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Nicoletti T, Bink A, Helmchen B, Briel N, Frontzek K, Vlad B, Gaspert A, Boudriot E, Jung HH, Reuss AM, Weller M, Hortobágyi T. Neurologic involvement in cystinosis: Focus on brain lesions and new evidence of four-repeat (4R-) Tau immunoreactivity. J Neurol Sci 2024; 456:122841. [PMID: 38101161 DOI: 10.1016/j.jns.2023.122841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/10/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023]
Abstract
Nephropathic cystinosis is a rare autosomal recessive storage disorder caused by CTNS gene mutations, leading to autophagy-lysosomal pathway impairment and cystine crystals accumulation. Neurologic involvement is highly variable and includes both neurodevelopmental and neurodegenerative disturbances, as well as focal neurologic deficits. By presenting longitudinal data of a 28-year-old patient with a large infratentorial lesion, we summarized the pathology, clinical and imaging features of neurological involvement in cystinosis patients. Brain damage in form of cystinosis-related cerebral lesions occurs in advanced disease phases and is characterized by the accumulation of cystine crystals, subsequent inflammation with vasculitis-like features, necrosis, and calcification. Epilepsy is a frequent comorbidity in affected individuals. Steroids might play a role in the symptomatic treatment of "stroke-like" episodes due to edematous-inflammatory lesions, but probably do not change the overall prognosis. Lifelong compliance to depleting therapy with cysteamine still represents the main therapeutic option. However, consequences of CTNS gene defects are not restricted to cystine accumulation. New evidence of four-repeat (4R-) Tau immunoreactivity suggests concurrent progressive neurodegeneration in cystinosis patients, highlighting the need of innovative therapeutic strategies, and shedding light on the crosstalk between proteinopathies and autophagy-lysosomal system defects. Eventually, emerging easily accessible biomarkers such as serum neurofilament light chains (NfL) might detect subclinical neurologic involvement in cystinosis patients.
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Affiliation(s)
- Tommaso Nicoletti
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland.
| | - Andrea Bink
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland; Department of Neuroradiology, University Hospital Zurich, Switzerland
| | - Birgit Helmchen
- Department of Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Nils Briel
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland; Center for Neuropathology and Prion Research, Ludwig-Maximilians-University, Munich, Germany
| | - Karl Frontzek
- Institute of Neuropathology, University Hospital Zurich, Zurich, Switzerland; Queen Square Brain Bank for Neurological Disorders, UCL Queen Square Institute of Neurology, London, UK
| | - Benjamin Vlad
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Ariana Gaspert
- Department of Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Elisabeth Boudriot
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Hans Heinrich Jung
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Anna Maria Reuss
- Institute of Neuropathology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland
| | - Tibor Hortobágyi
- Institute of Neuropathology, University Hospital Zurich, Zurich, Switzerland
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Francisco AA, Foxe JJ, Berruti A, Horsthuis DJ, Molholm S. Response inhibition and error-monitoring in cystinosis (CTNS gene mutations): Behavioral and electrophysiological evidence of a diverse set of difficulties. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.03.31.535145. [PMID: 37034772 PMCID: PMC10081337 DOI: 10.1101/2023.03.31.535145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Cystinosis, a rare lysosomal storage disease, is characterized by cystine crystallization and accumulation within tissues and organs, including the kidneys and brain. Its impact on neural function appears mild relative to its effects on other organs, but therapeutic advances have led to substantially increased life expectancy, necessitating deeper understanding of its impact on neurocognitive function. Behaviorally, some deficits in executive function have been noted in this population, but the underlying neural processes are not understood. Using standardized cognitive assessments and a Go/No-Go response inhibition task in conjunction with high-density electrophysiological recordings (EEG), we sought to investigate the behavioral and neural dynamics of inhibition of a prepotent response and of error monitoring (critical components of executive function) in individuals with cystinosis, when compared to age-matched controls. Thirty-seven individuals diagnosed with cystinosis (7-36 years old, 24 women) and 45 age-matched controls (27 women) participated in this study. Analyses focused on N2 and P3 No-Go responses and error-related positivity (Pe). Atypical inhibitory processing was shown behaviorally. Electrophysiological differences were additionally found between the groups, with individuals with cystinosis showing larger No-Go P3s. Error-monitoring was likewise different between the groups, with those with cystinosis showing reduced Pe amplitudes.
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Affiliation(s)
- Ana A. Francisco
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - John J. Foxe
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Neuroscience, Rose F. Kennedy Center, Albert Einstein College of Medicine, Bronx, New York, USA
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, Ernest J. Del Monte Institute for Neuroscience & Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Alaina Berruti
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Douwe J. Horsthuis
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sophie Molholm
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Neuroscience, Rose F. Kennedy Center, Albert Einstein College of Medicine, Bronx, New York, USA
- The Frederick J. and Marion A. Schindler Cognitive Neurophysiology Laboratory, Ernest J. Del Monte Institute for Neuroscience & Department of Neuroscience, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Central Nervous System Complications in Cystinosis: The Role of Neuroimaging. Cells 2022; 11:cells11040682. [PMID: 35203331 PMCID: PMC8870159 DOI: 10.3390/cells11040682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023] Open
Abstract
Despite improvement in the specific treatment, clinical and anatomo-functional central nervous system (CNS) abnormalities of various severities are still observed in cystinosis patients. Patients who develop CNS complications today have a worse compliance to cysteamine treatment. Radiological studies have shown that cortical or central (ventriculomegaly) atrophy is observed in more than two thirds of cystinosis patients’ magnetic resonance imaging (MRI) and correlates with the intelligence quotient score. Half of cystinosis patients have marked aspecific white matter hyperintensities. The development of advanced neuroimaging techniques provides new tools to further investigate CNS complications. A recent neuroimaging study using a voxel-based morphometry approach showed that cystinosis patients present a decreased grey matter volume in the left middle frontal gyrus. Diffusion tensor imaging studies have shown white matter microstructure abnormalities in children and adults with cystinosis, respectively in areas of the dorsal visual pathway and within the corpus callosum’s body. Finally, leucocyte cystine levels are associated with decreased resting cerebral blood flow, measured by arterial spin labelling, in the frontal cortex, which could be associated with the neurocognitive deficits described in these patients. These results reinforce the relevance of neuroimaging studies to further understand the mechanisms that underline CNS impairments.
