: 36835101 PMCID: PMC9960967 DOI: 10.3390/ijms24043690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/21/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Wolfram syndrome 1 (WS1) is a rare autosomal recessive neurodegenerative disease caused by mutations in WFS1 and WFS2 genes that produce wolframin, a protein involved in endoplasmic reticulum calcium homeostasis and cellular apoptosis. Its main clinical features are diabetes insipidus (DI), early-onset non-autoimmune insulin-dependent diabetes mellitus (DM), gradual loss of vision due to optic atrophy (OA) and deafness (D), hence the acronym DIDMOAD. Several other features from different systems have been reported such as urinary tract, neurological, and psychiatric abnormalities. In addition, endocrine disorders that can appear during childhood and adolescence include primary gonadal atrophy and hypergonadotropic hypogonadism in males and menstrual cycle abnormalities in females. Further, anterior pituitary dysfunction with deficient GH and/or ACTH production have been described. Despite the lack of specific treatment for the disease and its poor life expectancy, early diagnosis and supportive care is important for timely identifying and adequately managing its progressive symptoms. The current narrative review focuses on the pathophysiology and the clinical features of the disease, with a special emphasis on its endocrine abnormalities that appear during childhood and adolescence. Further, therapeutic interventions that have been proven to be effective in the management of WS1 endocrine complications are discussed.
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Affiliation(s)
- Anastasios Serbis
- Department of Pediatrics, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece
- Correspondence:
| | - Dimitrios Rallis
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece
| | - Vasileios Giapros
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece
| | - Assimina Galli-Tsinopoulou
- Second Department of Pediatrics, School of Medicine, Faculty of Health Sciences, AHEPA University General Hospital, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Ekaterini Siomou
- Department of Pediatrics, School of Medicine, University of Ioannina, 451 10 Ioannina, Greece
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4
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Maamouri R, Hizem S, Kammoun I, Elaribi Y, Rejeb I, Sebai M, Jilani H, Rouzier C, Cheour M, Paquis-Flucklinger V, Ben Jemaa L. A novel WFS1 variant associated with severe diabetic retinopathy in Wolfram syndrome type 1. Ophthalmic Genet 2022; 44:304-312. [PMID: 36094066 DOI: 10.1080/13816810.2022.2113546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Wolfram syndrome type 1 is a rare neurodegenerative disorder including diabetes insipidus, diabetes mellitus, optic atrophy, and deafness, with variable additional findings. The phenotypic spectrum is very heterogeneous, with non-autoimmune juvenile-onset diabetes and optic atrophy as minimal criteria for the diagnosis. Biallelic mutations in the WFS1 gene are the causative genetic anomaly for the syndrome, with, however, no evident genotype-phenotype correlation. Among the clinical features of the disease, diabetic retinopathy depicts a rarely reported microvascular complication. In this report, we describe the clinical and genetic findings in a 26-year-old patient presenting with Wolfram syndrome and severe diabetic retinopathy. METHODS The mutation screening was performed by polymerase chain reaction followed by Sanger sequencing of the entire coding sequence of the WFS1 gene. RESULTS A novel homozygous missense variant c.1901A>T (p.Lys634Met) was found in the proband and classified as probably pathogenic according to the American College of Medical Genetics and Genomics. CONCLUSIONS The molecular study of the WFS1 gene is essential for the diagnostic confirmation, to provide appropriate genetic counseling and a mutational screening in the at-risk relatives. The c.1901A>T (p.Lys634 Met) is a novel variant that could be responsible for a severe form of Wolfram syndrome with early and proliferative diabetic retinopathy.
