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Cui F, Wulan T, Zhang Q, Zhang VW, Jiang Y. Identification of a novel KCNT2 variant in a family with developmental and epileptic encephalopathies: a case report and literature review. Front Genet 2024; 15:1371282. [PMID: 38510274 PMCID: PMC10951377 DOI: 10.3389/fgene.2024.1371282] [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: 01/16/2024] [Accepted: 02/20/2024] [Indexed: 03/22/2024] Open
Abstract
Background: Developmental and epileptic encephalopathies (DEEs) are a group of heterogeneous neurodevelopmental diseases characterized mainly by developmental delay/intellectual disability and early-onset epilepsy. Researchers have identified variations in the KCNT2 gene (OMIM* 610044) as the cause of DEE type 57 (MIM# 617771). Case presentation: We report in this study a 46-year-old woman who presented with early-onset epilepsy, intellectual disability, hypertrichosis, coarse facial features, and short stature. Besides, there were four other affected individuals in her family history, including two elder brothers, a younger brother, and their mother. We collected blood samples from the proband, her two affected brothers, and her clinically normal daughter for genetic analysis. Clinical exome sequencing revealed a novel heterozygous variant in the KCNT2 gene (NM_198503: c.188G>A, p.Arg63His) in the proband and her two affected brothers, while her daughter did not carry this variant. Furthermore, we reviewed all 25 patients identified in the literature with KCNT2 variants and compared their phenotypes. Conclusion: Epilepsy and intellectual disability/developmental delay occur in almost all patients with KCNT2 variants. KCNT2-relevant DEEs partially overlap with the clinical phenotypes of KATP channel diseases, particularly in hypertrichosis and distinctive coarse facial features.
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Affiliation(s)
- Fengji Cui
- Department of Molecular Genetics, Chifeng Maternity Hospital, Chifeng, China
| | - Tuoya Wulan
- Department of Reproduction, Chifeng Maternity Hospital, Chifeng, China
| | | | | | - Yuhua Jiang
- Department of Obstetrics, Chifeng Maternity Hospital, Chifeng, China
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Boskabadi SJ, Ramezaninejad S, Sohrab M, Farhadi R. Diazoxide-Induced Hypertrichosis in a Neonate With Transient Hyperinsulinism. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231151330. [PMID: 36726424 PMCID: PMC9885027 DOI: 10.1177/11795476231151330] [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: 11/25/2022] [Accepted: 12/28/2022] [Indexed: 01/28/2023]
Abstract
Diazoxide is one of the FDA-approved pharmacologic treatments for hyperinsulinemic hypoglycemia, however, its adverse effects in infants are not well described. We reported a 37-week-old boy with the diagnosis of hypoglycemia. We started a dextrose infusion, but we used oral diazoxide, due to hypoglycemia episodes despite the increase in dextrose intake. The newborn had a normoglycemic condition after gradually increasing the diazoxide dose to 15 mg/kg/day. He was fully breastfed and discharged at 14 days of age with ongoing diazoxide. In weekly serial clinical follow-ups, the parents noticed an increase in the growth of forehead and facial hair that was diagnosed as diazoxide-induced hypertrichosis. Diazoxide was gradually tapered, and hypertrichosis continued until 1 month after dioxide discontinuation. Diazoxide use in NICU settings has increased over time. Diazoxide has many side effects, one of which is hypertrichosis. Many diazoxide side effects have been reported in adults or children and few studies have reported the prevalence of these adverse effects of diazoxide in neonates and infants.
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Affiliation(s)
- Seyyed Javad Boskabadi
- Department of Clinical Pharmacy,
Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Sima Ramezaninejad
- Department of Clinical Pharmacy,
Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Masoumeh Sohrab
- Department of Clinical Pharmacy,
Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Roya Farhadi
- Department of Neonatology, Pediatrics
Infectious Diseases Research Center, Mazandaran University of Medical Sciences,
Sari, Iran,Roya Farhadi, Department of Neonatology,
Pediatrics Infectious Diseases Research Center, Mazandaran University of Medical
Sciences, Sari, Iran; Division of neonatology, Department of Pediatrics, Boo Ali
Sina Hospital, Pasdaran Boulevard, P.O.Box 48158-38477, Sari, Iran. Emails:
;
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Gęgotek A, Skrzydlewska E. The Role of ABC Transporters in Skin Cells Exposed to UV Radiation. Int J Mol Sci 2022; 24:115. [PMID: 36613554 PMCID: PMC9820374 DOI: 10.3390/ijms24010115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
ABC transporters are expressed in skin cells to protect them against harmful xenobiotics. Moreover, these transmembrane proteins have a number of additional functions that ensure skin homeostasis. This review summarizes the current knowledge about the role of specific ABC proteins in the skin, including multi-drug resistance transporters (MDR1/3), the transporter associated with antigen processing 1/2 (TAP1/2), the cystic fibrosis transmembrane conductance regulator (CFTR), sulfonylurea receptors (SUR1/2), and the breast cancer resistance protein (BCRP). Additionally, the effect of UV radiation on ABC transporters is shown. The exposure of skin cells to UV radiation often leads to increased activity of ABC transporters-as has been observed in the case of MDRs, TAPs, CFTR, and BCRP. A different effect of oxidative stress has been observed in the case of mitochondrial SURs. However, the limited data in the literature-as indicated in this article-highlights the limited number of experimental studies dealing with the role of ABC transporters in the physiology and pathophysiology of skin cells and the skin as a whole. At the same time, the importance of such knowledge in relation to the possibility of daily exposure to UV radiation and xenobiotics, used for both skin care and the treatment of its diseases, is emphasized.