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Servais A, Saitovitch A, Hummel A, Boisgontier J, Scemla A, Sberro-Soussan R, Snanoudj R, Lemaitre H, Legendre C, Pontoizeau C, Antignac C, Anglicheau D, Funalot B, Boddaert N. Central nervous system complications in adult cystinosis patients. J Inherit Metab Dis 2020; 43:348-356. [PMID: 31444911 DOI: 10.1002/jimd.12164] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 11/06/2022]
Abstract
Little is known about the long-term progression of adult nephropathic cystinosis patients. Our objective was to study central nervous system complications in cystinosis patients in the era of early cysteamine treatment, using advanced neuroimaging techniques. Neurological examination and multimodal brain 3 Tesla MRI were performed in 21 adult cystinosis patients, including 18 infantile cystinosis patients, 20 controls matched for age and renal function, and 12 healthy controls. Differences in gray matter volume and rest cerebral blood flow (CBF) using arterial spin labeling sequence were investigated using whole-brain voxel-based approach. Median age was 33.8 years (18.7-65.8). Seven patients (38.9%) presented with at least one central nervous system clinical abnormality: two (11.1%) with seizures, three (16.7%) with memory defects, five (27.8%) with cognitive defect, and one (5.5%) with stroke-like episode. These patients had a worse compliance to treatment (compliance score 2 vs 1, P = .03) and received a lower median cysteamine dose (0.9 g/day vs 2.1 g/day, P = .02). Among patients with infantile cystinosis, 13 (72.2%) showed cortical atrophy, which was absent in controls, but it was not correlated with symptoms. Cystinosis patients showed a significant gray matter decrease in the middle frontal gyrus compared with healthy controls and a significant negative correlation between the cystine blood level and rest CBF was observed in the right superior frontal gyrus, a region associated with executive function. Compliance to cysteamine treatment is a major concern in these adult patients and could have an impact on the development of neurological and cognitive complications.
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Affiliation(s)
- Aude Servais
- Department of Nephrology and Transplantation, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Paris, France
- Inserm U1163, Imagine Institute, Paris Descartes University, Paris, France
| | - Ana Saitovitch
- Department of Pediatric Radiology, Necker hospital, APHP, Inserm U1000, Imagine Institute, Paris Descartes University, Paris, France
| | - Aurélie Hummel
- Department of Nephrology and Transplantation, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Paris, France
| | - Jennifer Boisgontier
- Department of Pediatric Radiology, Necker hospital, APHP, Inserm U1000, Imagine Institute, Paris Descartes University, Paris, France
| | - Anne Scemla
- Department of Nephrology and Transplantation, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Paris, France
| | - Rebecca Sberro-Soussan
- Department of Nephrology and Transplantation, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Paris, France
| | - Renaud Snanoudj
- Department of Nephrology and Transplantation, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Paris, France
| | - Hervé Lemaitre
- Department of Pediatric Radiology, Necker hospital, APHP, Inserm U1000, Imagine Institute, Paris Descartes University, Paris, France
| | - Christophe Legendre
- Department of Nephrology and Transplantation, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Paris, France
| | | | - Corinne Antignac
- Inserm U1163, Imagine Institute, Paris Descartes University, Paris, France
- Department of Genetics, Necker hospital, APHP, Paris, France
| | - Dany Anglicheau
- Department of Nephrology and Transplantation, Centre de référence des Maladies Rénales Héréditaires de l'Enfant et de l'Adulte, Necker Hospital, APHP, Paris, France
| | - Benoît Funalot
- Department of Genetics, Henri Mondor Hospital, APHP, Créteil, France
| | - Nathalie Boddaert
- Department of Pediatric Radiology, Necker hospital, APHP, Inserm U1000, Imagine Institute, Paris Descartes University, Paris, France
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Curie A, Touil N, Gaillard S, Galanaud D, Leboucq N, Deschênes G, Morin D, Abad F, Luauté J, Bodenan E, Roche L, Acquaviva C, Vianey-Saban C, Cochat P, Cotton F, Bertholet-Thomas A. Neuropsychological and neuroanatomical phenotype in 17 patients with cystinosis. Orphanet J Rare Dis 2020; 15:59. [PMID: 32102670 PMCID: PMC7045592 DOI: 10.1186/s13023-019-1271-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 12/03/2019] [Indexed: 01/19/2023] Open
Abstract
Background Cystinosis is a rare autosomal recessive disorder caused by intracellular cystine accumulation. Proximal tubulopathy (Fanconi syndrome) is one of the first signs, leading to end-stage renal disease between the age of 12 and 16. Other symptoms occur later and encompass endocrinopathies, distal myopathy and deterioration of the central nervous system. Treatment with cysteamine if started early can delay the progression of the disease. Little is known about the neurological impairment which occurs later. The goal of the present study was to find a possible neuroanatomical dysmorphic pattern that could help to explain the cognitive profile of cystinosis patients. We also performed a detailed review of the literature on neurocognitive complications associated with cystinosis. Methods 17 patients (mean age = 17.6 years, [5.4–33.3]) with cystinosis were included in the study. Neuropsychological assessment was performed including intelligence (Intelligence Quotient (IQ) with Wechsler’s scale), memory (Children Memory Scale and Wechsler Memory Scale), visuo-spatial (Rey’s figure test) and visuo-perceptual skills assessments. Structural brain MRI (3 T) was also performed in 16 out of 17 patients, with high resolution 3D T1-weighted, 3D FLAIR and spectroscopy sequences. Results Intellectual efficiency was normal in patients with cystinosis (mean Total IQ = 93). However the Perceptual Reasoning Index (mean = 87, [63–109]) was significantly lower than the Verbal Comprehension Index (mean = 100, [59–138], p = 0.003). Memory assessment showed no difference between visual and verbal memory. But the working memory was significantly impaired in comparison with the general memory skills (p = 0.003). Visuospatial skills assessment revealed copy and reproduction scores below the 50th percentile rank in more than 70% of the patients. Brain MRI showed cortical and sub-cortical cerebral atrophy, especially in the parieto-occipital region and FLAIR hypersignals in parietal, occipital and brain stem/cerebellum. Patients with atrophic brain had lower Total IQ scores compared to non-atrophic cystinosis patients. Conclusions Patients with cystinosis have a specific neuropsychological and neuroanatomical profile. We suggest performing a systematic neuropsychological assessment in such children aiming at considering adequate management.
