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Rose DJ, Castner DM, Wilson KS, Rubin DA. Examination of sensory reception and integration abilities in children with and without Prader-Willi syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 149:104730. [PMID: 38615631 DOI: 10.1016/j.ridd.2024.104730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 03/08/2024] [Accepted: 04/05/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Good postural stability control is dependent upon the complex integration of incoming sensory information (visual, somatosensory, vestibular) with neuromotor responses that are constructed in advance of a voluntary action or in response to an unexpected perturbation. AIMS To examine whether differences exist in how sensory inputs are used to control standing balance in children with and without Prader-Willi syndrome (PWS). METHODS AND PROCEDURES In this cross-sectional study, 18 children with PWS and 51 children categorized as obese but without PWS (without PWS) ages 8-11 completed the Sensory Organization Test®. This test measures the relative contributions of vision, somatosensory, and vestibular inputs to the control of standing balance. The composite equilibrium score (CES) derived from performance in all sensory conditions, in addition to equilibrium scores (EQs) and falls per condition were compared between groups. OUTCOMES AND RESULTS The CES was lower for children with PWS compared to children without PWS (M=53.93, SD=14.56 vs. M=66.17, SD=9.89, p = .001) while EQs declined in both groups between conditions 1 and 4 (F (1.305, 66.577) = 71.381, p < .001). No group differences in the percent of falls were evident in condition 5 but more children with PWS fell in condition 6 (χ2 (1) = 7.468, p = .006). Group differences in frequency of repeated falls also approached significance in conditions 5 (χ2 (3) = 4.630, p = .099) and 6 (χ2 (3) = 5.167, p = .076). CONCLUSIONS AND IMPLICATIONS Children with PWS demonstrated a lower overall level of postural control and increased sway when compared to children with obesity. Both the higher incidence and repeated nature of falls in children with PWS in conditions 5 and 6 suggest an inability to adapt to sensory conditions in which vestibular input must be prioritized. Postural control training programs in this population should include activities that improve their ability to appropriately weight sensory information in changing sensory environments, with a particular focus on the vestibular system. WHAT DOES THIS STUDY ADD?: This study shows that children with PWS demonstrate a lower level of postural stability. The results suggest that children with PWS show inability to adapt to sensory conditions that require prioritizing vestibular information to maintain postural control. This information can be used to help guide training programs in this population.
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Affiliation(s)
- Debra J Rose
- Movement Enhancement Laboratory, Department of Kinesiology, California State University, Fullerton, CA, USA
| | - Diobel M Castner
- Movement Enhancement Laboratory, Department of Kinesiology, California State University, Fullerton, CA, USA; Nike Sport Research Laboratory, Beaverton, OR, USA
| | - Kathleen S Wilson
- Movement Enhancement Laboratory, Department of Kinesiology, California State University, Fullerton, CA, USA
| | - Daniela A Rubin
- Movement Enhancement Laboratory, Department of Kinesiology, California State University, Fullerton, CA, USA.
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Madeo SF, Zagaroli L, Vandelli S, Calcaterra V, Crinò A, De Sanctis L, Faienza MF, Fintini D, Guazzarotti L, Licenziati MR, Mozzillo E, Pajno R, Scarano E, Street ME, Wasniewska M, Bocchini S, Bucolo C, Buganza R, Chiarito M, Corica D, Di Candia F, Francavilla R, Fratangeli N, Improda N, Morabito LA, Mozzato C, Rossi V, Schiavariello C, Farello G, Iughetti L, Salpietro V, Salvatoni A, Giordano M, Grugni G, Delvecchio M. Endocrine features of Prader-Willi syndrome: a narrative review focusing on genotype-phenotype correlation. Front Endocrinol (Lausanne) 2024; 15:1382583. [PMID: 38737552 PMCID: PMC11082343 DOI: 10.3389/fendo.2024.1382583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Abstract
Prader-Willi syndrome (PWS) is a complex genetic disorder caused by three different types of molecular genetic abnormalities. The most common defect is a deletion on the paternal 15q11-q13 chromosome, which is seen in about 60% of individuals. The next most common abnormality is maternal disomy 15, found in around 35% of cases, and a defect in the imprinting center that controls the activity of certain genes on chromosome 15, seen in 1-3% of cases. Individuals with PWS typically experience issues with the hypothalamic-pituitary axis, leading to excessive hunger (hyperphagia), severe obesity, various endocrine disorders, and intellectual disability. Differences in physical and behavioral characteristics between patients with PWS due to deletion versus those with maternal disomy are discussed in literature. Patients with maternal disomy tend to have more frequent neurodevelopmental problems, such as autistic traits and behavioral issues, and generally have higher IQ levels compared to those with deletion of the critical PWS region. This has led us to review the pertinent literature to investigate the possibility of establishing connections between the genetic abnormalities and the endocrine disorders experienced by PWS patients, in order to develop more targeted diagnostic and treatment protocols. In this review, we will review the current state of clinical studies focusing on endocrine disorders in individuals with PWS patients, with a specific focus on the various genetic causes. We will look at topics such as neonatal anthropometry, thyroid issues, adrenal problems, hypogonadism, bone metabolism abnormalities, metabolic syndrome resulting from severe obesity caused by hyperphagia, deficiencies in the GH/IGF-1 axis, and the corresponding responses to treatment.
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Affiliation(s)
- Simona F. Madeo
- Department of Medical and Surgical Sciences for Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Zagaroli
- Department of Pediatrics, University of L’Aquila, L’Aquila, Italy
| | - Sara Vandelli
- Department of Medical and Surgical Sciences for Mother, Children and Adults, Post-Graduate School of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy
| | - Valeria Calcaterra
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Pediatric Department, Buzzi Children’s Hospital, Milano, Italy
| | - Antonino Crinò
- Center for Rare Diseases and Congenital Defects, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Luisa De Sanctis
- Pediatric Endocrinology, Regina Margherita Children Hospital – Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - Maria Felicia Faienza
- Pediatric Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Bari, Italy
| | - Danilo Fintini
- Prader Willi Reference Center, Endocrinology and Diabetology Unit, Pediatric University Department, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Laura Guazzarotti
- Pediatric Endocrinology Unit, University Hospital of Padova, Padova, Italy
| | - Maria Rosaria Licenziati
- Neuro-endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - Enza Mozzillo
- Department of Translational and Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Roberta Pajno
- Pediatric Unit, IRCCS San Raffaele Institute, Milan, Italy
| | - Emanuela Scarano
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria E. Street
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
| | - Malgorzata Wasniewska
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
- Pediatric Unit, Gaetano Martino University Hospital of Messina, Messina, Italy
| | - Sarah Bocchini
- Prader Willi Reference Center, Endocrinology and Diabetology Unit, Pediatric University Department, IRCCS Bambino Gesù Children Hospital, Rome, Italy
| | - Carmen Bucolo
- Pediatric Unit, IRCCS San Raffaele Institute, Milan, Italy
| | - Raffaele Buganza
- Pediatric Endocrinology, Regina Margherita Children Hospital – Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - Mariangela Chiarito
- Pediatric Unit, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari “Aldo Moro”, Bari, Italy
| | - Domenico Corica
- Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy
- Pediatric Unit, Gaetano Martino University Hospital of Messina, Messina, Italy
| | - Francesca Di Candia
- Department of Translational and Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | | | - Nadia Fratangeli
- Division of Auxology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Verbania, Italy
| | - Nicola Improda
- Neuro-endocrine Diseases and Obesity Unit, Department of Neurosciences, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | | | - Chiara Mozzato
- Child and Women Health Department, University of Padova, Padova, Italy
| | - Virginia Rossi
- Pediatric Department, Buzzi Children’s Hospital, Milano, Italy
| | | | - Giovanni Farello
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences for Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Vincenzo Salpietro
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | | | - Mara Giordano
- Laboratory of Genetics, Struttura Complessa a Direzione Universitaria (SCDU) Biochimica Clinica, Ospedale Maggiore della Carità, Novara, Italy
- Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Graziano Grugni
- Division of Auxology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Verbania, Italy
| | - Maurizio Delvecchio
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
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Jin YY, Luo FH. Early psychomotor development and growth hormone therapy in children with Prader-Willi syndrome: a review. Eur J Pediatr 2024; 183:1021-1036. [PMID: 37987848 DOI: 10.1007/s00431-023-05327-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/22/2023] [Accepted: 10/31/2023] [Indexed: 11/22/2023]
Abstract
Prader-Willi syndrome (PWS) is a rare genetic disorder caused by the loss of imprinted gene expression on the paternal chromosome 15q11-q13. PWS is characterized by varying degrees of early psychomotor developmental deficits, primarily in cognition, language, and motor development. This review summarizes the early mental cognitive development, language development, and motor development in patients with PWS, compares the correlation of genotype with phenotype, and provides an update regarding the effects and concerns related to potential main side effects of treatment with recombinant human growth hormone on early psycho-cognitive and motor function development along with the linear growth and body composition of children with PWS.Conclusion: Early psychomotor development is strongly correlated with the prognosis of patients with PWS; moreover, current studies support that the initiation of interventions at an early age can exert significant beneficial effects on enhancing the cognitive and linguistic development of patients with PWS and allow them to "catch up" with motor development. What is Known: • Prader-Willi syndrome is a rare genetic disorder characterized by multisystem damage, and children with Prader-Willi syndrome are typically characterized by early developmental delays, specifically in the areas of cognitive and motor development. • Recombinant human growth hormone therapy is the only medical treatment approved for Prader-Willi syndrome. What is New: • Extensive presentation of psycho-cognitive and motor development features and genotype-phenotype correlation in children with Prader-Willi syndrome. • The effects of growth hormone on early psychomotor development in children with Prader-Willi syndrome were thoroughly reviewed, including their short- and long-term outcomes and any associated adverse effects.
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Affiliation(s)
- Yu-Yu Jin
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wan Yuan Road, Min Hang District, Shanghai, 201102, China
| | - Fei-Hong Luo
- Department of Pediatric Endocrinology and Inherited Metabolic Diseases, Children's Hospital of Fudan University, National Children's Medical Center, 399 Wan Yuan Road, Min Hang District, Shanghai, 201102, China.
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Rubin DA, Rose DJ, Escano DL, Holmes SC, Garcia SA, Pamukoff DN. Contributing factors to postural stability in Prader-Willi syndrome. Hum Mov Sci 2023; 91:103125. [PMID: 37515958 DOI: 10.1016/j.humov.2023.103125] [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: 07/13/2022] [Revised: 11/09/2022] [Accepted: 07/18/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Prader-Willi Syndrome (PWS) is a rare neurodevelopmental disorder affecting multiple functional parameters. This study examined postural stability and associated gait and neuromuscular factors in young adults with PWS. METHODS Participants included 10 adults with PWS [7 M/3F; Body Fat % 40.61 ± 7.79]; ten normal weight (NW) adults [7 M/3F; Body Fat % 23.42 ± 7.0]; ten obese (OB) adults [7 M/3F; Body Fat % 42.40 ± 5.62]. Participants completed the Sensory Organization Test (SOT)®. Condition (C) specific and a composite equilibrium score (CES) were calculated (maximum = 100). Quadriceps strength was assessed using an isokinetic dynamometer. Three-dimensional gait analyses were completed along a 10 m walkway using a motion capture system and two force plates. A gait stability ratio (GSR) was computed from gait speed and step length (steps/m). RESULTS The PWS group had lower scores for C1, C3, C4 and CES compared to the NW (p < .039 for all) and lower scores for C4 and CES than the OB (p < .019 for both) groups, respectively. In C5 (eyes closed, sway-referenced support) and C6 (sway-referenced vision and support), 33.3% of participants with PWS fell during the first trial in both conditions (X2 [2] 7.436, p = .024) and (X2 [2] 7.436, p = .024) but no participant in the other groups fell. Those with PWS showed higher GSR than participants with NW (p = .005) and those with obesity (p = .045). CONCLUSION Individuals with PWS had more difficulty maintaining standing balance when relying on information from the somatosensory (C3), visual-vestibular (C4) and vestibular systems (C5, C6). A more stable walk was related to shorter steps, slower velocity and reduced peak quadriceps torque. Participation in multisensory activities that require appropriate prioritization of sensory system(s) input for controlling balance in altered sensory environments should be routinely included. In addition, exercises targeting muscular force and power should be included as part of exercise programming in PWS.
