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Insights into the Molecular and Hormonal Regulation of Complications of X-Linked Hypophosphatemia. ENDOCRINES 2023. [DOI: 10.3390/endocrines4010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
X-linked hypophosphatemia (XLH) is characterized by mutations in the PHEX gene, leading to elevated serum levels of FGF23, decreased production of 1,25 dihydroxyvitamin D3 (1,25D), and hypophosphatemia. Those affected with XLH manifest impaired growth and skeletal and dentoalveolar mineralization as well as increased mineralization of the tendon–bone attachment site (enthesopathy), all of which lead to decreased quality of life. Many molecular and murine studies have detailed the role of mineral ions and hormones in regulating complications of XLH, including how they modulate growth and growth plate maturation, bone mineralization and structure, osteocyte-mediated mineral matrix resorption and canalicular organization, and enthesopathy development. While these studies have provided insight into the molecular underpinnings of these skeletal processes, current therapies available for XLH do not fully prevent or treat these complications. Therefore, further investigations are needed to determine the molecular pathophysiology underlying the complications of XLH.
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André J, Zhukouskaya VV, Lambert AS, Salles JP, Mignot B, Bardet C, Chaussain C, Rothenbuhler A, Linglart A. Growth hormone treatment improves final height in children with X-linked hypophosphatemia. Orphanet J Rare Dis 2022; 17:444. [PMID: 36544157 PMCID: PMC9768884 DOI: 10.1186/s13023-022-02590-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/AIM Despite optimal conventional treatment (oral phosphate supplements and active vitamin D analogs), about 40-50% of children with well-controlled X-linked hypophosphatemia (XLH) show linear growth failure, making them less likely to achieve an acceptable final height. Here, we studied the hypothesis that rhGH treatment improves final height in children with XLH and growth failure. METHODS Two cohorts of children with XLH were included in this retrospective longitudinal analysis: (1) a cohort treated with rhGH for short stature (n = 34) and (2) a cohort not treated with rhGH (n = 29). The mean duration of rhGH treatment was 4.4 ± 2.9 years. We collected the auxological parameters at various time points during follow-up until final height. RESULTS In rhGH-treated children, 2 years of rhGH therapy was associated with a significant increase in height from - 2.4 ± 0.9 to - 1.5 ± 0.7 SDS (p < 0.001). Their mean height at rhGH discontinuation was - 1.2 ± 0.9 SDS and at final height was - 1.3 ± 0.9 SDS corresponding to 165.5 ± 6.4 cm in boys and 155.5 ± 6.3 cm in girls. Notably, the two groups had similar final heights; i.e., the final height in children not treated with rhGH being - 1.2 ± 1.1 SDS (165.4 ± 6.8 cm in boys and 153.7 ± 7.8 cm in girls), p = 0.7. CONCLUSION Treatment with rhGH permits to improve final height in children with XLH and growth failure, despite optimal conventional treatment. We propose therefore that rhGH therapy could be considered as an option for short stature in the context of XLH.
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Affiliation(s)
- Julia André
- grid.413784.d0000 0001 2181 7253AP-HP, Endocrinology and Diabetes for Children, Reference Center for Rare Diseases of Calcium and Phosphate Metabolism, DMU SEA, OSCAR Filière, EndoRare and BOND ERN, Bicêtre Paris Saclay Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - Volha V. Zhukouskaya
- grid.413784.d0000 0001 2181 7253AP-HP, Endocrinology and Diabetes for Children, Reference Center for Rare Diseases of Calcium and Phosphate Metabolism, DMU SEA, OSCAR Filière, EndoRare and BOND ERN, Bicêtre Paris Saclay Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France ,grid.508487.60000 0004 7885 7602Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), Université Paris Cité, Montrouge, France
| | - Anne-Sophie Lambert
- grid.413784.d0000 0001 2181 7253AP-HP, Endocrinology and Diabetes for Children, Reference Center for Rare Diseases of Calcium and Phosphate Metabolism, DMU SEA, OSCAR Filière, EndoRare and BOND ERN, Bicêtre Paris Saclay Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France ,grid.413784.d0000 0001 2181 7253AP-HP, Medicine for Adolescents, Bicêtre Paris Saclay Hospital, Le Kremlin Bicêtre, France
| | - Jean-Pierre Salles
- grid.508721.9Unit of Endocrinology and Bone Diseases, Children Hospital, Toulouse University Hospital, CHU de Toulouse, Université de Toulouse, ERN BOND, INSERM UMR 1291/CNRS 5051, INFINITY Center, Toulouse, France
| | - Brigitte Mignot
- grid.411158.80000 0004 0638 9213Department of Pediatrics, CHU of Besancon, Besançon, France
| | - Claire Bardet
- grid.508487.60000 0004 7885 7602Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), Université Paris Cité, Montrouge, France
| | - Catherine Chaussain
- grid.413784.d0000 0001 2181 7253AP-HP, Endocrinology and Diabetes for Children, Reference Center for Rare Diseases of Calcium and Phosphate Metabolism, DMU SEA, OSCAR Filière, EndoRare and BOND ERN, Bicêtre Paris Saclay Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France ,grid.508487.60000 0004 7885 7602Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), Université Paris Cité, Montrouge, France ,grid.50550.350000 0001 2175 4109AP-HP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Dental Medicine Department, Bretonneau Hospital, GHN-Universite de Paris, Paris, France
| | - Anya Rothenbuhler
- grid.413784.d0000 0001 2181 7253AP-HP, Endocrinology and Diabetes for Children, Reference Center for Rare Diseases of Calcium and Phosphate Metabolism, DMU SEA, OSCAR Filière, EndoRare and BOND ERN, Bicêtre Paris Saclay Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France
| | - Agnès Linglart
- grid.413784.d0000 0001 2181 7253AP-HP, Endocrinology and Diabetes for Children, Reference Center for Rare Diseases of Calcium and Phosphate Metabolism, DMU SEA, OSCAR Filière, EndoRare and BOND ERN, Bicêtre Paris Saclay Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France ,grid.460789.40000 0004 4910 6535INSERM, Physiologie Et Physiopathologie Endocrinienne, Bicêtre Paris Saclay Hospital, Paris Saclay University, Le Kremlin Bicêtre, France
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3
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Kamiya Y, Matsushita M, Mishima K, Ohkawara B, Michigami T, Imagama S, Ohno K, Kitoh H. Meclozine ameliorates bone mineralization and growth plate structure in a mouse model of X‑linked hypophosphatemia. Exp Ther Med 2022; 25:39. [PMID: 36569439 PMCID: PMC9764053 DOI: 10.3892/etm.2022.11738] [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: 08/14/2022] [Accepted: 10/13/2022] [Indexed: 12/02/2022] Open
Abstract
X-linked hypophosphatemic rickets (XLH) is characterized by hypo-mineralization of the bone due to hypophosphatemia. XLH is caused by abnormally high levels of fibroblast growth factor 23, which trigger renal phosphate wasting. Activated fibroblast growth factor receptor 3 (FGFR3) signaling is considered to be involved in XLH pathology. Our previous study revealed that meclozine attenuated FGFR3 signaling and promoted longitudinal bone growth in an achondroplasia mouse model. The present study aimed to examine whether meclozine affected the bone phenotype in a mouse model of XLH [X-linked hypophosphatemic (Hyp) mice]. Meclozine was administered orally to 7-day-old Hyp mice for 10 days, after which the mice were subjected to blood sampling and histological analyses of the first coccygeal vertebra, femur and tibia. Villanueva Goldner staining was used to assess bone mineralization, hematoxylin and eosin staining was used to determine the growth plate structure and tartrate-resistant acid phosphatase staining was used to measure osteoclast activity. The osteoid volume/bone volume of cortical bone was lower in meclozine-treated Hyp mice compared with untreated Hyp mice. Meclozine treatment improved the abnormally thick hypertrophic zone of the growth plate and ameliorated the downregulation of osteoclast surface/bone surface in Hyp mice. However, meclozine had only a marginal effect on mineralization in the trabecular bone and on calcium and phosphate plasma levels. A 10-day-tratment with meclozine partially ameliorated bone mineralization in Hyp mice; hence, meclozine could alleviate XLH symptoms.