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Affiliation(s)
- Aurore Curie
- Service de neuropédiatrie Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS UMR 5304, 67 boulevard Pinel, 69675, Bron, France. .,Institut des Sciences Cognitives Marc Jeannerod, CNRS UMR 5304, L2C2, Bron, France. .,Faculté de médecine Lyon Est, Université Claude-Bernard Lyon 1, Lyon, France. .,EPICIME-CIC 1407/Inserm, UMR5558, Université de Lyon, Hospices Civils de Lyon, Bron, France.
| | - Nathalie Touil
- EPICIME-CIC 1407/Inserm, UMR5558, Université de Lyon, Hospices Civils de Lyon, Bron, France
| | - Ségolène Gaillard
- EPICIME-CIC 1407/Inserm, UMR5558, Université de Lyon, Hospices Civils de Lyon, Bron, France
| | - Damien Galanaud
- Service de neuroradiologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Nicolas Leboucq
- Service de neuroradiologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Georges Deschênes
- Service de néphropédiatrie, Hôpital Robert-Debré, AP-HP, Paris, France
| | - Denis Morin
- Service de néphrologie et diabétologie pédiatrique, Service de pédiatrie I, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Fanny Abad
- EPICIME-CIC 1407/Inserm, UMR5558, Université de Lyon, Hospices Civils de Lyon, Bron, France
| | - Jacques Luauté
- Service de rééducation fonctionnelle, Hôpital neurologique, Hospices Civils de Lyon, Bron, France
| | - Eurielle Bodenan
- EPICIME-CIC 1407/Inserm, UMR5558, Université de Lyon, Hospices Civils de Lyon, Bron, France
| | - Laurent Roche
- Service de biostatistiques, Hospices Civils de Lyon, Bron, France
| | - Cécile Acquaviva
- Service maladies héréditaires du métabolisme et dépistage néonatal, Centre de Biologie et Pathologie Est, Groupement Hospitalier Est (GHE), Hospices Civils de Lyon, Bron, France
| | - Christine Vianey-Saban
- Service maladies héréditaires du métabolisme et dépistage néonatal, Centre de Biologie et Pathologie Est, Groupement Hospitalier Est (GHE), Hospices Civils de Lyon, Bron, France
| | - Pierre Cochat
- Faculté de médecine Lyon Est, Université Claude-Bernard Lyon 1, Lyon, France.,Centre de référence des maladies rénales rares - Néphrogones - Filière ORKiD, Bron, France
| | - François Cotton
- Faculté de médecine Lyon Est, Université Claude-Bernard Lyon 1, Lyon, France.,Service de radiologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre Bénite, France.,CREATIS, CNRS UMR5220, INSERM U1044, Université Lyon 1, INSA Lyon, Villeurbanne, France
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Francisco AA, Foxe JJ, Horsthuis DJ, Molholm S. Impaired auditory sensory memory in Cystinosis despite typical sensory processing: A high-density electrical mapping study of the mismatch negativity (MMN). NEUROIMAGE-CLINICAL 2020; 25:102170. [PMID: 31954986 PMCID: PMC6965721 DOI: 10.1016/j.nicl.2020.102170] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/13/2019] [Accepted: 01/10/2020] [Indexed: 11/24/2022]
Abstract
Children and adolescents with Cystinosis show similar N1 responses to their age-matched peers. Children and adolescents with Cystinosis show reduced MMNs for longer SOAs. Our results suggest typical auditory processing, but impaired sensory memory in Cystinosis.
Cystinosis, a genetic rare disease characterized by cystine accumulation and crystallization, results in significant damage in a multitude of tissues and organs, such as the kidney, thyroid, eye, and brain. While Cystinosis’ impact on brain function is relatively mild compared to its effects on other organs, the increased lifespan of this population and thus potential for productive societal contributions have led to increased interest on the effects on brain function. Nevertheless, and despite some evidence of structural brain differences, the neural impact of the mutation is still not well characterized. Here, using a passive duration oddball paradigm (with different stimulus onset asynchronies (SOAs), representing different levels of demand on memory) and high-density electrophysiology, we tested basic auditory processing in a group of 22 children and adolescents diagnosed with Cystinosis (age range: 6-17 years old) and in neurotypical age-matched controls (N = 24). We examined whether the N1 and mismatch negativity (MMN) significantly differed between the groups and if those neural measures correlated with verbal and non-verbal IQ. Individuals diagnosed with Cystinosis presented similar N1 responses to their age-matched peers, indicating typical basic auditory processing in this population. However, whereas both groups showed similar MMN responses for the shortest (450 ms) SOA, suggesting intact change detection and sensory memory, individuals diagnosed with Cystinosis presented clearly reduced responses for the longer (900 ms and 1800 ms) SOAs. This could indicate reduced duration auditory sensory memory traces, and thus sensory memory impairment, in children and adolescents diagnosed with Cystinosis. Future work addressing other aspects of sensory and working memory is needed to understand the underlying bases of the differences described here, and their implication for higher order processing.
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Affiliation(s)
- Ana A Francisco
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA.; Department of Neuroscience, Rose F. Kennedy Center, Albert Einstein College of Medicine, Bronx, New York, USA..
| | - John J Foxe
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA.; Department of Neuroscience, Rose F. Kennedy Center, Albert Einstein College of Medicine, Bronx, New York, USA.; The Cognitive Neurophysiology Laboratory, Department of Neuroscience, The Ernest J. Del Monde Institute for Neuroscience, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
| | - Douwe J Horsthuis
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Sophie Molholm
- The Cognitive Neurophysiology Laboratory, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA.; Department of Neuroscience, Rose F. Kennedy Center, Albert Einstein College of Medicine, Bronx, New York, USA.; The Cognitive Neurophysiology Laboratory, Department of Neuroscience, The Ernest J. Del Monde Institute for Neuroscience, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA..