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Affiliation(s)
- Daniela A Rubin
- Department of Kinesiology, California State University, Fullerton, Fullerton, CA, United States of America.
| | - Debra J Rose
- Department of Kinesiology, California State University, Fullerton, Fullerton, CA, United States of America
| | - Derrick L Escano
- Department of Kinesiology, California State University, Fullerton, Fullerton, CA, United States of America
| | - Skylar C Holmes
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, MA, United States of America
| | - Steven A Garcia
- Department of Kinesiology, University of Michigan, Ann Arbor, MI, United States of America
| | - Derek N Pamukoff
- School of Kinesiology, University of Western Ontario, London, ON, Canada
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Bayartai ME, Luomajoki H, Tringali G, De Micheli R, Grugni G, Sartorio A. Differences in spinal postures and mobility among adults with Prader-Willi syndrome, essential obesity, and normal-weight individuals. Front Endocrinol (Lausanne) 2023; 14:1235030. [PMID: 37800136 PMCID: PMC10548364 DOI: 10.3389/fendo.2023.1235030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction Spinal kinematics/motion are reported to be altered in adolescents and adults with essential obesity, while no information is available in patients with Prader-Willi syndrome so far. The aim of this study was to examine cross-sectionally the characteristics of spinal postures and mobility in 34 patients with PWS, in 35 age- and sex-matched adults with essential obesity, and in 37 normal-weight individuals. Methods Spinal posture and mobility were assessed using a radiation-free back scan, the Idiag M360 (Idiag, Fehraltorf, Switzerland). Differences in spinal posture and mobility between the three groups were determined using a two-way analysis of variance. Results Adults with Prader-Willi syndrome had greater thoracic kyphosis [difference between groups (Δ) = 9.60, 95% CI 3.30 to 15.60, p = 0.001], less lumbar lordosis (Δ = -6.50, 95% CI -12.70 to -0.30, p = 0.03) as well as smaller lumbar and hip mobility than those with normal weight. Discussion Although the characteristics of the spine in patients with Prader-Will syndrome appear to be similar to that found in subjects with essential obesity, Prader-Willi syndrome was found to influence lumbar movements more than thoracic mobility. These results provide relevant information about the characteristics of the spine in adults with Prader-Willi syndrome to be taken into careful consideration in the management of spinal conditions. These findings also highlight the importance of considering the musculoskeletal assessment of spinal postures and approaches targeting spinal and hip flexibility in adults with Prader-Willi syndrome.
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Affiliation(s)
- Munkh-Erdene Bayartai
- Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, (ZHAW), Winterthur, Switzerland
- Department of Physical and Occupational Therapy, School of Nursing, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Hannu Luomajoki
- Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, (ZHAW), Winterthur, Switzerland
| | - Gabriella Tringali
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Experimental Laboratory for Auxo-Endocrinological Research, Piancavallo-Verbania, Italy
| | - Roberta De Micheli
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Experimental Laboratory for Auxo-Endocrinological Research, Piancavallo-Verbania, Italy
| | - Graziano Grugni
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Experimental Laboratory for Auxo-Endocrinological Research, Piancavallo-Verbania, Italy
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Division of Auxology, Piancavallo-Verbania, Italy
| | - Alessandro Sartorio
- Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Experimental Laboratory for Auxo-Endocrinological Research, Piancavallo-Verbania, Italy
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Zaffanello M, Pietrobelli A, Piacentini G, Guzzo A, Antoniazzi F. The Impact of Growth Hormone Therapy on Sleep-Related Health Outcomes in Children with Prader-Willi Syndrome: A Review and Clinical Analysis. J Clin Med 2023; 12:5504. [PMID: 37685570 PMCID: PMC10488332 DOI: 10.3390/jcm12175504] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
This literature review of growth hormone (GH) therapy and sleep-related health outcomes in children diagnosed with Prader-Willi syndrome (PWS) assembles evidence for the consequences of sleep deprivation and poor sleep quality: difficulty concentrating and learning at school, behavioral problems, diminished quality of life, and growth impairment. Sleep-disordered breathing (SDB) is another factor that impacts a child's well-being. We searched the electronic databases Medline PubMed Advanced Search Builder, Scopus, and Web of Science using MeSH terms and text words to retrieve articles on GH deficiency, recombinant human growth hormone (rhGH) therapy, sleep quality, SDB, and PWS in children. The censor date was April 2023. The initial search yielded 351 articles, 23 of which were analyzed for this review. The study findings suggest that while GH may have a role in regulating sleep, the relationship between GH treatment and sleep in patients with PWS is complex and influenced by GH dosage, patient age, and type and severity of respiratory disorders, among other factors. GH therapy can improve lung function, linear growth, and body composition in children with PWS; however, it can also trigger or worsen obstructive sleep apnea or hypoventilation in some. Long-term GH therapy may contribute to adenotonsillar hypertrophy and exacerbate sleep apnea in children with PWS. Finally, GH therapy can improve sleep quality in some patients but it can also cause or worsen SDB in others, leading to diminished sleep quality and overall quality of life. The current evidence suggests that the initial risk of worsening SDB may improve with long-term therapy. In conclusion, rhGH is the standard for managing patients with PWS. Nonetheless, its impact on respiratory function during sleep needs to be thoroughly evaluated. Polysomnography is advisable to assess the need for adenotonsillectomy before initiating rhGH therapy. Close monitoring of sleep disorders in patients with PWS receiving GH therapy is essential to ensure effective and safe treatment.
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Affiliation(s)
- Marco Zaffanello
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37129 Verona, Italy; (A.P.); (G.P.); (F.A.)
| | - Angelo Pietrobelli
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37129 Verona, Italy; (A.P.); (G.P.); (F.A.)
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37129 Verona, Italy; (A.P.); (G.P.); (F.A.)
| | - Alessandra Guzzo
- Department of Pathology and Diagnostics, School of Medicine, University of Verona, 37129 Verona, Italy;
| | - Franco Antoniazzi
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, 37129 Verona, Italy; (A.P.); (G.P.); (F.A.)
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van Abswoude DH, Pellikaan K, Nguyen N, Rosenberg AGW, Davidse K, Hoekstra FME, Rood IM, Poitou C, Grugni G, Høybye C, Markovic TP, Caixàs A, Crinò A, van den Berg SAA, van der Lely AJ, de Graaff LCG. Kidney disease in adults with Prader-Willi syndrome: international cohort study and systematic literature review. Front Endocrinol (Lausanne) 2023; 14:1168648. [PMID: 37547314 PMCID: PMC10402738 DOI: 10.3389/fendo.2023.1168648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Background Prader-Willi syndrome (PWS) is a rare, complex, genetic disorder characterized by hyperphagia, hypotonia, delayed psychomotor development, low muscle mass and hypothalamic dysfunction. Adults with PWS often have obesity, hypertension and type 2 diabetes mellitus (DM2), known risk factors for cardiovascular disease (CVD) and chronic kidney disease (CKD). Early symptoms of CVD and CKD may be masked by intellectual disability and inability to express physical complaints. Furthermore, kidney diseases are often asymptomatic. Therefore, renal and cardiovascular disease might be missed in patients with PWS. Microalbuminuria is an early sign of microvascular damage in the kidneys and other vascular beds. Therefore, we screened our adult PWS cohort for the presence of elevated urinary albumin and (micro)albuminuria. Methods We retrospectively collected anthropometric measurements, blood pressure, medical history, medication use, urine dipstick and biochemical measurements form electronic patient files. In addition, we performed a systematic literature review on kidney disease in PWS. Results We included 162 adults with genetically confirmed PWS (56% male, median age 28 years), of whom 44 (27%) had DM2. None had known CVD. All subjects had normal estimated glomerular filtration rate (eGFR) according to non-PWS reference intervals. Elevated urinary albumin or (micro)albuminuria was present in 28 (18%); 19 out of 75 (25%) had an increased urinary albumin-to-creatinine ratio (UACR) and 10 out of 57 (18%) had an increased urinary protein-to-creatinine ratio. Elevated urinary albumin was present at a young age (median age 26 (IQR 24-32) years) and was associated with an significantly higher BMI and LDL-cholesterol levels and higher prevalence of DM2, hypertension and dyslipidemia than those with normal UACR (p=0.027, p=0.019, p<0.001, p<0.001, p=0.011 and respectively). Conclusion Upon screening, one in every five adults with PWS had increased urinary albumin or (micro)albuminuria, early signs of microvascular disease. All had normal eGFR, according to non-PWS reference intervals, and none had a formal diagnosis of CVD. As muscle mass is low in PWS, creatinine levels and eGFR may be spuriously normal. Urinalysis in this patient group can be used as a screening tool for microvascular (kidney) disease. We propose an algorithm for the detection and management of microvascular disease in adults with PWS.
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Affiliation(s)
- Denise H. van Abswoude
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
- Dutch Center of Reference for Prader–Willi Syndrome, Rotterdam, Netherlands
- Academic Center for Growth Disorders, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Karlijn Pellikaan
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
- Dutch Center of Reference for Prader–Willi Syndrome, Rotterdam, Netherlands
- Academic Center for Growth Disorders, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Naomi Nguyen
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Anna G. W. Rosenberg
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
- Dutch Center of Reference for Prader–Willi Syndrome, Rotterdam, Netherlands
- Academic Center for Growth Disorders, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Kirsten Davidse
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
- Dutch Center of Reference for Prader–Willi Syndrome, Rotterdam, Netherlands
- Academic Center for Growth Disorders, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Franciska M. E. Hoekstra
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
- Internal Medicine, Division of Nephrology, Reinier de Graaf Gasthuis, Delft, Netherlands
| | - Ilse M. Rood
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Christine Poitou
- Assistance Publique-Hôpitaux de Paris, Rare Diseases Center of Reference ‘Prader-Willi Syndrome and Obesity with Eating Disorders’ (PRADORT), Nutrition Department, Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière Hospital, Sorbonne Université, National Institute of Health and Medical Research (INSERM), Nutriomics, Paris, France
- International Network for Research, Management & Education on adults with Prader-Willi Syndrome (INfoRMEd-PWS)
- European Reference Network on Rare Endocrine Conditions (ENDO-ERN)
| | - Graziano Grugni
- International Network for Research, Management & Education on adults with Prader-Willi Syndrome (INfoRMEd-PWS)
- European Reference Network on Rare Endocrine Conditions (ENDO-ERN)
- Division of Auxology, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Piancavallo, Italy
| | - Charlotte Høybye
- International Network for Research, Management & Education on adults with Prader-Willi Syndrome (INfoRMEd-PWS)
- European Reference Network on Rare Endocrine Conditions (ENDO-ERN)
- Department of Molecular Medicine and Surgery, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
- Department of Endocrinology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - Tania P. Markovic
- International Network for Research, Management & Education on adults with Prader-Willi Syndrome (INfoRMEd-PWS)
- Metabolism & Obesity Service, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- Charles Perkins Center and Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Assumpta Caixàs
- International Network for Research, Management & Education on adults with Prader-Willi Syndrome (INfoRMEd-PWS)
- Department of Endocrinology and Nutrition, Parc Tauli Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT) Instituto de Salud Carlos III (CERCA-ISCIII), Sabadell, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Antonino Crinò
- International Network for Research, Management & Education on adults with Prader-Willi Syndrome (INfoRMEd-PWS)
- Reference Center for Prader-Willi syndrome, Bambino Gesù Hospital, Research Institute, Palidoro, Italy
- Center for Rare Diseases and Congenital Defects, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Sjoerd A. A. van den Berg
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Clinical Chemistry, Erasmus Medical Center (MC), University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Aart J. van der Lely
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
- Academic Center for Growth Disorders, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Laura C. G. de Graaff
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
- Center for Adults with Rare Genetic Syndromes, Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
- Dutch Center of Reference for Prader–Willi Syndrome, Rotterdam, Netherlands
- Academic Center for Growth Disorders, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, Netherlands
- European Reference Network on Rare Endocrine Conditions (ENDO-ERN)
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Shields N, Bennell KL, Southby A, Rice LJ, Markovic T, Bigby C, Prendergast L, Watts JJ, Schofield C, Loughnan G, Franklin J, Levitt D, Chikani V, McCallum Z, Blair S, Proietto J, Taylor NF. Progressive resistance training in young people with Prader-Willi syndrome: protocol for a randomised trial (PRESTO). BMJ Open 2022; 12:e060306. [PMID: 36549735 PMCID: PMC9791392 DOI: 10.1136/bmjopen-2021-060306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Preliminary evidence suggests that progressive resistance training may be beneficial for people with Prader-Willi Syndrome (PWS), a rare genetic condition that results in muscle weakness and low muscle tone.To establish whether community-based progressive resistance training is effective in improving the muscle strength of people with PWS; to determine cost-effectiveness; and, to complete a process evaluation assessing intervention fidelity, exploring mechanisms of impact, understanding participant experiences and identifying contextual factors affecting implementation. METHODS AND ANALYSIS A multisite, randomised controlled trial will be completed. Sixty participants with PWS will be randomised to receive either progressive resistance training (experimental) or non-progressive exercise (placebo control). Participants will be aged 13 to 60 years, be able to follow simple instructions in English and have no contraindications to performing progressive resistance training. The experimental group will complete progressive resistance training two times weekly for 24 weeks supervised by an exercise professional at a community gym. The control group will receive all aspects of the intervention except progressive overload. Outcomes will be assessed at week 25 (primary endpoint) and week 52 by a blinded assessor. The primary outcome is muscle strength assessed using one repetition maximum for upper limb and lower limb. Secondary outcomes are muscle mass, functional strength, physical activity, community participation, health-related quality of life and behaviour. Health economic analysis will evaluate cost-effectiveness. Process evaluation will assess safety and intervention fidelity, investigate mechanism of impact, explore participant experiences and identify contextual factors affecting implementation. Data collection commenced in February 2020 and will conclude in September 2023. ETHICS AND DISSEMINATION Ethical approval was obtained from The Royal Children's Hospital Human Research Ethics Committee (HREC/50874/RCHM-2019) under the National Mutual Acceptance initiative. Research governance approvals were obtained from five clinical sites. Results will be disseminated through published manuscripts, conference presentations, public seminars and practical resources for stakeholder groups. TRIAL REGISTRATION NUMBER ACTRN12620000416998; Australian and New Zealand Clinical Trial Registry.
