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Ribeiro A, Decaup PH, Andriantavy M, Couture C, Garot E. Skeletal indicators of pathology in the context of early tooth loss in children: A systematic literature review. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2024; 46:37-49. [PMID: 39029336 DOI: 10.1016/j.ijpp.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 07/02/2024] [Accepted: 07/12/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVE To provide an evidence-based resource for paleopathologists to consider multiple skeletal indicators of pathology associated with early tooth loss in children to aid in diagnosis. MATERIALS Three databases (Cochrane Library, MedLine, and Scopus) were used for a review. METHODS According to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, a systematic review guideline, 85 articles were selected. RESULTS A total of 189 children had a syndrome or disease associated with early tooth loss. Our review, based on 25 diseases, lists the bone and dental lesions observable in archeological remains. CONCLUSIONS Based on a review of the literature, a synthesis of 25 diseases and syndromes that may be associated with premature loss of permanent or deciduous teeth in children was developed for paleopathologists. It highlights the importance of a thorough dental examination by paleopathologists to further assess past health conditions. SIGNIFICANCE This paper provides an extensive resource addressing early tooth loss in childhood to assist researchers with differential diagnosis. LIMITATIONS The articles included in this review are case reports based on living populations. SUGGESTIONS FOR FURTHER RESEARCH Further studies into diseases and their association with early tooth loss would complement this work, as would utilizing the differential diagnoses on archeological individuals to clarify its value and limitations.
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Affiliation(s)
- Ana Ribeiro
- Univ. de Bordeaux, UFR des Sciences odontologiques, Bordeaux, France; Pôle de médecine et chirurgie bucco-dentaire, C.H.U de Bordeaux, France
| | - Pierre-Hadrien Decaup
- Univ. de Bordeaux, UFR des Sciences odontologiques, Bordeaux, France; Université de Bordeaux, CNRS, Ministère de la Culture, PACEA, UMR 5199, Pessac, France; Centre de Compétence des Maladies Rares Orales et Dentaires, CCMR O-Rares, C.H.U. de Bordeaux, France
| | | | - Christine Couture
- Université de Bordeaux, CNRS, Ministère de la Culture, PACEA, UMR 5199, Pessac, France
| | - Elsa Garot
- Univ. de Bordeaux, UFR des Sciences odontologiques, Bordeaux, France; Université de Bordeaux, CNRS, Ministère de la Culture, PACEA, UMR 5199, Pessac, France; Centre de Compétence des Maladies Rares Orales et Dentaires, CCMR O-Rares, C.H.U. de Bordeaux, France.
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Sbrocchi AM, Cavin R, Marleau A, Fournier T, Beecroft M, Ferraz dos Santos B. Aetiologies of low alkaline phosphatase in a Canadian Paediatric Tertiary Care Centre. Paediatr Child Health 2023; 28:483-488. [PMID: 38638542 PMCID: PMC11022865 DOI: 10.1093/pch/pxad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 05/15/2023] [Indexed: 04/20/2024] Open
Abstract
Objectives Increasingly, laboratories flag low serum alkaline phosphatase (sALP) that are age-and sex-specific in paediatrics. The aim of this study was to report clinical manifestations of paediatric patients with age-and sex-specific low sALP, thereby increasing awareness of its potential aetiologies. Methods This retrospective Canadian tertiary care paediatric hospital study assessed all sALP of ambulatory patients aged less than 18 years from 2015 to 2017. The hospital used a Beckman Coulter AU assay to measure sALP and compared values to the Canadian age-and sex-specific reference intervals from CALIPER. All children who had at least one subnormal age-and sex-specific sALP were evaluated. A review of medical charts of included patients was performed and demographic characteristics, medical history and diagnosis were collected, and categorized under groups of medical disorders. Results Of 11,874 included patients, 1,001 patients (9.2%) had low sALP. Of those, 48% (485/1,001) had transient low sALP activity and 9.6% (96/1,001) had persistently low sALP. Prolonged immobilization and inflammatory bowel disease represented the main aetiologies for persistently low sALP. Interestingly, 13.5% (13/96) of patients with persistently low sALP had no apparent aetiology. Conclusions Our results report aetiologies of low sALP in a Canadian paediatric population using age-and sex-specific Canadian reference ranges. This study highlights that healthcare providers should be aware that a low sALP may have clinical significance and should be repeated if warranted based on further clinical assessment.
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Affiliation(s)
- Anne Marie Sbrocchi
- Department of Pediatrics, Montreal Children’s Hospital, Montreal
- Faculty of Medicine, McGill University, Montreal
| | - Rosalie Cavin
- Department of Pediatrics, Montreal Children’s Hospital, Montreal
| | - Annie Marleau
- Division of Dentistry, Department of Pediatric Surgery, Montreal Children’s Hospital, Montreal
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal
| | - Tanya Fournier
- Alexion, AstraZeneca Rare Disease, Boston, Massachusetts, USA
| | | | - Beatriz Ferraz dos Santos
- Division of Dentistry, Department of Pediatric Surgery, Montreal Children’s Hospital, Montreal
- Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal
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Tender GS, Bertozzi CR. Bringing enzymes to the proximity party. RSC Chem Biol 2023; 4:986-1002. [PMID: 38033727 PMCID: PMC10685825 DOI: 10.1039/d3cb00084b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/16/2023] [Indexed: 12/02/2023] Open
Abstract
Enzymes are used to treat a wide variety of human diseases, including lysosomal storage disorders, clotting disorders, and cancers. While enzyme therapeutics catalyze highly specific reactions, they often suffer from a lack of cellular or tissue selectivity. Targeting an enzyme to specific disease-driving cells and tissues can mitigate off-target toxicities and provide novel therapeutic avenues to treat otherwise intractable diseases. Targeted enzymes have been used to treat cancer, in which the enzyme is either carefully selected or engineered to reduce on-target off-tumor toxicity, or to treat lysosomal storage disorders in cell types that are not addressed by standard enzyme replacement therapies. In this review, we discuss the different targeted enzyme modalities and comment on the future of these approaches.
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Affiliation(s)
- Gabrielle S Tender
- Stanford University, Department of Chemistry and Sarafan ChEM-H Stanford CA 94305 USA
| | - Carolyn R Bertozzi
- Stanford University, Department of Chemistry and Sarafan ChEM-H Stanford CA 94305 USA
- Howard Hughes Medical Institute Stanford CA 94305 USA
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Different Dental Manifestations in Sisters with the Same ALPL Gene Mutation: A Report of Two Cases. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121850. [PMID: 36553293 PMCID: PMC9777029 DOI: 10.3390/children9121850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
Hypophosphatasia (HPP) is an inherited disease caused by mutation of the alkaline phosphatase (ALPL) gene in an autosomal dominant or an autosomal recessive manner. The main symptoms of HPP are bone hypomineralization and early exfoliation of the primary teeth. Some of the mutations identified in autosomal dominant families are reported to have dominant negative effects. In addition, the penetrance can vary among patients with the same variant even within the same family, resulting in various phenotypes of systemic symptoms. However, differences in dental symptoms between patients with HPP and carriers with the same ALPL variant have not been reported. Herein, we report on two sisters who had the same heterozygous ALPL variant with dominant negative effects. The older sister had bone and dental symptoms and was diagnosed with childhood HPP. In contrast, the younger sister was a carrier with no bone and dental symptoms. It can be inferred that this phenomenon was caused by the difference in penetrance. This case revealed that carriers with the ALPL mutation may have no dental symptoms characteristic of HPP. Because HPP is sometimes progressive, it is very important to carefully monitor carriers to detect the possible onset of dental and systemic symptoms.
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Okawa R, Nakano K. Dental manifestation and management of hypophosphatasia. JAPANESE DENTAL SCIENCE REVIEW 2022; 58:208-216. [PMID: 35814738 PMCID: PMC9260292 DOI: 10.1016/j.jdsr.2022.06.002] [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] [Received: 02/28/2022] [Revised: 06/22/2022] [Accepted: 06/26/2022] [Indexed: 11/24/2022] Open
Abstract
Hypophosphatasia is an inherited metabolic disorder characterized by defective mineralization of bones and teeth with a wide variety of manifestations, ranging from stillbirth to dental symptoms alone. Recently, the prognosis of severe hypophosphatasia patients has been greatly improved by the introduction of enzyme replacement therapy. The typical dental manifestation is early exfoliation of primary teeth due to disturbed cementum formation, so dentures are recommended to ensure that important oral functions are acquired. Some studies have shown that enzyme replacement therapy improves dental mineralization, resulting in the stabilization of periodontal tissues and better growth of tooth roots. A nationwide Japanese survey revealed the common genetic and dental manifestations of patients with mild hypophosphatasia, which markedly differ from those of the severe forms. There may be many undiagnosed mild patients, so dentists should contribute to the early diagnosis by screening possible cases based on the typical finding of early exfoliation of primary teeth. Early diagnosis is important for patients to receive early intervention in both medical and dental fields. The establishment of fundamental dental therapy to solve the dental problems is still underway and is eagerly anticipated.
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Held CM, Guebelin A, Krebs A, Sass JO, Wurm M, Lausch E, van der Werf-Grohmann N, Schwab KO. Screening for hypophosphatasia: does biochemistry lead the way? J Pediatr Endocrinol Metab 2022; 35:169-178. [PMID: 34551461 DOI: 10.1515/jpem-2021-0104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/16/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Patients with childhood hypophosphatasia (HPP) often have unspecific symptoms. It was our aim to identify patients with mild forms of HPP by laboratory data screening for decreased alkaline phosphatase (AP) within a pediatric population. METHODS We conducted a retrospective hospital-based data screening for AP activity below the following limits: Girls: ≤12 years: <125 U/L; >12 years: <50 U/L Boys: ≤14 years: <125 U/L; >14 years: <70 U/L. Screening positive patients with otherwise unexplained hypophosphatasemia were invited for further diagnostics: Re-test of AP activity, pyridoxal 5'-phosphate (PLP) in hemolyzed whole blood, phosphoethanolamine (PEA) in serum and urine, and inorganic pyrophosphate in urine. Sequencing of the ALPL gene was performed in patients with clinical and/or laboratory abnormalities suspicious for HPP. RESULTS We assessed a total of 14,913 samples of 6,731 patients and identified 393 screening-positive patients. The majority of patients were excluded due to known underlying diseases causing AP depression. Of the 30 patients who participated in the study, three had a decrease in AP activity in combination with an increase in PLP and PEA. A heterozygous ALPL mutation was detected in each of them: One patient with a short stature was diagnosed with childhood-HPP and started with enzyme replacement therapy. The remaining two are considered as mutation carriers without osseous manifestation of the disease. CONCLUSIONS A diagnostic algorithm based on decreased AP is able to identify patients with ALPL mutation after exclusion of the differential diagnoses of hypophosphatasemia and with additional evidence of increased AP substrates.
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Affiliation(s)
- Corinna Melanie Held
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Anic Guebelin
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Andreas Krebs
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Jörn Oliver Sass
- Department of Natural Sciences, Institute for Functional Gene Analytics (IFGA), Research Group Inborn Errors of Metabolism, Bonn-Rhein-Sieg University of Applied Science, Rheinbach, Germany
| | - Michael Wurm
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Ekkehart Lausch
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Natascha van der Werf-Grohmann
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Karl Otfried Schwab
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Centre, University of Freiburg, Freiburg, Germany
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Grue BH, Veres SP. Effect of increasing mineralization on pre-osteoblast response to native collagen fibril scaffolds for bone tissue repair and regeneration. J Appl Biomater Funct Mater 2022; 20:22808000221104000. [PMID: 35666125 DOI: 10.1177/22808000221104000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
With limited availability of auto- and allografts, there is increasing demand for alternative bone repair and regeneration materials. Inspired by a mimetic approach, the utility of producing engineered native protein scaffolds is being increasingly realized, demonstrating the need for continued research in this field. In previous work, we detailed a process for producing mineralized collagen scaffolds using tendon to create collagen templates of highly aligned, natively crosslinked collagen fibrils. The process produced mineral phase closely matching that of native bone, and integration of mineral with the collagen template was demonstrated to be easily controlled, allowing scaffolds to be mechanically tuned. In the current study, we have extended this work to investigate how variation in the mineralization level of these scaffolds affects the osteogenic response of pre-osteoblastic cells. Scaffolds were produced under three treatment groups, where collagen templates underwent 0, 5, or 20 mineralization cycles. Scaffolds in each treatment group were cultured with MC3T3-E1 cells for 1, 7, or 14 days. Morphologic assessment under SEM indicated decreased attachment to the mineralized scaffolds, supported by DNA results showing a significant drop between culture days 1 and 7 for mineralized scaffolds only. For adherent cells, increasing scaffold mineralization also delayed cell spreading. While mineralization presented a barrier to cell coverage of scaffolds, it increased osteogenic activity, with cells on the mineralized scaffolds showing significantly greater alkaline phosphatase activity and osteocalcin production. Understanding how increasing collagen mineralization effects pre-osteoblast function may enable design of more advanced mineralized collagen scaffolds for bone repair and regeneration.