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Affiliation(s)
- Yasunari Kamiya
- Department of Orthopaedic Surgery, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan,Division of Neurogenetics, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan
| | - Masaki Matsushita
- Department of Orthopaedic Surgery, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan,Division of Neurogenetics, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan,Correspondence to: Dr Masaki Matsushita, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kenichi Mishima
- Department of Orthopaedic Surgery, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan,Division of Neurogenetics, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan
| | - Bisei Ohkawara
- Division of Neurogenetics, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan
| | - Toshimi Michigami
- Department of Bone and Mineral Research, Research Institute, Osaka Women's and Children's Hospital, Osaka Prefectural Hospital Organization, Izumi, Osaka, 594-1101, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan
| | - Kinji Ohno
- Division of Neurogenetics, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan
| | - Hiroshi Kitoh
- Department of Orthopaedic Surgery, Aichi Children's Health and Medical Center, Obu, Aichi 474-8710, Japan,Department of Comprehensive Pediatric Medicine, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan
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Ertl DA, Le Lorier J, Gleiss A, Trabado S, Bensignor C, Audrain C, Zhukouskaya V, Coutant R, Berkenou J, Rothenbuhler A, Haeusler G, Linglart A. Growth pattern in children with X-linked hypophosphatemia treated with burosumab and growth hormone. Orphanet J Rare Dis 2022; 17:412. [PMID: 36371259 PMCID: PMC9652849 DOI: 10.1186/s13023-022-02562-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/23/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND X-linked hypophosphatemia (XLH) is characterized by increased serum concentrations of fibroblast growth factor 23 (FGF23), hypophosphatemia and insufficient endogenous synthesis of calcitriol. Beside rickets, odonto- and osteomalacia, disproportionate short stature is seen in most affected individuals. Vitamin D analogs and phosphate supplements, i.e., conventional therapy, can improve growth especially when started early in life. Recombinant human growth hormone (rhGH) therapy in XLH children with short stature has positive effects, although few reports are available. Newly available treatment (burosumab) targeting increased FGF23 signaling leads to minimal improvement of growth in XLH children. So far, we lack data on the growth of XLH children treated with concomitant rhGH and burosumab therapies. RESULTS Thirty-six patients received burosumab for at least 1 year after switching from conventional therapy. Of these, 23 received burosumab alone, while the others continued rhGH therapy after switching to burosumab. Children treated with burosumab alone showed a minimal change in height SDS after 1 year (mean ± SD 0.0 ± 0.3 prepubertal vs. 0.1 ± 0.3 pubertal participants). In contrast, rhGH clearly improved height during the first year of treatment before initiating burosumab (mean ± SD of height gain 1.0 ± 0.4); patients continued to gain height during the year of combined burosumab and rhGH therapies (mean ± SD height gain 0.2 ± 0.1). As expected, phosphate serum levels normalized upon burosumab therapy. No change in serum calcium levels, urinary calcium excretion, or 25-OHD levels was seen, though 1,25-(OH)2D increased dramatically under burosumab therapy. CONCLUSION To our knowledge, this is the first study on growth under concomitant rhGH and burosumab treatments. We did not observe any safety issue in this cohort of patients which is one of the largest in Europe. Our data suggest that continuing treatment with rhGH after switching from conventional therapy to burosumab, if the height prognosis is compromised, might be beneficial for the final height.
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Affiliation(s)
- Diana-Alexandra Ertl
- grid.413784.d0000 0001 2181 7253AP-HP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Filière OSCAR and Platform of Expertise for Rare Diseases Paris-Sud, Bicêtre Paris-Saclay Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France ,grid.460789.40000 0004 4910 6535University Paris Saclay, Le Kremlin-Bicêtre, France ,grid.50550.350000 0001 2175 4109AP-HP, Department of Endocrinology and Diabetology for Children and Department of Adolescent Medicine, Bicêtre Paris-Saclay Hospital, Le Kremlin-Bicêtre, France ,grid.22937.3d0000 0000 9259 8492Department of Pediatrics and Adolescent Medicine, Division of Pulmonology, Allergology and Endocrinology, Medical University of Vienna, Vienna, Austria ,Vienna Bone and Growth Center, Vienna, Austria
| | - Justin Le Lorier
- grid.413784.d0000 0001 2181 7253AP-HP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Filière OSCAR and Platform of Expertise for Rare Diseases Paris-Sud, Bicêtre Paris-Saclay Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France ,grid.460789.40000 0004 4910 6535University Paris Saclay, Le Kremlin-Bicêtre, France ,grid.50550.350000 0001 2175 4109AP-HP, Department of Endocrinology and Diabetology for Children and Department of Adolescent Medicine, Bicêtre Paris-Saclay Hospital, Le Kremlin-Bicêtre, France
| | - Andreas Gleiss
- grid.22937.3d0000 0000 9259 8492Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Séverine Trabado
- grid.7429.80000000121866389Department of Molecular Genetics, Pharmacogenetics and Hormonology, Inserm U1185 and University Paris Saclay, AP-HP Bicêtre Paris-Saclay Hospital, Le Kremlin-Bicêtre, France
| | | | - Christelle Audrain
- grid.413784.d0000 0001 2181 7253AP-HP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Filière OSCAR and Platform of Expertise for Rare Diseases Paris-Sud, Bicêtre Paris-Saclay Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France ,grid.460789.40000 0004 4910 6535University Paris Saclay, Le Kremlin-Bicêtre, France
| | - Volha Zhukouskaya
- grid.413784.d0000 0001 2181 7253AP-HP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Filière OSCAR and Platform of Expertise for Rare Diseases Paris-Sud, Bicêtre Paris-Saclay Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France ,grid.508487.60000 0004 7885 7602Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, Platforme d´Imaginerie du Vivant (PIV), University Paris Cite, Montrouge, France ,grid.508487.60000 0004 7885 7602AP-HP Cochin Hospital, Department of Diabetology, University Paris Cite, Paris, France
| | - Régis Coutant
- grid.411147.60000 0004 0472 0283Department of Pediatric Endocrinology and Diabetes, CHU Angers, Anger, France
| | - Jugurtha Berkenou
- grid.413784.d0000 0001 2181 7253AP-HP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Filière OSCAR and Platform of Expertise for Rare Diseases Paris-Sud, Bicêtre Paris-Saclay Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France ,grid.460789.40000 0004 4910 6535University Paris Saclay, Le Kremlin-Bicêtre, France
| | - Anya Rothenbuhler
- grid.413784.d0000 0001 2181 7253AP-HP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Filière OSCAR and Platform of Expertise for Rare Diseases Paris-Sud, Bicêtre Paris-Saclay Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France ,grid.460789.40000 0004 4910 6535University Paris Saclay, Le Kremlin-Bicêtre, France ,grid.50550.350000 0001 2175 4109AP-HP, Department of Endocrinology and Diabetology for Children and Department of Adolescent Medicine, Bicêtre Paris-Saclay Hospital, Le Kremlin-Bicêtre, France
| | - Gabriele Haeusler
- grid.22937.3d0000 0000 9259 8492Department of Pediatrics and Adolescent Medicine, Division of Pulmonology, Allergology and Endocrinology, Medical University of Vienna, Vienna, Austria ,Vienna Bone and Growth Center, Vienna, Austria
| | - Agnès Linglart
- grid.413784.d0000 0001 2181 7253AP-HP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Filière OSCAR and Platform of Expertise for Rare Diseases Paris-Sud, Bicêtre Paris-Saclay Hospital, 78 Rue du Général Leclerc, 94270 Le Kremlin Bicêtre, France ,grid.460789.40000 0004 4910 6535University Paris Saclay, Le Kremlin-Bicêtre, France ,grid.50550.350000 0001 2175 4109AP-HP, Department of Endocrinology and Diabetology for Children and Department of Adolescent Medicine, Bicêtre Paris-Saclay Hospital, Le Kremlin-Bicêtre, France