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Affiliation(s)
- Nora Shields
- Department of Physiothearpy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
| | - Kim L Bennell
- Centre for Health, Exercise & Sports Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Alesha Southby
- Department of Physiothearpy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
| | - Lauren J Rice
- Westmead Clinical School (Child & Adolescent Health), University of Sydney, Sydney, New South Wales, Australia
| | - Tania Markovic
- Boden Collaboration, University of Sydney, Sydney, New South Wales, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Christine Bigby
- Living with Disability Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Luke Prendergast
- Department of Mathematics and Statistics, La Trobe University, Bundoora, Victoria, Australia
| | - Jennifer J Watts
- School of Health & Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Cara Schofield
- Department of Physiothearpy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
| | - Georgina Loughnan
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Janet Franklin
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - David Levitt
- Department of Paediatric Medicine and Dermatology, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Viral Chikani
- Department of Endocrinology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Zoe McCallum
- Department of Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Susan Blair
- Prader-Willi Research Foundation of Australia, Heidelberg, Melbourne, Australia
| | - Joseph Proietto
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Nicholas F Taylor
- Department of Physiothearpy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
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9
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Ghosh R, Ray A, Roy D, Benito-Leon J. Hoffman's syndrome as the presenting manifestation of non-primary hypothyroidism in a case of Prader-Willi Syndrome. Neurologia 2022; 37:824-827. [PMID: 36468432 DOI: 10.1016/j.nrleng.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 01/01/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- R Ghosh
- Department of General Medicine, Burdwan, West Bengal, India
| | - A Ray
- R G Kar Medical College & Hospital, Kolkata, West Bengal, India
| | - D Roy
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India; Indian Institute of Technology (IIT), Madras, Tamil Nadu, India
| | - J Benito-Leon
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain; Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain; Department of Medicine, Complutense University, Madrid, Spain.
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10
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Predictive factors of responsiveness to a body weight reduction program in Prader-Willi patients at 6 years of follow-up. Sci Rep 2022; 12:5182. [PMID: 35338212 PMCID: PMC8956576 DOI: 10.1038/s41598-022-09096-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 03/16/2022] [Indexed: 11/08/2022] Open
Abstract
Prader-Willi syndrome (PWS), a multisystemic disorder caused by lack of expression of genes on the paternally inherited chromosome 15q11.2-q13 region, is characterized by hyperphagia and childhood-onset morbid obesity, A retrospective cohort study of 60 PWS patients, 38 females and 22 males, undergoing a 6-year rehabilitation program was analysed. Mean age at the time of first admission was 27 ± 7 years, body weight (BW) was 97 kg ± 29 kg and height was 1.53 ± 0.09 m. Twenty-four patients (40%) showed BW loss after 6 years of follow-up, seventeen (28%) remained stable and nineteen (32%) gained BW. Responsiveness in term of BW reduction was less frequent in patients with the UPD karyotype, karyotype del15 being more frequent among responsive patients. Furthermore, responsive PWS subjects had a higher BMI (47 vs. 36 kg/m2), waist (123 vs. 106 cm) and hip (136 vs. 118 cm) circumferences than non-responsive at the time of first hospitalization. Baseline body composition and metabolic parameters did not differentiate between responsive and non-responsive patients. Given the rarity of PWS and relative lack of studies, these results can be considered relevant because based on a relatively large number of PWS patients followed up for a long term period.
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11
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One Year of Recombinant Human Growth Hormone Treatment in Adults with Prader-Willi Syndrome Improves Body Composition, Motor Skills and Brain Functional Activity in the Cerebellum. J Clin Med 2022; 11:jcm11071831. [PMID: 35407437 PMCID: PMC8999376 DOI: 10.3390/jcm11071831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/18/2022] [Accepted: 03/24/2022] [Indexed: 12/29/2022] Open
Abstract
We compared body composition, biochemical parameters, motor function, and brain neural activation in 27 adults with Prader-Willi syndrome and growth-hormone deficiency versus age-and sex-matched controls and baseline versus posttreatment values of these parameters after one year of recombinant human growth hormone (rhGH) treatment. To study body composition, we analyzed percentage of fat mass, percentage of lean mass, and muscle-mass surrogate variables from dual X-ray absorptiometry. Biochemical parameters analyzed included IGF-I, glucose metabolism, and myokines (myostatin, irisin, and IL6). To explore muscle function, we used dynamometer-measured handgrip strength, the Timed Up and Go (TUG) test, and the Berg Balance Scale (BBS). To study brain activation, we acquired functional magnetic resonance images during three motor tasks of varying complexity. After one year of treatment, we observed an increase in lean mass and its surrogates, a decrease in fat mass, improvements in TUG test and BBS scores, and increased neural activation in certain cerebellar areas. The treatment did not significantly worsen glucose metabolism, and no side-effects were reported. Our findings support the benefits of rhGH treatment in adults with Prader-Willi syndrome and growth-hormone deficiency on body composition and suggest that it may also improve balance and brain neural activation.
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12
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Wang J, Shen X, Yang H, Shi W, Zhu X, Gao H, Yin H, Meng F, Wu Y. Inter- and intra-observer reliability of the "Assessment of Motor Repertoire- 3 to 5 Months" based on video recordings of infants with Prader-Willi syndrome. BMC Pediatr 2022; 22:150. [PMID: 35317775 PMCID: PMC8939132 DOI: 10.1186/s12887-022-03224-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background The “Assessment of Motor Repertoire—3 to 5 Months”, which is a part of Prechtl's General Movements Assessment (GMA), has been gradually applied to infants with genetic metabolic disorders. However, there have been no studies on the application of the GMA for infants with Prader-Willi syndrome (PWS). Aims The purpose of this study was to determine the inter- and intra-observer reliability of the assessment tool in a population of infants with PWS. Study design This was a reliability and agreement study. Subjects This was a cross-sectional study with15 infants with PWS born at an average gestational age of 38 weeks. Outcome measures Standardized video recordings of 15 infants with PWS (corrected ages of 3 to 5 months) were independently assessed by three observers. Kappa and ICC statistics were applied in inter- and intra- observer reliability analyses. Results The overall reliability ICC values of the “Motor Optimality Score” (MOS) ranged from 0.84 to 0.98, and the pairwise agreement ranged between 0.86 and 0.95 for inter- observe reliability. In addition, ICC values for the MOS ranged between 0.95 and 0.98 for tester agreement in intra-observer reliability. Complete agreement reliability (100%) was achieved in the subcategories of “Fidgety Movements” and “Movement Character” for the inter- and intra-observer reliability. Moderate to high inter- and intra-observer reliability were found in the subcategories of “Repertoire of Co-Existent Other Movements”, “Quality of Other Movements” and “Posture”, with kappa values ranging between 0.63 and 1.00. Conclusion There were high levels of inter-and intra-observer agreement in the “Assessment of Motor Repertoire—3 to 5 Months” for infants with PWS. It is possible to carry out standardized quantitative assessments of the motor performance of infants with PWS.
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Affiliation(s)
- Jun Wang
- Department of Rehabilitation, Children's Hospital, Fudan University, Shanghai, 201102, China.
| | - Xiushu Shen
- Department of Rehabilitation, Children's Hospital, Fudan University, Shanghai, 201102, China
| | - Hong Yang
- Department of Rehabilitation, Children's Hospital, Fudan University, Shanghai, 201102, China. .,Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, 201102, China.
| | - Wei Shi
- Department of Rehabilitation, Children's Hospital, Fudan University, Shanghai, 201102, China
| | - Xiaoyun Zhu
- Department of Rehabilitation, Children's Hospital, Fudan University, Shanghai, 201102, China
| | - Herong Gao
- Department of Rehabilitation, Children's Hospital, Fudan University, Shanghai, 201102, China
| | - Huanhuan Yin
- Department of Rehabilitation, Children's Hospital, Fudan University, Shanghai, 201102, China
| | - Fanzhe Meng
- Department of Rehabilitation, Children's Hospital, Fudan University, Shanghai, 201102, China
| | - Yun Wu
- Department of Rehabilitation, Children's Hospital, Fudan University, Shanghai, 201102, China
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Dietary Conjugated Linoleic Acid Reduces Body Weight and Fat in Snord116m+/p- and Snord116m-/p- Mouse Models of Prader-Willi Syndrome. Nutrients 2022; 14:nu14040860. [PMID: 35215509 PMCID: PMC8880678 DOI: 10.3390/nu14040860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/07/2022] [Accepted: 02/11/2022] [Indexed: 02/04/2023] Open
Abstract
Prader–Willi Syndrome (PWS) is a human genetic condition that affects up to 1 in 10,000 live births. Affected infants present with hypotonia and developmental delay. Hyperphagia and increasing body weight follow unless drastic calorie restriction is initiated. Recently, our laboratory showed that one of the genes in the deleted locus causative for PWS, Snord116, maintains increased expression of hypothalamic Nhlh2, a basic helix–loop–helix transcription factor. We have previously also shown that obese mice with a deletion of Nhlh2 respond to a conjugated linoleic acid (CLA) diet with weight and fat loss. In this study, we investigated whether mice with a paternal deletion of Snord116 (Snord116m+/p−) would respond similarly. We found that while Snord116m+/p− mice and mice with a deletion of both Snord116 alleles were not significantly obese on a high-fat diet, they did lose body weight and fat on a high-fat/CLA diet, suggesting that the genotype did not interfere with CLA actions. There were no changes in food intake or metabolic rate, and only moderate differences in exercise performance. RNA-seq and microbiome analyses identified hypothalamic mRNAs, and differentially populated gut bacteria, that support future mechanistic analyses. CLA may be useful as a food additive to reduce obesity in humans with PWS.
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14
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Ghosh R, Ray A, Roy D, Benito-Leon J. Hoffman's syndrome as the presenting manifestation of non-primary hypothyroidism in a case of Prader-Willi Syndrome. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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15
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Mai S, Fintini D, Mele C, Convertino A, Bocchini S, Grugni G, Aimaretti G, Vietti R, Scacchi M, Crinò A, Marzullo P. Circulating Irisin in Children and Adolescents With Prader-Willi Syndrome: Relation With Glucose Metabolism. Front Endocrinol (Lausanne) 2022; 13:918467. [PMID: 35774143 PMCID: PMC9238350 DOI: 10.3389/fendo.2022.918467] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/09/2022] [Indexed: 11/22/2022] Open
Abstract
Irisin is a myokine involved in the browning of white adipose tissue and regulation of energy expenditure, glucose homeostasis and insulin sensitivity. Debated evidence exists on the metabolic role played by irisin in children with overweight or obesity, while few information exist in children with Prader Willi Syndrome (PWS), a condition genetically prone to obesity. Here we assessed serum irisin in relation to the metabolic profile and body composition in children and adolescents with and without PWS. In 25 PWS subjects [age 6.6-17.8y; body mass index standard deviation score (BMI SDS) 2.5 ± 0.3] and 25 age, and BMI-matched controls (age 6.8-18.0y; BMI SDS, 2.8 ± 0.1) we assessed irisin levels and metabolic profile inclusive of oral glucose tolerance test (OGTT), and body composition by dual-energy X-ray absorptiometry (DXA). In PWS, we recorded lower levels of fat-free mass (FFM) (p <0.05), fasting (p<0.0001) and 2h post-OGTT insulin (p<0.05) and lower insulin resistance as expressed by homeostatic model of insulin resistance (HOMA-IR) (p<0.0001). Irisin levels were significantly lower in PWS group than in controls with common obesity (p<0.05). In univariate correlation analysis, positive associations linked irisin to insulin OGTT0 (p<0.05), insulin OGTT120 (p<0.005), HOMA-IR (p<0.05) and fasting C-peptide (p<0.05). In stepwise multivariable regression analysis, irisin levels were independently predicted by insulin OGTT120. These results suggest a link between irisin levels and insulin sensitivity in two divergent models of obesity.