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Affiliation(s)
- Rym Maamouri
- Department of Ophthalmology, Habib Thameur hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Syrine Hizem
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Department of congenital and hereditary diseases, Mongi Slim hospital, La Marsa, Tunis, Tunisia
| | - Ines Kammoun
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Department of endocrinology and metabolic diseases, National Institute "Zouhair Kallel" of Nutrition, Tunis, Tunisia
| | - Yasmina Elaribi
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Department of congenital and hereditary diseases, Mongi Slim hospital, La Marsa, Tunis, Tunisia
| | - Imen Rejeb
- Department of congenital and hereditary diseases, Mongi Slim hospital, La Marsa, Tunis, Tunisia
| | - Molka Sebai
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Department of congenital and hereditary diseases, Mongi Slim hospital, La Marsa, Tunis, Tunisia
| | - Houweyda Jilani
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Department of congenital and hereditary diseases, Mongi Slim hospital, La Marsa, Tunis, Tunisia
| | - Cécile Rouzier
- Department of Medical Genetics, National Center for Mitochondrial Diseases, Nice Teaching Hospital, Nice, France
| | - Monia Cheour
- Department of Ophthalmology, Habib Thameur hospital, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Véronique Paquis-Flucklinger
- Department of Medical Genetics, National Center for Mitochondrial Diseases, Nice Teaching Hospital, Nice, France
| | - Lamia Ben Jemaa
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.,Department of congenital and hereditary diseases, Mongi Slim hospital, La Marsa, Tunis, Tunisia
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5
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Gruber N, Pinhas-Hamiel O. Diabetes Out-of-the-Box: Diabetes Mellitus and Impairment in Hearing and Vision. Curr Diab Rep 2022; 22:423-432. [PMID: 35789979 DOI: 10.1007/s11892-022-01483-y] [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] [Accepted: 05/18/2022] [Indexed: 01/19/2023]
Abstract
PURPOSEOF REVIEW This review aims to provide an update on the etiologies of diabetes that are due to genetic disorders and that co-occur with impaired hearing or vision and to compare them. The potential mechanisms, including novel treatments, will be detailed. RECENT FINDINGS Wolfram syndrome, Kearns-Sayre syndrome, thiamine-responsive megaloblastic anemia, and maternally inherited diabetes and deafness are genetic disorders characterized by diabetes, impaired hearing, and vision. They differ in mode of inheritance, age at presentation, and the involvement of other organs; they are often misdiagnosed as type 1 or type 2 diabetes. Suspicion of a genetic diabetes syndrome should be raised when pancreatic autoantibodies are negative, other organs are involved, and family history includes diabetes. Correct diagnosis of the various syndromes is important for tailoring the most advanced treatment, preventing disease progression, and enabling proper genetic counseling.
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Affiliation(s)
- Noah Gruber
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Orit Pinhas-Hamiel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
- The National Juvenile Diabetes Center, Maccabi Health Care Services, Ra'anana, Israel.
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6
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Zhang X, Xie Y, Xu K, Chang H, Zhang X, Li Y. Comprehensive Genetic Analysis Unraveled the Missing Heritability in a Chinese Cohort With Wolfram Syndrome 1: Clinical and Genetic Findings. Invest Ophthalmol Vis Sci 2022; 63:9. [PMID: 36098976 PMCID: PMC9482318 DOI: 10.1167/iovs.63.10.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To identify the missing heritability of patients with Wolfram syndrome 1 (WFS1) in a Chinese cohort and to report their clinical and genetic features. Methods We recruited 24 unrelated patients with suspected WFS1 who carried at least one variant in WFS1. All patients underwent ophthalmic examinations and comprehensive molecular genetic analyses, including Sanger-DNA sequencing of WFS1 and next-generation sequencing of the whole WFS1 sequence. Results We identified 38 distinct pathogenic variants of WFS1 in the 24 probands, comprising 23 patients with biallelic variants and one patient with a monoallelic variant. Sanger-DNA sequencing of WFS1 initially detected 35 variants, and subsequent whole genome sequencing revealed three missing variants: one novel deep intronic variant (DIV), one copy number variant (CNV), and one variant in the promoter region. Minigene assays showed that the DIV activated cryptic splice sites, leading to the insertion of pseudoexons. Optic atrophy was observed in all patients, and diabetes mellitus (DM) was revealed in 21 patients (91.3%), hearing loss in nine patients (39.1%), renal tract abnormalities in nine patients (39.1%), and diabetes insipidus in five patients (21.7%). The mean onset age for DM was significantly younger in the patients with biallelic null variants than in the patients with biallelic missense variants. Conclusions Our results extend the pathogenic variant spectrum of WFS1. DIVs and CNVs explained rare unresolved Chinese cases with WFS1. The patients showed a wide and variable clinical spectrum, supporting the importance of genetic analysis for patients with atypical WFS1.
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Affiliation(s)
- Xin Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab. Beijing, China
| | - Yue Xie
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab. Beijing, China
| | - Ke Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab. Beijing, China
| | - Haoyu Chang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab. Beijing, China
| | - Xiaohui Zhang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab. Beijing, China
| | - Yang Li
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Lab. Beijing, China
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7
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β-cyclodextrin based nano gene delivery using pharmaceutical applications to treat Wolfram syndrome. Ther Deliv 2022; 13:449-462. [PMID: 36748654 DOI: 10.4155/tde-2022-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Wolfram syndrome is a rare multisystem autosomal recessive neurodegenerative disorder that affects the brain and central nervous system. Currently, there is no cure or treatment for Wolfram syndrome. Therefore, new techniques are needed to target the loss of the WFS1 gene. Gene therapy approach to introduce a functional gene using a viral or a non-viral vector could be a treatment strategy for Wolfram syndrome 1 (WS1). Viral vectors have therapeutic benefits and greater efficiency; however, they pose a high health risk. Recently pharmaceutical therapeutic research has developed cell-penetrating non-viral nano molecules that could be used as vectors for gene delivery. Among nonviral vectors, the unique properties of β-cyclodextrin suggest that it can be a promising safe vector for gene delivery.