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Affiliation(s)
- Brendan H Grue
- Division of Engineering, Saint Mary's University, Halifax, NS, Canada
| | - Samuel P Veres
- Division of Engineering, Saint Mary's University, Halifax, NS, Canada.,School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
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Endocrinology of bone mineralization: an update. ANNALES D'ENDOCRINOLOGIE 2021; 83:46-53. [PMID: 34921812 DOI: 10.1016/j.ando.2021.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 11/20/2022]
Abstract
Throughout the world, millions of people suffer from fragilizing osteopathies such as osteomalacia and osteoporosis.Osteomalacia is a rare disorder, corresponding to mineralization abnormalities in adult bone, as opposed to rickets in children. Renal phosphate loss and hypophosphatasia are the main causes of vitamin-resistant osteomalacia. Diagnosis is based on clinical history, phosphocalcic metabolism assessment and, if necessary, molecular characterization, and must be rapid in order to initiate the most appropriate treatment and consider new treatments such as burosumab if necessary.Osteoporosis is characterized by reduced bone mass and strength, which increases the risk of fragility fracture. Fracture-related burden is expected to increase over the coming decades linked to the aging of population and a treatment gap. In order to reduce this treatment gap, it is important to develop two strategies: improvement of screening and of treatment. Systematic screening using the FRAX® fracture risk assessment tool could be useful to increase anti-osteoporosis medical treatment and reduce fracture rates. The question of treatment sequencing in osteoporosis is another challenge, notably after denosumab cessation, complicated by a decrease in bone mineral density and increased risk of fracture. New treatments are also available, including romosozumab, a humanized monoclonal antibody which promotes bone formation and inhibits bone resorption by inhibiting sclerostin. Romosozumab is approved in several countries, including France, for treating severe osteoporosis in postmenopausal women at high risk of fracture and free of cardiovascular comorbidity.Endocrinologists need to be aware of these fragilizing osteopathies in order to improve both diagnosis and treatment.
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Abstract
Hypophosphatasia (HPP) is an inherited metabolic disease caused by loss-of-function mutations in the tissue non-specific alkaline phosphatase (TNAP) gene. Reduced activity of TNAP leads to the accumulation of its substrates, mainly inorganic pyrophosphate and pyridoxal-5′-phosphate, metabolic aberrations that largely explain the musculoskeletal and systemic features of the disease. More than 400 ALPL mutations, mostly missense, are reported to date, transmitted by either autosomal dominant or recessive mode. Severe disease is rare, with incidence ranging from 1:100,000 to 1:300,000 live births, while the estimated prevalence of the less severe adult form is estimated to be between 1:3100 to 1:508, in different countries in Europe. Presentation largely varies, ranging from death in utero to asymptomatic adults. In infants and children, clinical features include skeletal, respiratory and neurologic complications, while recurrent, poorly healing fractures, muscle weakness and arthropathy are common in adults. Persistently low serum alkaline phosphatase is the cardinal biochemical feature of the disease. Management requires a dedicated multidisciplinary team. In mild cases, treatment is usually symptomatic. Severe cases, with life-threating or debilitating complications, can be successfully treated with enzyme replacement therapy with asfotase alfa.
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Hasegawa A, Nakamura-Takahashi A, Kasahara M, Saso N, Narisawa S, Millán JL, Samura O, Sago H, Okamoto A, Umezawa A. Prenatal enzyme replacement therapy for Akp2 -/- mice with lethal hypophosphatasia. Regen Ther 2021; 18:168-175. [PMID: 34277899 PMCID: PMC8267436 DOI: 10.1016/j.reth.2021.06.002] [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: 04/08/2021] [Revised: 05/28/2021] [Accepted: 06/06/2021] [Indexed: 11/21/2022] Open
Abstract
Hypophosphatasia (HPP) is a congenital skeletal disease. Impairment of bone mineralization and seizures are due to a deficiency of tissue-nonspecific alkaline phosphatase (TNAP). Enzyme replacement therapy (ERT) is available as a highly successful treatment for pediatric-onset HPP. However, the potential for prenatal ERT has not been fully investigated to date. In this study, we assessed outcomes and maternal safety using a combinational approach with prenatal and postnatal administration of recombinant TNAP in Akp2−/− mice as a model of infantile HPP. For the prenatal ERT, we administered subcutaneous injections of recombinant TNAP to pregnant mice from embryonic day 11.5–14.5 until delivery, and then sequentially to Akp2−/− pups from birth to day 18. For the postnatal ERT, we injected Akp2−/− pups from birth until day 18. Prenatal ERT did not cause any ectopic mineralization in heterozygous maternal mice. Both prenatal and postnatal ERT preserved growth, survival rate and improved bone calcification in Akp2−/− mice. However, the effects of additional prenatal treatment to newborn mice appeared to be minimal, and the difference between prenatal and postnatal ERT was subtle. Further improvement of the prenatal ERT schedule and long-term observation will be required. The present paper sets a standard for such future studies.
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Affiliation(s)
- Akihiro Hasegawa
- Center for Regenerative Medicine, National Center for Child Health and Development Research Institute, Tokyo, Japan.,Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | | | | | - Nana Saso
- Center for Regenerative Medicine, National Center for Child Health and Development Research Institute, Tokyo, Japan
| | - Sonoko Narisawa
- Sanford Children's Health Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - José Luis Millán
- Sanford Children's Health Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA
| | - Osamu Samura
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Haruhiko Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Aikou Okamoto
- Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akihiro Umezawa
- Center for Regenerative Medicine, National Center for Child Health and Development Research Institute, Tokyo, Japan
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Fenn JS, Lorde N, Ward JM, Borovickova I. Hypophosphatasia. J Clin Pathol 2021; 74:635-640. [PMID: 33931563 DOI: 10.1136/jclinpath-2021-207426] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/04/2022]
Abstract
Hypophosphatasia (HPP) is a group of inherited disorders characterised by the impaired mineralisation of bones and/or teeth and low serum alkaline phosphatase (ALP) activity. It is caused by a mutation in the ALPL gene encoding the tissue-non-specific isoenzyme of ALP (TNSALP) resulting in a loss of function. The disease is highly heterogenous in its clinical expression ranging from stillbirth without mineralised bone to the mild form of late adult onset with symptoms and signs such as musculoskeletal pain, arthropathy, lower-extremity fractures, premature loss of teeth or an incidental finding of reduced serum ALP activity. A classification based on the age at diagnosis and the presence or absence of bone symptoms was historically used: perinatal, prenatal benign, infantile, childhood, adult and odontohypophosphatasia. These subtypes are known to have overlapping signs and complications. Three forms of HPP distinguishable by their genetic characteristics have been described: severe, moderate and mild. Severe forms of HPP (perinatal and infantile severe) are recessively inherited, whereas moderate HPP may be dominantly or recessively inherited. The biochemical hallmark of HPP is persistently low serum ALP for age and increase in natural substrates of TNSALP, pyridoxal 5'-phosphate and phosphoethanolamine supported by radiological findings. The diagnosis is confirmed by ALPL sequencing. A multidisciplinary team of experts is essential for the effective management. Calcium restriction is recommended in infants/children to manage hypercalcaemia. A targeted enzyme replacement therapy for HPP has become available and correct diagnosis is crucial to allow early treatment.
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Affiliation(s)
- Jonathan Samuel Fenn
- Black Country Pathology Services, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Nathan Lorde
- Department of Clinical Chemistry, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - John Martin Ward
- Department of Radiology, McGill University Health Center, Montreal, Québec, Canada
| | - Ingrid Borovickova
- Department of Biochemical Genetics, Children's Health Ireland at Temple Street, Dublin, Ireland
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Araci MB, Akgun B, Atik T, Isik E, Ak G, Barutcuoglu B, Ozkinay F. Clinical and molecular findings in children and young adults with persistent low alkaline phosphatase concentrations. Ann Clin Biochem 2021; 58:335-341. [PMID: 33601892 DOI: 10.1177/00045632211000102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hypophosphatasia is a rare inherited metabolic disease resulted by ALPL gene mutations. It is characterized by defective bone and teeth mineralization. The phenotypic spectrum is highly variable ranging from lethal perinatal form to mild forms which are only diagnosed in adulthood or remain undiagnosed despite persistently low concentrations of ALP. The aim of this study is to evaluate the clinical phenotype and frequency of ALPL mutations in a group of patient with hypophosphatasaemia. METHODS Thirty individuals with alkaline phosphatase values below 40 IU/L in at least two assessments and having no alternative explanation for their low ALP concentrations were included in the study. The clinical features and radiological data of the study group were re-investigated for hypophosphatasia-related findings. ALPL sequence analysis was performed using Sanger sequencing. RESULTS No patient in the study group had severe symptoms, nor had they initially been diagnosed as having hypophosphatasia. Four different heterozygous ALPL mutations (c.542C>T, c.648 + 1G>A, c.657G>T and c.862 + 1G>C) were found in four patients. One splice site mutation (c.862 + 1G>C) was reported for the first time in this study. CONCLUSION ALPL sequence analysis may help to diagnosing genetic defects in individuals with persistently low ALP concentrations and provide to take preventive measures before symptoms appear. As in the other populations, HPP displays allelic heterogeneity in our population.
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Affiliation(s)
- Mehmet Bilal Araci
- Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Bilcag Akgun
- Subdivision of Pediatric Genetics, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Tahir Atik
- Subdivision of Pediatric Genetics, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Esra Isik
- Subdivision of Pediatric Genetics, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Gunes Ak
- Department of Biochemistry, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Burcu Barutcuoglu
- Department of Biochemistry, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Ferda Ozkinay
- Subdivision of Pediatric Genetics, Department of Pediatrics, Faculty of Medicine, Ege University, Izmir, Turkey
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Estimation of the carrier frequencies and proportions of potential patients by detecting causative gene variants associated with autosomal recessive bone dysplasia using a whole-genome reference panel of Japanese individuals. Hum Genome Var 2021; 8:2. [PMID: 33452237 PMCID: PMC7810679 DOI: 10.1038/s41439-020-00133-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/04/2022] Open
Abstract
Bone dysplasias are a group of rare hereditary diseases, with up to 436 disease types. Perinatal diagnosis is clinically important for adequate personalized management and counseling. There are no reports focused on pathogenic variants of bone dysplasias in the general population. In this study, we focused on autosomal recessive bone dysplasias. We identified pathogenic variants using whole-genome reference panel data from 3552 Japanese individuals. For the first time, we were able to estimate the carrier frequencies and the proportions of potential patients. For autosomal recessive bone dysplasias, we detected 198 pathogenic variants of 54 causative genes. We estimated the variant carrier frequencies and the proportions of potential patients with variants associated with four clinically important bone dysplasias: osteogenesis imperfecta (OI), hypophosphatasia (HPP), asphyxiating thoracic dysplasia (ATD), and Ellis–van Creveld syndrome (EvC). The proportions of potential patients with OI, ATD, and EvC based on pathogenic variants classified as “pathogenic” and “likely pathogenic” by InterVar were closer to the reported incidence rates in Japanese subjects. Furthermore, the proportions of potential patients with HPP variants classified as “pathogenic” and “likely pathogenic” in InterVar and “pathogenic” in ClinVar were closer to the reported incidence rates. For bone dysplasia, the findings of this study will provide a better understanding of the variant types and frequencies in the Japanese general population, and should be useful for clinical diagnosis, genetic counseling, and personalized medicine. A bioinformatics approach helps estimate carrier frequency of a rare inherited bone disease which causes abnormalities in skeletal shape and structure. Autosomal recessive bone dysplasias affect bone and cartilage development and result from inheriting two mutated genes, one from each parent. Junichi Sugawara, Tohoku University, Sendai, Japan, and colleagues used mutation databases and a bioinformatics tool for variant interpretation to detect 198 pathogenic variants in 54 genes associated with autosomal recessive bone dysplasia in a whole-genome reference panel of 3,552 general Japanese individuals (3.5KJPNv2). They then estimated the frequency of people in the sample carrying bone dysplasia mutations and the expected proportion in whom the disorder could manifest, which compared well with reported incidence rates in the general population. These findings could prove useful for calculating the risk of bone dysplasia in the future children of carrier parents.
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Huang H, Wang J, Liang Y, Wei X, Guo D, Sun H, Zhang X, Xu X, Xiong F. A compound heterozygous mutation of the alkaline phosphatase ALPL gene causes hypophosphatasia in a Han Chinese family. Exp Ther Med 2020; 20:152. [PMID: 33093890 PMCID: PMC7571384 DOI: 10.3892/etm.2020.9281] [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: 06/26/2019] [Accepted: 04/07/2020] [Indexed: 11/06/2022] Open
Abstract
Hypophosphatasia (HPP) is a rare hereditary systemic disease that is characterized by defective bone and/or dental mineralization, and is caused by mutations in the alkaline phosphatase gene (ALPL). The present study investigated the ALPL mutation in a Chinese Han family with HPP and studied the pathogenesis of the mutations of the ALPL gene. DNA was extracted from peripheral venous blood of the family members. Sanger sequencing was used to screen the mutations. Associations between pathogenesis for both mutations were analyzed by bioinformatics, subcellular localization, measurement of enzyme activity and western blotting. Sanger sequencing revealed the compound heterozygous mutations c.203C>T (p.T68M) and c.571G>A (p.E191K). The mutations were located at exon 4 and 6 of the ALPL gene and were predicted by Polyphen-2 analysis to be harmful. Protein analysis indicated a decrease in mature protein production and lower enzyme activity in 293T cells transfected with plasmids carrying the mutations. The ALPL gene was cloned into the pcDNA3.1(+) vector and mutant plasmids ALPL-pT68M and ALPL-pE191K were constructed. Immunofluorescence observed in cells transfected with the ALPL-pE191K mutant plasmid was mainly located in the cell membrane. However, staining in the cytoplasm was increased compared with the wild type, and almost no fluorescence was identified in 293T cells transfected with the ALPL-pT68M mutant plasmid. The present findings demonstrated that the compound heterozygous c.571G>A and c.203C>T mutations may contribute to childhood HPP by resulting in mislocalization, decreased protein expression and loss of enzyme activity in a Han Chinese family. The results of the current study may provide insights into the potential molecular mechanism of HPP.