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Frankel AM, Trauner DA. Visual and verbal learning and memory in cystinosis. Brain Cogn 2019; 135:103578. [PMID: 31233961 DOI: 10.1016/j.bandc.2019.103578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/01/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
Abstract
Cystinosis is a rare genetic lysosomal storage disorder characterized by the accumulation of cystine in lysosomes. Many organ systems are vulnerable to this cystine accumulation including the CNS. A past study demonstrated that children with cystinosis have deficits in visual learning and memory while their verbal learning and memory and global intellectual function are spared (Spilkin, Ballantyne, & Trauner, 2009). However, no related study has been performed to assess the dissociation between visual and verbal learning and memory in adults with cystinosis who have had the benefit of longterm treatment with the cystine-depleting agent, cysteamine. In this study we assessed visual and verbal learning and memory in 15 adults with cystinosis, with a mean age of 30.2 years. The results indicate that adults with cystinosis have no significant deficits in either verbal or visual learning and memory. However, the individuals did perform better on the verbal assessment. The results suggest that if early and continued treatment is given to individuals with cystinosis there is a relative sparing of visual learning and memory that might have otherwise declined. This emphasizes the essential nature of the proper clinical management of cystinosis.
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Affiliation(s)
- Alexandra M Frankel
- Department of Neurosciences, University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093-0935, USA.
| | - Doris A Trauner
- Department of Neurosciences, University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093-0935, USA.
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Sathappan A, Trauner D. Hierarchical processing of visual stimuli in nephropathic cystinosis. J Inherit Metab Dis 2019; 42:545-552. [PMID: 30671973 PMCID: PMC6483842 DOI: 10.1002/jimd.12062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/16/2019] [Indexed: 12/25/2022]
Abstract
Previous studies have shown that individuals with cystinosis may exhibit difficulty with visuospatial tasks. Global and local (hierarchical) processing are specific types of visuospatial tasks mediated by the right and left parietal lobes respectively. The study objective was to determine whether individuals with cystinosis and carriers of the cystinosin gene mutation show deficits in global and/or local processing. The study included 48 children (32 controls, 16 cystinosis) and 56 adults (25 controls, 25 carriers, and 6 cystinosis). Participants were instructed to replicate 10 hierarchical stimuli to assess global-local processing. The primary outcome measure was mean global and local performance on the hierarchical stimuli task between subgroups. Error subtypes were included to further assess each image. Compared to the control subgroups, adult and child cystinosis patients as well adult carriers demonstrated significant deficits in the global processing of a hierarchical stimulus against a background of unimpaired local processing. Child cystinosis patients performed significantly more poorly than controls on all error subtypes except local shape distortion. Adult cystinosis patients and carriers made significantly more global shape distortion errors than the controls. Our study shows that the cognitive profile documented in cystinosis patients and carriers includes significant difficulties with the global processing of an image. Results of the carrier population are important since they suggest that the cognitive impairments observed in patients cannot be attributed to symptomatic manifestations of the disease. Instead, the global processing deficits observed provide insight into the potential role of the cystinosin gene mutation on neurodevelopmental differences seen in these individuals.
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Affiliation(s)
| | - Doris Trauner
- Corresponding Author: Doris Trauner, M.D, Mailing Address:, UCSD School of Medicine, , 9500 Gilman Drive, La Jolla CA 92093-0935, USA, Phone: 858-822-6700,
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Abstract
PURPOSE OF REVIEW Over the past few decades, cystinosis, a rare lysosomal storage disorder, has evolved into a treatable metabolic disease. The increasing understanding of its pathophysiology has made cystinosis a prototype disease, delivering new insights into several fundamental biochemical and cellular processes. RECENT FINDINGS In this review, we aim to provide an overview of the latest advances in the pathogenetic, clinical, and therapeutic aspects of cystinosis. SUMMARY The development of alternative therapeutic monitoring strategies and new systemic and ocular cysteamine formulations might improve outcome of cystinosis patients in the near future. With the dawn of stem cell based therapy and new emerging gene-editing technologies, novel tools have become available in the search for a cure for cystinosis.
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White Matter Microstructure and Subcortical Gray Matter Structure Volumes in Aspartylglucosaminuria; a 5-Year Follow-up Brain MRI Study of an Adolescent with Aspartylglucosaminuria and His Healthy Twin Brother. JIMD Rep 2017; 35:105-115. [PMID: 28185224 DOI: 10.1007/8904_2016_36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 12/06/2016] [Accepted: 12/09/2016] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Aspartylglucosaminuria is an inherited, lysosomal storage disease causing progressive decline in cognitive and motor functions. The aim of this study was to evaluate volumes of subcortical gray matter structures and white matter microstructure in aspartylglucosaminuria in adolescence in a longitudinal study for the first time. METHODS A boy with aspartylglucosaminuria and his healthy twin brother were imaged twice with a 3.0 T MRI scanner at the ages of 10 and 15 years. Subcortical gray matter structure volumes were measured using an atlas-based automatic method, and diffusion tensor imaging was used to evaluate the white matter microstructure of the corpus callosum and the thalamocortical pulvinar tracts. RESULTS The subcortical gray matter structures were smaller at onset and diminished at follow-up in the affected twin, with the exception of the amygdala which was larger and remained the size. The largest difference in volume between the twins was found in the thalami. The total gray and white matter volumes decreased in the affected twin. In diffusion tensor imaging analysis, the fractional anisotropy was decreased at onset in the affected twin compared to the healthy brother in the evaluated tracts. The axial, radial and mean diffusivity values were increased in the affected twin. The difference between the twins increased slightly at follow-up. INTERPRETATION The findings suggest that volumetric measurements and diffusion tensor imaging based microstructural analysis may be useful modalities for monitoring disease progression and response to emerging treatment in aspartylglucosaminuria, but further studies with more subjects are necessary to confirm the results.