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8
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Chapla A, Johnson J, Korula S, Mohan N, Ahmed A, Varghese D, Rangasamy P, Ravichandran L, Jebasingh F, Kumar Agrawal K, Somasundaram N, Hesarghatta Shyamasunder A, Mathai S, Simon A, Jha S, Chowdry S, Venkatesan R, Raghupathy P, Thomas N. WFS1 Gene-associated Diabetes Phenotypes and Identification of a Founder Mutation in Southern India. J Clin Endocrinol Metab 2022; 107:1328-1336. [PMID: 35018440 DOI: 10.1210/clinem/dgac002] [Citation(s) in RCA: 3] [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: 07/19/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Wolfram syndrome (WFS) is a rare autosomal recessive disorder characterized by juvenile-onset diabetes, diabetes insipidus, optic atrophy, deafness, and progressive neurodegeneration. However, due to the progressive nature of the disease and a lack of complete clinical manifestations, a confirmed diagnosis of WFS at the time of onset of diabetes is a challenge. OBJECTIVE With WFS1 rare heterozygous variants reported in diabetes, there is a need for comprehensive genetic screening strategies for the early diagnosis of WFS and delineating the phenotypic spectrum associated with the WFS1 gene variants in young-onset diabetes. METHODS This case series of 11 patients who were positive for WFS1 variants were identified with next-generation sequencing (NGS)-based screening of 17 genemonogenic diabetes panel. These results were further confirmed with Sanger sequencing. RESULTS 9 out of 11 patients were homozygous for pathogenic/likely pathogenic variants in the WFS1 gene. Interestingly, 3 of these probands were positive for the novel WFS1 (NM_006005.3): c.1107_1108insA (p.Ala370Serfs*173) variant, and haplotype analysis suggested a founder effect in 3 families from Southern India. Additionally, we identified 2 patients with young-onset diabetes who were heterozygous for a likely pathogenic variant or a variant of uncertain significance in the WFS1 gene. CONCLUSION These results project the need for NGS-based parallel multigene testing as a tool for early diagnosis of WFS and identify heterozygous WFS1 variants implicated in young-onset diabetes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Anna Simon
- Christian Medical College Vellore, India
| | - Sujeet Jha
- Max Super Speciality Hospital, New Delhi, India
| | - Subhankar Chowdry
- Institute of Post-Graduate Medical Education and Research, Kolkotta, India
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9
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Wolfram Syndrome 1: From Genetics to Therapy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063225. [PMID: 35328914 PMCID: PMC8949990 DOI: 10.3390/ijerph19063225] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 02/01/2023]
Abstract
Wolfram syndrome 1 (WS1) is a rare neurodegenerative disease transmitted in an autosomal recessive mode. It is characterized by diabetes insipidus (DI), diabetes mellitus (DM), optic atrophy (OA), and sensorineural hearing loss (D) (DIDMOAD). The clinical picture may be complicated by other symptoms, such as urinary tract, endocrinological, psychiatric, and neurological abnormalities. WS1 is caused by mutations in the WFS1 gene located on chromosome 4p16 that encodes a transmembrane protein named wolframin. Many studies have shown that wolframin regulates some mechanisms of ER calcium homeostasis and therefore plays a role in cellular apoptosis. More than 200 mutations are responsible for WS1. However, abnormal phenotypes of WS with or without DM, inherited in an autosomal dominant mode and associated with one or more WFS1 mutations, have been found. Furthermore, recessive Wolfram-like disease without DM has been described. The prognosis of WS1 is poor, and the death occurs prematurely. Although there are no therapies that can slow or stop WS1, a careful clinical monitoring can help patients during the rapid progression of the disease, thus improving their quality of life. In this review, we describe natural history and etiology of WS1 and suggest criteria for a most pertinent approach to the diagnosis and clinical follow up. We also describe the hallmarks of new therapies for WS1.
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10
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Rigoli L, Caruso V, Aloi C, Salina A, Maghnie M, d’Annunzio G, Lamacchia O, Salzano G, Lombardo F, Picca G. An Atypical Case of Late-Onset Wolfram Syndrome 1 without Diabetes Insipidus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042473. [PMID: 35206658 PMCID: PMC8872384 DOI: 10.3390/ijerph19042473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 12/04/2022]
Abstract
Wolfram syndrome 1, a rare autosomal recessive neurodegenerative disease, is caused by mutations in the WFS1 gene. It is characterized by diabetes insipidus, diabetes mellitus, optic atrophy, and deafness (DIDMOAD), and other clinical manifestations such as urological and neurological disorders. Here we described the case of a patient with an atypical late-onset Wolfram syndrome 1 without DI. Our WS1 patient was a c.1620_1622delGTG (p.Trp540del)/c.124 C > T (p.Arg42*) heterozygous compound. The p.Arg42* nonsense mutation was also found in heterozygosity in his sister and niece, both suffering from psychiatric disorders. The p.Arg42* nonsense mutation has never been found in WS1 and its pathogenicity is unclear so far. Our study underlined the need to study a greater number of WS1 cases in order to better understand the clinical significance of many WFS1 variants.