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Affiliation(s)
- Stefania Mai
- Laboratory of Metabolic Research, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Giuseppe Hospital, Piancavallo, Verbania, Italy
- *Correspondence: Stefania Mai,
| | - Danilo Fintini
- Reference Center for Prader Willi Syndrome, Research Institute, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Chiara Mele
- Division of Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Alessio Convertino
- Reference Center for Prader Willi Syndrome, Research Institute, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Sarah Bocchini
- Reference Center for Prader Willi Syndrome, Research Institute, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Graziano Grugni
- Division of Auxology, Istituto Auxologico Italiano, IRCCS, San Giuseppe Hospital, Piancavallo, Verbania, Italy
| | - Gianluca Aimaretti
- Division of Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Roberta Vietti
- Laboratory of Metabolic Research, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Giuseppe Hospital, Piancavallo, Verbania, Italy
| | - Massimo Scacchi
- Laboratory of Metabolic Research, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Giuseppe Hospital, Piancavallo, Verbania, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Antonino Crinò
- Reference Center for Prader Willi Syndrome, Research Institute, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Paolo Marzullo
- Laboratory of Metabolic Research, Istituto Auxologico Italiano, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Giuseppe Hospital, Piancavallo, Verbania, Italy
- Division of Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
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Abstract
OBJECTIVE To explore motor praxis in adults with Prader-Willi syndrome (PWS) in comparison with a control group of people with intellectual disability (ID) and to examine the relationship with brain structural measurements. METHOD Thirty adult participants with PWS and 132 with ID of nongenetic etiology (matched by age, sex, and ID level) were assessed using a comprehensive evaluation of the praxis function, which included pantomime of tool use, imitation of meaningful and meaningless gestures, motor sequencing, and constructional praxis. RESULTS Results support specific praxis difficulties in PWS, with worse performance in the imitation of motor actions and better performance in constructional praxis than ID peers. Compared with both control groups, PWS showed increased gray matter volume in sensorimotor and subcortical regions. However, we found no obvious association between these alterations and praxis performance. Instead, praxis scores correlated with regional volume measures in distributed apparently normal brain areas. CONCLUSIONS Our findings are consistent in showing significant impairment in gesture imitation abilities in PWS and, otherwise, further indicate that the visuospatial praxis domain is relatively preserved. Praxis disability in PWS was not associated with a specific, focal alteration of brain anatomy. Altered imitation gestures could, therefore, be a consequence of widespread brain dysfunction. However, the specific contribution of key brain structures (e.g., areas containing mirror neurons) should be more finely tested in future research.
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Mohr AK, Laemmer C, Schulte S, Gohlke B. Effects of COVID-19 Lockdown on Weight, Body Composition, and Behavior of Children, Adolescents, and Young Adults with Prader-Willi Syndrome. J Clin Med 2021; 10:jcm10204746. [PMID: 34682869 PMCID: PMC8541437 DOI: 10.3390/jcm10204746] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/21/2022] Open
Abstract
To reduce transmission of the coronavirus disease 2019 (COVID-19), many countries implemented lockdowns, causing the closure of childcare services. This study was designed to evaluate the impact of the COVID-19 lockdown in March-April 2020 on children, adolescents, and young adults with Prader-Willi syndrome (PWS) living in Germany. We recruited 180 participants with a genetically confirmed PWS. All families completed a questionnaire, and participants underwent a post-lockdown assessment; the last examination before the lockdown was determined as the pre-lockdown assessment. We used bivariate analyses to compare pre- and post-lockdown outcomes. Weight standard deviation scores (SDSPWS) and body mass index (BMI)-SDSPWS remained stable or even decreased in some age groups. A statistically significant gain in lean body mass (LBM) was found in all groups <18 years of age. We observed an increase in IGF-I and IGFBP-3 concentrations without a significant change in growth hormone (GH) dosage. Most families (95.4%) reported set mealtimes and implementation of structured activities (72.2%) during the lockdown period. We therefore suggest that the favorable development of weight/BMI and LBM was caused by an interplay of a suspected enhanced GH administration and continuous parental commitment. However, more intense behavioral problems were observed in 45.7%, which persisted post-lockdown in 33.7%.
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Affiliation(s)
- Andrea Karoline Mohr
- Department of Pediatric Endocrinology and Diabetology, Children’s Hospital, University of Bonn, Venusberg-Campus, 53127 Bonn, Germany; (S.S.); (B.G.)
- Correspondence:
| | - Constanze Laemmer
- Pediatric Endocrinology and Diabetology, St. Bernward Hospital, Treibestraße 9, 31134 Hildesheim, Germany;
| | - Sandra Schulte
- Department of Pediatric Endocrinology and Diabetology, Children’s Hospital, University of Bonn, Venusberg-Campus, 53127 Bonn, Germany; (S.S.); (B.G.)
| | - Bettina Gohlke
- Department of Pediatric Endocrinology and Diabetology, Children’s Hospital, University of Bonn, Venusberg-Campus, 53127 Bonn, Germany; (S.S.); (B.G.)
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18
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Cerebellar Dysfunction in Adults with Prader Willi Syndrome. J Clin Med 2021; 10:jcm10153320. [PMID: 34362104 PMCID: PMC8347444 DOI: 10.3390/jcm10153320] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/15/2021] [Accepted: 07/26/2021] [Indexed: 01/08/2023] Open
Abstract
Severe hypotonia during infancy is a hallmark feature of Prader Willi syndrome (PWS). Despite its transient expression, moto development is delayed and deficiencies in motor coordination are present at older ages, with no clear pathophysiological mechanism yet identified. The diverse motor coordination symptoms present in adult PWS patients could be, in part, the result of a common alteration(s) in basic motor control systems. We aimed to examine the motor system in PWS using functional MRI (fMRI) during motor challenge. Twenty-three adults with PWS and 22 matched healthy subjects participated in the study. fMRI testing involved three hand motor tasks of different complexity. Additional behavioral measurements of motor function were obtained by evaluating hand grip strength, functional mobility, and balance. Whole brain activation maps were compared between groups and correlated with behavioral measurements. Performance of the motor tasks in PWS engaged the neural elements typically involved in motor processing. While our data showed no group differences in the simplest task, increasing task demands evoked significantly weaker activation in patients in the cerebellum. Significant interaction between group and correlation pattern with measures of motor function were also observed. Our study provides novel insights into the neural substrates of motor control in PWS by demonstrating reduced cerebellar activation during movement coordination.
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Pellikaan K, Rosenberg AGW, Davidse K, Kattentidt-Mouravieva AA, Kersseboom R, Bos-Roubos AG, Grootjen LN, Damen L, van den Berg SAA, van der Lely AJ, Hokken-Koelega ACS, de Graaff LCG. Effects of Childhood Multidisciplinary Care and Growth Hormone Treatment on Health Problems in Adults with Prader-Willi Syndrome. J Clin Med 2021; 10:jcm10153250. [PMID: 34362034 PMCID: PMC8347981 DOI: 10.3390/jcm10153250] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 12/26/2022] Open
Abstract
Prader-Willi syndrome (PWS) is a complex hypothalamic disorder. Features of PWS include hyperphagia, hypotonia, intellectual disability, and pituitary hormone deficiencies. The combination of growth hormone treatment and multidisciplinary care (GHMDc) has greatly improved the health of children with PWS. Little is known about the effects of childhood GHMDc on health outcomes in adulthood. We retrospectively collected clinical data of 109 adults with PWS. Thirty-nine had received GHMDc during childhood and adolescence (GHMDc+ group) and sixty-three had never received growth hormone treatment (GHt) nor multidisciplinary care (GHMDc− group). Our systematic screening revealed fewer undetected health problems in the GHMDc+ group (10%) than in the GHMDc− group (84%). All health problems revealed in the GHMDc+ group had developed between the last visit to the paediatric and the first visit to the adult clinic and/or did not require treatment. Mean BMI and the prevalence of diabetes mellitus type 2 were significantly lower in the GHMDc+ group compared to the GHMDc− group. As all patients who received GHt were treated in a multidisciplinary setting, it is unknown which effects are the result of GHt and which are the result of multidisciplinary care. However, our data clearly show that the combination of both has beneficial effects. Therefore, we recommend continuing GHMDc after patients with PWS have reached adult age.
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Affiliation(s)
- Karlijn Pellikaan
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (A.G.W.R.); (K.D.); (S.A.A.v.d.B.); (A.J.v.d.L.)
- Department of Internal Medicine, Division of Endocrinology, Center for Adults with Rare Genetic Syndromes, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands; (L.N.G.); (L.D.); (A.C.S.H.-K.)
- Academic Centre for Growth Disorders, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Anna G. W. Rosenberg
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (A.G.W.R.); (K.D.); (S.A.A.v.d.B.); (A.J.v.d.L.)
- Department of Internal Medicine, Division of Endocrinology, Center for Adults with Rare Genetic Syndromes, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands; (L.N.G.); (L.D.); (A.C.S.H.-K.)
- Academic Centre for Growth Disorders, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Kirsten Davidse
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (A.G.W.R.); (K.D.); (S.A.A.v.d.B.); (A.J.v.d.L.)
- Department of Internal Medicine, Division of Endocrinology, Center for Adults with Rare Genetic Syndromes, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands; (L.N.G.); (L.D.); (A.C.S.H.-K.)
- Academic Centre for Growth Disorders, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands
| | | | - Rogier Kersseboom
- Stichting Zuidwester, 3241 LB Middelharnis, The Netherlands; (A.A.K.-M.); (R.K.)
| | - Anja G. Bos-Roubos
- Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, 5803 AC Venray, The Netherlands;
| | - Lionne N. Grootjen
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands; (L.N.G.); (L.D.); (A.C.S.H.-K.)
- Academic Centre for Growth Disorders, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Centre—Sophia Children’s Hospital, 3015 GD Rotterdam, The Netherlands
- Dutch Growth Research Foundation, 3016 AH Rotterdam, The Netherlands
| | - Layla Damen
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands; (L.N.G.); (L.D.); (A.C.S.H.-K.)
- Academic Centre for Growth Disorders, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Centre—Sophia Children’s Hospital, 3015 GD Rotterdam, The Netherlands
- Dutch Growth Research Foundation, 3016 AH Rotterdam, The Netherlands
| | - Sjoerd A. A. van den Berg
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (A.G.W.R.); (K.D.); (S.A.A.v.d.B.); (A.J.v.d.L.)
- Department of Clinical Chemistry, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Aart J. van der Lely
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (A.G.W.R.); (K.D.); (S.A.A.v.d.B.); (A.J.v.d.L.)
| | - Anita C. S. Hokken-Koelega
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands; (L.N.G.); (L.D.); (A.C.S.H.-K.)
- Academic Centre for Growth Disorders, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands
- Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Centre—Sophia Children’s Hospital, 3015 GD Rotterdam, The Netherlands
- Dutch Growth Research Foundation, 3016 AH Rotterdam, The Netherlands
| | - Laura C. G. de Graaff
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (K.P.); (A.G.W.R.); (K.D.); (S.A.A.v.d.B.); (A.J.v.d.L.)
- Department of Internal Medicine, Division of Endocrinology, Center for Adults with Rare Genetic Syndromes, Erasmus Medical Center, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome, 3015 GD Rotterdam, The Netherlands; (L.N.G.); (L.D.); (A.C.S.H.-K.)
- Academic Centre for Growth Disorders, Erasmus Medical Center, University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands
- Correspondence: ; Tel.: +31-6188-43010
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Mele C, Crinò A, Fintini D, Mai S, Convertino A, Bocchini S, Di Paolo P, Grugni G, Aimaretti G, Scacchi M, Marzullo P. Angiopoietin-like 8 (ANGPTL8) as a potential predictor of NAFLD in paediatric patients with Prader-Willi Syndrome. J Endocrinol Invest 2021; 44:1447-1456. [PMID: 33067796 PMCID: PMC8195791 DOI: 10.1007/s40618-020-01444-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/06/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE Angiopoietin-like 8 (ANGPTL8) is a liver- and adipose tissue-produced protein that predicts non-alcoholic fatty liver disease (NAFLD) and altered metabolic homeostasis in the general population as well as in persons with common and genetic obesity, including the Prader-Willi syndrome (PWS). However, its metabolic correlate in paediatric patients with respect to PWS is unknown. METHODS This cross-sectional study investigated circulating ANGPTL8 and adipocytokines levels in 28 PWS and 28 age-, sex- and BMI-matched children and adolescents (age, 7.0-17.8y) in relation to NAFLD and metabolic homeostasis assessed by OGTT, paediatric metabolic index (PMI) and fatty liver index (FLI), liver ultrasonography (US), as well as dual-energy X-ray absorptiometry (DEXA) for analysis of fat (FM) and fat-free mass (FFM). RESULTS At the set level of significance, PWS children showed lower values of FFM (p < 0.01) but healthier insulin profiles (p < 0.01) and PMI values (p < 0.05) than matched controls. By US, the prevalence of NAFLD was similar between groups but less severe in PWS than controls. Analysis of ANGPTL8 levels showed no difference between groups, yet only in PWS ANGPTL8 levels were associated with ALT levels, FLI values and NAFLD. In stepwise multivariable regression analysis on merged data, ANGPTL8 levels were independently predicted by BMI SDS, leptin levels and NAFLD. CONCLUSION ANGPTL8 levels are similar in PWS and controls and, overall, they are directly associated with the presence and severity of NAFLD in patients with PWS.