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Transición coordinada del paciente con cistinosis desde la medicina pediátrica a la medicina del adulto. Nefrologia 2016; 36:616-630. [DOI: 10.1016/j.nefro.2016.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/10/2016] [Indexed: 11/22/2022] Open
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Elmonem MA, Veys KR, Soliman NA, van Dyck M, van den Heuvel LP, Levtchenko E. Cystinosis: a review. Orphanet J Rare Dis 2016; 11:47. [PMID: 27102039 PMCID: PMC4841061 DOI: 10.1186/s13023-016-0426-y] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 04/15/2016] [Indexed: 01/01/2023] Open
Abstract
Cystinosis is the most common hereditary cause of renal Fanconi syndrome in children. It is an autosomal recessive lysosomal storage disorder caused by mutations in the CTNS gene encoding for the carrier protein cystinosin, transporting cystine out of the lysosomal compartment. Defective cystinosin function leads to intra-lysosomal cystine accumulation in all body cells and organs. The kidneys are initially affected during the first year of life through proximal tubular damage followed by progressive glomerular damage and end stage renal failure during mid-childhood if not treated. Other affected organs include eyes, thyroid, pancreas, gonads, muscles and CNS. Leucocyte cystine assay is the cornerstone for both diagnosis and therapeutic monitoring of the disease. Several lines of treatment are available for cystinosis including the cystine depleting agent cysteamine, renal replacement therapy, hormonal therapy and others; however, no curative treatment is yet available. In the current review we will discuss the most important clinical features of the disease, advantages and disadvantages of the current diagnostic and therapeutic options and the main topics of future research in cystinosis.
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Affiliation(s)
- Mohamed A Elmonem
- Department of Pediatric Nephrology & Growth and Regeneration, University Hospitals Leuven & KU Leuven, UZ Herestraat 49-3000, Leuven, Belgium.,Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Koenraad R Veys
- Department of Pediatric Nephrology & Growth and Regeneration, University Hospitals Leuven & KU Leuven, UZ Herestraat 49-3000, Leuven, Belgium
| | - Neveen A Soliman
- Department of Pediatrics, Center of Pediatric Nephrology and Transplantation (CPNT), Faculty of Medicine, Cairo University, Cairo, Egypt.,EGORD, Egyptian group of orphan renal diseases, Cairo, Egypt
| | - Maria van Dyck
- Department of Pediatric Nephrology & Growth and Regeneration, University Hospitals Leuven & KU Leuven, UZ Herestraat 49-3000, Leuven, Belgium
| | - Lambertus P van den Heuvel
- Department of Pediatric Nephrology & Growth and Regeneration, University Hospitals Leuven & KU Leuven, UZ Herestraat 49-3000, Leuven, Belgium.,Department of Pediatric Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elena Levtchenko
- Department of Pediatric Nephrology & Growth and Regeneration, University Hospitals Leuven & KU Leuven, UZ Herestraat 49-3000, Leuven, Belgium.
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Besouw MTP, Van Dyck M, Cassiman D, Claes KJ, Levtchenko EN. Management dilemmas in pediatric nephrology: Cystinosis. Pediatr Nephrol 2015; 30:1349-60. [PMID: 25956701 DOI: 10.1007/s00467-015-3117-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/13/2015] [Accepted: 04/15/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cystinosis is a rare, inherited autosomal recessive disease caused by the accumulation of free cystine in lysosomes. It is treated by the administration of cysteamine, which should be monitored by trough white blood cell (WBC) cystine measurements to ensure effective treatment. CASE-DIAGNOSIS/TREATMENT The index case had an older brother who had previously been diagnosed with cystinosis, allowing early diagnosis of the index case at the age of 5 months. Cysteamine therapy was started at the age of 3 years; however, monitoring of WBC cystine levels did not occur on a regular basis during most of his life. Growth retardation improved after correction of electrolyte disturbances, the initiation of cysteamine therapy and treatment with recombinant human growth hormone. Renal replacement therapy was started at the age of 11 years, and renal transplantation was performed at the age of 12 years. Extra-renal cystine accumulation caused multiple endocrinopathies (including adrenal insufficiency, hypothyroidism and primary hypogonadism), neurological symptoms, pancytopenia owing to splenomegaly and portal hypertension due to nodular regenerative hyperplasia, aggravated by splenic vein thrombosis and partial portal vein thrombosis. The patient died of diffuse intra-abdominal bleeding caused by severe portal hypertension. CONCLUSION Cysteamine treatment should be started as early as possible, and dosage should be monitored and adapted based on trough WBC cystine levels. RELEVANT INTERNATIONAL GUIDELINE Emma F et al. (2014) Nephropathic cystinosis: an international consensus document. Nephrol Dial Transplant 29:iv87-iv94.
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Affiliation(s)
- Martine T P Besouw
- Department of Pediatric Nephrology, University Hospital Ghent, De Pintelaan 185, 9000, Ghent, Belgium,
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Cistinosis en pacientes adolescentes y adultos: Recomendaciones para la atención integral de la cistinosis. Nefrologia 2015. [DOI: 10.1016/j.nefro.2015.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ariceta G, Camacho JA, Fernández-Obispo M, Fernández-Polo A, Gamez J, García-Villoria J, Lara Monteczuma E, Leyes P, Martín-Begué N, Oppenheimer F, Perelló M, Morell GP, Torra R, Santandreu AV, Güell A. Cystinosis in adult and adolescent patients: Recommendations for the comprehensive care of cystinosis. Nefrologia 2015; 35:304-321. [PMID: 26523297 DOI: 10.1016/j.nefroe.2015.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
INTRODUCTION Cystinosis is a rare lysosomal systemic disease that mainly affects the kidney and the eye. Patients with cystinosis begin renal replacement therapy during the first decade of life in absence of treatment. Prognosis of cystinosis depends on early diagnosis, and prompt starting and good compliance with cysteamine treatment. Kidney disease progression, extra-renal complications and shorter life expectancy are more pronounced in those patients that do not follow treatment. The objective of this work was to elaborate recommendations for the comprehensive care of cystinosis and the facilitation of patient transition from paediatric to adult treatment, based on clinical experience. The goal is to reduce the impact of the disease, and to improve patient quality of life and prognosis. METHODS Bibliographic research and consensus meetings among a multidisciplinary professional team of experts in the clinical practice, with cystinotic patients (T-CiS.bcn group) from 5 hospitals located in Barcelona. RESULTS This document gathers specific recommendations for diagnosis, treatment and multidisciplinary follow-up of cystinotic patients in the following areas: nephrology, dialysis,renal transplant, ophthalmology, endocrinology, neurology, laboratory, genetic counselling,nursing and pharmacy. CONCLUSIONS A reference document for the comprehensive care of cystinosis represents a support tool for health professionals who take care of these patients. It is based on the following main pillars: (a) a multi-disciplinary approach, (b) appropriate disease monitoring and control of intracellular cystine levels in leukocytes, (c) the importance of adherence to treatment with cysteamine, and (d) the promotion of patient self-care by means of disease education programmes. All these recommendations will lead us, in a second phase, to create a coordinated transition model between paediatric and adult care services which will contemplate the specific needs of cystinosis.