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Affiliation(s)
- Luciana Rigoli
- Department of Human Pathology of Adulthood and Childhood G. Barresi, University of Messina, 98125 Messina, Italy; (G.S.); (F.L.)
- Correspondence: ; Tel.: +39-090-2217163
| | - Valerio Caruso
- Psychiatry 2 Unit, Clinical and Experimental Medicine Department, University of Pisa, 56126 Pisa, Italy;
| | - Concetta Aloi
- Pediatric Clinic, LABSIEM (Laboratory for the Study of Inborn Errors of Metabolism), IRCCS Institute Giannina Gaslini, 16147 Genoa, Italy; (C.A.); (A.S.); (M.M.); (G.d.)
| | - Alessandro Salina
- Pediatric Clinic, LABSIEM (Laboratory for the Study of Inborn Errors of Metabolism), IRCCS Institute Giannina Gaslini, 16147 Genoa, Italy; (C.A.); (A.S.); (M.M.); (G.d.)
| | - Mohamad Maghnie
- Pediatric Clinic, LABSIEM (Laboratory for the Study of Inborn Errors of Metabolism), IRCCS Institute Giannina Gaslini, 16147 Genoa, Italy; (C.A.); (A.S.); (M.M.); (G.d.)
| | - Giuseppe d’Annunzio
- Pediatric Clinic, LABSIEM (Laboratory for the Study of Inborn Errors of Metabolism), IRCCS Institute Giannina Gaslini, 16147 Genoa, Italy; (C.A.); (A.S.); (M.M.); (G.d.)
| | - Olga Lamacchia
- Unit of Endocrinology and Diabetology, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy; (O.L.); (G.P.)
| | - Giuseppina Salzano
- Department of Human Pathology of Adulthood and Childhood G. Barresi, University of Messina, 98125 Messina, Italy; (G.S.); (F.L.)
| | - Fortunato Lombardo
- Department of Human Pathology of Adulthood and Childhood G. Barresi, University of Messina, 98125 Messina, Italy; (G.S.); (F.L.)
| | - Giuseppe Picca
- Unit of Endocrinology and Diabetology, Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy; (O.L.); (G.P.)
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Wolfram Syndrome Type 2: A Systematic Review of a Not Easily Identifiable Clinical Spectrum. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020835. [PMID: 35055657 PMCID: PMC8776149 DOI: 10.3390/ijerph19020835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 12/11/2022]
Abstract
Background: Wolfram syndrome (WS) is a rare autosomal recessive disorder that is characterized by the presence of diabetes mellitus, optic atrophy and hearing loss, all of which are crucial elements for the diagnosis. WS is variably associated with diabetes insipidus, neurological disorders, urinary tract anomalies, endocrine dysfunctions and many other systemic manifestations. Since Wolfram and Wagener first described WS in 1938, new phenotypic/genotypic variants of the syndrome have been observed and the clinical picture has been significantly enriched. To date, two main subtypes of WS that associated with two different mutations are known: WS type 1 (WS1), caused by the mutation of the wolframine gene (WS1; 606201), and WS type 2 (WS2), caused by the mutation of the CISD2 gene (WS2; 604928). Methods: A systematic review of the literature was describe the phenotypic characteristics of WS2 in order to highlight the key elements that differentiate it from the classic form. Conclusion: WS2 is the rarest and most recently identified subtype of WS; its clinical picture is partially overlapping with that of WS1, from which it traditionally differs by the absence of diabetes insipidus and the presence of greater bleeding tendency and peptic ulcers.
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Salzano G, Rigoli L, Valenzise M, Chimenz R, Passanisi S, Lombardo F. Clinical Peculiarities in a Cohort of Patients with Wolfram Syndrome 1. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010520. [PMID: 35010780 PMCID: PMC8744633 DOI: 10.3390/ijerph19010520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/30/2021] [Accepted: 01/02/2022] [Indexed: 02/01/2023]
Abstract
Wolfram syndrome 1 is a rare, autosomal recessive, neurodegenerative, progressive disorder. Insulin-dependent, non-autoimmune diabetes mellitus and bilateral progressive optic atrophy are both sensitive and specific criteria for clinical diagnosis. The leading cause of death is central respiratory failure resulting from brainstem atrophy. We describe the clinical features of fourteen patients from seven different families followed in our Diabetes Center. The mean age at Wolfram syndrome 1 diagnosis was 12.4 years. Diabetes mellitus was the first clinical manifestation, in all patients. Sensorineural hearing impairment and central diabetes insipidus were present in 85.7% of patients. Other endocrine findings included hypogonadotropic hypogonadism (7.1%), hypergonadotropic hypogonadism (7.1%), and Hashimoto’s thyroiditis (21.4%). Neuropsychiatric disorders were detected in 35.7% of patients, and urogenital tract abnormalities were present in 21.4%. Finally, heart diseases were found in 14.2% of patients. Eight patients (57.1%) died at the mean age of 27.3 years. The most common cause of death was respiratory failure which occurred in six patients. The remaining two died due to end-stage renal failure and myocardial infarction. Our data are superimposable with those reported in the literature in terms of mean age of onset, the clinical course of the disease, and causes of death. The frequency of deafness and diabetes insipidus was higher in our patients. The incidence of urogenital diseases was lower although it led to the death of one patient. Long-term follow-up studies including large patient cohorts are necessary to establish potential genotype-phenotype correlation in order to personalize the most suitable clinical approach for each patient.