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Affiliation(s)
- C Mele
- Division of Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
- Division of General Medicine, Istituto Auxologico Italiano, IRCCS, San Giuseppe Hospital, Piancavallo, Verbania, Italy
| | - A Crinò
- Reference Center for Prader-Willi Syndrome, Bambino Gesù Children's Hospital, Research Institute, Palidoro (Rome), Italy
| | - D Fintini
- Reference Center for Prader-Willi Syndrome, Bambino Gesù Children's Hospital, Research Institute, Palidoro (Rome), Italy
| | - S Mai
- Laboratory of Metabolic Research, Istituto Auxologico Italiano, IRCCS, San Giuseppe Hospital, Piancavallo, Verbania, Italy
| | - A Convertino
- Reference Center for Prader-Willi Syndrome, Bambino Gesù Children's Hospital, Research Institute, Palidoro (Rome), Italy
| | - S Bocchini
- Reference Center for Prader-Willi Syndrome, Bambino Gesù Children's Hospital, Research Institute, Palidoro (Rome), Italy
| | - P Di Paolo
- Radiology Unit, Bambino Gesù Children's Hospital, Research Institute, Palidoro (Rome), Italy
| | - G Grugni
- Division of Auxology and Metabolic Diseases, Istituto Auxologico Italiano, IRCCS, San Giuseppe Hospital, Piancavallo, Verbania, Italy
| | - G Aimaretti
- Division of Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - M Scacchi
- Division of General Medicine, Istituto Auxologico Italiano, IRCCS, San Giuseppe Hospital, Piancavallo, Verbania, Italy
| | - P Marzullo
- Division of Endocrinology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.
- Division of General Medicine, Istituto Auxologico Italiano, IRCCS, San Giuseppe Hospital, Piancavallo, Verbania, Italy.
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Gait strategy and body composition in patients with Prader-Willi syndrome. Eat Weight Disord 2021; 26:115-124. [PMID: 31797332 DOI: 10.1007/s40519-019-00825-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE Individuals with Prader-Willi syndrome (PWS) exhibit reduced lean body mass and increased fat-lean mass ratio when compared with individuals of normal weight and obese ones. Thus, research on the association of functional limitations during gait and body composition may be of great importance from a rehabilitative viewpoint. In particular, the aim of this study was to compare the gait profile of persons with PWS to that of unaffected individuals and to see if a relationship exists between gait profile and body composition in individuals with PWS. METHODS Eighteen individuals with PWS and 20 unaffected individuals (Healthy Group: HG) were assessed. Their gait pattern was quantified with 3D-Gait Analysis (3D-GA). Overall body weight, lean and fat masses were measured by dual-energy X-ray absorptiometry. RESULTS Individuals with PWS were found to be characterized by a significantly different (p < 0.05) gait pattern with respect to healthy controls in terms of both kinematic and kinetic parameters. No correlations were found between kinematic parameters and overall mass and lean/fat mass, while some parameters associated with ground reaction force were found to be significantly correlated with overall mass, lean mass and fat mass. Significant regression models were obtained, including impact and propulsive force and loading rate. CONCLUSION Our data suggest that in individuals with PWS, gait is influenced by the overall and lean body mass. Thus, therapeutic strategies should target both weight reduction and lean mass increase to optimize gait, minimize articular stress, and reduce the risk of repetitive strain on the lower limbs. LEVEL OF EVIDENCE Level III: Case-control analytic study.
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Stephan C, Clasen L, Adeyemi E, Lee NR. Speech Impairments Explain Unique Variance in Adaptive Behavior Skills in Young People With Down Syndrome. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:253-259. [PMID: 33197320 PMCID: PMC8740564 DOI: 10.1044/2020_ajslp-20-00054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Background Down syndrome (DS) is a disorder characterized by impairments in global cognitive abilities and adaptive function. In addition, individuals with DS demonstrate pronounced speech and language deficits. However, little is known about the linguistic correlates of impaired adaptive functioning in DS. Method Using the Adaptive Behavior Assessment System-Second Edition and the Children's Communication Checklist-Second Edition (CCC-2), this study investigated the unique variance in adaptive skills accounted for by speech and language impairments in individuals with DS (N = 29, M age = 13.46). Results Pearson correlations revealed that a composite of CCC-2 structural language scales, but not pragmatic language scales, was significantly correlated with the Adaptive Behavior Assessment System-Second Edition Global Adaptive Composite, Conceptual, and Practical domains. Further investigation utilizing hierarchical regression analyses identified only the Speech scale on the CCC-2 as contributing unique variance to the prediction of adaptive behavior scores in the Global Adaptive Composite, Conceptual, and Practical domains. Conclusion Speech impairments may serve as flags to identify children with DS who are at risk for adaptive behavior deficits and reinforce the need for speech-language therapies that focus on speech for these individuals. Supplemental Material https://doi.org/10.23641/asha.13231985.
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Affiliation(s)
| | - Liv Clasen
- Developmental Neurogenomics Unit, National Institute of Mental Health, Bethesda, MD
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Yang X. Growth hormone treatment for Prader-Willi syndrome: A review. Neuropeptides 2020; 83:102084. [PMID: 32859387 DOI: 10.1016/j.npep.2020.102084] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/21/2020] [Accepted: 08/18/2020] [Indexed: 12/30/2022]
Abstract
The Prader-Willi Syndrome (PWS) is a rare developmental disorder that contributed by multiple genes. Phenotypically, infants with PWS exhibit hypotonia and developmental delay, whilst older children and adults have cognitive impairments, neuropsychiatric symptoms, impaired motor development, neurological anomalies, endocrine dysfunctions like growth hormone (GH) deficiency, and hyperphagia that leads to obesity. Although mechanisms remain elusive, GH treatment has been recommended as the standard treatment for PWS children. In addition to better motor development, improved body composition and linear growth have been well established, but mental flexibility and behavioural problems remained largely untouched. This review will systemically analyze the recent clinical trials of GH treatment on PWS patients. The emphasis is on the mental and behavioural improvements by GH treatment, and a few concerns to initiate GH treatment. This review will finally propose possible future explorations on basic studies that may shed new light on clinical trials of GH treatment on PWS.
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Affiliation(s)
- Xin Yang
- Gritscience Biopharmaceuticals Co., Ltd, Life Science Park Road, Changping District, Beijing, China.
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Chung MS, Langouët M, Chamberlain SJ, Carmichael GG. Prader-Willi syndrome: reflections on seminal studies and future therapies. Open Biol 2020; 10:200195. [PMID: 32961075 PMCID: PMC7536080 DOI: 10.1098/rsob.200195] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/02/2020] [Indexed: 12/13/2022] Open
Abstract
Prader-Willi syndrome (PWS) is caused by the loss of function of the paternally inherited 15q11-q13 locus. This region is governed by genomic imprinting, a phenomenon in which genes are expressed exclusively from one parental allele. The genomic imprinting of the 15q11-q13 locus is established in the germline and is largely controlled by a bipartite imprinting centre. One part, termed the Prader-Willi syndrome imprinting center (PWS-IC), comprises a CpG island that is unmethylated on the paternal allele and methylated on the maternal allele. The second part, termed the Angelman syndrome imprinting centre, is required to silence the PWS_IC in the maternal germline. The loss of the paternal contribution of the imprinted 15q11-q13 locus most frequently occurs owing to a large deletion of the entire imprinted region but can also occur through maternal uniparental disomy or an imprinting defect. While PWS is considered a contiguous gene syndrome based on large-deletion and uniparental disomy patients, the lack of expression of only non-coding RNA transcripts from the SNURF-SNRPN/SNHG14 may be the primary cause of PWS. Patients with small atypical deletions of the paternal SNORD116 cluster alone appear to have most of the PWS related clinical phenotypes. The loss of the maternal contribution of the 15q11-q13 locus causes a separate and distinct condition called Angelman syndrome. Importantly, while much has been learned about the regulation and expression of genes and transcripts deriving from the 15q11-q13 locus, there remains much to be learned about how these genes and transcripts contribute at the molecular level to the clinical traits and developmental aspects of PWS that have been observed.
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Affiliation(s)
| | | | | | - Gordon G. Carmichael
- Department of Genetics and Genome Sciences, UCONN Health, 400 Farmington Avenue, Farmington, CT 06030, USA
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Fat-Free Mass Is Better Related to Serum Uric Acid Than Metabolic Homeostasis in Prader-Willi Syndrome. Nutrients 2020; 12:nu12092583. [PMID: 32854398 PMCID: PMC7551470 DOI: 10.3390/nu12092583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 12/29/2022] Open
Abstract
Background: Prader-Willi syndrome (PWS) is conventionally regarded as a model of genetic obesity carrying a metabolically healthier profile and fat compartmentalization than subjects with non-syndromic obesity. Serum uric acid (sUA) is a recognized surrogate marker of metabolic derangement. As no information is currently available on sUA levels in adults with PWS, we aimed to analyze sUA in a large cohort of adult patients with PWS in comparison to a control counterpart; secondly, we aimed to investigate the metabolic and non-metabolic determinants of sUA in PWS. Methods: A cross-sectional study was conducted on 89 consecutive adult patients with genetically confirmed PWS spanning a wide BMI range (17.2–56.7 kg/m2). As controls, 180 age-, sex- and BMI-matched healthy controls were included. sUA levels were analyzed in relation to the PWS status, metabolic variables, hormone status, body composition, and resting energy expenditure (REE). Bivariate correlation and multivariable regression studies were used to test for predictors of sUA in PWS. Results: Despite having similar BMI values, patients with PWS presented with higher FM (p < 0.0001), lower FFM (p < 0.0001) and REE values than controls (p < 0.0001). In PWS, sUA levels were non-significantly different between subjects with and without obesity (5.4 ± 1.3 vs. 4.9 ± 1.1 mg/dL, p = 0.09), and did not vary significantly in relation to genotype, sex steroid or GH replacement, as well as psychiatric treatments. Rates of hyperuricaemia (19.1% vs. 33.7%, p < 0.01) and absolute sUA levels were lower in patients with PWS compared to controls owing to significant differences between subgroups with obesity (5.5 ± 1.4 vs. 6.6 ± 1.6 mg/dL, p < 0.0001). In merged populations, sUA increased in parallel with age, BMI, FM, FFM, REE, glucolipid homeostasis, and inflammatory markers. In a separate analysis in PWS, however, sUA correlations with BMI, FM, and inflammatory markers were null. Stepwise multivariable regression analysis in the PWS group adjusted for karyotype, age, sex, FM, FFM, obesity, triglycerides, and HDL cholesterol, showed that sUA levels were independently associated with FFM (β = 0.35, p < 0.0001) and, albeit less significantly, with triglycerides (β = 0.23, p < 0.05). The introduction of height-normalized FFM (FFM index) in the regression model, however, abrogated the predictive role of FFM on sUA. Conclusions: FFM mass is a strong predictor of sUA. PWS is associated to lower sUA levels than controls likely due to genetic predisposition to different body composition and healthier metabolic phenotype. Further studies are warranted to assess purine metabolism and the clinical significance of the FFM index in PWS.
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Cimolin V, Pau M, Cau N, Leban B, Porta M, Capodaglio P, Sartorio A, Grugni G, Galli M. Changes in symmetry during gait in adults with Prader-Willi syndrome. Comput Methods Biomech Biomed Engin 2020; 23:1094-1101. [PMID: 32619156 DOI: 10.1080/10255842.2020.1787999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Most studies on locomotion of individuals with the Prader-Willi Syndrome (PWS) have been performed in a laboratory setting using quantitative motion analysis. Recently, wireless inertial sensors have been successfully employed for gait analysis in different pathological states with the advantages of reproducing a testing condition very close to those encountered in daily living. Using such devices, it is possible not only to characterize the conventional spatio-temporal parameters, but also extract information on further less conventional metrics, such as the harmonic ratio (HR), a measure of step-to-step symmetry based on trunk acceleration processing. In the present study, this technique was used to quantify gait parameters during level walking in 20 adults with PWS who were compared to 20 unaffected individuals. While no differences between the two groups were found in terms of spatio-temporal parameters, individuals with PWS exhibited significantly reduced values of HR in the antero-posterior and vertical directions. Such results, which indicate a poorer gait symmetry in PWS, suggest that upper body accelerations, as well as HR, provide novel information on gait in people with PWS that could not be extracted from spatio-temporal parameters only.