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Affiliation(s)
- Huajie Huang
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China.,Medical Genetic Centre, Guangdong Women and Children Hospital, Guangzhou, Guangdong 511400, P.R. China
| | - Jian Wang
- Department of Orthopedic Surgery, Southern Medical University, Nanfang Hospital, Guangzhou, Guangdong 510515, P.R. China
| | - Yingyin Liang
- Department of Neurology, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, P.R. China
| | - Xiaofeng Wei
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Dan Guo
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Hengbiao Sun
- Department of Clinical Laboratory, The Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong 510630, P.R. China
| | - Xuelian Zhang
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Xiangmin Xu
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China.,Guangdong Provincial Key Laboratory of Single Cell Technology and Application, Guangzhou, Guangdong 510515, P.R. China
| | - Fu Xiong
- Department of Medical Genetics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China.,Guangdong Provincial Key Laboratory of Single Cell Technology and Application, Guangzhou, Guangdong 510515, P.R. China
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15
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Bianchi ML, Bishop NJ, Guañabens N, Hofmann C, Jakob F, Roux C, Zillikens MC. Hypophosphatasia in adolescents and adults: overview of diagnosis and treatment. Osteoporos Int 2020; 31:1445-1460. [PMID: 32162014 DOI: 10.1007/s00198-020-05345-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 02/11/2020] [Indexed: 12/11/2022]
Abstract
This article provides an overview of the current knowledge on hypophosphatasia-a rare genetic disease of very variable presentation and severity-with a special focus on adolescents and adults. It summarizes the available information on the many known mutations of tissue-nonspecific alkaline phosphatase (TNSALP), the epidemiology and clinical presentation of the disease in adolescents and adults, and the essential diagnostic clues. The last section reviews the therapeutic approaches, including recent reports on enzyme replacement therapy (EnzRT).
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Affiliation(s)
- M L Bianchi
- Laboratorio sperimentale di ricerche sul metabolismo osseo infantile, Centro Malattie Metaboliche Ossee, Istituto Auxologico Italiano IRCCS, Milan, Italy.
| | - N J Bishop
- Department of Oncology and Metabolism, University of Sheffield, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - N Guañabens
- Servicio de Reumatología, Hospital Clínic, Universidad de Barcelona, IDIBAPS CIBERehd, Barcelona, Spain
| | - C Hofmann
- Children's Hospital, University of Würzburg, Würzburg, Germany
| | - F Jakob
- Orthopedic Centre for Musculoskeletal Research, University of Würzburg, Würzburg, Germany
| | - C Roux
- INSERM U1153 APHP Centre, Université de Paris, Department of Rheumatology, Paris, France
| | - M C Zillikens
- Department of Internal Medicine, Endocrinology Section, Erasmus Medical Centre, Rotterdam, The Netherlands
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16
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Nakamura-Takahashi A, Tanase T, Matsunaga S, Shintani S, Abe S, Nitahara-Kasahara Y, Watanabe A, Hirai Y, Okada T, Yamaguchi A, Kasahara M. High-Level Expression of Alkaline Phosphatase by Adeno-Associated Virus Vector Ameliorates Pathological Bone Structure in a Hypophosphatasia Mouse Model. Calcif Tissue Int 2020; 106:665-677. [PMID: 32076747 DOI: 10.1007/s00223-020-00676-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/09/2020] [Indexed: 01/01/2023]
Abstract
Hypophosphatasia (HPP) is a systemic skeletal disease caused by mutations in the gene encoding tissue-nonspecific alkaline phosphatase (TNALP). We recently reported that survival of HPP model mice can be prolonged using an adeno-associated virus (AAV) vector expressing bone-targeted TNALP with deca-aspartate at the C terminus (TNALP-D10); however, abnormal bone structure and hypomineralization remained in the treated mice. Here, to develop a more effective and clinically applicable approach, we assessed whether transfection with TNALP-D10 expressing virus vector at a higher dose than previously used would ameliorate bone structure defects. We constructed a self-complementary AAV8 vector expressing TNALP driven by the chicken beta-actin (CBA) promoter (scAAV8-CB-TNALP-D10). The vector was injected into both quadriceps femoris muscles of newborn HPP mice at a dose of 4.5 × 1012 vector genome (v.g.)/body, resulting in 20 U/mL of serum ALP activity. The 4.5 × 1012 v.g./body-treated HPP mice grew normally and displayed improved bone structure at the knee joints in X-ray images. Micro-CT analysis showed normal trabecular bone structure and mineralization. The mechanical properties of the femur were also recovered. Histological analysis of the femurs demonstrated that ALP replacement levels were sufficient to promote normal, growth plate cartilage arrangement. These results suggest that AAV vector-mediated high-dose TNALP-D10 therapy is a promising option for improving the quality of life (QOL) of patients with the infantile form of HPP.
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Affiliation(s)
- Aki Nakamura-Takahashi
- Department of Pharmacology, Tokyo Dental College, 2-9-18, Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.
- Tokyo Dental College Research Branding Project, Tokyo Dental College, Tokyo, Japan.
| | - Toshiki Tanase
- Department of Pediatric Dentistry, Tokyo Dental College, Tokyo, Japan
| | - Satoru Matsunaga
- Tokyo Dental College Research Branding Project, Tokyo Dental College, Tokyo, Japan
- Department of Anatomy, Tokyo Dental College, Tokyo, Japan
| | - Seikou Shintani
- Tokyo Dental College Research Branding Project, Tokyo Dental College, Tokyo, Japan
- Department of Pediatric Dentistry, Tokyo Dental College, Tokyo, Japan
| | - Shinichi Abe
- Tokyo Dental College Research Branding Project, Tokyo Dental College, Tokyo, Japan
- Department of Anatomy, Tokyo Dental College, Tokyo, Japan
| | - Yuko Nitahara-Kasahara
- Department of Molecular Therapy, National Center of Neurology and Psychiatry, National Institute of Neuroscience, Tokyo, Japan
| | - Atsushi Watanabe
- Division of Clinical Genetics, Kanazawa University Hospital, Ishikawa, Japan
| | - Yukihiko Hirai
- Division of Molecular and Medical Genetics, The Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Takashi Okada
- Division of Molecular and Medical Genetics, The Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Akira Yamaguchi
- Tokyo Dental College Research Branding Project, Tokyo Dental College, Tokyo, Japan
- Oral Health Science Center, Tokyo Dental College, Tokyo, Japan
| | - Masataka Kasahara
- Department of Pharmacology, Tokyo Dental College, 2-9-18, Kandamisaki-cho, Chiyoda-ku, Tokyo, 101-0061, Japan.
- Tokyo Dental College Research Branding Project, Tokyo Dental College, Tokyo, Japan.
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17
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Michigami T, Ohata Y, Fujiwara M, Mochizuki H, Adachi M, Kitaoka T, Kubota T, Sawai H, Namba N, Hasegawa K, Fujiwara I, Ozono K. Clinical Practice Guidelines for Hypophosphatasia. Clin Pediatr Endocrinol 2020; 29:9-24. [PMID: 32029969 PMCID: PMC6958520 DOI: 10.1297/cpe.29.9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 08/16/2019] [Indexed: 12/17/2022] Open
Abstract
Hypophosphatasia (HPP) is a rare bone disease caused by inactivating mutations in the
ALPL gene, which encodes tissue-nonspecific alkaline phosphatase
(TNSALP). Patients with HPP have varied clinical manifestations and are classified based
on the age of onset and severity. Recently, enzyme replacement therapy using bone-targeted
recombinant alkaline phosphatase (ALP) has been developed, leading to improvement in the
prognosis of patients with life-threatening HPP. Considering these recent advances,
clinical practice guidelines have been generated to provide physicians with guides for
standard medical care for HPP and to support their clinical decisions. A task force was
convened for this purpose, and twenty-one clinical questions (CQs) were formulated,
addressing the issues of clinical manifestations and diagnosis (7 CQs) and those of
management and treatment (14 CQs). A systematic literature search was conducted using
PubMed/MEDLINE, and evidence-based recommendations were developed. The guidelines have
been modified according to the evaluations and suggestions from the Clinical Guideline
Committee of The Japanese Society for Pediatric Endocrinology (JSPE) and public comments
obtained from the members of the JSPE and a Japanese HPP patient group, and then approved
by the Board of Councils of the JSPE. We anticipate that the guidelines will be revised
regularly and updated.
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Affiliation(s)
- Toshimi Michigami
- Department of Bone and Mineral Research, Research Institute, Osaka Women's and Children's Hospital, Osaka Prefectural Hospital Organization, Osaka, Japan.,Task Force for Hypophosphatasia Guidelines
| | - Yasuhisa Ohata
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.,Task Force for Hypophosphatasia Guidelines
| | - Makoto Fujiwara
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.,Task Force for Hypophosphatasia Guidelines
| | - Hiroshi Mochizuki
- Division of Endocrinology and Metabolism, Saitama Children's Medical Center, Saitama, Japan.,Task Force for Hypophosphatasia Guidelines
| | - Masanori Adachi
- Department of Endocrinology and Metabolism, Kanagawa Children's Medical Center, Kanagawa, Japan.,Task Force for Hypophosphatasia Guidelines
| | - Taichi Kitaoka
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.,Task Force for Hypophosphatasia Guidelines
| | - Takuo Kubota
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.,Task Force for Hypophosphatasia Guidelines
| | - Hideaki Sawai
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Hyogo, Japan.,Task Force for Hypophosphatasia Guidelines
| | - Noriyuki Namba
- Division of Pediatrics and Perinatology, Tottori University Faculty of Medicine, Tottori, Japan.,Task Force for Hypophosphatasia Guidelines
| | - Kosei Hasegawa
- Department of Pediatrics, Okayama University Hospital, Okayama, Japan.,Task Force for Hypophosphatasia Guidelines
| | - Ikuma Fujiwara
- Department of Pediatrics, Sendai City Hospital, Miyagi, Japan.,Task Force for Hypophosphatasia Guidelines
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.,Task Force for Hypophosphatasia Guidelines
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18
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Fujisawa Y, Kitaoka T, Ono H, Nakashima S, Ozono K, Ogata T. Case Report: Efficacy of Reduced Doses of Asfotase Alfa Replacement Therapy in an Infant With Hypophosphatasia Who Lacked Severe Clinical Symptoms. Front Endocrinol (Lausanne) 2020; 11:590455. [PMID: 33391183 PMCID: PMC7775725 DOI: 10.3389/fendo.2020.590455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 11/12/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hypophosphatasia is a rare bone disease characterized by impaired bone mineralization and low alkaline phosphatase activity. Here, we describe the course of bone-targeted enzyme replacement therapy with asfotase alpha for a female infant patient with hypophosphatasia who lacked apparent severe clinical symptoms. CASE PRESENTATION The patient exhibited low serum alkaline phosphatase (60 U/L; age-matched reference range, 520-1,580) in a routine laboratory test at birth. Further examinations revealed skeletal demineralization and rachitic changes, as well as elevated levels of serum calcium (2.80 mmol/L; reference range, 2.25-2.75 mmol/L) and ionic phosphate (3.17 mmol/L; reference range, 1.62-2.48 mmol/L), which are typical features in patients with hypophosphatasia. Sequencing analysis of the tissue-nonspecific alkaline phosphatase (TNSALP) gene identified two pathogenic mutations: c.406C>T, p.Arg136Cys and c.979T>C, p.Phe327Leu. Thus, the patient was diagnosed with hypophosphatasia. At the age of 37 days, she began enzyme replacement therapy using asfotase alpha at the standard dose of 6 mg/kg/week. Initial therapy from the age of 37 days to the age of 58 days substantially improved rickets signs in the patient; it also provided immediate normalization of serum calcium and ionic phosphate levels. However, serum ionic phosphate returned to a high level (2.72 mmol/L), which was presumed to be a side effect of asfotase alpha. Thus, the patient's asfotase alfa treatment was reduced to 2 mg/kg/week, which allowed her to maintain normal or near normal skeletal features thereafter, along with lowered serum ionic phosphate levels. Because the patient exhibited slight distal metaphyseal demineralization in the knee at the age of 2 years and 6 months, her asfotase alfa treatment was increased to 2.4 mg/kg/week. No signs of deterioration in bone mineralization were observed thereafter. At the age of 3 years, the patient's motor and psychological development both appeared normal, compared with children of similar age. CONCLUSION This is the first report in which reduced doses of asfotase alfa were administered to an infant patient with hypophosphatasia who lacked apparent severe clinical symptoms. The results demonstrate the potential feasibility of a tailored therapeutic option based on clinical severity in patients with hypophosphatasia.