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Affiliation(s)
- Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (L.R.); (M.V.); (S.P.); (F.L.)
- Correspondence: ; Tel.: +39-090-2213-023; Fax: +39-090-2213-170
| | - Luciana Rigoli
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (L.R.); (M.V.); (S.P.); (F.L.)
| | - Mariella Valenzise
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (L.R.); (M.V.); (S.P.); (F.L.)
| | - Roberto Chimenz
- Unit of Pediatric Nephrology and Dialysis, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, 98125 Messina, Italy;
| | - Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (L.R.); (M.V.); (S.P.); (F.L.)
| | - Fortunato Lombardo
- Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (L.R.); (M.V.); (S.P.); (F.L.)
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Mishra R, Chen BS, Richa P, Yu-Wai-Man P. Wolfram syndrome: new pathophysiological insights and therapeutic strategies. THERAPEUTIC ADVANCES IN RARE DISEASE 2021; 2:26330040211039518. [PMID: 37181110 PMCID: PMC10032446 DOI: 10.1177/26330040211039518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/23/2021] [Indexed: 05/16/2023]
Abstract
Wolfram Syndrome (WS) is an ultra-rare, progressive neurodegenerative disease characterized by early-onset diabetes mellitus and irreversible loss of vision, secondary to optic nerve degeneration. Visual loss in WS is an important cause of registrable blindness in children and young adults and the pathological hallmark is the preferential loss of retinal ganglion cells within the inner retina. In addition to optic atrophy, affected individuals frequently develop variable combinations of neurological, endocrinological, and psychiatric complications. The majority of patients carry recessive mutations in the WFS1 (4p16.1) gene that encodes for a multimeric transmembrane protein, wolframin, embedded within the endoplasmic reticulum (ER). An increasingly recognised subgroup of patients harbor dominant WFS1 mutations that usually cause a milder phenotype, which can be limited to optic atrophy. Wolframin is a ubiquitous protein with high levels of expression in retinal, neuronal, and muscle tissues. It is a multifunctional protein that regulates a host of cellular functions, in particular the dynamic interaction with mitochondria at mitochondria-associated membranes. Wolframin has been implicated in several crucial cellular signaling pathways, including insulin signaling, calcium homeostasis, and the regulation of apoptosis and the ER stress response. There is currently no cure for WS; management remains largely supportive. This review will cover the clinical, genetic, and pathophysiological features of WS, with a specific focus on disease models and the molecular pathways that could serve as potential therapeutic targets. The current landscape of therapeutic options will also be discussed in the context of the latest evidence, including the pipeline for repurposed drugs and gene therapy. Plain language summary Wolfram syndrome - disease mechanisms and treatment options Wolfram syndrome (WS) is an ultra-rare genetic disease that causes diabetes mellitus and progressive loss of vision from early childhood. Vision is affected in WS because of damage to a specialized type of cells in the retina, known as retinal ganglion cells (RGCs), which converge at the back of the eye to form the optic nerve. The optic nerve is the fast-conducting cable that transmits visual information from the eye to the vision processing centers within the brain. As RGCs are lost, the optic nerve degenerates and it becomes pale in appearance (optic atrophy). Although diabetes mellitus and optic atrophy are the main features of WS, some patients can develop more severe problems because the brain and other organs, such as the kidneys and the bladder, are also affected. The majority of patients with WS carry spelling mistakes (mutations) in the WFS1 gene, which is located on the short arm of chromosome 4 (4p16.1). This gene is highly expressed in the eye and in the brain, and it encodes for a protein located within a compartment of the cell known as the endoplasmic reticulum. For reasons that still remain unclear, WFS1 mutations preferentially affect RGCs, accounting for the prominent visual loss in this genetic disorder. There is currently no effective treatment to halt or slow disease progression and management remains supportive, including the provision of visual aids and occupational rehabilitation. Research into WS has been limited by its relative rarity and the inability to get access to eye and brain tissues from affected patients. However, major advances in our understanding of this disease have been made recently by making use of more accessible cells from patients, such as skin cells (fibroblasts), or animal models, such as mice and zebrafish. This review summarizes the mechanisms by which WFS1 mutations affect cells, impairing their function and eventually leading to their premature loss. The possible treatment strategies to block these pathways are also discussed, with a particular focus on drug repurposing (i.e., using drugs that are already approved for other diseases) and gene therapy (i.e., replacing or repairing the defective WFS1 gene).