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TNF overexpression and dexamethasone treatment impair chondrogenesis and bone growth in an additive manner. Sci Rep 2022; 12:18189. [PMID: 36307458 PMCID: PMC9616891 DOI: 10.1038/s41598-022-22734-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 10/19/2022] [Indexed: 12/31/2022] Open
Abstract
Children with chronic inflammation are often treated with glucocorticoids (GCs) and many of them experience growth retardation. It is poorly understood how GCs interact with inflammatory cytokines causing growth failure as earlier experimental studies have been performed in healthy animals. To address this gap of knowledge, we used a transgenic mouse model where human TNF is overexpressed (huTNFTg) leading to chronic polyarthritis starting from the first week of age. Our results showed that femur bone length and growth plate height were significantly decreased in huTNFTg mice compared to wild type animals. In the growth plates of huTNFTg mice, increased apoptosis, suppressed Indian hedgehog, decreased hypertrophy, and disorganized chondrocyte columns were observed. Interestingly, the GC dexamethasone further impaired bone growth, accelerated chondrocyte apoptosis and reduced the number of chondrocyte columns in huTNFTg mice. We conclude that TNF and dexamethasone separately suppress chondrogenesis and bone growth when studied in an animal model of chronic inflammation. Our data give a possible mechanistic explanation to the commonly observed growth retardation in children with chronic inflammatory diseases treated with GCs.
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Jurca CM, Iuhas O, Kozma K, Petchesi CD, Zaha DC, Bembea M, Jurca S, Paul C, Jurca AD. Effects of Burosumab Treatment on Two Siblings with X-Linked Hypophosphatemia. Case Report and Literature Review. Genes (Basel) 2022; 13:genes13081392. [PMID: 36011303 PMCID: PMC9407333 DOI: 10.3390/genes13081392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
X-linked hypophosphatemia (XLH) or vitamin D-resistant rickets (MIM#307800), is a monogenic disorder with X-linked inheritance. It is caused by mutations present in the Phosphate Regulating Endopeptidase Homolog X-Linked (PHEX) gene responsible for the degradation of the bone-derived hormone fibroblast growth factor 23 (FGF23) into inactive fragments, but the entire mechanism is currently unclear. The inactivation of the gene prevents the degradation of FGF23, causing increased levels of FGF23, which leads to decreased tubular reabsorbtion of phosphorus. Clinical aspects are growth delay, limb deformities, bone pain, osteomalacia, dental anomalies, and enthesopathy. Laboratory evaluation shows hypophosphatemia, elevated alkaline phosphatase (ALP), and normal serum calcium levels, whereas parathormone (PTH) may be normal or increased and FGF23 greatly increased. Conventional treatment consists of administration of oral phosphate and calcitriol. Treatment with Burosumab, a monoclonal antibody that binds to FGF23, reducing its activity, was approved in 2018. Methods. We describe a case of two siblings, a girl and a boy, diagnosed with XLH, monitored by the Genetic Department of the County Emergency Clinical Hospital since 2019. The clinical picture is suggestive for XLH, both siblings exhibiting short stature, lower limb curvature, bone pain, marked walking weakness, and fatigue. Radiological aspects showed marked deformity of the lower limbs: genu varum in the girl, genu varum and valgum in the boy. Laboratory investigations showed hypophosphathemia, hyperphosphaturia, elevated ALP, normal PTH, and highly increased FGF23 in both. DNA analysis performed on the two siblings revealed a nonsense mutation in exone 5 of the PHEX gene: NM_000444.6(PHEX):c.565C > T (p.Gln189Ter). Results. At the age of 13½ on 7 June 2021, the two children started treatment with Burosumab in therapeutic doses and were monitored clinically and biochemically at regular intervals according to the protocol established by the Endocrinology Commission of the Romanian Health Ministry. Conclusions. The first results of the Burosumab treatment in the two siblings are extremely encouraging and suggest a favorable long-term evolution under this treatment.
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Affiliation(s)
- Claudia Maria Jurca
- Faculty of Medicine and Pharmacy, Department of Preclinical Disciplines, 1 December Sq., University of Oradea, 410081 Oradea, Romania
- Regional Center of Medical Genetics Bihor, County Emergency Clinical Hospital Oradea, Romania, (Part of ERN THACA), 410469 Oradea, Romania
| | - Oana Iuhas
- Regional Center of Medical Genetics Bihor, County Emergency Clinical Hospital Oradea, Romania, (Part of ERN THACA), 410469 Oradea, Romania
| | - Kinga Kozma
- Faculty of Medicine and Pharmacy, Department of Preclinical Disciplines, 1 December Sq., University of Oradea, 410081 Oradea, Romania
- Regional Center of Medical Genetics Bihor, County Emergency Clinical Hospital Oradea, Romania, (Part of ERN THACA), 410469 Oradea, Romania
| | - Codruta Diana Petchesi
- Faculty of Medicine and Pharmacy, Department of Preclinical Disciplines, 1 December Sq., University of Oradea, 410081 Oradea, Romania
- Correspondence:
| | - Dana Carmen Zaha
- Faculty of Medicine and Pharmacy, Department of Preclinical Disciplines, 1 December Sq., University of Oradea, 410081 Oradea, Romania
| | - Marius Bembea
- Faculty of Medicine and Pharmacy, Department of Preclinical Disciplines, 1 December Sq., University of Oradea, 410081 Oradea, Romania
| | - Sanziana Jurca
- Faculty of Medicine and Pharmacy, Department of Preclinical Disciplines, 1 December Sq., University of Oradea, 410081 Oradea, Romania
| | - Corina Paul
- Department of Pediatrics, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Alexandru Daniel Jurca
- Faculty of Medicine and Pharmacy, Department of Preclinical Disciplines, 1 December Sq., University of Oradea, 410081 Oradea, Romania
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7
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Pathogenesis of FGF23-Related Hypophosphatemic Diseases Including X-linked Hypophosphatemia. ENDOCRINES 2022. [DOI: 10.3390/endocrines3020025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Since phosphate is indispensable for skeletal mineralization, chronic hypophosphatemia causes rickets and osteomalacia. Fibroblast growth factor 23 (FGF23), which is mainly produced by osteocytes in bone, functions as the central regulator of phosphate metabolism by increasing the renal excretion of phosphate and suppressing the production of 1,25-dihydroxyvitamin D. The excessive action of FGF23 results in hypophosphatemic diseases, which include a number of genetic disorders such as X-linked hypophosphatemic rickets (XLH) and tumor-induced osteomalacia (TIO). Phosphate-regulating gene homologous to endopeptidase on the X chromosome (PHEX), dentin matrix protein 1 (DMP1), ectonucleotide pyrophosphatase phosphodiesterase-1, and family with sequence similarity 20c, the inactivating variants of which are responsible for FGF23-related hereditary rickets/osteomalacia, are highly expressed in osteocytes, similar to FGF23, suggesting that they are local negative regulators of FGF23. Autosomal dominant hypophosphatemic rickets (ADHR) is caused by cleavage-resistant variants of FGF23, and iron deficiency increases serum levels of FGF23 and the manifestation of symptoms in ADHR. Enhanced FGF receptor (FGFR) signaling in osteocytes is suggested to be involved in the overproduction of FGF23 in XLH and autosomal recessive hypophosphatemic rickets type 1, which are caused by the inactivation of PHEX and DMP1, respectively. TIO is caused by the overproduction of FGF23 by phosphaturic tumors, which are often positive for FGFR. FGF23-related hypophosphatemia may also be associated with McCune-Albright syndrome, linear sebaceous nevus syndrome, and the intravenous administration of iron. This review summarizes current knowledge on the pathogenesis of FGF23-related hypophosphatemic diseases.