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Affiliation(s)
- Yasuko Fujisawa
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan
- *Correspondence: Yasuko Fujisawa,
| | - Taichi Kitaoka
- Department of Pediatrics, Faculty of Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hiroyuki Ono
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shinichi Nakashima
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Faculty of Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tsutomu Ogata
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan
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19
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Ishiguro T, Sugiyama Y, Ueda K, Muramatsu Y, Tsuda H, Kotani T, Michigami T, Tachikawa K, Akiyama T, Hayakawa M. Findings of amplitude-integrated electroencephalogram recordings and serum vitamin B6 metabolites in perinatal lethal hypophosphatasia during enzyme replacement therapy. Brain Dev 2019; 41:721-725. [PMID: 31000369 DOI: 10.1016/j.braindev.2019.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/17/2019] [Accepted: 03/29/2019] [Indexed: 11/24/2022]
Abstract
Hypophosphatasia (HPP) is a rare disorder caused by low serum tissue non-specific alkaline phosphatase (ALP) activity due to hypomorphic mutations in the ALPL gene. HPP is characterized by defective bone mineralization. It frequently accompanies pyridoxine-responsive seizures. Because alkaline phosphatase change pyridoxal 5' phosphate (PLP) into pyridoxal (PL), which can cross the blood brain barrier and regulates inhibitory neurotransmitter gamma-aminobutyric acid. The female patient was born at a gestational age of 37 weeks 2 days. She presented severe respiratory disorder due to extreme thoracic hypoplasia. With the extremely low serum ALP value (14 IU/L), she was clinically diagnosed as HPP. The diagnosis was confirmed with genetic testing. On day1, the subclinical seizures were detected by aEEG. Together with enzyme replacement therapy by asfotase alfa, pyridoxine hydrochloride was administered, then the seizures were rapidly controlled. While confirming that there was no seizure by aEEG monitoring, pyridoxine hydrochloride was gradually discontinued after 1 month. Before administration of pyridoxine hydrochloride, PL was extremely low (4.7 nM) and PLP was increased (1083 nM). After the withdrawal, PL was increased to 84.9 nM only by enzyme replacement. Monitoring with aEEG enabled early intervention for pyridoxine responsive seizures. Confirming increased serum PL concentration is a prudent step in determining when to reduce or discontinue pyridoxine hydrochloride during enzyme replacement therapy.
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Affiliation(s)
- Tomonori Ishiguro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuichiro Sugiyama
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan.
| | - Kazuto Ueda
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
| | - Yukako Muramatsu
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Tsuda
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshimi Michigami
- Department of Bone and Mineral Research, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Kanako Tachikawa
- Department of Bone and Mineral Research, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Tomoyuki Akiyama
- Department of Child Neurology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masahiro Hayakawa
- Division of Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, Japan
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20
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Fukushima K, Kawai-Kowase K, Yonemoto Y, Fujiwara M, Sato H, Sato M, Kubota T, Ozono K, Tamura J. Adult hypophosphatasia with compound heterozygous p.Phe327Leu missense and c.1559delT frameshift mutations in tissue-nonspecific alkaline phosphatase gene: a case report. J Med Case Rep 2019; 13:101. [PMID: 31014398 PMCID: PMC6480864 DOI: 10.1186/s13256-019-2045-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/08/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Hypophosphatasia is an inherited bone disease characterized by low alkaline phosphatase activity encoded by ALPL. Clinically, hypophosphatasia can be categorized as perinatal, infantile, childhood, and adult forms, as well as odonto-hypophosphatasia, according to the age at first sign or dental manifestations. Adult hypophosphatasia typically presents in middle-aged patients who appear to be in good health in early adulthood and manifests as painful feet caused by recurrent, slow-healing stress fractures of the lower limb. Because the symptoms of adult hypophosphatasia vary and are common, many patients with hypophosphatasia might be not diagnosed accurately and thus may receive inappropriate treatment. CASE PRESENTATION We report a case of a 35-year-old Japanese woman with low serum alkaline phosphatase detected at a routine medical checkup. She had mild muscle/bone pain but no history of rickets, fractures, or dental problems. Measurement of bone mineral density of the lumbar spine and the femoral neck revealed osteopenia below the expected range for age in a young adult. Abdominal ultrasonography revealed numerous microcalcifications in both kidneys. Analysis of amino acids in urine revealed that phosphoethanolamine was elevated. Low serum alkaline phosphatase activity, elevation of phosphoethanolamine, and low bone mineral density supported the diagnosis of hypophosphatasia. ALPL mutation analysis revealed two mutations: p.Phe327Leu and c.1559delT. These genetic abnormalities were previously reported in perinatal, infantile, and childhood but not adult hypophosphatasia. On the basis of the clinical presentation, laboratory and imaging findings, and genetic analyses, the patient was definitively diagnosed with adult hypophosphatasia. To the best of our knowledge, this is the first case report of adult hypophosphatasia with the compound heterozygous mutations p.Phe327Leu and c.1559delT. CONCLUSIONS Although the risk of bone fracture was high in this case, treatment approaches differ between osteoporosis and hypophosphatasia. Because adult hypophosphatasia diagnosis is often difficult because of their varied symptoms, hypophosphatasia should be considered in the differential diagnosis of low serum alkaline phosphatase. Early diagnosis is important so that appropriate treatment can be initiated.
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Affiliation(s)
- Kazunori Fukushima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Keiko Kawai-Kowase
- Department of General Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan.
| | - Yukio Yonemoto
- Department of Orthopedic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Makoto Fujiwara
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroko Sato
- Department of General Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Mahito Sato
- Department of General Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Takuo Kubota
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Junich Tamura
- Department of General Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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21
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Luo E, Liu H, Zhao Q, Shi B, Chen Q. Dental-craniofacial manifestation and treatment of rare diseases. Int J Oral Sci 2019; 11:9. [PMID: 30783081 PMCID: PMC6381182 DOI: 10.1038/s41368-018-0041-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/22/2018] [Accepted: 10/28/2018] [Indexed: 02/05/2023] Open
Abstract
Rare diseases are usually genetic, chronic and incurable disorders with a relatively low incidence. Developments in the diagnosis and management of rare diseases have been relatively slow due to a lack of sufficient profit motivation and market to attract research by companies. However, due to the attention of government and society as well as economic development, rare diseases have been gradually become an increasing concern. As several dental-craniofacial manifestations are associated with rare diseases, we summarize them in this study to help dentists and oral maxillofacial surgeons provide an early diagnosis and subsequent management for patients with these rare diseases.
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Affiliation(s)
- En Luo
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hanghang Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Qiucheng Zhao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | - Qianming Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
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22
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Liu W, Zhang L, Xuan K, Hu C, Li L, Zhang Y, Jin F, Jin Y. Alkaline Phosphatase Controls Lineage Switching of Mesenchymal Stem Cells by Regulating the LRP6/GSK3β Complex in Hypophosphatasia. Am J Cancer Res 2018; 8:5575-5592. [PMID: 30555565 PMCID: PMC6276305 DOI: 10.7150/thno.27372] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 09/18/2018] [Indexed: 01/17/2023] Open
Abstract
Lineage differentiation of bone marrow mesenchymal stem cells (BMMSCs) is the key to bone-fat reciprocity in bone marrow. To date, the regulators of BMMSC lineage switching have all been identified to be transcription factors, and researchers have not determined whether other genes control this process. This study aims to reveal a previously unknown role of tissue-nonspecific alkaline phosphatase (TNSALP) in controlling BMMSC lineage selection. Methods: We compared the characteristics of cultured BMMSCs from patients with hypophosphatasia (HPP), which is caused by mutations in the liver/bone/kidney alkaline phosphatase (ALPL) gene, and an ALPL knockout (ko) mouse model. We performed ALPL downregulation and overexpression experiments to investigate the regulatory role of ALPL in BMMSC lineage switching. Using the PathScan array, coimmunoprecipitation experiments and pathway-guided small molecule treatments, we explored the possible mechanism underlying the regulatory effects of ALPL on cell differentiation and evaluated its therapeutic effect on ALPL ko mice. Results: BMMSCs from both patients with HPP and ALPL ko mice exhibited defective lineage differentiation, including a decrease in osteogenic differentiation and a parallel increase in adipogenic differentiation. Mechanistically, TNSALP directly interacted with LRP6 and regulated the phosphorylation of GSK3β, subsequently resulting in lineage switching of BMMSCs. Re-phosphorylation of GSK3β induced by LiCl treatment restored differentiation of BMMSCs and attenuated skeletal deformities in Alpl+/- mice. Conclusion: Based on our findings, TNSALP acts as a signal regulator to control lineage switching of BMMSCs by regulating the LRP6/GSK3β cascade.
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23
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Taillandier A, Domingues C, Dufour A, Debiais F, Guggenbuhl P, Roux C, Cormier C, Cortet B, Porquet-Bordes V, Coury F, Geneviève D, Chiesa J, Colin T, Fletcher E, Guichet A, Javier RM, Laroche M, Laurent M, Lausch E, LeHeup B, Lukas C, Schwabe G, van der Burgt I, Muti C, Simon-Bouy B, Mornet E. Genetic analysis of adults heterozygous for ALPL mutations. J Bone Miner Metab 2018; 36:723-733. [PMID: 29236161 DOI: 10.1007/s00774-017-0888-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 11/11/2017] [Indexed: 12/11/2022]
Abstract
Hypophosphatasia (HPP) is a rare inherited metabolic bone disease due to a deficiency of the tissue nonspecific alkaline phosphatase isoenzyme (TNSALP) encoded by the ALPL gene. Patients have consistently low serum alkaline phosphatase (AP), so that this parameter is a good hallmark of the disease. Adult HPP is heterogeneous, and some patients present only mild nonpathognomonic symptoms which are also common in the general population such as joint pain, osteomalacia and osteopenia, chondrocalcinosis, arthropathy and musculoskeletal pain. Adult HPP may be recessively or dominantly inherited; the latter case is assumed to be due to the dominant negative effect (DNE) of missense mutations derived from the functional homodimeric structure of TNSALP. However, there is no biological argument excluding the possibility of other causes of dominant HPP. Rheumatologists and endocrinologists are increasingly solicited for patients with low AP and nonpathognomonic symptoms of HPP. Many of these patients are heterozygous for an ALPL mutation and a challenging question is to determine if these symptoms, which are also common in the general population, are attributable to their heterozygous ALPL mutation or not. In an attempt to address this question, we reviewed a cohort of 61 adult patients heterozygous for an ALPL mutation. Mutations were distinguished according to their statistical likelihood to show a DNE. One-half of the patients carried mutations predicted with no DNE and were slightly less severely affected by the age of onset, serum AP activity and history of fractures. We hypothesized that these mutations result in another mechanism of dominance or are recessive alleles. To identify other genetic factors that could trigger the disease phenotype in heterozygotes for potential recessive mutations, we examined the next-generation sequencing results of 32 of these patients for a panel of 12 genes involved in the differential diagnosis of HPP or candidate modifier genes of HPP. The heterozygous genotype G/C of the COL1A2 coding SNP rs42524 c.1645C > G (p.Pro549Ala) was associated with the severity of the phenotype in patients carrying mutations with a DNE whereas the homozygous genotype G/G was over-represented in patients carrying mutations without a DNE, suggesting a possible role of this variant in the disease phenotype. These preliminary results support COL1A2 as a modifier gene of HPP and suggest that a significant proportion of adult heterozygotes for ALPL mutations may have unspecific symptoms not attributable to their heterozygosity.
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Affiliation(s)
- Agnès Taillandier
- Unité de Génétique Constitutionnelle, Service de Biologie, Centre Hospitalier de Versailles, 177 rue de Versailles, 78150, Le Chesnay, France
| | - Christelle Domingues
- Unité de Génétique Constitutionnelle, Service de Biologie, Centre Hospitalier de Versailles, 177 rue de Versailles, 78150, Le Chesnay, France
| | - Annika Dufour
- Unité de Génétique Constitutionnelle, Service de Biologie, Centre Hospitalier de Versailles, 177 rue de Versailles, 78150, Le Chesnay, France
| | - Françoise Debiais
- Service de Rhumatologie, CHU de Poitiers, 86021, Poitiers cedex, France
| | - Pascal Guggenbuhl
- Service de Rhumatologie, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, BP90347, 35203, Rennes cedex 2, France
| | | | | | | | - Valérie Porquet-Bordes
- Endocrinologie, Maladies Osseuses, Génétique et Gynécologie Médicale, Hôpital des Enfants, CHU de Toulouse, Toulouse Cedex 9, France
| | - Fabienne Coury
- Service de Rhumatologie, CHU Lyon, Centre Hospitalier Lyon-Sud, Pierre Bénite, France
| | - David Geneviève
- Service de Génétique Clinique, Département de Génétique Médicale, maladies rares et médecine personnalisée, CHU Montpellier, université Montpellier, unité Inserm U1183, Montpellier, France
| | - Jean Chiesa
- Department of Genetics, University Hospital, Nîmes, France
| | - Thierry Colin
- Service de Rhumatologie, CH Public du Cotentin, Cherbourg, France
| | - Elaine Fletcher
- Clinical Genetics, Molecular Medicine Center, Western General Hospital, Edinburgh, UK
| | - Agnès Guichet
- Département Biochimie et génétique, CHU d'Angers, Angers, France
| | | | - Michel Laroche
- Service de Rhumatologie, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Michael Laurent
- Center for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Ekkehart Lausch
- Universitätsklinikum Freiburg, Zentrum für Kinder- und Jugendmedizin, Freiburg, Germany
| | - Bruno LeHeup
- Médecine infantile 3, CHU Nancy, Vandoeuvre, France
| | - Cédric Lukas
- Département de Rhumatologie, CHRU Montpellier, Montpellier, France
| | - Georg Schwabe
- Otto-Heubner-Centrum für Kinder und Jugendmedizin Allgemeine Päediatrie Charité, Campus Virchow Klinikum Augustenburger Platz 1, Berlin, Germany
| | | | - Christine Muti
- Unité de Génétique Constitutionnelle, Service de Biologie, Centre Hospitalier de Versailles, 177 rue de Versailles, 78150, Le Chesnay, France
| | - Brigitte Simon-Bouy
- Unité de Génétique Constitutionnelle, Service de Biologie, Centre Hospitalier de Versailles, 177 rue de Versailles, 78150, Le Chesnay, France
| | - Etienne Mornet
- Unité de Génétique Constitutionnelle, Service de Biologie, Centre Hospitalier de Versailles, 177 rue de Versailles, 78150, Le Chesnay, France.