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Affiliation(s)
- Ratnakar Mishra
- Cambridge Centre for Brain Repair and MRC
Mitochondrial Biology Unit, Department of Clinical Neurosciences, University
of Cambridge, Cambridge, UK
| | - Benson S. Chen
- Cambridge Centre for Brain Repair and MRC
Mitochondrial Biology Unit, Department of Clinical Neurosciences, University
of Cambridge, Cambridge, UK
- Cambridge Eye Unit, Addenbrooke’s Hospital,
Cambridge University Hospitals, Cambridge, UK
| | - Prachi Richa
- Department of Physiology, Development and
Neuroscience, University of Cambridge, Cambridge, UK
| | - Patrick Yu-Wai-Man
- Cambridge Centre for Brain Repair and MRC
Mitochondrial Biology Unit, Department of Clinical Neurosciences, University
of Cambridge, ED Adrian Building, Robinson Way, Cambridge, CB2 0PY, UK
- Cambridge Eye Unit, Addenbrooke’s Hospital,
Cambridge University Hospitals, Cambridge, UK
- Moorfields Eye Hospital, London, UK
- UCL Institute of Ophthalmology, University
College London, London, UK
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Rigoli L, Aloi C, Salina A, Di Bella C, Salzano G, Caruso R, Mazzon E, Maghnie M, Patti G, D'Annunzio G, Lombardo F. Wolfram syndrome 1 in the Italian population: genotype-phenotype correlations. Pediatr Res 2020; 87:456-462. [PMID: 31266054 DOI: 10.1038/s41390-019-0487-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/14/2019] [Accepted: 06/20/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES We studied 45 patients with Wolfram syndrome 1 (WS1) to describe their clinical history and to search for possible genotype-phenotype correlations. METHODS Clinical criteria contributing to WS1 diagnosis were analyzed. The patients were classified into three genotypic classes according to type of detected mutations. RESULTS WS1 prevalence in Italy is 0.74/1,000,000. All four manifestations of DIDMOAD were found in 46.7% of patients. Differently combined WS1 clinical features were detected in 53.3% of patients. We found 35 WFS1 different mutations and a novel missense mutation, c.1523A>G. WS1 patients were homozygotes or compound heterozygotes for WFS1 mutations except for 2 heterozygote patients (4.5%). Each genotypic group exhibited a different age onset of DM, D, and DI but not of OA. Genotypic Group 2 patients manifested a lower number of clinical manifestations compared to Groups 1 and 3. Moreover, genotypic Group 1 patients tended to have a shorter survival time than the other groups. No differences were found regarding type of clinical pictures. CONCLUSIONS Our study suggested that molecular WFS1 typing is a useful tool for early assessment of clinical history, follow-up, and prognosis of WS1.
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Affiliation(s)
- Luciana Rigoli
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Concetta Aloi
- LABSIEM (Laboratory for the Study of Inborn Errors of Metabolism), Istituto Giannina Gaslini, Genoa, Italy
| | - Alessandro Salina
- LABSIEM (Laboratory for the Study of Inborn Errors of Metabolism), Istituto Giannina Gaslini, Genoa, Italy
| | - Chiara Di Bella
- Department of Human Pathology, University of Messina, Messina, Italy
| | | | - Rosario Caruso
- Department of Human Pathology, University of Messina, Messina, Italy
| | | | - Mohamad Maghnie
- Department of Pediatrics, University of Genoa, Istituto Giannina Gaslini, Genova, Italy
| | - Giuseppa Patti
- Department of Pediatrics, University of Genoa, Istituto Giannina Gaslini, Genova, Italy
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Pallotta MT, Tascini G, Crispoldi R, Orabona C, Mondanelli G, Grohmann U, Esposito S. Wolfram syndrome, a rare neurodegenerative disease: from pathogenesis to future treatment perspectives. J Transl Med 2019; 17:238. [PMID: 31337416 PMCID: PMC6651977 DOI: 10.1186/s12967-019-1993-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/17/2019] [Indexed: 02/06/2023] Open
Abstract
Background Wolfram syndrome (WS), a rare genetic disorder, is considered the best prototype of endoplasmic reticulum (ER) diseases. Classical WS features are childhood-onset diabetes mellitus, optic atrophy, deafness, diabetes insipidus, neurological signs, and other abnormalities. Two causative genes (WFS1 and WFS2) have been identified. The transmission of the disease takes place in an autosomal recessive mode but autosomal dominant mutations responsible for WS-related disorders have been described. Prognosis is poor, death occurs at the median age of 39 years with a major cause represented by respiratory failure as a consequence of brain stem atrophy and neurodegeneration. The aim of this narrative review is to focus on etiology, pathogenesis and natural history of WS for an adequate patient management and for the discussion of future therapeutic interventions. Main body WS requires a multidisciplinary approach in order to be successfully treated. A prompt diagnosis decreases morbidity and mortality through prevention and treatment of complications. Being a monogenic pathology, WS represents a perfect model to study the mechanisms of ER stress and how this condition leads to cell death, in comparison with other prevalent diseases in which multiple factors interact to produce the disease manifestations. WS is also an important disease prototype to identify drugs and molecules associated with ER homeostasis. Evidence indicates that specific metabolic diseases (type 1 and type 2 diabetes), neurodegenerative diseases, atherosclerosis, inflammatory pathologies and also cancer are closely related to ER dysfunction. Conclusions Therapeutic strategies in WS are based on drug repurposing (i.e., investigation of approved drugs for novel therapeutic indications) with the aim to stop the progression of the disease by reducing the endoplasmic reticulum stress. An extensive understanding of WS from pathophysiology to therapy is fundamental and more studies are necessary to better manage this devastating disease and guarantee the patients a better quality of life and longer life expectancy.