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Affiliation(s)
- Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Massimiliano Pau
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Nicola Cau
- Orthopaedic Rehabilitation Unit and Clinical Lab for Gait Analysis and Posture, Ospedale San Giuseppe, Istituto Auxologico Italiano, IRCCS, Italy Piancavallo di Oggebbio (Verbania)
| | - Bruno Leban
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Micaela Porta
- Department of Mechanical, Chemical and Materials Engineering, University of Cagliari, Cagliari, Italy
| | - Paolo Capodaglio
- Orthopaedic Rehabilitation Unit and Clinical Lab for Gait Analysis and Posture, Ospedale San Giuseppe, Istituto Auxologico Italiano, IRCCS, Italy Piancavallo di Oggebbio (Verbania)
| | - Alessandro Sartorio
- Division of Auxology and Experimental Laboratory for Auxo-endocrinological Research, Ospedale S. Giuseppe, Istituto Auxologico Italiano, IRCCS, Piancavallo di Oggebbio (Verbania), Italy
| | - Graziano Grugni
- Division of Auxology and Experimental Laboratory for Auxo-endocrinological Research, Ospedale S. Giuseppe, Istituto Auxologico Italiano, IRCCS, Piancavallo di Oggebbio (Verbania), Italy
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
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Tan Q, Orsso CE, Deehan EC, Triador L, Field CJ, Tun HM, Han JC, Müller TD, Haqq AM. Current and emerging therapies for managing hyperphagia and obesity in Prader-Willi syndrome: A narrative review. Obes Rev 2020; 21:e12992. [PMID: 31889409 DOI: 10.1111/obr.12992] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/07/2019] [Accepted: 12/09/2019] [Indexed: 12/16/2022]
Abstract
In early childhood, individuals with Prader-Willi syndrome (PWS) experience excess weight gain and severe hyperphagia with food compulsivity, which often leads to early onset morbid obesity. Effective treatments for appetite suppression and weight control are currently unavailable for PWS. Our aim to further understand the pathogenesis of PWS led us to carry out a comprehensive search of the current and emerging therapies for managing hyperphagia and extreme weight gain in PWS. A literature search was performed using PubMed and the following keywords: "PWS" AND "therapy" OR "[drug name]"; reference lists, pharmaceutical websites, and the ClinicalTrials.gov registry were also reviewed. Articles presenting data from current standard treatments in PWS and also clinical trials of pharmacological agents in the pipeline were selected. Current standard treatments include dietary restriction/modifications, exercise, and growth hormone replacement, which appear to have limited efficacy for appetite and weight control in patients with PWS. The long-term safety and effectiveness of bariatric surgery in PWS remains unknown. However, many promising pharmacotherapies are in development and, if approved, will bring much needed choices into the PWS pharmacological armamentarium. With the progress that is currently being made in our understanding of PWS, an effective treatment may not be far off.
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Affiliation(s)
- Qiming Tan
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Camila E Orsso
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Edward C Deehan
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Lucila Triador
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Hein Min Tun
- HKU-Pasteur Research Pole, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, SAR, China
| | - Joan C Han
- Departments of Pediatrics and Physiology, College of Medicine, University of Tennessee Health Science Center and Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee, USA
| | - Timo D Müller
- Institute for Diabetes and Obesity, Helmholtz Diabetes Center at Helmholtz Zentrum München, Neuherberg, Germany.,Department of Pharmacology and Experimental Therapy, Institute of Experimental and Clinical Pharmacology and Toxicology, Eberhard Karls University Hospitals and Clinics, Tübingen, Germany
| | - Andrea M Haqq
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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Barrea L, Muscogiuri G, Pugliese G, Aprano S, de Alteriis G, Di Somma C, Colao A, Savastano S. The Sun's Vitamin in Adult Patients Affected by Prader-Willi Syndrome. Nutrients 2020; 12:E1132. [PMID: 32316673 PMCID: PMC7230761 DOI: 10.3390/nu12041132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 02/06/2023] Open
Abstract
Prader-Willi syndrome (PWS) is a genetic disorder characterized by hyperphagia with progressive, severe obesity, and an increased risk of obesity-related comorbidities in adult life. Although low dietary vitamin D intake and low 25-hydroxy vitamin D (25OHD) levels are commonly reported in PWS in the context of bone metabolism, the association of low 25OHD levels with fat mass has not been extensively evaluated in PWS adults. The aims of this study were to investigate the following in PWS adults: (1) 25OHD levels and the dietary vitamin D intake; (2) associations among 25OHD levels with anthropometric measurements and fat mass; (3) specific cut-off values for body mass index (BMI) and fat mass predictive of the 25OHD levels. In this cross-sectional, single-center study we enrolled 30 participants, 15 PWS adults (age 19-41 years and 40% males) and 15 control subjects matched by age, sex, and BMI from the same geographical area (latitude 40° 49' N; elevation 17 m). Fat mass was assessed using a bioelectrical impedance analysis (BIA) phase-sensitive system. The 25OHD levels were determined by a direct competitive chemiluminescence immunoassay. Dietary vitamin D intake data was collected by three-day food records. The 25OHD levels in the PWS adults were constantly lower across all categories of BMI and fat mass compared with their obese counterpart. The 25OHD levels were negatively associated with BMI (p = 0.04), waist circumference (p = 0.03), fat mass (p = 0.04), and dietary vitamin D intake (p < 0.001). During multiple regression analysis, dietary vitamin D intake was entered at the first step (p < 0.001), thus explaining 84% of 25OHD level variability. The threshold values of BMI and fat mass predicting the lowest decrease in the 25OHD levels were found at BMI ≥ 42 kg/m2 (p = 0.01) and fat mass ≥ 42 Kg (p = 0.003). In conclusion, our data indicate that: (i) 25OHD levels and dietary vitamin D intake were lower in PWS adults than in the control, independent of body fat differences; (ii) 25OHD levels were inversely associated with BMI, waist circumference, and fat mass, but low dietary vitamin D intake was the major determinant of low vitamin D status in these patients; (iii) sample-specific cut-off values of BMI and fat mass might help to predict risks of the lowest 25OHD level decreases in PWS adults. The presence of trained nutritionists in the integrated care teams of PWS adults is strongly suggested in order to provide an accurate nutritional assessment and tailored vitamin D supplementations.
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Affiliation(s)
- Luigi Barrea
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (G.M.); (G.P.); (S.A.); (G.d.A.); (C.D.S.); (A.C.); (S.S.)
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Giovanna Muscogiuri
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (G.M.); (G.P.); (S.A.); (G.d.A.); (C.D.S.); (A.C.); (S.S.)
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Gabriella Pugliese
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (G.M.); (G.P.); (S.A.); (G.d.A.); (C.D.S.); (A.C.); (S.S.)
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Sara Aprano
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (G.M.); (G.P.); (S.A.); (G.d.A.); (C.D.S.); (A.C.); (S.S.)
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Giulia de Alteriis
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (G.M.); (G.P.); (S.A.); (G.d.A.); (C.D.S.); (A.C.); (S.S.)
| | - Carolina Di Somma
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (G.M.); (G.P.); (S.A.); (G.d.A.); (C.D.S.); (A.C.); (S.S.)
| | - Annamaria Colao
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (G.M.); (G.P.); (S.A.); (G.d.A.); (C.D.S.); (A.C.); (S.S.)
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy
- Cattedra Unesco “Educazione alla salute e allo sviluppo sostenibile”, University Federico II, 80138 Naples, Italy
| | - Silvia Savastano
- Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy; (G.M.); (G.P.); (S.A.); (G.d.A.); (C.D.S.); (A.C.); (S.S.)
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Via Sergio Pansini 5, 80131 Naples, Italy
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Circulating microRNA Associated to Different Stages of Liver Steatosis in Prader-Willi Syndrome and Non-Syndromic Obesity. J Clin Med 2020; 9:jcm9041123. [PMID: 32295264 PMCID: PMC7230920 DOI: 10.3390/jcm9041123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Prader-Willi syndrome (PWS) is a rare and poorly characterized disease. Recent genomic and transcriptomic studies contributed to elucidate the molecular bases of the syndrome. In this study, we characterized the expression of circulating miRNAs in patients with PWS compared to those with non-syndromic obesity in association with liver steatosis. METHODS MiRNAs were studied by qRT-PCR in serum samples from 30 PWS and 30 non-syndromic obese subjects. RESULTS MiRNA expression was associated with the presence of the syndrome and to the grade of liver steatosis. MiR-122-5p, miR-151a, miR-92a-3p were up-regulated in obese (4.38-fold, p < 0.01; 2.72-fold, p < 0.05; 1.34-fold p < 0.05, respectively) and were able to differentiate obese from PWS (AUC = 0.81, sens/spec 78/71%). When stratifying groups according to the presence of steatosis, the expression of miR-151a-5p, miR-92a-3p, miR-106b-5p, and miR-93-5p were lower in PWS with steatosis grade 1. Within the group with steatosis grade 1, miR-151a-5p was significantly distinguished PWS from obese (AUC = 0.85, sens/spec 80/85%) and the combination of miR-106b-5p and miR-93-5p showed higher performances in discriminating different grades of steatosis in PWS (AUC = 0.84, sens/spec 93/74%). CONCLUSIONS MiRNAs represent a tool to better classify and characterize PWS, providing new information about the clinical picture and the extent of steatosis.
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Famelart N, Diene G, Çabal-Berthoumieu S, Glattard M, Molinas C, Guidetti M, Tauber M. Equivocal expression of emotions in children with Prader-Willi syndrome: what are the consequences for emotional abilities and social adjustment? Orphanet J Rare Dis 2020; 15:55. [PMID: 32085791 PMCID: PMC7035757 DOI: 10.1186/s13023-020-1333-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/07/2020] [Indexed: 11/25/2022] Open
Abstract
Background People with Prader-Willi Syndrome (PWS) experience great difficulties in social adaptation that could be explained by disturbances in emotional competencies. However, current knowledge about the emotional functioning of people with PWS is incomplete. In particular, despite being the foundation of social adaptation, their emotional expression abilities have never been investigated. In addition, motor and cognitive difficulties - characteristic of PWS - could further impair these abilities. Method To explore the expression abilities of children with PWS, twenty-five children with PWS aged 5 to 10 years were assessed for 1) their emotional facial reactions to a funny video-clip and 2) their ability to produce on demand the facial and bodily expressions of joy, anger, fear and sadness. Their productions were compared to those of two groups of children with typical development, matched to PWS children by chronological age and by developmental age. The analyses focused on the proportion of expressive patterns relating to the target emotion and to untargeted emotions in the children’s productions. Results The results showed that the facial and bodily emotional expressions of children with PWS were particularly difficult to interpret, involving a pronounced mixture of different emotional patterns. In addition, it was observed that the emotions produced on demand by PWS children were particularly poor and equivocal. Conclusions As far as we know, this study is the first to highlight the existence of particularities in the expression of emotions in PWS children. These results shed new light on emotional dysfunction in PWS and consequently on the adaptive abilities of those affected in daily life.
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Affiliation(s)
- Nawelle Famelart
- CLLE, University of Toulouse, CNRS, Toulouse, France. .,Université Toulouse Jean Jaurès, Maison de la Recherche, Laboratoire CLLE, 5, allée Antonio Machado, 31058, Toulouse Cedex 9, France.
| | - Gwenaelle Diene
- Centre de Référence du Syndrome de Prader-Willi, CHU Toulouse, Toulouse, France
| | | | - Mélanie Glattard
- Centre de Référence du Syndrome de Prader-Willi, CHU Toulouse, Toulouse, France
| | - Catherine Molinas
- Centre de Référence du Syndrome de Prader-Willi, CHU Toulouse, Toulouse, France
| | | | - Maithe Tauber
- Centre de Référence du Syndrome de Prader-Willi, CHU Toulouse, Toulouse, France.,CPTP, University of Toulouse, CNRS, INSERM, Toulouse, France
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Mackay J, McCallum Z, Ambler GR, Vora K, Nixon G, Bergman P, Shields N, Milner K, Kapur N, Crock P, Caudri D, Curran J, Verge C, Seton C, Tai A, Tham E, Musthaffa Y, Lafferty AR, Blecher G, Harper J, Schofield C, Nielsen A, Wilson A, Leonard H, Choong CS, Downs J. Requirements for improving health and well-being of children with Prader-Willi syndrome and their families. J Paediatr Child Health 2019; 55:1029-1037. [PMID: 31257692 PMCID: PMC6852695 DOI: 10.1111/jpc.14546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/15/2019] [Accepted: 06/02/2019] [Indexed: 12/16/2022]
Abstract
Prader-Willi syndrome (PWS) is a rare genetic condition with multi-system involvement. The literature was reviewed to describe neurodevelopment and the behavioural phenotype, endocrine and metabolic disorders and respiratory and sleep functioning. Implications for child and family quality of life were explored. Challenging behaviours contribute to poorer well-being and quality of life for both the child and caregiver. Recent evidence indicates healthy outcomes of weight and height can be achieved with growth hormone therapy and dietary restriction and should be the current target for all individuals with PWS. Gaps in the literature included therapies to manage challenging behaviours, as well as understanding the effects of growth hormone on respiratory and sleep function. New knowledge regarding the transition of children and families from schooling and paediatric health services to employment, accommodation and adult health services is also needed. Developing a national population-based registry could address these knowledge gaps and inform advocacy for support services that improve the well-being of individuals with PWS and their families.