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Abstract
Hypophosphatasia (HPP) is a rare inherited disorder primarily affecting bone and dental mineralization. Although there is a continuum in the severity of the disease, clinical forms may be arbitrarily distinguished on the basis of age at onset and the presence or absence of bone symptoms: perinatal, infantile, juvenile, adult, prenatal benign, and odontological. Severe forms (perinatal and infantile) are autosomally recessively inherited while less severe forms may be autosomally recessively or dominantly inherited. Genetic counseling is complicated by the coexistence of the two modes of inheritance, the incomplete penetrance of the dominant forms, the markedly variable expression of the disease, including intra-familial expression, and the existence of a benign prenatal form that may sometimes be difficult to distinguish from the severe prenatal form. The disease is due to loss-of-function mutations in the Alkaline Phosphatase-Liver (ALPL) gene encoding the tissue nonspecific alkaline phosphatase (TNSALP). The great variety of missence mutations and the dominant negative effect of some mutations largely explain the clinical heterogeneity. Directed mutagenesis studies allowed further elucidation of the cellular pathophysiology of HPP, classification of the alleles in terms of their severity and dominant negative effect, and molecular explanations of the dominant inheritance mode. Genetics significantly contributed to show that there are in fact two HPPs, rare, severe and recessive HPP, and mild recessive or mild dominant HPP, which is markedly more frequent and probably under-diagnosed. The prevalence of the severe forms of HPP has been estimated to be 1/300,000 in France and Northern Europe while the prevalence of the moderate forms of HPP may reach 1/6,370.
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Affiliation(s)
- E Mornet
- Service de biologie, unité de génétique constitutionnelle, centre hospitalier de Versailles, Le Chesnay, France.
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Liu W, Zhang L, Xuan K, Hu C, Liu S, Liao L, Li B, Jin F, Shi S, Jin Y. Alpl prevents bone ageing sensitivity by specifically regulating senescence and differentiation in mesenchymal stem cells. Bone Res 2018; 6:27. [PMID: 30210899 PMCID: PMC6131243 DOI: 10.1038/s41413-018-0029-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/16/2018] [Accepted: 07/09/2018] [Indexed: 12/21/2022] Open
Abstract
Mutations in the liver/bone/kidney alkaline phosphatase (Alpl) gene cause hypophosphatasia (HPP) and early-onset bone dysplasia, suggesting that this gene is a key factor in human bone development. However, how and where Alpl acts in bone ageing is largely unknown. Here, we determined that ablation of Alpl induces prototypical premature bone ageing characteristics, including bone mass loss and marrow fat gain coupled with elevated expression of p16INK4A (p16) and p53 due to senescence and impaired differentiation in mesenchymal stem cells (MSCs). Mechanistically, Alpl deficiency in MSCs enhances ATP release and reduces ATP hydrolysis. Then, the excessive extracellular ATP is, in turn, internalized by MSCs and causes an elevation in the intracellular ATP level, which consequently inactivates the AMPKα pathway and contributes to the cell fate switch of MSCs. Reactivating AMPKα by metformin treatment successfully prevents premature bone ageing in Alpl+/- mice by improving the function of endogenous MSCs. These results identify a previously unknown role of Alpl in the regulation of ATP-mediated AMPKα alterations that maintain MSC stemness and prevent bone ageing and show that metformin offers a potential therapeutic option.
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Affiliation(s)
- Wenjia Liu
- MS-State Key Laboratory & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Center for Tissue Engineering, School of Stomatology, Fourth Military Medical University, Xi’an, China
- Xi’an Institute of Tissue Engineering and Regenerative Medicine, Xi’an, China
| | - Liqiang Zhang
- MS-State Key Laboratory & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Center for Tissue Engineering, School of Stomatology, Fourth Military Medical University, Xi’an, China
- Xi’an Institute of Tissue Engineering and Regenerative Medicine, Xi’an, China
| | - Kun Xuan
- MS-State Key Laboratory & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Center for Tissue Engineering, School of Stomatology, Fourth Military Medical University, Xi’an, China
| | - Chenghu Hu
- Xi’an Institute of Tissue Engineering and Regenerative Medicine, Xi’an, China
| | - Shiyu Liu
- MS-State Key Laboratory & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Center for Tissue Engineering, School of Stomatology, Fourth Military Medical University, Xi’an, China
| | - Li Liao
- Xi’an Institute of Tissue Engineering and Regenerative Medicine, Xi’an, China
| | - Bei Li
- MS-State Key Laboratory & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Center for Tissue Engineering, School of Stomatology, Fourth Military Medical University, Xi’an, China
| | - Fang Jin
- MS-State Key Laboratory & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Center for Tissue Engineering, School of Stomatology, Fourth Military Medical University, Xi’an, China
| | - Songtao Shi
- Department of Anatomy and Cell Biology, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Yan Jin
- MS-State Key Laboratory & National Clinical Research Center for Oral Diseases & Shaanxi International Joint Research Center for Oral Diseases, Center for Tissue Engineering, School of Stomatology, Fourth Military Medical University, Xi’an, China
- Xi’an Institute of Tissue Engineering and Regenerative Medicine, Xi’an, China
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Martos-Moreno GÁ, Calzada J, Couce ML, Argente J. Hypophosphatasia: Clinical manifestations, diagnostic recommendations and therapeutic options. An Pediatr (Barc) 2018. [DOI: 10.1016/j.anpede.2017.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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27
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Abstract
We review here clinical, pathophysiological, diagnostic, genetic and molecular aspects of Hypophosphatasia (HPP), a rare inherited metabolic disorder. The clinical presentation is a continuum ranging from a prenatal lethal form with no skeletal mineralization to a mild form with late adult onset presenting with nonpathognomonic symptoms. The prevalence of severe forms is low, whereas less severe forms are more frequently observed. The disease is caused by loss-of-function mutations in the ALPL gene encoding the Tissue Nonspecific Alkaline Phosphatase (TNSALP), a central regulator of mineralization. Severe forms are recessively inherited, whereas moderate forms are either recessively or dominantly inherited, and the more severe the disease is, the more often it is subject to recessive inheritance. The diagnosis is based on a constantly low alkaline phosphatase (AP) activity in serum and genetic testing that identifies ALPL mutations. More than 340 mutations have been identified and are responsible for the extraordinary clinical heterogeneity. A clear but imperfect genotype-phenotype correlation has been observed, suggesting that other genetic or environmental factors modulate the phenotype. Enzyme replacement therapy is now available for HPP, and other approaches, such as gene therapy, are currently being investigated.
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Affiliation(s)
- Etienne Mornet
- Unité de Génétique Constitutionnelle, Service de Biologie, Centre Hospitalier de Versailles, 177 rue de Versailles, 78150 Le Chesnay, France.
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28
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Sodi R, Hall D. A Man with Recurrent Fractures and Foot Pain. Clin Chem 2018; 64:639-644. [PMID: 29592905 DOI: 10.1373/clinchem.2017.275628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/11/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Ravinder Sodi
- Department of Biochemistry, Blood Sciences, Royal Lancaster Infirmary & Furness General Hospital, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, UK; .,Lancaster Medical School, University of Lancaster, Lancaster, UK
| | - David Hall
- Medwyn Medical Practice, Carnwath, Lanarkshire, UK
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29
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Impaired Osteogenesis of Disease-Specific Induced Pluripotent Stem Cells Derived from a CFC Syndrome Patient. Int J Mol Sci 2017; 18:ijms18122591. [PMID: 29194391 PMCID: PMC5751194 DOI: 10.3390/ijms18122591] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 12/21/2022] Open
Abstract
Cardiofaciocutaneous (CFC) syndrome is a rare genetic disorder caused by mutations in the extracellular signal-regulated kinase (ERK) signaling. However, little is known about how aberrant ERK signaling is associated with the defective bone development manifested in most CFC syndrome patients. In this study, induced pluripotent stem cells (iPSCs) were generated from dermal fibroblasts of a CFC syndrome patient having rapidly accelerated fibrosarcoma kinase B (BRAF) gain-of-function mutation. CFC-iPSCs were differentiated into mesenchymal stem cells (CFC-MSCs) and further induced to osteoblasts in vitro. The osteogenic defects of CFC-MSCs were revealed by alkaline phosphatase activity assay, mineralization assay, quantitative real-time polymerase chain reaction (qRT-PCR), and western blotting. Osteogenesis of CFC-MSCs was attenuated compared to wild-type (WT)-MSCs. In addition to activated ERK signaling, increased p-SMAD2 and decreased p-SMAD1 were observed in CFC-MSCs during osteogenesis. The defective osteogenesis of CFC-MSCs was rescued by inhibition of ERK signaling and SMAD2 signaling or activation of SMAD1 signaling. Importantly, activation of ERK signaling and SMAD2 signaling or inhibition of SMAD1 signaling recapitulated the impaired osteogenesis in WT-MSCs. Our findings indicate that SMAD2 signaling and SMAD1 signaling as well as ERK signaling are responsible for defective early bone development in CFC syndrome, providing a novel insight on the pathological mechanism and therapeutic targets.
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30
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Conti F, Ciullini L, Pugliese G. Hypophosphatasia: clinical manifestation and burden of disease in adult patients. ACTA ACUST UNITED AC 2017; 14:230-234. [PMID: 29263739 DOI: 10.11138/ccmbm/2017.14.1.230] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hypophosphatasia (HPP) is a rare inherited disease with a heterogeneous clinical expression. The adult form of HPP is often difficult to be recognized with a delayed diagnosis and inappropriate treatments. Though severity of HPP decreases with age at onset, important complications could occur at any age and the burden of HPP among adult patients is found to be significant. Adult patients with HPP suffer of chronic pain, recurrent fractures and other orthopedics problems, with severe disability that have a serious negative impact on all aspects of their life. The aim of this paper is to summarize the main aspects of HPP in adult patients reviewing the literature and focusing on its burden for patients suffering from this condition.
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Affiliation(s)
- Francesco Conti
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, "S. Andrea" Hospital, Diabetes Units, Rome, Italy
| | - Lorenzo Ciullini
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, "S. Andrea" Hospital, Diabetes Units, Rome, Italy
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, "Sapienza" University of Rome, "S. Andrea" Hospital, Diabetes Units, Rome, Italy
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Kishnani PS, Rush ET, Arundel P, Bishop N, Dahir K, Fraser W, Harmatz P, Linglart A, Munns CF, Nunes ME, Saal HM, Seefried L, Ozono K. Monitoring guidance for patients with hypophosphatasia treated with asfotase alfa. Mol Genet Metab 2017; 122:4-17. [PMID: 28888853 DOI: 10.1016/j.ymgme.2017.07.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 11/15/2022]
Abstract
Hypophosphatasia (HPP) is a rare, inherited, systemic, metabolic disorder caused by autosomal recessive mutations or a single dominant-negative mutation in the gene encoding tissue-nonspecific alkaline phosphatase (TNSALP). The disease is associated with a broad range of signs, symptoms, and complications, including impaired skeletal mineralization, altered calcium and phosphate metabolism, recurrent fractures, pain, respiratory problems, impaired growth and mobility, premature tooth loss, developmental delay, and seizures. Asfotase alfa is a human, recombinant enzyme replacement therapy that is approved in many countries for the treatment of patients with HPP. To address the unmet need for guidance in the monitoring of patients receiving asfotase alfa, an international panel of physicians with experience in diagnosing and managing HPP convened in May 2016 to discuss treatment monitoring parameters. The panel discussions focused on recommendations for assessing and monitoring patients after the decision to treat with asfotase alfa had been made and did not include recommendations for whom to treat. Based on the consensus of panel members, this review provides guidance on the monitoring of patients with HPP during treatment with asfotase alfa, including recommendations for laboratory, efficacy, and safety assessments and the frequency with which these should be performed during the course of treatment. Recommended assessments are based on patient age and include regular monitoring of biochemistry, skeletal radiographs, respiratory function, growth, pain, mobility and motor function, and quality of life. Because of the systemic presentation of HPP, a coordinated, multidisciplinary, team-based, patient-focused approach is recommended in the management of patients receiving asfotase alfa. Monitoring of efficacy and safety outcomes must be tailored to the individual patient, depending on medical history, clinical manifestations, availability of resources in the clinical setting, and the clinician's professional judgment.