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Affiliation(s)
- Maria Teresa Pallotta
- Pharmacology Section, Department of Experimental Medicine, Università degli Studi di Perugia, Perugia, Italy
| | - Giorgia Tascini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy
| | - Roberta Crispoldi
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy
| | - Ciriana Orabona
- Pharmacology Section, Department of Experimental Medicine, Università degli Studi di Perugia, Perugia, Italy
| | - Giada Mondanelli
- Pharmacology Section, Department of Experimental Medicine, Università degli Studi di Perugia, Perugia, Italy
| | - Ursula Grohmann
- Pharmacology Section, Department of Experimental Medicine, Università degli Studi di Perugia, Perugia, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy.
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16
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Karzon R, Narayanan A, Chen L, Lieu JEC, Hershey T. Longitudinal hearing loss in Wolfram syndrome. Orphanet J Rare Dis 2018; 13:102. [PMID: 29945639 PMCID: PMC6020390 DOI: 10.1186/s13023-018-0852-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/20/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Wolfram syndrome (WFS) is a rare autosomal recessive disease with clinical manifestations of diabetes mellitus (DM), diabetes insipidus (DI), optic nerve atrophy (OA) and sensorineural hearing loss (SNHL). Although SNHL is a key symptom of WFS, there is limited information on its natural history using standardized measures. Such information is important for clinical care and determining its use as an outcome measure in clinical trials. METHODS Standardized audiologic measures, including pure-tone testing, tympanometry, speech perception, and the unaided Speech Intelligibility Index (SII) were assessed in patients with confirmed WFS annually. Mixed model analyses were used to examine main effects of age, time or interactions for pure tone average (PTA), high frequency average (HFA) and SII. RESULTS Forty WFS patients were evaluated between 1 and 6 times. Mean age at initial enrollment was 13.5 years (SD = 5.6). Patients were classified as having normal hearing (n = 10), mild-to-severe (n = 24) or profound SNHL (n = 6). Mean age of diagnosis for SNHL was 8.3 years (SD = 5.1) with 75% prevalence. HFA worsened over time for both ears, and SII worsened over time in the worse ear, with greater decline in both measures in younger patients. Average estimated change over 1 year for all measures was in the subclinical range and power analyses suggest that 100 patients would be needed per group (treatment vs. placebo) to detect a 60% reduction in annual change of HFA over 3 years. If trials focused on just those patients with SNHL, power estimates suggest 55 patients per group would be sufficient. CONCLUSIONS Most patients had a slow progressive SNHL emerging in late childhood. Change over time with standard audiologic tests (HFA, SII) was small and would not be detectable for at least 2 years in an individual. Relatively large sample sizes would be necessary to detect significant impact on hearing progression in a clinical trial. Hearing function should be monitored clinically in WFS to provide appropriate intervention. Because SNHL can occur very early in WFS, audiologists and otolaryngologists should be aware of and refer for later emerging symptoms.
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Affiliation(s)
- Roanne Karzon
- Saint Louis Children's Hospital, One Children's Place, St. Louis, MO, 63110, USA.,Program in Audiology and Communication Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Anagha Narayanan
- Department of Psychiatry, Washington University in St. Louis School of Medicine, 4525 Scott Avenue, Campus Box 8134, St. Louis, MO, 63110, USA
| | - Ling Chen
- Division of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Judith E C Lieu
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA
| | - Tamara Hershey
- Department of Psychiatry, Washington University in St. Louis School of Medicine, 4525 Scott Avenue, Campus Box 8134, St. Louis, MO, 63110, USA. .,Department of Radiology, Washington University in St. Louis School of Medicine, 4525 Scott Avenue, Campus Box 8134, St. Louis, MO, 63110, USA.