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Fuente R, García-Bengoa M, Fernández-Iglesias Á, Gil-Peña H, Santos F, López JM. Cellular and Molecular Alterations Underlying Abnormal Bone Growth in X-Linked Hypophosphatemia. Int J Mol Sci 2022; 23:ijms23020934. [PMID: 35055123 PMCID: PMC8778463 DOI: 10.3390/ijms23020934] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 12/21/2022] Open
Abstract
X-linked hypophosphatemia (XLH), the most common form of hereditary hypophosphatemic rickets, is caused by inactivating mutations of the phosphate-regulating endopeptidase gene (PHEX). XLH is mainly characterized by short stature, bone deformities and rickets, while in hypophosphatemia, normal or low vitamin D levels and low renal phosphate reabsorption are the principal biochemical aspects. The cause of growth impairment in patients with XLH is not completely understood yet, thus making the study of the growth plate (GP) alterations necessary. New treatment strategies targeting FGF23 have shown promising results in normalizing the growth velocity and improving the skeletal effects of XLH patients. However, further studies are necessary to evaluate how this treatment affects the GP as well as its long-term effects and the impact on adult height.
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Affiliation(s)
- Rocío Fuente
- Division of Pediatrics, Department of Medicine, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain; (R.F.); (M.G.-B.); (Á.F.-I.); (H.G.-P.); (F.S.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Institute of Physiology, Center for Integrative Human Physiology (ZIHP), University of Zurich, Winterthurerstrasse 190, CH-8057 Zurich, Switzerland
| | - María García-Bengoa
- Division of Pediatrics, Department of Medicine, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain; (R.F.); (M.G.-B.); (Á.F.-I.); (H.G.-P.); (F.S.)
- Research Center for Emerging Infections and Zoonoses (RIZ), University of Veterinary Medicine Hannover, 30559 Hanover, Germany
| | - Ángela Fernández-Iglesias
- Division of Pediatrics, Department of Medicine, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain; (R.F.); (M.G.-B.); (Á.F.-I.); (H.G.-P.); (F.S.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Helena Gil-Peña
- Division of Pediatrics, Department of Medicine, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain; (R.F.); (M.G.-B.); (Á.F.-I.); (H.G.-P.); (F.S.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Department of Pediatrics, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
| | - Fernando Santos
- Division of Pediatrics, Department of Medicine, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain; (R.F.); (M.G.-B.); (Á.F.-I.); (H.G.-P.); (F.S.)
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Department of Pediatrics, Hospital Universitario Central de Asturias (HUCA), 33011 Oviedo, Spain
| | - José Manuel López
- Department of Morphology and Cellular Biology, Faculty of Medicine, University of Oviedo, 33006 Oviedo, Spain
- Correspondence:
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9
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Zhukouskaya VV, Jauze L, Charles S, Leborgne C, Hilliquin S, Sadoine J, Slimani L, Baroukh B, van Wittenberghe L, Danièle N, Rajas F, Linglart A, Mingozzi F, Chaussain C, Bardet C, Ronzitti G. A novel therapeutic strategy for skeletal disorders: Proof of concept of gene therapy for X-linked hypophosphatemia. SCIENCE ADVANCES 2021; 7:eabj5018. [PMID: 34705504 PMCID: PMC8550245 DOI: 10.1126/sciadv.abj5018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/03/2021] [Indexed: 06/13/2023]
Abstract
Adeno-associated virus (AAV) vectors are a well-established gene transfer approach for rare genetic diseases. Nonetheless, some tissues, such as bone, remain refractory to AAV. X-linked hypophosphatemia (XLH) is a rare skeletal disorder associated with increased levels of fibroblast growth factor 23 (FGF23), resulting in skeletal deformities and short stature. The conventional treatment for XLH, lifelong phosphate and active vitamin D analogs supplementation, partially improves quality of life and is associated with severe long-term side effects. Recently, a monoclonal antibody against FGF23 has been approved for XLH but remains a high-cost lifelong therapy. We developed a liver-targeting AAV vector to inhibit FGF23 signaling. We showed that hepatic expression of the C-terminal tail of FGF23 corrected skeletal manifestations and osteomalacia in a XLH mouse model. Our data provide proof of concept for AAV gene transfer to treat XLH, a prototypical bone disease, further expanding the use of this modality to treat skeletal disorders.