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Affiliation(s)
- Priya S Kishnani
- Division of Medical Genetics, Duke University Medical Center, Durham, NC 27710, USA.
| | - Eric T Rush
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE 68198, USA(2)
| | - Paul Arundel
- Metabolic Bone Team, Sheffield Children's NHS Foundation Trust, Sheffield S10 2TH, UK
| | - Nick Bishop
- Academic Unit of Child Health, University of Sheffield and Sheffield Children's Hospital, Sheffield S10 2TH, UK
| | - Kathryn Dahir
- Division of Diabetes and Endocrinology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - William Fraser
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich NR4 7UY, UK
| | - Paul Harmatz
- Pediatric Gastroenterology and Nutrition, UCSF Benioff Children's Hospital Oakland, Oakland, CA 94609, USA
| | - Agnès Linglart
- Service d'Endocrinologie Pédiatrique, Hôpital Bicêtre Paris-Sud, APHP, 94270 Le Kremlin Bicêtre, France
| | - Craig F Munns
- Paediatrics & Child Health, The Children's Hospital at Westmead, Westmead, NSW 2145, Australia; Sydney Medical School, University of Sydney, Sydney, NSW 2006, Australia
| | - Mark E Nunes
- Department of Pediatrics, University of California, San Diego, San Diego, CA 92093, USA
| | - Howard M Saal
- Division of Human Genetics, Cincinnati Children's Hospital, Cincinnati, OH 45229, USA
| | - Lothar Seefried
- Orthopedic Department, University of Würzburg, Würzburg, Bavaria 97074, Germany
| | - Keiichi Ozono
- Department of Pediatrics, Osaka University, Suita, Osaka 565-0871, Japan
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Martos-Moreno GA, Calzada J, Couce ML, Argente J. [Hypophosphatasia: Clinical manifestations, diagnostic recommendations and therapeutic options]. An Pediatr (Barc) 2017; 88:356.e1-356.e11. [PMID: 28720214 DOI: 10.1016/j.anpedi.2017.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/06/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022] Open
Abstract
Hypophosphatasia is a very rare bone metabolism disorder caused by a deficiency in alkaline phosphatase activity, due to mutations in the ALPL gene. Its clinical hallmark is the impairment of skeletal and teeth mineralisation, although extra-skeletal manifestations are frequent. Its phenotypic spectrum is widely variable from a subtype with exclusive odontological impairment (odontohypophosphatasia) to five subtypes with systemic involvement, classified according to the age at the onset of the first symptoms (four of them in the paediatric age range: perinatal lethal, perinatal benign, infant and childhood hypophosphatasia). Those subtypes of hypophosphatasia with an earliest onset usually involve a worse prognosis, due to the risk of developing potentially lethal complications, such as seizures or severe respiratory insufficiency, secondary to rib cage malformations. Due to the extremely low prevalence of the severe forms of hypophosphatasia, its clinical variability and overlapping phenotypic features with several more prevalent conditions, the diagnosis of hypophosphatasia in the clinical setting is challenging. However, its potential lethality and impact on the patient's quality of life, along with the recent availability of an enzyme replacement therapy, increases the relevance of the early and accurate identification of patients affected with hypophosphatasia. On the basis of published evidence and clinical experience, this article suggests an algorithm with practical recommendations for the differential diagnosis of childhood hypophosphatasia, as well as an updated review of current therapeutic options.
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Affiliation(s)
- Gabriel A Martos-Moreno
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación Sanitaria La Princesa, Departamento de Pediatría, Universidad Autónoma de Madrid, CIBERobn, Instituto de Salud Carlos III, Madrid, España.
| | - Joan Calzada
- Respuesta inflamatoria sistémica en pediatría, Institut de Recerca Sant Joan de Déu, Sección de Reumatología Pediátrica, Servicio de Pediatría, Hospital Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - María L Couce
- Unidad de Diagnóstico y Tratamiento de Enfermedades Metabólicas Congénitas, Servicio de Neonatología, Complejo Hospitalario Universitario de Santiago, CIBERER, IDIS , Santiago de Compostela, La Coruña, España
| | - Jesús Argente
- Servicio de Endocrinología, Hospital Infantil Universitario Niño Jesús, Instituto de Investigación Sanitaria La Princesa, Departamento de Pediatría, Universidad Autónoma de Madrid, CIBERobn, Instituto de Salud Carlos III, Madrid, España; Instituto de Alimentación IMDEA, CEI UAM+CSIC, Madrid, España
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Chen B, Li L, Ren W, Yi L, Wang Y, Yan F. A novel missense mutation in the ALPL gene causes dysfunction of the protein. Mol Med Rep 2017; 16:710-718. [PMID: 28586049 PMCID: PMC5482188 DOI: 10.3892/mmr.2017.6668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 03/06/2017] [Indexed: 11/06/2022] Open
Abstract
Hypophosphatasia (HP) is a rare genetic disease caused by mutation in the alkaline phosphatase, liver/bone/kidney (ALPL) gene with highly variable clinical manifestations. Efforts have been made to collect cases with novel mutations and to examine how a missense mutation affects ALPL protein function, which remains difficult to predict. The present study investigated the underlying mechanism of ALPL dysfunction in a patient diagnosed with HP. Bidirectional sequencing of the ALPL gene was conducted in a 5‑year‑old Chinese girl preliminary diagnosed with childhood HP. Sorting Intolerant from Tolerant (SIFT) and Polymorphism Phenotyping v2 (PolyPhen‑2) tools were used to forecast the impact of the mutation on protein function. Site‑directed mutagenesis was performed and transfected into cells to verify the role of the specific mutation. Furthermore, the mechanism of the impact was investigated via all‑atom molecular dynamics (MD) simulation. The patient demonstrated a compound heterozygote with two missense mutations in the ALPL gene, p.Trp29Arg and p.Ile395Val. Trp29 and Ile395 were determined to be 'tolerable' by SIFT, whereas they were 'possibly damaging' by PolyPhen‑2 in terms of conservation. Additionally, HEK293 cells were transfected with plasmids expressing wild type and/or mutated ALPL. Only 4.1% of ALP activity remained when Trp29 was substituted by Arg, whereas 19.1, 33.7, 50.1 and 7.6% ALP activity remained in cells expressing p.Ile395Val, wild type+p.Trp29Arg, wild type+p.Ile395Val and p.Trp29Arg+p.Ile395Val substitutions, respectively. All‑atom MD simulation demonstrated that the N‑terminal helix of mutated ALPL, where Trp29 is located, separated from the main body of the protein after 30 nsec, and moved freely. These results demonstrated that p.Trp29Arg, as a novel missense mutation in the ALPL gene, reduced the enzymatic activity of ALPL. This effect may be associated with an uncontrolled N‑terminal helix. These results provide novel information about the genetic basis of HP, and may facilitate the development of future therapies.
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Affiliation(s)
- Bin Chen
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Lili Li
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Weitong Ren
- National Laboratory of Solid State Microstructure and Department of Physics, Nanjing University, Nanjing, Jiangsu 210008, P.R. China
| | - Long Yi
- Jiangsu Key Laboratory of Molecular Medicine, Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Yaping Wang
- Department of Medical Genetics, Nanjing University Medical School, Nanjing, Jiangsu 210008, P.R. China
| | - Fuhua Yan
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210008, P.R. China
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Baujat G, Michot C, Le Quan Sang K, Cormier-Daire V. Perinatal and infantile hypophosphatasia: clinical features and treatment. Arch Pediatr 2017; 24:5S61-5S65. [DOI: 10.1016/s0929-693x(18)30016-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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35
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36
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Rothenbuhler A, Linglart A. Hypophosphatasia in children and adolescents: clinical features and treatment. Arch Pediatr 2017; 24:5S66-5S70. [DOI: 10.1016/s0929-693x(18)30017-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Seefried L, Baumann J, Hemsley S, Hofmann C, Kunstmann E, Kiese B, Huang Y, Chivers S, Valentin MA, Borah B, Roubenoff R, Junker U, Jakob F. Efficacy of anti-sclerostin monoclonal antibody BPS804 in adult patients with hypophosphatasia. J Clin Invest 2017; 127:2148-2158. [PMID: 28436937 DOI: 10.1172/jci83731] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 02/21/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hypophosphatasia (HPP) is a rare genetic disorder resulting in variable alterations of bone formation and mineralization that are caused by mutations in the ALPL gene, encoding the tissue-nonspecific alkaline phosphatase (ALP) enzyme. METHODS In this phase IIA open-label, single-center, intra-patient, dose-escalating study, adult patients with HPP received 3 ascending intravenous doses of 5, 10, and 20 mg/kg BPS804, a fully human anti-sclerostin monoclonal antibody, on days 1, 15, and 29, respectively. Patients were followed for 16 weeks after the last dose. We assessed the pharmacodynamics, pharmacokinetics, preliminary efficacy, and safety of BPS804 administrations at specified intervals during treatment and follow-up. RESULTS Eight patients (mean age 47.8 years) were enrolled in the study (6 females, 2 males). BPS804 treatment increased mean ALP and bone-specific ALP enzymatic activity between days 2 and 29. Transient increases in the bone formation markers procollagen type-I N-terminal propeptide (PINP), osteocalcin, and parathyroid hormone as well as a transient decrease in the bone resorption marker C-telopeptide of type I collagen (CTX-1) were observed. Lumbar spine bone mineral density showed a mean increase by day 85 and at end of study. Treatment-associated adverse events were mild and transient. CONCLUSION BPS804 treatment was well tolerated and resulted in increases in bone formation biomarkers and bone mineral density, suggesting that sclerostin inhibition could be applied to enhance bone mineral density, stability, and regeneration in non-life-threatening clinical situations in adults with HPP. TRIAL REGISTRATION Clinicaltrials.gov NCT01406977. FUNDING Novartis Institutes for BioMedical Research, Basel, Switzerland.
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Affiliation(s)
- Lothar Seefried
- Orthopedic Center of Musculoskeletal Research, Orthopedic Department, University of Würzburg, Würzburg, Germany
| | - Jasmin Baumann
- Orthopedic Center of Musculoskeletal Research, Orthopedic Department, University of Würzburg, Würzburg, Germany
| | - Sarah Hemsley
- Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | | | - Erdmute Kunstmann
- Institute for Human Genetics, University of Würzburg, Würzburg, Germany
| | | | - Yue Huang
- Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Simon Chivers
- Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Marie-Anne Valentin
- Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Babul Borah
- Novartis Institutes for BioMedical Research Inc., Cambridge, Massachusetts, USA
| | - Ronenn Roubenoff
- Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Uwe Junker
- Novartis Institutes for BioMedical Research, Novartis Pharma AG, Basel, Switzerland
| | - Franz Jakob
- Orthopedic Center of Musculoskeletal Research, Orthopedic Department, University of Würzburg, Würzburg, Germany
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Tenorio J, Álvarez I, Riancho-Zarrabeitia L, Martos-Moreno GÁ, Mandrile G, de la Flor Crespo M, Sukchev M, Sherif M, Kramer I, Darnaude-Ortiz MT, Arias P, Gordo G, Dapía I, Martinez-Villanueva J, Gómez R, Iturzaeta JM, Otaify G, García-Unzueta M, Rubinacci A, Riancho JA, Aglan M, Temtamy S, Hamid MA, Argente J, Ruiz-Pérez VL, Heath KE, Lapunzina P. Molecular and clinical analysis ofALPLin a cohort of patients with suspicion of Hypophosphatasia. Am J Med Genet A 2017; 173:601-610. [DOI: 10.1002/ajmg.a.37991] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/18/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Jair Tenorio
- Institute of Medical and Molecular Genetics (INGEMM); Hospital Universitario La Paz, IdiPAZ; Universidad Autónoma de Madrid; Madrid Spain
- CIBERER; Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII; Madrid Spain
| | | | | | - Gabriel Á. Martos-Moreno
- Department of Endocrinology; Hospital Universitario Niño Jesús, IIS La Princesa; Madrid Spain
- Department of Pediatrics; Universidad Autónoma de Madrid; Madrid Spain
- CIBEROBN, Centro de Investigación Biomédica en Red sobre Fisiopatología de la obesidad y nutrición; Instituto de Salud Carlos III; Madrid Spain
| | - Giorgia Mandrile
- Department of Medical Genetics; San Luigi University Hospital; Orbassano Italy
- Department Clinical and Biological Sciences; University of Torino; Torino Italy
| | | | - Mikhail Sukchev
- Diagnostic Specialist; Alexion Pharmaceuticals; Moscow Russia
| | - Mostafa Sherif
- Medical Division; Alexion Pharma Middle East; Dubai Media City United Arab Emirates
| | - Iza Kramer
- Department of Pediatrics; Privat Hospitalet Denmark; Charlottenlund Denmark
| | | | - Pedro Arias
- Institute of Medical and Molecular Genetics (INGEMM); Hospital Universitario La Paz, IdiPAZ; Universidad Autónoma de Madrid; Madrid Spain
- CIBERER; Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII; Madrid Spain
| | - Gema Gordo
- Institute of Medical and Molecular Genetics (INGEMM); Hospital Universitario La Paz, IdiPAZ; Universidad Autónoma de Madrid; Madrid Spain
- CIBERER; Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII; Madrid Spain
| | - Irene Dapía
- Institute of Medical and Molecular Genetics (INGEMM); Hospital Universitario La Paz, IdiPAZ; Universidad Autónoma de Madrid; Madrid Spain
- CIBERER; Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII; Madrid Spain
| | | | - Rubén Gómez
- Department of Biochemistry; Hospital Universitario La Paz, IdiPaz; Madrid Spain
| | | | - Ghada Otaify
- Division of Human Genetics and Genome Research; Department of Clinical Genetics; National Research Centre, Cairo; Egypt
- Centre of Excellence for Human Genetics; National Research Centre; Cairo Egypt
| | - Mayte García-Unzueta
- Department of Clinical Biochemistry; Hospital Universitario Marqués Valdecilla, IDIVAL; Santander Spain
| | | | - José A. Riancho
- Department of Internal Medicine; Hospital Universitario Marqués Valdecilla, IDIVAL; University of Cantabria, RETICEF; Santander Spain
| | - Mona Aglan
- Division of Human Genetics and Genome Research; Department of Clinical Genetics; National Research Centre, Cairo; Egypt
- Centre of Excellence for Human Genetics; National Research Centre; Cairo Egypt
| | - Samia Temtamy
- Division of Human Genetics and Genome Research; Department of Clinical Genetics; National Research Centre, Cairo; Egypt
- Centre of Excellence for Human Genetics; National Research Centre; Cairo Egypt
| | - Mohamed Abdel Hamid
- Centre of Excellence for Human Genetics; National Research Centre; Cairo Egypt