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Affiliation(s)
- Jessica Mackay
- Telethon Kids Institute, Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia,School of MedicineUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Zoe McCallum
- Department of Neurodevelopment and DisabilityRoyal Children's HospitalMelbourneVictoriaAustralia,Department of Gastroenterology and Clinical NutritionRoyal Children's HospitalMelbourneVictoriaAustralia
| | - Geoffrey R Ambler
- Institute of Endocrinology and DiabetesChildren's Hospital at WestmeadSydneyNew South WalesAustralia
| | - Komal Vora
- Department of Paediatric Endocrinology and DiabetesJohn Hunter Children's HospitalNewcastleNew South WalesAustralia
| | - Gillian Nixon
- Melbourne Children's Sleep CentreMonash Children's HospitalMelbourneVictoriaAustralia,The Ritchie CentreMelbourneVictoriaAustralia,Department of PaediatricsMonash UniversityMelbourneVictoriaAustralia
| | - Philip Bergman
- Department of PaediatricsMonash UniversityMelbourneVictoriaAustralia,Department of Paediatric Endocrinology and DiabetesMonash Children's HospitalMelbourneVictoriaAustralia
| | - Nora Shields
- School of Allied HealthLa Trobe UniversityMelbourneVictoriaAustralia
| | - Kate Milner
- Department of Neurodevelopment and DisabilityRoyal Children's HospitalMelbourneVictoriaAustralia,Centre for International Child HealthMurdoch Children's Research InstituteMelbourneVictoriaAustralia
| | - Nitin Kapur
- Respiratory and Sleep MedicineQueensland Children's HospitalBrisbaneQueenslandAustralia,School of Clinical MedicineUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Patricia Crock
- Department of Paediatric Endocrinology and DiabetesJohn Hunter Children's HospitalNewcastleNew South WalesAustralia,Hunter Medical Research InstituteUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Daan Caudri
- Telethon Kids Institute, Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia,Erasmus University Medical CenterRotterdamthe Netherlands
| | - Jaqueline Curran
- Department of EndocrinologyPerth Children's HospitalPerthWestern AustraliaAustralia
| | - Charles Verge
- Department of EndocrinologySydney Children's HospitalSydneyNew South WalesAustralia,School of Women's and Children's HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Chris Seton
- Department of Sleep MedicineChildren's Hospital WestmeadSydneyNew South WalesAustralia,Woolcock Institute of Medical ResearchSydney UniversitySydneyNew South WalesAustralia
| | - Andrew Tai
- Respiratory and Sleep DepartmentWomen's and Children's HospitalAdelaideSouth AustraliaAustralia
| | - Elaine Tham
- Endrocrinology and Diabetes DepartmentWomen's and Children's HospitalAdelaideSouth AustraliaAustralia
| | - Yassmin Musthaffa
- Diamantina Institute, Faculty of MedicineUniversity of QueenslandBrisbaneQueenslandAustralia,Translational Research InstituteUniversity of QueenslandBrisbaneQueenslandAustralia
| | - Antony R Lafferty
- Department of Endocrinology and DiabetesCanberra HospitalCanberraAustralian Capital TerritoryAustralia,Medical SchoolAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Greg Blecher
- Department of Sleep MedicineSydney Children's HospitalSydneyNew South WalesAustralia
| | - Jessica Harper
- Department of EndocrinologySydney Children's HospitalSydneyNew South WalesAustralia
| | - Cara Schofield
- Telethon Kids Institute, Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Aleisha Nielsen
- Respiratory and Sleep MedicinePerth Children's HospitalPerthWestern AustraliaAustralia
| | - Andrew Wilson
- Telethon Kids Institute, Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia,Respiratory and Sleep MedicinePerth Children's HospitalPerthWestern AustraliaAustralia
| | - Helen Leonard
- Telethon Kids Institute, Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Catherine S Choong
- Telethon Kids Institute, Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia,Department of EndocrinologyPerth Children's HospitalPerthWestern AustraliaAustralia
| | - Jenny Downs
- Telethon Kids Institute, Centre for Child Health ResearchUniversity of Western AustraliaPerthWestern AustraliaAustralia,School of Physiotherapy and Exercise ScienceCurtin UniversityPerthWestern AustraliaAustralia
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Morales JS, Valenzuela PL, Pareja-Galeano H, Rincón-Castanedo C, Rubin DA, Lucia A. Physical exercise and Prader-Willi syndrome: A systematic review. Clin Endocrinol (Oxf) 2019; 90:649-661. [PMID: 30788853 DOI: 10.1111/cen.13953] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 02/15/2019] [Accepted: 02/18/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The aim of this systematic review was to summarize evidence on the acute responses of individuals with Prader-Willi syndrome (PWS) to physical exercise, and on the effectiveness of long-term exercise interventions to improve the clinical manifestations of this syndrome. DESIGN/METHODS Relevant articles were identified in the electronic databases PubMed, Medline, CINAHL and SPORTDiscus (from inception to December 2018). Twenty-two studies including a total of 356 patients with PWS met all inclusion criteria and were included in the review. RESULTS Patients with PWS present with a decreased physical performance and impaired cardiorespiratory (maximal oxygen consumption, heart rate recovery after exercise) and hormonal (growth hormone release) responses to exercise. Most long-term exercise interventions have proven to decrease body mass while improving physical performance. Some benefits have also been reported in biochemical (glucose homeostasis, lipid profile) and biomechanical (gait pattern) variables, although there is controversy regarding the effects on body composition. No exercise-related adverse events have been reported in patients with PWS. CONCLUSION Physical exercise seems to be safe and effective for improving several phenotypes in PWS, notably physical fitness. However, further research is needed to confirm these results and especially to corroborate whether exercise per se or combined with dietary intervention is an effective coadjuvant treatment for reducing body mass in these patients.
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Affiliation(s)
- Javier S Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Pedro L Valenzuela
- Physiology Unit, Systems Biology Department, University of Alcalá, Madrid, Spain
- Department of Sport and Health, Spanish Agency for Health Protection in Sport (AEPSAD), Madrid, Spain
| | - Helios Pareja-Galeano
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
- Research Institute of the Hospital 12 de Octubre (i+12), Madrid, Spain
| | | | - Daniela A Rubin
- Department of Kinesiology, California State University, Fullerton, California
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain
- Research Institute of the Hospital 12 de Octubre (i+12), Madrid, Spain
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Shields N, Westle A, Bennell KL, Taylor NF. Physiotherapists perceived developing positive rapport facilitates participation in exercise among people with Prader-Willi Syndrome: a qualitative study. Disabil Rehabil 2019; 42:3475-3480. [PMID: 30971136 DOI: 10.1080/09638288.2019.1597176] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: To explore the experiences of physiotherapists delivering community-based progressive resistance training for people with Prader-Willi syndrome (PWS).Method: Participants in this qualitative study were fifteen physiotherapists (13 female) who had supervised 14 young adults with PWS to complete a progressive resistance training program, twice per week for 10 weeks. Semi-structured interviews with the physiotherapists were audio-recorded and transcribed verbatim. Interview transcripts were checked for accuracy by the physiotherapists. Data were analysed using thematic analysis with an inductive approach and data were managed using NVivo software.Results: Development of positive rapport between physiotherapists and people with PWS emerged as the critical factor. Components of developing positive rapport with a person with PWS included clear communication, adaptability in approach, fostering independence in the person with PWS, and motivating the person by developing confidence. Creating a routine, empowering the people with PWS to take ownership of their progress and developing confidence made continued participation in exercise by the people with PWS more likely.Conclusions: Our findings highlight the importance of developing rapport with people with PWS to facilitate their participation in exercise. Physiotherapist attributes and skills such as adaptability and communication positively influence participation in community-based exercise for people with PWS. Implications for rehabilitationThe critical factor for maximising the participation of people with PWS in high-intensity exercise is the development of positive rapport by the physiotherapistDevelopment of positive rapport was facilitated by therapist adaptability and clear communication.People with PWS might be motivated to exercise by developing their confidence and fostering their independence.
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Affiliation(s)
- Nora Shields
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Bundoora, Victoria, Australia
| | - Andrew Westle
- School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Kim L Bennell
- Centre for Health Exercise and Sports Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Nicholas F Taylor
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Bundoora, Victoria, Australia.,Eastern Health, Allied Health Clinical Research Office, Box Hill, Victoria, Australia
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Shields N, Bennell KL, Radcliffe J, Taylor NF. Is strength training feasible for young people with Prader-Willi syndrome? A phase I randomised controlled trial. Physiotherapy 2019; 106:136-144. [PMID: 30930051 DOI: 10.1016/j.physio.2019.01.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 01/28/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the feasibility of progressive resistance training for people with Prader-Willi syndrome (PWS), who have muscle weakness and very low muscle mass. DESIGN Randomised controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. SETTING Community gymnasium. PARTICIPANTS Sixteen participants with PWS (eight female; mean age 25 years) were randomly assigned with 1:1 allocation to an experimental (n=8) or control group (n=8). INTERVENTION Progressive resistance training was performed twice a week for 10 weeks. The training was supervised one-to-one by a physiotherapist and comprised seven exercises. The control group continued their usual activities and were offered the training after follow-up assessment. MAIN OUTCOME MEASURES Three domains of feasibility were evaluated: implementation (attendance and adherence), practicality (safety) and limited efficacy testing. Muscle strength (one repetition maximum for chest and leg press), physical function (box stacking test, timed stairs climb), muscle composition (US) and body composition (whole-body DXA scan) were measured before and after the intervention. RESULTS Participants attended 92% of scheduled sessions and adhered by progressing their training resistance by 82% (range 60-140%). There was one unexpected serious adverse event unrelated to the intervention and several non-serious expected adverse events related to the intervention. Estimates of standardised mean differences indicated moderate to large effects in favour of the experimental group for arm (0.92, 95%CI -0.11 to 1.95) and leg strength (0.78, 95%CI -0.27 to 1.83). The effect was uncertain for secondary outcomes. CONCLUSIONS There is preliminary evidence showing progressive resistance training is feasible for people with Prader-Willi syndrome and may increase muscle strength. Clinical Trial Registration Australia New Zealand Clinical Trials Registry ACTRN12616000107426.
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Affiliation(s)
- Nora Shields
- La Trobe University, Kingsbury Drive, Bundoora, Victoria 3086, Australia.
| | - Kim L Bennell
- The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia.
| | - Jessica Radcliffe
- La Trobe University, Kingsbury Drive, Bundoora, Victoria 3086, Australia.
| | - Nicholas F Taylor
- La Trobe University, Kingsbury Drive, Bundoora, Victoria 3086, Australia; Eastern Health, 5 Arnold Street, Box Hill, Victoria 3128, Australia.
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Hsu WL, Chiu VJY, Chang WH, Lin MC, Wei JT, Tzeng IS. Hand strength and dexterity in patients with Prader-Willi syndrome: a pilot intervention study. J Int Med Res 2018; 46:4669-4677. [PMID: 30213215 PMCID: PMC6259402 DOI: 10.1177/0300060518788243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/20/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE The study aim was to examine the hand function (hand strength and dexterity) and intervention effects of training in adults with Prader-Willi syndrome (PWS). METHODS Six adults with PWS (two females; mean age 26.14 years) underwent hand muscle strength and dexterity training for 3 months (2 hours per week). The following hand function tests were performed pre- and post-intervention: (1) hand grip, lateral pinch, and tip pinch hand strength tests, (2) the Box and Block test (BBT) for gross manual dexterity and (3) the Purdue Pegboard test for finger dexterity. RESULTS Before treatment, all subjects showed lower hand grip, lateral pinch, tip pinch strength, and poorer manual/finger dexterity relative to healthy adults. After training, hand function scores improved on many test items, but only the left hand tip pinch and the right hand BBT performance showed significant improvements. CONCLUSIONS All subjects showed lower hand strength and poorer manual/finger dexterity compared with healthy adults; this should be considered during physical training programs. Owing to limitations in the intervention intensity and possible subject behavioral deficits, further research is needed to clarify the effects of this intervention on hand function in PWS patients.
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Affiliation(s)
- Wan-Ling Hsu
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Valeria Jia-Yi Chiu
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Wei-Hsiu Chang
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Mei-Chun Lin
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Jang-Ting Wei
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
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Mackenzie ML, Triador L, Gill JK, Pakseresht M, Mager D, Field CJ, Haqq AM. Dietary intake in youth with prader-willi syndrome. Am J Med Genet A 2018; 176:2309-2317. [PMID: 30216657 DOI: 10.1002/ajmg.a.40491] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 06/12/2018] [Accepted: 07/06/2018] [Indexed: 01/09/2023]
Abstract
Dietary management is important to prevent severe obesity in individuals with Prader-Willi syndrome (PWS); however, few studies have examined dietary intake and quality in youth with PWS. Our objective was to estimate intake of essential nutrients and diet quality in youth with PWS compared to those without PWS. Three-day food records were used to estimate intake of energy, nutrients, nutrient-density, foods, and adherence to healthy eating guidelines. Data were presented as medians and interquartile ranges with Mann-Whitney U and Fisher's test used to compare between groups with p < .05 considered significant. Youth with (n = 23) and without (n = 23) PWS were similar in age and sex distribution. The PWS group had a lower energy intake (p ≤ .001), higher nutrient density (p = .003), and better adherence to guidelines (p = .007) compared to the control group. The proportion with nutrient intake from food below Estimated Average Requirement or Adequate Intake were similar between groups. Fiber, vitamin D, calcium, and potassium intake were below recommendations in 50% or more in both groups. The inclusion of supplement intake lowered the proportion below recommendations, except for fiber and potassium. Youth with PWS had a similar nutrient intake as those without PWS despite a lower energy intake, which could be attributed to higher diet quality. However, more than half of youth with PWS were at risk of inadequate fiber, vitamin D, calcium, and potassium intake. A greater emphasis on nutrient-dense foods would improve nutrient intake, but supplements may be warranted in youth with PWS who do not meet recommendations.