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Emma F, Nesterova G, Langman C, Labbé A, Cherqui S, Goodyer P, Janssen MC, Greco M, Topaloglu R, Elenberg E, Dohil R, Trauner D, Antignac C, Cochat P, Kaskel F, Servais A, Wühl E, Niaudet P, Van't Hoff W, Gahl W, Levtchenko E. Nephropathic cystinosis: an international consensus document. Nephrol Dial Transplant 2014; 29 Suppl 4:iv87-94. [PMID: 25165189 DOI: 10.1093/ndt/gfu090] [Citation(s) in RCA: 126] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cystinosis is caused by mutations in the CTNS gene (17p13.2), which encodes for a lysosomal cystine/proton symporter termed cystinosin. It is the most common cause of inherited renal Fanconi syndrome in young children. Because of its rarity, the diagnosis and specific treatment of cystinosis are frequently delayed, which has a significant impact on the overall prognosis. In this document, we have summarized expert opinions on several aspects of the disease to improve knowledge and provide guidance for diagnosis and treatment.
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Affiliation(s)
- Francesco Emma
- Division of Nephrology and Dialysis, Bambino Gesu` Children's Hospital - IRCCS, Rome, Italy
| | - Galina Nesterova
- Section on Human Biochemical Genetics, Human Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892-1851, USA
| | - Craig Langman
- Kidney Diseases, Feinberg School of Medicine, Northwestern University and the Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Antoine Labbé
- Quinze-Vingts National Ophthalmology Hospital, Paris and Versailles Saint-Quentin-en-Yvelines University, Versailles, France Clinical Investigations Center, INSERM 503, Quinze-Vingts National Ophthalmology Hospital, Paris, France
| | - Stephanie Cherqui
- Division of Genetics, Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Paul Goodyer
- Department of Pediatrics, McGill University, Montreal Children's Hospital, Montreal, Québec, Canada
| | - Mirian C Janssen
- Department of Internal Medicine, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Marcella Greco
- Division of Nephrology and Dialysis, Bambino Gesu` Children's Hospital - IRCCS, Rome, Italy
| | - Rezan Topaloglu
- Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ewa Elenberg
- Renal Service, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Ranjan Dohil
- Department of Pediatrics, Rady Children's Hospital, San Diego, University of California San Diego, San Diego, CA, USA
| | - Doris Trauner
- Department of Neurosciences, University of California, San Diego, School of Medicine, San Diego, CA, USA
| | - Corinne Antignac
- Laboratory of Inherited Kidney Diseases, Inserm UMR 1163, Paris, France Paris Descartes-Sorbonne Paris Cité University, Imagine Institute, Paris, France APHP, Department of Genetics, Necker Hospital, Paris, France
| | - Pierre Cochat
- Centre de référence des maladies rénales rares, Hospices Civils de Lyon and Université Claude-Bernard Lyon 1, Lyon, France
| | - Frederick Kaskel
- Pediatric Nephrology, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Aude Servais
- Department of Adult Nephrology, Hôpital Necker-Enfants Malades, APHP, Paris Descartes University, Paris, France
| | - Elke Wühl
- Division of Pediatric Nephrology, Center of Pediatrics and Adolescent Medicine, University of Heidelberg, Heidelberg, Germany
| | - Patrick Niaudet
- Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris 75015, France
| | | | - William Gahl
- Section on Human Biochemical Genetics, Human Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892-1851, USA
| | - Elena Levtchenko
- Department of Pediatric Nephrology and Growth and Regeneration, University Hospitals Leuven, Katholieke Universiteit Leuven, Leuven, Belgium
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Alroy J, Garganta C, Wiederschain G. Secondary biochemical and morphological consequences in lysosomal storage diseases. BIOCHEMISTRY (MOSCOW) 2014; 79:619-36. [DOI: 10.1134/s0006297914070049] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Viltz L, Trauner DA. Effect of age at treatment on cognitive performance in patients with cystinosis. J Pediatr 2013; 163:489-92. [PMID: 23462307 PMCID: PMC3676483 DOI: 10.1016/j.jpeds.2013.01.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 12/13/2012] [Accepted: 01/11/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether early treatment with cysteamine affects cognitive functioning in patients with nephropathic cystinosis. STUDY DESIGN Forty-six subjects aged 3-18 years with cystinosis underwent cognitive testing to determine intelligence, visual-spatial abilities, and visual-motor skills. An age-matched control group (n = 85; age 2-22 years) underwent the same tests. Age at diagnosis and age at initiation of treatment with cysteamine were recorded at the time of testing. RESULTS Patients with cystinosis treated at or after age 2 years (late-treatment group) scored significantly lower on verbal, performance, and full-scale IQ measures, as well as on a test of visual-spatial skills, compared with patients treated before age 2 years (early-treatment group) and controls. Both groups of subjects with cystinosis demonstrated impaired visual-motor skills compared with controls, with no difference between the early-treatment and late-treatment groups. CONCLUSION Early treatment with cysteamine appears to improve intellectual function in patients with nephropathic cystinosis. However, the lack of improvement in visual-motor function with early cysteamine treatment suggests possibly different mechanisms underlying visual-motor performance compared with other areas of cognition in this disorder.