- Division of Human Genetics and Genome Research; Department of Medical Molecular Genetics; National Research Centre; El Cairo Egypt
| | - Jesús Argente
- Department of Endocrinology; Hospital Universitario Niño Jesús, IIS La Princesa; Madrid Spain
- Department of Pediatrics; Universidad Autónoma de Madrid; Madrid Spain
- CIBEROBN, Centro de Investigación Biomédica en Red sobre Fisiopatología de la obesidad y nutrición; Instituto de Salud Carlos III; Madrid Spain
| | - Víctor L. Ruiz-Pérez
- CIBERER; Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII; Madrid Spain
- Skeletal Dysplasia Multidisciplinary Unit (UMDE); Hospital Universitario La Paz; Madrid Spain
- Instituto de Investigaciones Biológicas (IB); Consejo Superior de Investigaciones Científicas (CSIC)-Universidad Autónoma de Madrid; Madrid Spain
| | - Karen E. Heath
- Institute of Medical and Molecular Genetics (INGEMM); Hospital Universitario La Paz, IdiPAZ; Universidad Autónoma de Madrid; Madrid Spain
- CIBERER; Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII; Madrid Spain
- Skeletal Dysplasia Multidisciplinary Unit (UMDE); Hospital Universitario La Paz; Madrid Spain
| | - Pablo Lapunzina
- Institute of Medical and Molecular Genetics (INGEMM); Hospital Universitario La Paz, IdiPAZ; Universidad Autónoma de Madrid; Madrid Spain
- CIBERER; Centro de Investigación Biomédica en Red de Enfermedades Raras, ISCIII; Madrid Spain
- Skeletal Dysplasia Multidisciplinary Unit (UMDE); Hospital Universitario La Paz; Madrid Spain
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Okawa R, Iijima O, Kishino M, Okawa H, Toyosawa S, Sugano-Tajima H, Shimada T, Okada T, Ozono K, Ooshima T, Nakano K. Gene therapy improves dental manifestations in hypophosphatasia model mice. J Periodontal Res 2016; 52:471-478. [PMID: 27561677 DOI: 10.1111/jre.12412] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVE Hypophosphatasia is a rare inherited skeletal disorder characterized by defective bone mineralization and deficiency of tissue non-specific alkaline phosphatase (TNSALP) activity. The disease is caused by mutations in the liver/bone/kidney alkaline phosphatase gene (ALPL) encoding TNSALP. Early exfoliation of primary teeth owing to disturbed cementum formation, periodontal ligament weakness and alveolar bone resorption are major complications encountered in oral findings, and discovery of early loss of primary teeth in a dental examination often leads to early diagnosis of hypophosphatasia. Although there are no known fundamental treatments or effective dental approaches to prevent early exfoliation of primary teeth in affected patients, several possible treatments have recently been described, including gene therapy. Gene therapy has also been applied to TNSALP knockout mice (Alpl-/- ), which phenocopy the infantile form of hypophosphatasia, and improved their systemic condition. In the present study, we investigated whether gene therapy improved the dental condition of Alpl-/- mice. MATERIAL AND METHODS Following sublethal irradiation (4 Gy) at the age of 2 d, Alpl-/- mice underwent gene therapy using bone marrow cells transduced with a lentiviral vector expressing a bone-targeted form of TNSALP injected into the jugular vein (n = 3). Wild-type (Alpl+/+ ), heterozygous mice (Alpl+/- ) and Alpl-/- mice were analyzed at 9 d of age (n = 3 of each), while Alpl+/+ mice and treated or untreated Alpl-/- mice were analyzed at 1 mo of age (n = 3 of each), and Alpl+/- mice and Alpl-/- mice with gene therapy were analyzed at 3 mo of age (n = 3 of each). A single mandibular hemi-section obtained at 1 mo of age was analyzed using a small animal computed tomography machine to assess alveolar bone formation. Other mandibular hemi-sections obtained at 9 d, 1 mo and 3 mo of age were subjected to hematoxylin and eosin staining and immunohistochemical analysis of osteopontin, a marker of cementum. RESULTS Immunohistochemical analysis of osteopontin, a marker of acellular cementum, revealed that Alpl-/- mice displayed impaired formation of cementum and alveolar bone, similar to the human dental phenotype. Cementum formation was clearly present in Alpl-/- mice that underwent gene therapy, but did not recover to the same level as that in wild-type (Alpl+/+ ) mice. Micro-computed tomography examination showed that gene therapy improved alveolar bone mineral density in Alpl-/- mice to a similar level to that in Alpl+/+ mice. CONCLUSIONS Our results suggest that gene therapy can improve the general condition of Alpl-/- mice, and induce significant alveolar bone formation and moderate improvement of cementum formation, which may contribute to inhibition of early spontaneous tooth exfoliation.
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Affiliation(s)
- R Okawa
- Osaka University Graduate School of Dentistry, Osaka, Japan
| | - O Iijima
- Nippon Medical School, Tokyo, Japan
| | - M Kishino
- Osaka University Graduate School of Dentistry, Osaka, Japan
| | - H Okawa
- Osaka University Graduate School of Dentistry, Osaka, Japan
| | - S Toyosawa
- Osaka University Graduate School of Dentistry, Osaka, Japan
| | | | | | - T Okada
- Nippon Medical School, Tokyo, Japan
| | - K Ozono
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - T Ooshima
- Osaka University Graduate School of Dentistry, Osaka, Japan
| | - K Nakano
- Osaka University Graduate School of Dentistry, Osaka, Japan
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40
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Wang ZY, Zhang K, Zheng GS, Qiao W, Su YX. Current concepts in odontohypophosphatasia form of hypophosphatasia and report of two cases. BMC Oral Health 2016; 16:70. [PMID: 27531358 PMCID: PMC4988024 DOI: 10.1186/s12903-016-0266-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 08/02/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Hypophosphatasia is a rare inherited disease derived from mutations in tissue non-specific alkaline phosphatase genes, with typical oral symptoms including short root anomaly and dysplasia of dentin or cementum. CASE PRESENTATION Two young female patients presented with short root anomaly with a history of premature loss of deciduous and/or permanent teeth. The laboratory and imaging investigations were performed. One case was diagnosed as odontohypophosphatasia concurrent with hyperthyroidism, the other was odontohypophosphatasia concurrent with multiple radicular cysts. CONCLUSION This report presents two cases of odontohypophosphatasia, a rare disease which is difficult to be diagnosed, and highlights that the history of premature loss of deciduous and/or permanent teeth, oral manifestation and laboratory tests are crucial for clinical diagnosis.
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Affiliation(s)
- Zhu-yu Wang
- Department of Endodontics, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Kai Zhang
- Department of Endodontics, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Guang-sen Zheng
- Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Wei Qiao
- Department of Endodontics, Guanghua School of Stomatology, Sun Yat-sen University, Guangzhou, China
| | - Yu-xiong Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, the University of Hong Kong, 34 Hospital Road, Hong Kong, Hong Kong
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42
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Abstract
Hypophosphatasia is a rare disorder due to a mutation in the ALPL gene encoding the alkaline phosphatase (ALP) leading to a diminished activity of the enzyme in bone, liver, and kidney. Hypophosphatasia is a heterogeneous disease, ranging from extreme life-threatening forms revealed at birth in young infants presenting with severely impaired bone mineralization, seizures, and hypercalcemia, to young adults with premature exfoliation of their teeth without any other symptom. We will review the challenges of the clinical, biochemical, radiological, and genetic diagnosis. Schematically, the diagnosis relies on low ALP levels and, in most cases, on the genetic defect in the ALPL gene. An enzyme replacement therapy is now developed for hypophosphatasia; early results in the severe form of the disease are extremely encouraging. However, multidisciplinary care remains the core of treatment of hypophosphatasia encompassing nutritional support, adjustment of calcium and phosphate intake, monitoring of vitamin D levels, careful and personalized physical therapy, and regular dental monitoring and care.
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Affiliation(s)
- Agnès Linglart
- Department of Pediatric Endocrinology and Diabetology for Children, APHP, Bicêtre Paris Sud, Le Kremlin Bicêtre, 94270, France.
- APHP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism and Plateforme d'Expertise Paris Sud Maladies Rares, Le Kremlin Bicêtre, 94270, France.
| | - Martin Biosse-Duplan
- APHP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism and Plateforme d'Expertise Paris Sud Maladies Rares, Le Kremlin Bicêtre, 94270, France
- Department of Odontology, APHP, Bretonneau Paris Nord Val de Seine, Paris, 75018, France
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43
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Aeby M, Wyss T, Mentrup B, Kunstmann E, Jakob F, Aeberli D. Low-energy trauma-induced intercondylar femoral fracture. CLINICAL CASES IN MINERAL AND BONE METABOLISM : THE OFFICIAL JOURNAL OF THE ITALIAN SOCIETY OF OSTEOPOROSIS, MINERAL METABOLISM, AND SKELETAL DISEASES 2016; 13:151-153. [PMID: 27920814 PMCID: PMC5119715 DOI: 10.11138/ccmbm/2016.13.2.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present a 44-year-old female patient with recurrent fragility fractures including an intercondylar femoral fracture and with normal planar bone densitometry. Diagnosis of hypophosphatasia was suggested by low volumetric cortical bone mineral density and laboratory findings. DNA sequencing revealed heterozygous mutations in the exons 5, 6 and 9 of the ALPL gene, thus confirming the suspected diagnosis.
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Affiliation(s)
- Mathias Aeby
- Department of Rheumatology, Immunology and Allergology, Inselspital Bern, Bern, Switzerland
| | - Tobias Wyss
- Orthopedic Clinic Sonnenhof Bern, Bern, Switzerland
| | - Birgit Mentrup
- Orthopedic Center for Musculoskeletal Research Experimental and Clinical Osteology, Orthopedic Department University of Würzburg, Würzburg, Germany
| | - Erdmute Kunstmann
- Department of Human Genetics, University of Würzburg, Würzburg, Germany
| | - Franz Jakob
- Orthopedic Center for Musculoskeletal Research Experimental and Clinical Osteology, Orthopedic Department University of Würzburg, Würzburg, Germany
| | - Daniel Aeberli
- Department of Rheumatology, Immunology and Allergology, Inselspital Bern, Bern, Switzerland
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44
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Abstract
Skeletal dysplasias are a heterogeneous group of conditions associated with various abnormalities of the skeleton. Some of them are perinatally lethal and can be diagnosed at birth. Lethality is usually due to thoracic underdevelopment and lung hypoplasia. A correct diagnosis and typing of the skeletal disorder is essential for the prognosis as is genetic counseling of the family. A retrospective review of 12 cases of clinico-radiologic diagnosis of skeletal dysplasia, leading to thoracic insufficiency, was conducted.We aimed to make differential diagnosis with special emphasis on radiological findings, and to emphasize the importance of parental counseling.
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Affiliation(s)
- Mehmet Sah İpek
- From the Department of Neonatology (MSİ), Maternity and Children's Hospital; and Department of Radiology (CA), Dicle University School of Medicine, Diyarbakir, Turkey
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45
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Belkhouribchia J, Bravenboer B, Meuwissen M, Velkeniers B. Osteomalacia with low alkaline phosphatase: a not so rare condition with important consequences. BMJ Case Rep 2016; 2016:bcr-2015-212827. [PMID: 26823351 DOI: 10.1136/bcr-2015-212827] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hypophosphatasia is a genetic disorder, characterised by a dysfunctional tissue-non-specific isoenzyme of alkaline phosphatase that impacts bone metabolism and predisposes to osteomalacia or rickets. The clinical presentation is very diverse, depending on the age of onset and the severity of the disease. Several forms of hypophosphatasia are recognised. We present a case of a 50-year-old woman with low impact fractures and loss of teeth at a young age. She also had a low alkaline phosphatase and was diagnosed with adult hypophosphatasia. Although the severe forms of hypophosphatasia are rather rare, the adult form is thought to occur quite frequently. As this condition is not well known by healthcare professionals, the time to diagnosis and initiation of adequate treatment is often postponed. When encountering a patient with low alkaline phosphatase, low bone density or a history of bone fractures, the possibility of hypophosphatasia should be considered.
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Affiliation(s)
| | - Bert Bravenboer
- Department of Endocrinology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Marije Meuwissen
- Department of Genetics, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
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46
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Abstract
Hypophosphatasia (HPP) is due to deficient activity of the tissue-nonspecific isoenzyme of alkaline phosphatase (TNAP). This enzyme cleaves extracellular substrates inorganic pyrophosphates (PPi), pyridoxal-5'-phosphate (PLP), phosphoethanolamine (PEA) and nucleotides, and probably other substrates not yet identified. During the last 15 years the role of TNAP in mineralization, and to a less degree in brain, has been investigated, providing hypotheses and explanations for both bone and neuronal HPP phenotypes. ALPL, the gene encoding TNAP, is subject to many mutations, mostly missense mutations. A few number of mutations are recurrently found and may be quite frequent in particular populations. This reflects founder effects. The great variety of mutations results in a great number of compound heterozygous genotypes and in highly variable clinical expressivity. A good correlation was observed between the severity of the disease and in vitro enzymatic activity of the mutant protein measured after site-directed mutagenesis. Many missense mutations found in severe hypophosphatasia produced a mutant protein that failed to reach the cell membrane , was accumulated in the cis-Golgi and was subsequently degraded in the proteasome. Missense mutations located in the catalytic site or in the homodimer interface were often shown by site-directed mutagenesis to have a dominant negative effect. Currently molecular diagnosis of HPP is based on the sequencing of the coding sequence of ALPL that allows detection of approximately 95 % of mutations in severe cases. In addition, other genes, especially genes encoding proteins involved in the regulation of extracellular PPi concentration, could modify the phenotype (modifier genes).