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Affiliation(s)
- Volha V. Zhukouskaya
- Genethon, 91000 Evry, France
- Université Paris-Saclay, Univ Evry, Inserm, Genethon, INTEGRARE Research Unit UMR_S951, 91000 Evry, France
- Université de Paris, Institut des maladies musculo-squelettiques, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), Montrouge, France
- Paris-Saclay University, INSERM U1185, AP-HP, DMU SEA, Endocrinology and Diabetes for Children, Reference Center for Rare Diseases of the Calcium and Phosphate Metabolism, OSCAR filière, EndoRare, and BOND ERN, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Louisa Jauze
- Genethon, 91000 Evry, France
- Université Paris-Saclay, Univ Evry, Inserm, Genethon, INTEGRARE Research Unit UMR_S951, 91000 Evry, France
- Institut National de la Santé et de la Recherche Médicale, U1213, Lyon F-69008, France
| | - Séverine Charles
- Genethon, 91000 Evry, France
- Université Paris-Saclay, Univ Evry, Inserm, Genethon, INTEGRARE Research Unit UMR_S951, 91000 Evry, France
| | - Christian Leborgne
- Genethon, 91000 Evry, France
- Université Paris-Saclay, Univ Evry, Inserm, Genethon, INTEGRARE Research Unit UMR_S951, 91000 Evry, France
| | - Stéphane Hilliquin
- Université de Paris, Institut des maladies musculo-squelettiques, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), Montrouge, France
- AP-HP, Department of Rheumatology, Cochin Hospital, Université de Paris, Paris, France
| | - Jérémy Sadoine
- Université de Paris, Institut des maladies musculo-squelettiques, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), Montrouge, France
| | - Lotfi Slimani
- Université de Paris, Institut des maladies musculo-squelettiques, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), Montrouge, France
| | - Brigitte Baroukh
- Université de Paris, Institut des maladies musculo-squelettiques, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), Montrouge, France
| | | | | | - Fabienne Rajas
- Institut National de la Santé et de la Recherche Médicale, U1213, Lyon F-69008, France
| | - Agnès Linglart
- Paris-Saclay University, INSERM U1185, AP-HP, DMU SEA, Endocrinology and Diabetes for Children, Reference Center for Rare Diseases of the Calcium and Phosphate Metabolism, OSCAR filière, EndoRare, and BOND ERN, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Federico Mingozzi
- Genethon, 91000 Evry, France
- Université Paris-Saclay, Univ Evry, Inserm, Genethon, INTEGRARE Research Unit UMR_S951, 91000 Evry, France
| | - Catherine Chaussain
- Université de Paris, Institut des maladies musculo-squelettiques, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), Montrouge, France
- Paris-Saclay University, INSERM U1185, AP-HP, DMU SEA, Endocrinology and Diabetes for Children, Reference Center for Rare Diseases of the Calcium and Phosphate Metabolism, OSCAR filière, EndoRare, and BOND ERN, Bicêtre Hospital, Le Kremlin-Bicêtre, France
- AP-HP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Dental Medicine Department, Bretonneau Hospital, GHN-Université de Paris, Paris 75018, France
| | - Claire Bardet
- Université de Paris, Institut des maladies musculo-squelettiques, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), Montrouge, France
| | - Giuseppe Ronzitti
- Genethon, 91000 Evry, France
- Université Paris-Saclay, Univ Evry, Inserm, Genethon, INTEGRARE Research Unit UMR_S951, 91000 Evry, France
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10
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Fuente R, Gehring N, Bettoni C, Gil-Peña H, Alonso-Durán L, Michalke B, Santos F, Wagner CA, Rubio-Aliaga I. Systemic Jak1 activation causes extrarenal calcitriol production and skeletal alterations provoking stunted growth. FASEB J 2021; 35:e21721. [PMID: 34118090 DOI: 10.1096/fj.202100587r] [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] [Received: 04/06/2021] [Revised: 05/12/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023]
Abstract
Mineral homeostasis is regulated by a complex network involving endocrine actions by calcitriol, parathyroid hormone (PTH), and FGF23 on several organs including kidney, intestine, and bone. Alterations of mineral homeostasis are found in chronic kidney disease and other systemic disorders. The interplay between the immune system and the skeletal system is not fully understood, but cytokines play a major role in modulating calcitriol production and function. One of the main cellular signaling pathways mediating cytokine function is the Janus kinase (JAK)--signal transducer and activator of transcription (STAT) pathway. Here, we used a mouse model (Jak1S645P+/- ) that resembles a constitutive activating mutation of the Jak1/Stat3 signaling pathway in humans, and shows altered mineral metabolism, with higher fibroblast growth factor 23 (FGF23) levels, lower PTH levels, and higher calcitriol levels. The higher calcitriol levels are probably due to extrarenal calcitriol production. Furthermore, systemic Jak1/Stat3 activation led to growth impairment and skeletal alterations. The growth plate in long bones showed decreased chondrocyte proliferation rates and reduced height of terminal chondrocytes. Furthermore, we demonstrate that Jak1 is also involved in bone remodeling early in life. Jak1S645P+/- animals have decreased bone and cortical volume, imbalanced bone remodeling, reduced MAP kinase signaling, and local inflammation. In conclusion, Jak1 plays a major role in bone health probably both, directly and systemically by regulating mineral homeostasis. Understanding the role of this signaling pathway will contribute to a better knowledge in bone growth and in mineral physiology, and to the development of selective Jak inhibitors as osteoprotective agents.
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Affiliation(s)
- Rocío Fuente
- Institute of Physiology, University of Zurich, Zurich, Switzerland.,National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland.,Division of Pediatrics, University of Oviedo, Oviedo, Spain
| | - Nicole Gehring
- Institute of Physiology, University of Zurich, Zurich, Switzerland.,National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
| | - Carla Bettoni
- Institute of Physiology, University of Zurich, Zurich, Switzerland.,National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
| | | | | | - Bernhard Michalke
- Department of Environmental Science, Research Unit Analytical, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Fernando Santos
- Division of Pediatrics, University of Oviedo, Oviedo, Spain.,Department of Pediatrics, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Carsten A Wagner
- Institute of Physiology, University of Zurich, Zurich, Switzerland.,National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
| | - Isabel Rubio-Aliaga
- Institute of Physiology, University of Zurich, Zurich, Switzerland.,National Center of Competence in Research NCCR Kidney.CH, Zurich, Switzerland
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11
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Liu F, Kong A, Fu P, Cao QQ, Tao KS, Liu DY, Wang XB, Tong ZX, Rehman MU, Huang SC. Lactobacillus rhamnosus JYLR-005 Prevents Thiram-Induced Tibial Dyschondroplasia by Enhancing Bone-Related Growth Performance in Chickens. Probiotics Antimicrob Proteins 2021; 13:19-31. [PMID: 32504282 DOI: 10.1007/s12602-020-09670-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Tibial dyschondroplasia (TD) is a leg disorder caused by the abnormal development of the tibia in fast-growing poultry. Lactobacillus rhamnosus (L. rhamnosus) strains have been reported to have effects on increasing bone growth and improving osteoporosis in animals. However, whether L. rhamnosus JYLR-005 can improve bone growth in TD chickens remains unclear. In this study, we noted that L. rhamnosus JYLR-005 could not reduce the suppression of the production performance of TD broilers (p > 0.05) but had a slight protective effect on the broiler survival rate (χ2 = 5.571, p = 0.062). However, for thiram-induced TD broiler chickens, L. rhamnosus JYLR-005 could promote tibia growth by increasing tibia-related parameters, including the tibia weight (day 11, p = 0.040), tibia length (day 15, p = 0.013), and tibia mean diameter (day 15, p = 0.035). Moreover, L. rhamnosus JYLR-005 supplementation improved the normal growth and development of the tibial growth plate by maintaining the morphological structure of the chondrocytes and restored the balance of calcium and phosphorus. Taken together, these findings provide a proof of principle that L. rhamnosus JYLR-005 may represent a therapeutic strategy to treat leg disease in chickens.
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Affiliation(s)
- Fang Liu
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, 95# Wenhua Road, Jinshui District, Zhengzhou, 450002, Henan, People's Republic of China
| | - Anan Kong
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, 95# Wenhua Road, Jinshui District, Zhengzhou, 450002, Henan, People's Republic of China
| | - Pengfei Fu
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, 95# Wenhua Road, Jinshui District, Zhengzhou, 450002, Henan, People's Republic of China
| | - Qin-Qin Cao
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, 95# Wenhua Road, Jinshui District, Zhengzhou, 450002, Henan, People's Republic of China
| | - Kun-Sheng Tao
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, 95# Wenhua Road, Jinshui District, Zhengzhou, 450002, Henan, People's Republic of China
| | - Di-Yi Liu
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, 95# Wenhua Road, Jinshui District, Zhengzhou, 450002, Henan, People's Republic of China
| | - Xue-Bing Wang
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, 95# Wenhua Road, Jinshui District, Zhengzhou, 450002, Henan, People's Republic of China
| | - Zong-Xi Tong
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, 95# Wenhua Road, Jinshui District, Zhengzhou, 450002, Henan, People's Republic of China
| | - Mujeeb Ur Rehman
- Research Center of Avian Disease, College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, People's Republic of China
| | - Shu-Cheng Huang
- College of Animal Science and Veterinary Medicine, Henan Agricultural University, 95# Wenhua Road, Jinshui District, Zhengzhou, 450002, Henan, People's Republic of China.