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Affiliation(s)
- Lisa Viltz
- Department of Neurosciences, UCSD School of Medicine, La Jolla CA USA
| | - Doris A. Trauner
- Department of Neurosciences, UCSD School of Medicine, La Jolla CA USA,Department of Pediatrics, UCSD School of Medicine, La Jolla CA USA,Rady Children’s Hospital San Diego
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Does a paper's country of origin affect the length of the review process? Cortex 2012; 48:945-51. [DOI: 10.1016/j.cortex.2012.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 05/25/2012] [Indexed: 11/20/2022]
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Niemiec S, Ballantyne A, Trauner DA. Cognition in nephropathic cystinosis: pattern of expression in heterozygous carriers. Am J Med Genet A 2012; 158A:1902-8. [PMID: 22786804 PMCID: PMC3402617 DOI: 10.1002/ajmg.a.35467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 04/16/2012] [Indexed: 12/17/2022]
Abstract
Individuals with cystinosis exhibit specific cognitive deficits in visual spatial function. The purpose of the current study was to examine if obligate heterozygotes of the CTNS mutation have the same pattern of cognitive functioning seen in homozygotes, namely aberrant visual-spatial functioning against a background of relatively intact visual-perceptual functioning and overall cognitive ability. Study participants were 254 adults (100 heterozygotes and 154 controls), ages 17 years 10 months through 74 years 9 months. Tests of intelligence, visual perceptual, and visual spatial functioning were administered. Our results showed that cystinosis heterozygotes demonstrated intelligence within the normal range, and performed similarly to controls on tests of visual-perceptual ability. In contrast, the heterozygotes performed significantly more poorly on each of the visual-spatial tests when compared to controls. Obligate heterozygotes for the CTNS mutation display a similar pattern of visual processing decrements as do individuals with cystinosis. Namely, carriers demonstrate relative weaknesses in visual-spatial processing, while maintaining normal visual perceptual ability and intelligence in the normal range. The visual spatial decrements in heterozygotes were not as marked as those found in individuals with cystinosis, suggesting a gene dosing effect. This study provides an impetus for other studies of gene-behavior relationships in recessive disorders, and may stimulate further interest in the role of aberrant genes on "individual differences" in behavior.
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Affiliation(s)
- Stephen Niemiec
- Johns Hopkins University, Department of Neurosciences, University of California San Diego School of Medicine, La Jolla, California 92093-0935, USA
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Foley JA, Valkonen L. Are higher cited papers accepted faster for publication? Cortex 2012; 48:647-53. [DOI: 10.1016/j.cortex.2012.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 03/23/2012] [Indexed: 10/28/2022]
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Ortibus E, Verhoeven J, Sunaert S, Casteels I, de Cock P, Lagae L. Integrity of the inferior longitudinal fasciculus and impaired object recognition in children: a diffusion tensor imaging study. Dev Med Child Neurol 2012; 54:38-43. [PMID: 22171928 DOI: 10.1111/j.1469-8749.2011.04147.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM In this study, we explored the integrity of the inferior longitudinal fasciculus (ILF) by means of diffusion tensor imaging tractography in children with visual perceptual impairment, and more specifically, object recognition deficits, compared with typically developing children. METHODS Eleven individuals (nine males, two females; mean age 7 y 8 mo; range 3 y 5 mo-13 y) were assessed with the L94 visual perceptual battery after assessment of performance age. In all participants, an ophthalmological evaluation was carried out. Diffusion tensor imaging tractography of the ILF was performed. The mean fractional anisotropy was determined for every child and compared with data for 11 age- and sex-matched typically developing children. RESULTS The mean fractional anisotropy value in the left ILF was consistently lower in the study participants than in the comparison group. The five children with L94 impairment showed a significantly lower ILF fractional anisotropy on the left as well as on the right side. Furthermore, the decrease in ILF fractional anisotropy was correlated with the number of impaired subtests. INTERPRETATION The results suggest an association between ILF integrity loss and object recognition deficits. Moreover, the severity of clinical impairment is reflected in the degree of ILF integrity loss. Therefore, the ILF plays a potential role in object recognition.
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Affiliation(s)
- Els Ortibus
- Paediatric Neurology Department, University Hospitals of the Catholic University of Leuven, Leuven, Belgium.
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McIntosh RD, Brooks JL. Current tests and trends in single-case neuropsychology. Cortex 2011; 47:1151-9. [PMID: 21930266 DOI: 10.1016/j.cortex.2011.08.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 07/29/2011] [Accepted: 08/08/2011] [Indexed: 01/27/2023]
Abstract
In this issue of Cortex, Crawford, Garthwaite and Ryan publish bayesian statistical tests that will enable researchers to take account of covariates when comparing single patients to control samples. In this article, we provide some context for this development, from an audit of the Cortex archives. We suggest that single-case research is alive and well, and more rigorous than ever, and that current practice has been shaped considerably by Crawford and colleagues' statistical refinements over the past 12 years. However, there is scope for further tightening and standardisation of statistical methods and reporting standards. The advantages offered by the new bayesian tests should promote the even wider use of appropriate statistical methods, with benefits for the validity of individual studies, and for cross-comparability in the single-case literature.
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Affiliation(s)
- Robert D McIntosh
- Human Cognitive Neuroscience, Psychology, University of Edinburgh, UK.
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Foley JA, Della Sala S. Do shorter Cortex papers have greater impact? Cortex 2011; 47:635-42. [PMID: 21463860 DOI: 10.1016/j.cortex.2011.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 03/18/2011] [Indexed: 01/02/2023]
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Davies EH, Seunarine KK, Banks T, Clark CA, Vellodi A. Brain white matter abnormalities in paediatric Gaucher Type I and Type III using diffusion tensor imaging. J Inherit Metab Dis 2011; 34:549-53. [PMID: 21318351 DOI: 10.1007/s10545-011-9288-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 01/23/2011] [Accepted: 01/25/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Biomarkers to monitor neurological dysfunction in Neuronopathic Gaucher disease (NGD) are lacking. Diffusion tensor imaging (DTI) is a technique which allows us to probe the microstructure of the white-matter of the brain, in-vivo. The aim of this study was to investigate the value of DTI to visualise and quantify white matter integrity in children with NGD and Type I Gaucher. DESIGN DTI was performed and fractional anisotropy (FA), mean diffusivity (MD), axial (λ(axial)) diffusivity and radial (λ(radial)) diffusivity maps calculated. Tract-based spatial statistics (TBSS) was used to perform a voxel-wise statistical analysis of the main white matter structures compared to age-sex matched control groups. SETTING The study was performed at Great Ormond Street Children's Hospital NHS Trust PATIENTS Four NGD and three Type I Gaucher paediatric patients were recruited RESULTS The findings suggest the presence of microstructural white matter changes in NGD patients primarily in the middle cerebellar peduncles compared to an age-sex matched control group. This finding is relevant to the clinical manifestation of ataxia seen in NGD. Diffuse non-specific changes were seen in the Type I patients, but without a focal point. CONCLUSIONS This study is the first to use DTI to examine the Gaucher brain. While the numbers studied are small, the results suggest that DTI may be an attractive surrogate marker of NGD, worthy of further exploration for use in clinical studies.