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Bianchi ML. Hypophosphatasia: an overview of the disease and its treatment. Osteoporos Int 2015; 26:2743-57. [PMID: 26245849 DOI: 10.1007/s00198-015-3272-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 07/28/2015] [Indexed: 11/30/2022]
Abstract
This review presents the current knowledge on hypophosphatasia, a rare genetic disease of very variable severity (from lethal to mild) and clinical presentation, caused by defective production of tissue-non-specific alkaline phosphatase (TNSALP). Hypophosphatasia can affect babies in utero as well as infants, children, and adults. The article first presents the genetics of TNSALP and its many known mutations underlying the disease. Then, it presents the epidemiology, classification, and clinical presentation of the six different forms of the disease (perinatal lethal, prenatal benign, infantile, childhood, adult, and odontohypophosphatasia) as well as the essential diagnostic clues. The last section on treatment presents a survey of the therapeutic approaches, up to the ongoing phase 2 studies of enzyme replacement therapy.
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Affiliation(s)
- M L Bianchi
- Experimental Laboratory for Children's Bone Metabolism Research, Bone Metabolism Unit, Istituto Auxologico Italiano IRCCS, via L. Ariosto 13, 20145, Milano, Italy.
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48
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Taillandier A, Domingues C, De Cazanove C, Porquet-Bordes V, Monnot S, Kiffer-Moreira T, Rothenbuhler A, Guggenbuhl P, Cormier C, Baujat G, Debiais F, Capri Y, Cohen-Solal M, Parent P, Chiesa J, Dieux A, Petit F, Roume J, Isnard M, Cormier-Daire V, Linglart A, Millán JL, Salles JP, Muti C, Simon-Bouy B, Mornet E. Molecular diagnosis of hypophosphatasia and differential diagnosis by targeted Next Generation Sequencing. Mol Genet Metab 2015; 116:215-20. [PMID: 26432670 PMCID: PMC5257278 DOI: 10.1016/j.ymgme.2015.09.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 09/26/2015] [Accepted: 09/26/2015] [Indexed: 11/24/2022]
Abstract
Hypophosphatasia (HPP) is a rare inherited skeletal dysplasia due to loss of function mutations in the ALPL gene. The disease is subject to an extremely high clinical heterogeneity ranging from a perinatal lethal form to odontohypophosphatasia affecting only teeth. Up to now genetic diagnosis of HPP is performed by sequencing the ALPL gene by Sanger methodology. Osteogenesis imperfecta (OI) and campomelic dysplasia (CD) are the main differential diagnoses of severe HPP, so that in case of negative result for ALPL mutations, OI and CD genes had often to be analyzed, lengthening the time before diagnosis. We report here our 18-month experience in testing 46 patients for HPP and differential diagnosis by targeted NGS and show that this strategy is efficient and useful. We used an array including ALPL gene, genes of differential diagnosis COL1A1 and COL1A2 that represent 90% of OI cases, SOX9, responsible for CD, and 8 potentially modifier genes of HPP. Seventeen patients were found to carry a mutation in one of these genes. Among them, only 10 out of 15 cases referred for HPP carried a mutation in ALPL and 5 carried a mutation in COL1A1 or COL1A2. Interestingly, three of these patients were adults with fractures and/or low BMD. Our results indicate that HPP and OI may be easily misdiagnosed in the prenatal stage but also in adults with mild symptoms for these diseases.
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Affiliation(s)
- Agnès Taillandier
- Unité de Génétique Constitutionnelle, Centre Hospitalier de Versailles, 78150 Le Chesnay, France.
| | - Christelle Domingues
- Unité de Génétique Constitutionnelle, Centre Hospitalier de Versailles, 78150 Le Chesnay, France.
| | - Clémence De Cazanove
- Unité de Génétique Constitutionnelle, Centre Hospitalier de Versailles, 78150 Le Chesnay, France.
| | - Valérie Porquet-Bordes
- Endocrinologie, Maladies Osseuses, Génétique et Gynécologie Médicale, Hôpital des Enfants, CHU de Toulouse, Toulouse Cedex 9, France.
| | - Sophie Monnot
- Université Paris-Descartes, Sorbonne Paris Cité, Institut Imagine and INSERM U1163, Hôpital Necker-Enfants Malades, Paris, France.
| | - Tina Kiffer-Moreira
- Sanford Children's Health Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA.
| | - Agnès Rothenbuhler
- APHP, Bicêtre Paris Sud, Department of Pediatric Endocrinology and Diabetology for Children, Le Kremlin Bicêtre 94270, France; APHP, Reference Center for Rare Disorders of the Mineral Metabolism and Plateforme D'expertise Paris Sud, Le Kremlin Bicêtre 94270, France.
| | - Pascal Guggenbuhl
- Service de Rhumatologie, Hôpital Sud, CHU de Rennes, 16, Boulevard de Bulgarie, BP90347, 35203 Rennes Cedex 2, France.
| | - Catherine Cormier
- Rheumatology Department, Cochin University Hospital, 75015 Paris, France.
| | - Geneviève Baujat
- Centres de Référence Maladies Osseuses Constitutionnelles (MOC), Hôpital Universitaire Necker-Enfants Malades et Institut Imagine (AP-HP), 75015 Paris, France.
| | - Françoise Debiais
- Service de rhumatologie, CHU de Poitiers, 86021 Poitiers Cedex, France.
| | - Yline Capri
- Department of Genetics, APHP-Robert Debré University Hospital, Paris, France.
| | - Martine Cohen-Solal
- Department of Rheumatology, INSERM UMR-1132, Lariboisière Hospital and University, Paris Diderot Sorbonne, Paris, France.
| | - Philippe Parent
- Service de Génétique Clinique, CHU Brest, Brest F-29200, France.
| | - Jean Chiesa
- Department of Genetics, University Hospital, Nîmes, France.
| | - Anne Dieux
- Service de Génétique Clinique, CHU, Lille, France.
| | | | - Joelle Roume
- Unité de Génétique Médicale, Centre Intercommunal Poissy-St-Germain en Laye, Poissy, France.
| | - Monica Isnard
- Gynécologie Obstétrique, Centre Hospitalier de Mulhouse, 68051 Mulhouse Cedex, France
| | - Valérie Cormier-Daire
- Université Paris-Descartes, Sorbonne Paris Cité, Institut Imagine and INSERM U1163, Hôpital Necker-Enfants Malades, Paris, France.
| | - Agnès Linglart
- APHP, Bicêtre Paris Sud, Department of Pediatric Endocrinology and Diabetology for Children, Le Kremlin Bicêtre 94270, France; APHP, Reference Center for Rare Disorders of the Mineral Metabolism and Plateforme D'expertise Paris Sud, Le Kremlin Bicêtre 94270, France.
| | - José Luis Millán
- Sanford Children's Health Research Center, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, CA, USA.
| | - Jean-Pierre Salles
- Endocrinologie, Maladies Osseuses, Génétique et Gynécologie Médicale, Hôpital des Enfants, CHU de Toulouse, Toulouse Cedex 9, France.
| | - Christine Muti
- Unité de Génétique Constitutionnelle, Centre Hospitalier de Versailles, 78150 Le Chesnay, France.
| | - Brigitte Simon-Bouy
- Unité de Génétique Constitutionnelle, Centre Hospitalier de Versailles, 78150 Le Chesnay, France.
| | - Etienne Mornet
- Unité de Génétique Constitutionnelle, Centre Hospitalier de Versailles, 78150 Le Chesnay, France.
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49
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Abstract
Osteoporosis is a metabolic bone disease characterized by loss of bone mass and strength, resulting in increased risk of fractures. It is classically divided into primary (post-menopausal or senile), secondary and idiopathic forms. There are many rare diseases, that cause directly or indirectly osteoporosis. The identification and classification of most of these rare causes of osteoporosis is crucial for the specialists in endocrinology and not, in order to prevent this bone complication and to provide for an early therapy. Several pathogenic mechanisms are involved, including various aspects of bone metabolism such as: decreased bone formation, increased bone resorption, altered calcium, phosphorus and/or vitamin D homeostasis, and abnormal collagen synthesis. In this review, less common forms of primary and secondary osteoporosis are described, specifying, if applicable: genetic causes, epidemiology, clinical features, and pathogenic mechanisms causing osteoporosis. A greater awareness of all rare causes of osteoporosis could reduce the number of cases classified as idiopathic osteoporosis and allow the introduction of appropriate and timely treatments.
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Affiliation(s)
- Gemma Marcucci
- Bone Metabolic Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Maria Luisa Brandi
- Bone Metabolic Diseases Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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50
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Taketani T, Oyama C, Mihara A, Tanabe Y, Abe M, Hirade T, Yamamoto S, Bo R, Kanai R, Tadenuma T, Michibata Y, Yamamoto S, Hattori M, Katsube Y, Ohnishi H, Sasao M, Oda Y, Hattori K, Yuba S, Ohgushi H, Yamaguchi S. Ex Vivo Expanded Allogeneic Mesenchymal Stem Cells with Bone Marrow Transplantation Improved Osteogenesis in Infants with Severe Hypophosphatasia. Cell Transplant 2015; 24:1931-43. [DOI: 10.3727/096368914x685410] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Patients with severe hypophosphatasia (HPP) develop osteogenic impairment with extremely low alkaline phosphatase (ALP) activity, resulting in a fatal course during infancy. Mesenchymal stem cells (MSCs) differentiate into various mesenchymal lineages, including bone and cartilage. The efficacy of allogeneic hematopoietic stem cell transplantation for congenital skeletal and storage disorders is limited, and therefore we focused on MSCs for the treatment of HPP. To determine the effect of MSCs on osteogenesis, we performed multiple infusions of ex vivo expanded allogeneic MSCs for two patients with severe HPP who had undergone bone marrow transplantation (BMT) from asymptomatic relatives harboring the heterozygous mutation. There were improvements in not only bone mineralization but also muscle mass, respiratory function, and mental development, resulting in the patients being alive at the age of 3. After the infusion of MSCs, chimerism analysis of the mesenchymal cell fraction isolated from bone marrow in the patients demonstrated that donor-derived DNA sequences existed. Adverse events of BMT were tolerated, whereas those of MSC infusion did not occur. However, restoration of ALP activity was limited, and normal bony architecture could not be achieved. Our data suggest that multiple MSC infusions, following BMT, were effective and brought about clinical benefits for patients with lethal HPP. Allogeneic MSC-based therapy would be useful for patients with other congenital bone diseases and tissue disorders if the curative strategy to restore clinically normal features, including bony architecture, can be established.
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Affiliation(s)
- Takeshi Taketani
- Division of Blood Transfusion, Shimane University Hospital, Izumo, Shimane, Japan
- Department of Pediatrics, Shimane University School of Medicine, Izumo, Shimane, Japan
| | - Chigusa Oyama
- Department of Pediatrics, Shimane University School of Medicine, Izumo, Shimane, Japan
| | - Aya Mihara
- Department of Pediatrics, Shimane University School of Medicine, Izumo, Shimane, Japan
| | - Yuka Tanabe
- Department of Pediatrics, Shimane University School of Medicine, Izumo, Shimane, Japan
| | - Mariko Abe
- Department of Pediatrics, Shimane University School of Medicine, Izumo, Shimane, Japan
| | - Tomohiro Hirade
- Department of Pediatrics, Shimane University School of Medicine, Izumo, Shimane, Japan
| | - Satoshi Yamamoto
- Department of Pediatrics, Shimane University School of Medicine, Izumo, Shimane, Japan
| | - Ryosuke Bo
- Department of Pediatrics, Shimane University School of Medicine, Izumo, Shimane, Japan
| | - Rie Kanai
- Department of Pediatrics, Shimane University School of Medicine, Izumo, Shimane, Japan
| | - Taku Tadenuma
- Division of Rehabilitation, Shimane University Hospital, Izumo, Shimane, Japan
| | - Yuko Michibata
- Division of Rehabilitation, Shimane University Hospital, Izumo, Shimane, Japan
| | - Soichiro Yamamoto
- Department of Orthopedics, Shimane University School of Medicine, Izumo, Shimane, Japan
| | - Miho Hattori
- Division of Blood Transfusion, Shimane University Hospital, Izumo, Shimane, Japan
| | - Yoshihiro Katsube
- Department of Life Science and Biotechnology, National Institute of Advanced Industrial Science and Technology, Amagasaki, Hyogo, Japan
| | - Hiroe Ohnishi
- Department of Life Science and Biotechnology, National Institute of Advanced Industrial Science and Technology, Amagasaki, Hyogo, Japan
| | - Mari Sasao
- Department of Life Science and Biotechnology, National Institute of Advanced Industrial Science and Technology, Amagasaki, Hyogo, Japan
| | - Yasuaki Oda
- Department of Life Science and Biotechnology, National Institute of Advanced Industrial Science and Technology, Amagasaki, Hyogo, Japan
| | - Koji Hattori
- Department of Life Science and Biotechnology, National Institute of Advanced Industrial Science and Technology, Amagasaki, Hyogo, Japan
| | - Shunsuke Yuba
- Department of Life Science and Biotechnology, National Institute of Advanced Industrial Science and Technology, Amagasaki, Hyogo, Japan
| | - Hajime Ohgushi
- Department of Life Science and Biotechnology, National Institute of Advanced Industrial Science and Technology, Amagasaki, Hyogo, Japan
| | - Seiji Yamaguchi
- Department of Pediatrics, Shimane University School of Medicine, Izumo, Shimane, Japan
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