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12
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Cauliez A, Zhukouskaya VV, Hilliquin S, Sadoine J, Slimani L, Miceli-Richard C, Briot K, Linglart A, Chaussain C, Bardet C. Impact of Early Conventional Treatment on Adult Bone and Joints in a Murine Model of X-Linked Hypophosphatemia. Front Cell Dev Biol 2021; 8:591417. [PMID: 33681179 PMCID: PMC7930336 DOI: 10.3389/fcell.2020.591417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022] Open
Abstract
X-linked hypophosphatemia (XLH) is the most common form of genetic rickets. Mainly diagnosed during childhood because of growth retardation and deformities of the lower limbs, the disease affects adults with early enthesopathies and joint structural damage that significantly alter patient quality of life. The conventional treatment, based on phosphorus supplementation and active vitamin D analogs, is commonly administered from early childhood to the end of growth; unfortunately, it does not allow complete recovery from skeletal damage. Despite adequate treatment during childhood, bone and joint complications occur in adults and become a dominant feature in the natural history of the disease. Our previous data showed that the Hyp mouse is a relevant model of XLH for studying early enthesophytes and joint structural damage. Here, we studied the effect of conventional treatment on the development of bone and joint alterations in this mouse model during growth and young adulthood. Mice were supplemented with oral phosphorus and calcitriol injections, following two timelines: (i) from weaning to 3 months of age and (ii) from 2 to 3 months to evaluate the effects of treatment on the development of early enthesophytes and joint alterations, and on changes in bone and joint deformities already present, respectively. We showed that early conventional treatment improved bone microarchitecture, and partially prevented bone and joint complications, but with no noticeable improvement in enthesophytes. In contrast, later administration had limited efficacy in ameliorating bone and joint alterations. Despite the improvement in bone microarchitecture, the conventional treatment, early or late, had no effect on osteoid accumulation. Our data underline the usefulness of the Hyp murine model for preclinical studies on skeletal and extraskeletal lesions. Although the early conventional treatment is important for the improvement of bone microarchitecture, the persistence of osteomalacia implies seeking new therapeutic strategies, in particular anti-FGF23 approach, in order to optimize the treatment of XLH.
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Affiliation(s)
- Axelle Cauliez
- Université de Paris, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP 2496 and FHU-DDS-Net, Dental School, and Plateforme d'Imagerie du Vivant (PIV), Montrouge, France
| | - Volha V Zhukouskaya
- Université de Paris, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP 2496 and FHU-DDS-Net, Dental School, and Plateforme d'Imagerie du Vivant (PIV), Montrouge, France.,INTEGRARE, Genethon, Inserm, Université d'Evry, Université Paris-Saclay, Evry, France.,Centre de référence des maladies rares du métabolisme du calcium et du phosphate, Plateforme d'expertise maladies rares Paris Saclay, filière OSCAR, EndoRare and BOND ERN, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Stéphane Hilliquin
- Université de Paris, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP 2496 and FHU-DDS-Net, Dental School, and Plateforme d'Imagerie du Vivant (PIV), Montrouge, France.,Department of Rheumatology, Cochin Hospital, Université de Paris, Paris, France
| | - Jérémy Sadoine
- Université de Paris, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP 2496 and FHU-DDS-Net, Dental School, and Plateforme d'Imagerie du Vivant (PIV), Montrouge, France
| | - Lotfi Slimani
- Université de Paris, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP 2496 and FHU-DDS-Net, Dental School, and Plateforme d'Imagerie du Vivant (PIV), Montrouge, France
| | | | - Karine Briot
- Centre de référence des maladies rares du métabolisme du calcium et du phosphate, Plateforme d'expertise maladies rares Paris Saclay, filière OSCAR, EndoRare and BOND ERN, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,Department of Rheumatology, Cochin Hospital, Université de Paris, Paris, France
| | - Agnès Linglart
- Centre de référence des maladies rares du métabolisme du calcium et du phosphate, Plateforme d'expertise maladies rares Paris Saclay, filière OSCAR, EndoRare and BOND ERN, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,Université Paris-Saclay, AP-HP, Service d'endocrinologie et diabète de l'enfant, Service de médecine des adolescents, Hôpital de Bicêtre, INSERM U1185, Le Kremlin-Bicêtre, France
| | - Catherine Chaussain
- Université de Paris, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP 2496 and FHU-DDS-Net, Dental School, and Plateforme d'Imagerie du Vivant (PIV), Montrouge, France.,Centre de référence des maladies rares du métabolisme du calcium et du phosphate, Plateforme d'expertise maladies rares Paris Saclay, filière OSCAR, EndoRare and BOND ERN, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.,AP-HP Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Dental Medicine Department, Bretonneau Hospital, GHN, Paris, France
| | - Claire Bardet
- Université de Paris, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP 2496 and FHU-DDS-Net, Dental School, and Plateforme d'Imagerie du Vivant (PIV), Montrouge, France
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13
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Robinson ME, AlQuorain H, Murshed M, Rauch F. Mineralized tissues in hypophosphatemic rickets. Pediatr Nephrol 2020; 35:1843-1854. [PMID: 31392510 DOI: 10.1007/s00467-019-04290-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 06/03/2019] [Accepted: 06/06/2019] [Indexed: 12/19/2022]
Abstract
Hypophosphatemic rickets is caused by renal phosphate wasting that is most commonly due to X-linked dominant mutations in PHEX. PHEX mutations cause hypophosphatemia indirectly, through the increased expression of fibroblast growth factor 23 (FGF23) by osteocytes. FGF23 decreases renal phosphate reabsorption and thereby increases phosphate excretion. The lack of phosphate leads to a mineralization defect at the level of growth plates (rickets), bone tissue (osteomalacia), and teeth, where the defect facilitates the formation of abscesses. The bone tissue immediately adjacent to osteocytes often remains unmineralized ("periosteocytic lesions"), highlighting the osteocyte defect in this disorder. Common clinical features of XLH include deformities of the lower extremities, short stature, enthesopathies, dental abscesses, as well as skull abnormalities such as craniosynostosis and Chiari I malformation. For the past four decades, XLH has been treated by oral phosphate supplementation and calcitriol, which improves rickets and osteomalacia and the dental manifestations, but often does not resolve all aspects of the mineralization defects. A newer treatment approach using inactivating FGF23 antibodies leads to more stable control of serum inorganic phosphorus levels and seems to heal rickets more reliably. However, the long-term benefits of FGF23 antibody treatment remain to be elucidated.
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Affiliation(s)
- Marie-Eve Robinson
- Shriners Hospital for Children and McGill University, 1003 Boulevard Decarie, Montreal, Québec, H4A 0A9, Canada
| | - Haitham AlQuorain
- Shriners Hospital for Children and McGill University, 1003 Boulevard Decarie, Montreal, Québec, H4A 0A9, Canada
| | - Monzur Murshed
- Shriners Hospital for Children and McGill University, 1003 Boulevard Decarie, Montreal, Québec, H4A 0A9, Canada
| | - Frank Rauch
- Shriners Hospital for Children and McGill University, 1003 Boulevard Decarie, Montreal, Québec, H4A 0A9, Canada.