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Affiliation(s)
- Elin Haf Davies
- Institute of Child Health, University College London, London, WC1N 1EH, UK.
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Cystinosis: practical tools for diagnosis and treatment. Pediatr Nephrol 2011; 26:205-15. [PMID: 20734088 PMCID: PMC3016220 DOI: 10.1007/s00467-010-1627-6] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Revised: 07/05/2010] [Accepted: 07/07/2010] [Indexed: 02/07/2023]
Abstract
Cystinosis is the major cause of inherited Fanconi syndrome, and should be suspected in young children with failure to thrive and signs of renal proximal tubular damage. The diagnosis can be missed in infants, because not all signs of renal Fanconi syndrome are present during the first months of life. In older patients cystinosis can mimic idiopathic nephrotic syndrome due to focal and segmental glomerulosclerosis. Measuring elevated white blood cell cystine content is the corner stone for the diagnosis. The diagnosis is confirmed by molecular analysis of the cystinosin gene. Corneal cystine crystals are invariably present in all patients with cystinosis after the age of 1 year. Treatment with the cystine depleting drug cysteamine should be initiated as soon as possible and continued lifelong to prolong renal function survival and protect extra-renal organs. This educational feature provides practical tools for the diagnosis and treatment of cystinosis.
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Besouw MTP, Hulstijn-Dirkmaat GM, van der Rijken REA, Cornelissen EAM, van Dael CM, Vande Walle J, Lilien MR, Levtchenko EN. Neurocognitive functioning in school-aged cystinosis patients. J Inherit Metab Dis 2010; 33:787-93. [PMID: 20814825 PMCID: PMC2992654 DOI: 10.1007/s10545-010-9182-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2009] [Revised: 05/11/2010] [Accepted: 07/26/2010] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Cystinosis is an autosomal recessive disorder leading to intralysosomal cystine accumulation in various tissues. It causes renal Fanconi syndrome and end stage renal failure around the age of 10 years if not treated with cysteamine. Children with cystinosis seem to have a normal intelligence but frequently show learning difficulties. These problems may be due to specific neurocognitive deficits rather than impaired renal function. Whether cysteamine treatment can improve cognitive functioning of cystinosis patients is thus far unknown. We aim to analyze neurocognitive functioning of school-aged cystinosis patients treated with cysteamine in order to identify specific deficits that can lead to learning difficulties. PATIENTS AND METHODS Fourteen Dutch and Belgian school-aged cystinosis patients were included. Glomerular filtration rate was estimated using the Schwartz formula. Children were tested for general intelligence, visual-motor integration, inhibition, interference, sustained attention, accuracy, planning, visual memory, processing speed, motor planning, fluency and speed, and behavioural and emotional functioning using standardized methods. RESULTS Glomerular filtration rate ranged from 22 to 120 ml min(-1) 1.73 m(-2). Median full-scale intelligence was below the average of a normal population (87, range 60-132), with a discrepancy between verbal (median 95, range 60-125) and performance (median 87, range 65-130) intelligence. Over 50% of the patients scored poorly on visual-motor integration, sustained attention, visual memory, planning, or motor speed. The other tested areas showed no differences between patients' and normal values. CONCLUSION Neurocognitive diagnostics are indicated in cystinosis patients. Early recognition of specific deficits and supervision from special education services might reduce learning difficulties and improve school careers.
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Affiliation(s)
- M. T. P. Besouw
- Department of Pediatrics/Pediatric Nephrology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
| | - G. M. Hulstijn-Dirkmaat
- Department of Medical Psychology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - R. E. A. van der Rijken
- Department of Medical Psychology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - E. A. M. Cornelissen
- Department of Pediatric Nephrology, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - C. M. van Dael
- Department of Pediatric Nephrology, University Medical Centre Groningen, Groningen, The Netherlands
| | - J. Vande Walle
- Department of Pediatric Nephrology, University Hospital Ghent, Ghent, Belgium
| | - M. R. Lilien
- Department of Pediatric Nephrology, Wilhelmina Children Hospital Utrecht, Utrecht, The Netherlands
| | - E. N. Levtchenko
- Department of Pediatrics/Pediatric Nephrology, University Hospital Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium
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Neurological impairment in nephropathic cystinosis: motor coordination deficits. Pediatr Nephrol 2010; 25:2061-6. [PMID: 20652328 PMCID: PMC2923721 DOI: 10.1007/s00467-010-1589-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Revised: 05/20/2010] [Accepted: 06/02/2010] [Indexed: 11/25/2022]
Abstract
Nephropathic cystinosis is a rare genetic metabolic disorder that results in accumulation of the amino acid cystine in lysosomes due to lack of a cystine-specific transporter protein. Cystine accumulates in cells throughout the body and causes progressive damage to multiple organs, including the brain. Neuromotor deficits have been qualitatively described in individuals with cystinosis. This study quantitatively examined fine-motor coordination in individuals with cystinosis. Brain magnetic resonance imaging (MRI) scans were also performed to determine whether structural changes were associated with motor deficits. Participants were 52 children and adolescents with infantile nephropathic cystinosis and 49 controls, ages 2-17 years, divided into preacademic and school-age groups. Results indicated that both the preacademic and school-age cystinosis groups performed significantly more poorly than their matched control groups on the Motor Coordination Test. Further, the level of performance was not significantly different between the preacademic and school-age groups. There were no significant differences in motor coordination scores based on MRI findings. This is the first study to document a persistent, nonprogressive, fine-motor coordination deficit in children and adolescents with cystinosis. The fact that these difficulties are present in the preschool years lends further support to the theory that cystinosis adversely affects neurological functioning early in development. The absence of a relationship between brain structural changes and motor function suggests that an alternative cause for motor dysfunction must be at work in this disorder.
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