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17
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Genetic and clinical aspects of Wolfram syndrome 1, a severe neurodegenerative disease. Pediatr Res 2018; 83:921-929. [PMID: 29774890 DOI: 10.1038/pr.2018.17] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/31/2017] [Indexed: 12/14/2022]
Abstract
Wolfram syndrome 1 (WS1) is a rare autosomal recessive neurodegenerative disease characterized by diabetes insipidus, diabetes mellitus, optic atrophy, deafness, and other abnormalities. WS1 usually results in death before the age of 50 years. The pathogenesis of WS1 is ascribed to mutations of human WFS1 gene on chromosome 4p encoding a transmembrane protein called wolframin, which has physiological functions in membrane trafficking, secretion, processing, and/or regulation of ER calcium homeostasis. Different types of WFS1 mutations have been identified, and some of these have been associated with a dominant, severe type of WS. Mutations of CISD2 gene cause autosomal recessive Wolfram syndrome 2 (WS2) characterized by the absence of diabetes insipidus and psychiatric disorders, and by bleeding upper intestinal ulcer and defective platelet aggregation. Other WFS1-related disorders such as DFNA6/14/38 nonsyndromic low-frequency sensorineural hearing loss and Wolfram syndrome-like disease with autosomal dominant transmission have been described. WS1 is a devastating disease for the patients and their families. Thus, early diagnosis is imperative to enable proper prognostication, prevent complications, and reduce the transmission to further progeny. Although there is currently no effective therapy, potential new drugs have been introduced, attempting to improve the progression of this fatal disease.
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Blanco-Aguirre ME, la Parra DRD, Tapia-Garcia H, Gonzalez-Rodriguez J, Welschen D, Welskin D, Arroyo-Yllanes ME, Escudero I, Nuñez-Hernandez JA, Medina-Bravo P, Zenteno JC. Identification of unsuspected Wolfram syndrome cases through clinical assessment and WFS1 gene screening in type 1 diabetes mellitus patients. Gene 2015; 566:63-7. [PMID: 25895475 DOI: 10.1016/j.gene.2015.04.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/09/2015] [Accepted: 04/10/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Wolfram syndrome (WS) is a severe autosomal recessive pleiotropic disease primarily characterized by the association of juvenile-onset diabetes mellitus and optic atrophy. Earlier reports have shown that a proportion of WS cases may remain unrecognized due to misdiagnosis as type 1 diabetes mellitus (T1DM). The objectives of this work were to estimate the prevalence of patients fulfilling clinical criteria for WS in a cohort of subjects diagnosed as T1DM and to identify causal WFS1 gene mutations in those individuals meeting clinical criteria for the disease. METHODS A cohort of 131 unrelated Mexican T1DM patients was collected, including 77 females and 54 males. Additional clinical anomalies suggesting WS were identified through review of medical files, detailed physical examination and/or specialized tests. WFS1 gene analysis was performed using exon-by-exon PCR amplification and direct Sanger sequencing on genomic DNA from patients reaching WS clinical criteria. RESULTS Clinical criteria for a WS diagnosis were reached in 6 probands, corresponding to a 4.58% frequency of the disease. WFS1 mutations were identified in 4 out of 5 (80%) individuals fulfilling WS clinical criteria, including two homozygous, one compound heterozygous, and one patient with a single allele mutation. No WFS1 mutations were identified in the remaining subject. CONCLUSIONS In our cohort, approximately 6% of cases diagnosed as T1DM were in fact patients with Wolfram syndrome. WFS1 mutations were identified in 4 out of 5 individuals (80%) fulfilling clinical criteria for WS. Clinical and genetic analyses of large cohorts of T1DM patients from different ethnic origins would help to better estimate the occurrence of WS and will lead to a better management of such patients.
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Affiliation(s)
- Maria E Blanco-Aguirre
- Department of Genetics, Hospital Materno Perinatal "Monica Pretelini Sainz", Instituto de Salud del Estado de México, Toluca, Mexico
| | - David Rivera-De la Parra
- Centro de Atención Integral del Paciente con Diabetes, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | | | | | | | - Daniela Welskin
- Ophthalmology Service, Hospital General de México, O.D, Mexico City, Mexico
| | | | - Irineo Escudero
- Servicio de Endocrinología, Centro Médico Nacional "20 de Noviembre" ISSSTE. Mexico City, Mexico
| | | | - Patricia Medina-Bravo
- Department of Endocrinology, Hospital Infantil de Mexico "Federico Gomez", Mexico City, Mexico
| | - Juan C Zenteno
- Department of Genetics-Research Unit, Institute of Ophthalmology "Conde de Valenciana", Mexico City, Mexico; Department of Biochemistry, Faculty of Medicine, UNAM, Mexico City, Mexico.
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