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14
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Fernández-Iglesias Á, Fuente R, Gil-Peña H, Alonso-Durán L, García-Bengoa M, Santos F, López JM. Innovative Three-Dimensional Microscopic Analysis of Uremic Growth Plate Discloses Alterations in the Process of Chondrocyte Hypertrophy: Effects of Growth Hormone Treatment. Int J Mol Sci 2020; 21:ijms21124519. [PMID: 32630463 PMCID: PMC7350242 DOI: 10.3390/ijms21124519] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/21/2020] [Accepted: 06/23/2020] [Indexed: 12/30/2022] Open
Abstract
Chronic kidney disease (CKD) alters the morphology and function of the growth plate (GP) of long bones by disturbing chondrocyte maturation. GP chondrocytes were analyzed in growth-retarded young rats with CKD induced by adenine intake (AD), control rats fed ad libitum (C) or pair-fed with the AD group (PF), and CKD rats treated with growth hormone (ADGH). In order to study the alterations in the process of GP maturation, we applied a procedure recently described by our group to obtain high-quality three-dimensional images of whole chondrocytes that can be used to analyze quantitative parameters like cytoplasm density, cell volume, and shape. The final chondrocyte volume was found to be decreased in AD rats, but GH treatment was able to normalize it. The pattern of variation in the cell cytoplasm density suggests that uremia could be causing a delay to the beginning of the chondrocyte hypertrophy process. Growth hormone treatment appears to be able to compensate for this disturbance by triggering an early chondrocyte enlargement that may be mediated by Nkcc1 action, an important membrane cotransporter in the GP chondrocyte enlargement.
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Affiliation(s)
- Ángela Fernández-Iglesias
- Division of Pediatrics, Department of Medicine, Faculty of Medicine, University of Oviedo, CP 33006 Oviedo, Asturias, Spain; (A.F.-I.); (R.F.); (H.G.-P.); (L.A.-D.); (M.G.-B.); (J.M.L.)
- Instituto de Investigación sanitaria del Principado de Asturias (ISPA), 33012 Oviedo, Spain
| | - Rocío Fuente
- Division of Pediatrics, Department of Medicine, Faculty of Medicine, University of Oviedo, CP 33006 Oviedo, Asturias, Spain; (A.F.-I.); (R.F.); (H.G.-P.); (L.A.-D.); (M.G.-B.); (J.M.L.)
| | - Helena Gil-Peña
- Division of Pediatrics, Department of Medicine, Faculty of Medicine, University of Oviedo, CP 33006 Oviedo, Asturias, Spain; (A.F.-I.); (R.F.); (H.G.-P.); (L.A.-D.); (M.G.-B.); (J.M.L.)
- Instituto de Investigación sanitaria del Principado de Asturias (ISPA), 33012 Oviedo, Spain
- Department of Pediatrics, Hospital Universitario Central de Asturias (HUCA), 33013 Oviedo, Asturias, Spain
| | - Laura Alonso-Durán
- Division of Pediatrics, Department of Medicine, Faculty of Medicine, University of Oviedo, CP 33006 Oviedo, Asturias, Spain; (A.F.-I.); (R.F.); (H.G.-P.); (L.A.-D.); (M.G.-B.); (J.M.L.)
- Instituto de Investigación sanitaria del Principado de Asturias (ISPA), 33012 Oviedo, Spain
| | - María García-Bengoa
- Division of Pediatrics, Department of Medicine, Faculty of Medicine, University of Oviedo, CP 33006 Oviedo, Asturias, Spain; (A.F.-I.); (R.F.); (H.G.-P.); (L.A.-D.); (M.G.-B.); (J.M.L.)
| | - Fernando Santos
- Division of Pediatrics, Department of Medicine, Faculty of Medicine, University of Oviedo, CP 33006 Oviedo, Asturias, Spain; (A.F.-I.); (R.F.); (H.G.-P.); (L.A.-D.); (M.G.-B.); (J.M.L.)
- Instituto de Investigación sanitaria del Principado de Asturias (ISPA), 33012 Oviedo, Spain
- Department of Pediatrics, Hospital Universitario Central de Asturias (HUCA), 33013 Oviedo, Asturias, Spain
- Correspondence: ; Tel.: +34-985102728
| | - José Manuel López
- Division of Pediatrics, Department of Medicine, Faculty of Medicine, University of Oviedo, CP 33006 Oviedo, Asturias, Spain; (A.F.-I.); (R.F.); (H.G.-P.); (L.A.-D.); (M.G.-B.); (J.M.L.)
- Department of Morphology and Cellular Biology, Faculty of Medicine, University of Oviedo, CP 33006 Oviedo, Asturias, Spain
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15
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Abstract
Metabolic skeletal dysplasias comprise an extensive group of diseases capable of causing changes, usually progressive, in the bone and are due to hereditary disorders in many cases. The diagnosis and treatment of these diseases are not without difficulty, both because of their rarity and their possible confusion with more common diseases. A paradigmatic case of these metabolic skeletal dysplasias is X-linked hypophosphataemic rickets, which causes phosphaturia, a condition that alters the phosphate-calcium metabolism balance consequently causing, among other conditions, skeletal deformities and short stature. The genetic advances in recent years allow a much more accurate diagnosis of this disease when suspected, making differential diagnosis easier with similar entities but whose real causes are different. A better understanding of the phosphate-calcium metabolism allows us to replace the symptomatic treatment currently available with one that involves rebalancing the excess of fibroblast growth factor 23 (FGF23) by using monoclonal antibodies. In November 2018, a symposium sponsored by Kyowa Kirin Pharmaceuticals took place in Madrid, in which national and international experts addressed several aspects of these rare kidney diseases. Some topics addressed were the present and future genetic diagnosis, the use of multi-gene panels in renal or skeletal diseases, the role of animal models to better understand underlying skeletal changes, and the role of conventional radiology and surgery in the diagnosis and final treatment of bone deformities; all these without forgetting the important role of FGF23 and Klotho imbalances that result in the genetic change causing this disease. The optimization and limitations of conventional treatments currently available was also a topic addressed extensively, as well as the implications that new treatments against FGF23 could have in the future. This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by the author.
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Affiliation(s)
- Antonio González-Meneses López
- Unidad de Dismorfología, Unidad de Gestión Clínica de Pediatría, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
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16
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Abstract
X-linked hypophosphataemia (XLH) is the most prevalent form of hereditary rickets characterized by an alteration of phosphate metabolism which frequently leads to the appearance of fractures, bone deformities and growth delay. Although the mechanism of growth impairment in patients with XLH still needs to be clarified, it is known that this alteration is not due to genetic or endocrine factors. A potential explanation for the impairment of growth in this disease is the alteration of the growth plate, a structure responsible for longitudinal growth of bones. Some of the findings in the growth plate of patients with XLH include atypical organization of chondrocytes due to low rates of proliferation and apoptosis and disturbance of chondrocyte hypertrophy, overactivation of the mitogen-activated protein kinase (MAPK) signalling pathway and upregulation of phosphorylated extracellular signal-regulated kinase (pERK). Conventional treatment of XLH (consisting of oral phosphate supplements and active vitamin D analogues) is often insufficient for the longitudinal growth of bone, but other strategies based on recombinant growth hormone or therapies targeting fibroblast growth factor 23 (FGF23) or its receptor, such as burosumab, have shown promising results. This article briefly describes the relationship between XLH and growth retardation, and how to address this alteration in patients with XLH.
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Affiliation(s)
- Fernando Santos Rodríguez
- Unidad de Nefrología Pediátrica, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain.