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Affiliation(s)
- Agnieszka Gęgotek
- Department of Analytical Chemistry, Medical University of Bialystok, 15-089 Białystok, Poland
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Brar PC, Heksch R, Cossen K, De Leon DD, Kamboj MK, Marks SD, Marshall BA, Miller R, Page L, Stanley T, Mitchell D, Thornton P. Management and Appropriate Use of Diazoxide in Infants and Children with Hyperinsulinism. J Clin Endocrinol Metab 2020; 105:5894029. [PMID: 32810255 DOI: 10.1210/clinem/dgaa543] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 08/11/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The diagnosis of hypoglycemia and the use of diazoxide have risen in the last decade. Diazoxide is the only Food and Drug Agency-approved pharmacologic treatment for neonatal hypoglycemia caused by hyperinsulinism (HI). Recent publications have highlighted that diazoxide has serious adverse effects (AEs) such as pulmonary hypertension (2-3%) and neutropenia (15%). Despite its increasing use, there is little information regarding dosing of diazoxide and/or monitoring for AEs. METHODS We convened a working group of pediatric endocrinologists who were members of the Drug and Therapeutics Committee of the Pediatric Endocrine Society (PES) to review the available literature. Our committee sent a survey to its PES members regarding the use of diazoxide in their endocrine practices. Our review of the results concluded that there was substantial heterogeneity in usage and monitoring for AEs for diazoxide among pediatric endocrinologists. CONCLUSIONS Based on our extensive literature review and on the lack of consensus regarding use of diazoxide noted in our PES survey, our group graded the evidence using the framework of the Grading of Recommendations, Assessment, Development and Evaluation Working Group, and has proposed expert consensus practice guidelines for the appropriate use of diazoxide in infants and children with HI. We summarized the information on AEs reported to date and have provided practical ideas for dosing and monitoring for AEs in infants treated with diazoxide.
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Affiliation(s)
- Preneet Cheema Brar
- Division of Endocrinology and Diabetes, Department of Pediatrics, New York University Grossman School of Medicine, New York City, New York
| | - Ryan Heksch
- Center for Diabetes and Endocrinology, Department of Pediatrics, Akron Children's Hospital, Akron, Ohio
| | - Kristina Cossen
- Division of Pediatric Endocrinology, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Diva D De Leon
- Division of Endocrinology and Diabetes, Department of Pediatrics, The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Manmohan K Kamboj
- Division of Endocrinology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Seth D Marks
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bess A Marshall
- Division of Endocrinology and Diabetes, Department or Pediatrics, Washington University in St. Louis, St. Louis, Missouri
| | - Ryan Miller
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Laura Page
- Division of Pediatric Endocrinology, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Takara Stanley
- Division of Pediatric Endocrinology, Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Deborah Mitchell
- Division of Pediatric Endocrinology, Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Paul Thornton
- Congenital Hyperinsulinism Center, Cook Children's Medical Center, Fort Worth, Texas
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McClenaghan C, Huang Y, Yan Z, Harter TM, Halabi CM, Chalk R, Kovacs A, van Haaften G, Remedi MS, Nichols CG. Glibenclamide reverses cardiovascular abnormalities of Cantu syndrome driven by KATP channel overactivity. J Clin Invest 2020; 130:1116-1121. [PMID: 31821173 DOI: 10.1172/jci130571] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 12/05/2019] [Indexed: 12/12/2022] Open
Abstract
Cantu syndrome (CS) is a complex disorder caused by gain-of-function (GoF) mutations in ABCC9 and KCNJ8, which encode the SUR2 and Kir6.1 subunits, respectively, of vascular smooth muscle (VSM) KATP channels. CS includes dilated vasculature, marked cardiac hypertrophy, and other cardiovascular abnormalities. There is currently no targeted therapy, and it is unknown whether cardiovascular features can be reversed once manifest. Using combined transgenic and pharmacological approaches in a knockin mouse model of CS, we have shown that reversal of vascular and cardiac phenotypes can be achieved by genetic downregulation of KATP channel activity specifically in VSM, and by chronic administration of the clinically used KATP channel inhibitor, glibenclamide. These findings demonstrate that VSM KATP channel GoF underlies CS cardiac enlargement and that CS-associated abnormalities are reversible, and provide evidence of in vivo efficacy of glibenclamide as a therapeutic agent in CS.
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Affiliation(s)
- Conor McClenaghan
- Center for the Investigation of Membrane Excitability Diseases.,Department of Cell Biology.,Department of Physiology
| | - Yan Huang
- Center for the Investigation of Membrane Excitability Diseases.,Department of Cell Biology.,Department of Physiology
| | - Zihan Yan
- Center for the Investigation of Membrane Excitability Diseases.,Division of Endocrinology, Department of Medicine, and
| | - Theresa M Harter
- Center for the Investigation of Membrane Excitability Diseases.,Department of Cell Biology.,Department of Physiology
| | - Carmen M Halabi
- Center for the Investigation of Membrane Excitability Diseases.,Division of Nephrology, Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Rod Chalk
- Structural Genomics Consortium, University of Oxford, Oxford, United Kingdom
| | - Attila Kovacs
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Gijs van Haaften
- Center for Molecular Medicine, Department of Genetics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Maria S Remedi
- Center for the Investigation of Membrane Excitability Diseases.,Division of Endocrinology, Department of Medicine, and
| | - Colin G Nichols
- Center for the Investigation of Membrane Excitability Diseases.,Department of Cell Biology.,Department of Physiology
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