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17
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A simple method based on confocal microscopy and thick sections recognizes seven subphases in growth plate chondrocytes. Sci Rep 2020; 10:6935. [PMID: 32332842 PMCID: PMC7181680 DOI: 10.1038/s41598-020-63978-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/08/2020] [Indexed: 12/23/2022] Open
Abstract
This manuscript reports a novel procedure to imaging growth plate chondrocytes by using confocal microscopy. The method is based on fixed undecalcified bone samples, in-block staining with eosin, epoxy resin embedding and grinding to obtain thick sections. It is simple, inexpensive and provides three-dimensional images of entire chondrocytes inside their native lacunae. Quantitative analysis of volume, shape and cytoplasm density of chondrocytes at different strata of the growth plate allowed to objectively grade chondrocytes of the growth plate in seven different clusters. These seven categories of chondrocytes were subsequently evaluated by immunohistochemistry of some well-defined molecular landmarks of chondrocyte differentiation. Furthermore, immunohistochemical analysis of proteins responsible for ionic changes and water transport allowing chondrocyte swelling during hypertrophy was also performed. Results obtained indicate that four subphases can be defined in the pre-hypertrophic zone and three subphases in the hypertrophic zone, a fact that raises that chondrocytes of the growth plate are less homogeneous than usually considered when different zones are defined according to subjective cell morphological criteria. Results in the present study provide a technological innovation and gives new insights into the complexity of the process of chondrocyte differentiation in the growth plate.
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Li H, Jing Y, Zhang R, Zhang Q, Wang J, Martin A, Feng JQ. Hypophosphatemic rickets accelerate chondrogenesis and cell trans-differentiation from TMJ chondrocytes into bone cells via a sharp increase in β-catenin. Bone 2020; 131:115151. [PMID: 31751752 PMCID: PMC6930687 DOI: 10.1016/j.bone.2019.115151] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/06/2019] [Accepted: 11/08/2019] [Indexed: 02/05/2023]
Abstract
Dentin matrix protein 1 (DMP1) is primarily expressed in osteocytes, although a low level of DMP1 is also detected in chondrocytes. Removing Dmp1 in mice or a mutation in humans leads to hypophosphatemic rickets (identical to X-linked hypophosphatemia). The deformed skeletons were currently thought to be a consequence of an inhibition of chondrogenesis (leading to an accumulation of hypertrophic chondrocytes and a failure in the replacement of cartilage by bone). To precisely study the mechanisms by which DMP1 and phosphorus control temporomandibular condyle formation, we first showed severe malformed condylar phenotypes in Dmp1-null mice (great expansions of deformed cartilage layers and subchondral bone), which worst as aging. Next, we excluded the direct role of DMP1 in condylar hypertrophic-chondrogenesis by conditionally deleting Dmp1 in hypertrophic chondrocytes using Col10a1-Cre and Dmp1 loxP mice (displaying no apparent phosphorous changes and condylar phenotype). To address the mechanism by which the onset of endochondral phenotypes takes place, we generated two sets of tracing lines in the Dmp1 KO background: AggrecanCreERT2-ROSA-tdTomato and Col 10a1-Cre-ROSA-tdTomato, respectively. Both tracing lines displayed an acceleration of chondrogenesis and cell trans-differentiation from chondrocytes into bone cells in the Dmp1 KO. Next, we showed that administrations of neutralizing fibroblast growth factor 23 (FGF23) antibodies in Dmp1-null mice restored hypophosphatemic condylar cartilage phenotypes. In further addressing the rescue mechanism, we generated compound mice containing Col10a1-Cre with ROSA-tdTomato and Dmp1 KO lines with and without a high Pi diet starting at day 10 for 39 days. We demonstrated that hypophosphatemia leads to an acceleration of chondrogenesis and trans-differentiation of chondrocytes to bone cells, which were largely restored under a high Pi diet. Finally, we identified the causative molecule (β-catenin). Together, this study demonstrates that the Dmp1-null caused hypophosphatemia, leading to acceleration (instead of inhibition) of chondrogenesis and bone trans-differentiation from chondrocytes but inhibition of bone cell maturation due to a sharp increase in β-catenin. These findings will aid in the future treatment of hypophosphatemic rickets with FGF23 neutralizing antibodies.
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Affiliation(s)
- Hui Li
- Department of Biomedical Sciences, Texas A&M University College of Dentistry, Dallas, TX 75246, USA; State Key Laboratory of Oral Diseases, Department of Traumatic and Plastic Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Yan Jing
- Department of Orthodontics, Texas A&M University College of Dentistry, Dallas, TX 75246, USA
| | - Rong Zhang
- Department of Biomedical Sciences, Texas A&M University College of Dentistry, Dallas, TX 75246, USA; Faculty of Medicine, Northwest University, #229 Taibai North Rd, Xi'an, Shaanxi, 710069, China
| | - Qi Zhang
- Department of Biomedical Sciences, Texas A&M University College of Dentistry, Dallas, TX 75246, USA; Laboratory of Oral Biomedical Science and Translational Medicine, Department of Endodontics, School of Stomatology, Tongji University, Shanghai, China
| | - Jun Wang
- Department of Biomedical Sciences, Texas A&M University College of Dentistry, Dallas, TX 75246, USA; State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Periodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - Aline Martin
- Center for Translational Metabolism and Health, Division of Nephrology/Hypertension, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Jian Q Feng
- Department of Biomedical Sciences, Texas A&M University College of Dentistry, Dallas, TX 75246, USA.
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19
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Fuente R, Gil-Peña H, Claramunt-Taberner D, Hernández-Frías O, Fernández-Iglesias Á, Alonso-Durán L, Rodríguez-Rubio E, Hermida-Prado F, Anes-González G, Rubio-Aliaga I, Wagner C, Santos F. MAPK inhibition and growth hormone: a promising therapy in XLH. FASEB J 2019; 33:8349-8362. [DOI: 10.1096/fj.201802007r] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Rocío Fuente
- Division of PediatricsDepartment of MedicineFaculty of Medicine and Health SciencesUniversity of Oviedo Oviedo Spain
- Department of Developmental BiologyHarvard School of Dental MedicineHarvard University Boston Massachusetts USA
| | - Helena Gil-Peña
- Department of PediatricsHospital Universitario Central de Asturias Oviedo Spain
| | - Débora Claramunt-Taberner
- Division of PediatricsDepartment of MedicineFaculty of Medicine and Health SciencesUniversity of Oviedo Oviedo Spain
| | - Olaya Hernández-Frías
- Division of PediatricsDepartment of MedicineFaculty of Medicine and Health SciencesUniversity of Oviedo Oviedo Spain
| | - Ángela Fernández-Iglesias
- Division of PediatricsDepartment of MedicineFaculty of Medicine and Health SciencesUniversity of Oviedo Oviedo Spain
| | - Laura Alonso-Durán
- Division of PediatricsDepartment of MedicineFaculty of Medicine and Health SciencesUniversity of Oviedo Oviedo Spain
| | - Enrique Rodríguez-Rubio
- Division of PediatricsDepartment of MedicineFaculty of Medicine and Health SciencesUniversity of Oviedo Oviedo Spain
| | - Francisco Hermida-Prado
- Department of OtorhinolaryngologyHospital Universitario Central de AsturiasInstituto Universitario de Oncología del Principado de Asturias Oviedo Spain
| | | | - Isabel Rubio-Aliaga
- Kidney and Acid-Base Physiology GroupInstitute of PhysiologyUniversity of Zurich Zurich Switzerland
| | - Carsten Wagner
- Kidney and Acid-Base Physiology GroupInstitute of PhysiologyUniversity of Zurich Zurich Switzerland
| | - Fernando Santos
- Division of PediatricsDepartment of MedicineFaculty of Medicine and Health SciencesUniversity of Oviedo Oviedo Spain
- Department of PediatricsHospital Universitario Central de Asturias Oviedo Spain
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