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Affiliation(s)
| | - Lucila Triador
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jasmeena K Gill
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Mohammadreza Pakseresht
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Diana Mager
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea M Haqq
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
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Woods SG, Knehans A, Arnold S, Dionne C, Hoffman L, Turner P, Baldwin J. The associations between diet and physical activity with body composition and walking a timed distance in adults with Prader-Willi syndrome. Food Nutr Res 2018; 62:1343. [PMID: 29942245 PMCID: PMC6010474 DOI: 10.29219/fnr.v62.1343] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/01/2018] [Accepted: 05/07/2018] [Indexed: 12/01/2022] Open
Abstract
Background Research on aging in Prader–Willi syndrome (PWS) is limited, although people with PWS are living longer. Individuals with PWS present with high fat mass, low lean mass, and low levels of physical activity (PA). Previous reports in children and young adults with PWS show inadequate nutrient intake and body fat percentage indicating obesity. Previous studies in PWS rarely included individuals beyond young adulthood, especially studies conducted in the United States. This study includes adults from 18 to 62 years of age, and includes 19 of the estimated 60 adult individuals with PWS in Oklahoma. Because individuals with PWS are living longer, information must be provided on aging with PWS. This study is a report of the initial data for a planned longitudinal study on aging with PWS. Objective Determine associations between body composition, diet, PA, and a timed walk for adults with PWS, and to assess adequacy of dietary intake for those individuals aging with PWS. Design This cross-sectional investigation determined dietary habits, PA, and body composition of adults with PWS, and tested associations between these variables. Results Participants ranged in age from 18 to 62 years. They had healthier body composition, at 26.8% body fat, than previously reported. Mean body mass index (BMI) was in the overweight range at 26.7. Those who consumed higher amounts of fat (as a percent of total kilocalories) had statistically significant lower body fat percentage, but this may simply reflect that individuals with lower body fat percentages felt freer to consume fat. Mean steps taken per day was 7631.7 steps but only 16% of participants met healthy PA recommendations despite participating in daily structured exercise. All participants’ diets met Dietary Guidelines for macronutrient distribution, but 80% were deficient in calcium, 100% were deficient in dietary vitamin D, and 87% were deficient in fiber. Sample size was small, so it was difficult to reach statistical significance, despite seeing clinical significance. Conclusions Recommend working toward healthy PA recommendations for all age groups by decreasing time in sedentary activity. Recommend increasing vitamin A and D fortified dairy products and high-fiber foods, and consider dietary supplementation, especially for calcium, vitamin D, and fiber.
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Affiliation(s)
- Susan G Woods
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Allen Knehans
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sandra Arnold
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Carol Dionne
- Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Leah Hoffman
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Peggy Turner
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jonathan Baldwin
- Department of Medical Imaging and Radiation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Chiu VJY, Tsai LP, Wei JT, Tzeng IS, Wu HC. Motor performance in Prader-Willi syndrome patients and its potential influence on caregiver's quality of life. PeerJ 2017; 5:e4097. [PMID: 29255649 PMCID: PMC5732539 DOI: 10.7717/peerj.4097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/04/2017] [Indexed: 12/21/2022] Open
Abstract
Background Prader-Willi syndrome (PWS) is a complex, multisystem genetic disorder characterized by a variety of physical, cognitive, and behavioral impairments. PWS is a unique sarcopenia model characterized by an abnormal increase in body fat mass and a decrease in muscle mass that predisposes patients to reduced physical activity, functional limitations, and disability. These manifestations may require both symptomatic and supportive management, thus negatively influencing their lifelong family caregiver’s quality of life. The aim of this study was to examine the functional motor performance of adults with PWS in Taiwan and to measure the quality of life of their primary family caregivers. Methods The functional motor tests consisted of the following: (1) 30-s sit-to-stand test, (2) timed up-and-go test, (3) hand grip and lateral pinch strength tests, and (4) Berg Balance Scale. The World Health Organization Quality of Life-short form (WHOQOL-BREF) and the Short-Form 36 Health Survey Questionnaire (SF-36) were used to evaluate health-related quality of life, and the parenting stress index was used to assess the magnitude of stress within the parent-child system. Results The participants included seven adults (two females and five males) with genetically confirmed PWS and their respective main caregivers. The mean age of the adults with PWS was 25.28 years; range 18–31 years, SD 5.10; the mean BMI was 29.2 kg/m2, SD 6.43. All adults with PWS showed lower hand grip and lateral pinch strengths, fewer sit-to-stand cycles during the 30-s chair stand test, and greater average time during the timed up-and-go test when compared to the normative data on healthy adults. Balance was negatively correlated with the caregiver’s health concepts of social functioning (rs −0.879, P = 0.009) and with role limitations due to physical problems (rs −0.899, P = 0.006) and emotional problems (rs −0.794, P = 0.033); hand grip strength was negatively correlated with bodily pain (rs −0.800, P = 0.031), as assessed using the SF-36 questionnaire. The timed up-and-go test was positively correlated with the social relationship domain (rs 0.831, P = 0.021), as assessed using the WHOQOL-BREF questionnaire. The parenting stress index showed no association with the PWS patient’s physical activities. Conclusions All adults with PWS showed decreased upper and lower limb strength and functional mobility when compared to healthy adults. Some of their motor performance might have negative effects on their primary family members in terms of social participation and physical and emotional role limitations. Future research should explore the relationship between physical performances, psychological difficulties of PWS and caregiver’s QOL.
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Affiliation(s)
- Valeria Jia-Yi Chiu
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Li-Ping Tsai
- Department of Pediatrics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,Department of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jang-Ting Wei
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Hsin-Chi Wu
- Department of Rehabilitation Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.,Department of Medicine, Tzu Chi University, Hualien, Taiwan
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Scheermeyer E, Harris M, Hughes I, Crock PA, Ambler G, Verge CF, Bergman P, Werther G, Craig ME, Choong CS, Davies PSW. Low dose growth hormone treatment in infants and toddlers with Prader-Willi syndrome is comparable to higher dosage regimens. Growth Horm IGF Res 2017; 34:1-7. [PMID: 28427039 DOI: 10.1016/j.ghir.2017.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/13/2017] [Accepted: 03/23/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Evaluate benefit and risk of low dose growth hormone treatment (GHT, 4.5mg/m2/week) in very young children with Prader-Willi Syndrome (PWS). DESIGN Prospective longitudinal clinical intervention. METHODS We evaluated 31 infants (aged 2-12months) and 42 toddlers (13-24months) from the PWS-OZGROW database for height, weight and BMI using the World Health Organization standard deviation scores (SDSWHO) and PWS specific BMI (SDSPWS), bone age, insulin-like growth factor 1 (IGF-I) levels and adverse events over 3years of GHT. RESULTS At commencement of GHT infants had a lower BMI SDSWHO (-0.88 vs 0.40) than toddlers, while toddlers had a lower height SDSWHO (-1.44 vs -2.09) (both P<0.05). All increased height SDSWHO (2year delta height infants +1.26 SDS, toddlers+1.21 SDS), but infants normalised height sooner, achieving a height SDS of -0.56 within 1year, while toddlers achieved a height SDS of -0.88 in two years. BMI SDSWHO increased, while BMI SDSPWS decreased (both P<0.0001) and remained negative. The GHT response did not differ with gestation (preterm 23%) or genetic subtype (deletion vs maternal uniparental disomy). Bone age advancement paralleled chronological age. All children had low serum IGF-I at baseline which increased, but remained within the age-based reference range during GHT (for 81% in first year). Four children had spinal curvature at baseline; two improved, two progressed to a brace and two developed an abnormal curve over the observation period. Mild to severe central and/or obstructive sleep apnoea were observed in 40% of children prior to GHT initiation; 11% commenced GHT on positive airway pressure (PAP), oxygen or both. Eight children ceased GHT due to onset or worsening of sleep apnoea: 2 infants in the first few months and 6 children after 6-24months. Seven resumed GHT usually after adjusting PAP but five had adenotonsillectomy. One child ceased GHT temporarily due to respiratory illness. No other adverse events were reported. Two children substantially improved their breathing shortly after GHT initiation. CONCLUSION Initiation of GHT in infants with 4.5mg/m2/week was beneficial and comparable in terms of auxological response to a dose of 7mg/m2/week. Regular monitoring pre and post GH initiation assisted in early detection of adverse events. IGF-I levels increased with the lower dose but not excessively, which may lower potential long-term risks.
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Affiliation(s)
- Elly Scheermeyer
- Faculty of Medicine, Primary Care Clinical Unit, The University of Queensland, Brisbane, Australia; Child Health Research Centre, The University of Queensland, Brisbane, Australia.
| | - Mark Harris
- Lady Cilento Children's Hospital, Brisbane, Australia; Mater Research Institute - UQ, The University of Queensland, Brisbane, Australia
| | - Ian Hughes
- Mater Research Institute - UQ, The University of Queensland, Brisbane, Australia
| | - Patricia A Crock
- John Hunter Children's Hospital, School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Geoffrey Ambler
- The Children's Hospital at Westmead and Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Charles F Verge
- Sydney Children's Hospital, School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | | | | | - Maria E Craig
- The Children's Hospital at Westmead and Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Catherine S Choong
- Princess Margaret Hospital, School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
| | - Peter S W Davies
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
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Orsso CE, Mackenzie M, Alberga AS, Sharma AM, Richer L, Rubin DA, Prado CM, Haqq AM. The use of magnetic resonance imaging to characterize abnormal body composition phenotypes in youth with Prader-Willi syndrome. Metabolism 2017; 69:67-75. [PMID: 28285653 DOI: 10.1016/j.metabol.2017.01.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) provides detailed assessment of body composition compartments. No studies have employed state-of-the-art MRI methods to accurately examine abdominal adipose tissue (AT) and skeletal muscle in youth with Prader-Willi syndrome (PWS). Therefore, this study aimed to describe AT distribution and skeletal muscle in the abdominal region of youth with PWS using MRI. METHODS Anthropometric measures and whole-abdominal T1-weighted MRI were performed in sixteen (5 males and 11 females) youth diagnosed with PWS, and seventeen (10 males and 7 females) youth who did not have PWS (controls). Volume of subcutaneous, visceral, intermuscular, and total AT, and skeletal muscle in the abdominal region were quantified using a semiautomatic procedure. Results were summarized using median and interquartile range (IQR, 25th-75th), and ANCOVA test was used (with age and sex as covariates) to examine differences in body composition compartments between PWS and control group. RESULTS PWS group had similar age (10.5, 6.6-13.9 vs. 12.8, 10.0-14.4years; P=0.14) and BMI z-score (0.5, 0.2-1.3 vs. 0.2, -0.3 to 1.0; P=0.33) when compared with controls. Significant differences were observed in absolute volumes of total AT (PWS: 4.1, 2.0-6.6L; control: 2.9, 2.0-4.5L; P=0.01), subcutaneous AT (PWS: 2.8, 1.4-4.8L; control: 1.8, 1.1-3.2L; P=0.01), and intermuscular AT (PWS: 0.3, 0.1-0.4L; control: 0.3, 0.2-0.3L; P<0.005). Visceral AT/subcutaneous AT was lower in PWS (0.4, 0.3-0.5) compared to controls (0.5, 0.4-0.6), P=0.01. In addition, skeletal muscle volume was lower in PWS (1.5, 1.0-2.6L) compared to controls (3.1, 1.6-3.9L), P=0.03. Ratios of abdominal AT compartments to skeletal muscle were all higher in PWS compared to controls (all P<0.005). CONCLUSIONS PWS youth have greater abdominal adiposity, particularly subcutaneous AT and intermuscular AT, and lower volume of skeletal muscle compared to controls. The decreased ratio of visceral AT/subcutaneous AT in youth with PWS suggests an improved metabolic profile for the level of adiposity present; however, elevated ratios of AT to skeletal muscle suggest a sarcopenic obesity-like phenotype, which could lead to worse health outcomes.
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Affiliation(s)
- Camila E Orsso
- Department of Agricultural, Food and Nutritional Science, University of Alberta, 4-002 Li Ka Shing Centre, Edmonton, AB, Canada T6G 2E1; Department of Pediatrics, University of Alberta, 11405-87 Avenue, Edmonton, AB, Canada T6G 2R3
| | - Michelle Mackenzie
- Department of Pediatrics, University of Alberta, 11405-87 Avenue, Edmonton, AB, Canada T6G 2R3
| | - Angela S Alberga
- Department of Exercise Science, Concordia University, 7141 Sherbrooke Street West, Office SP-165.06, Montreal, QB, Canada H4B1R6
| | - Arya M Sharma
- Department of Medicine, 1-116 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, AB, Canada T6G 2E1
| | - Lawrence Richer
- Department of Pediatrics, University of Alberta, 11405-87 Avenue, Edmonton, AB, Canada T6G 2R3
| | - Daniela A Rubin
- Department of Kinesiology, California State University, Fullerton, 800 N. State College Blvd, CA 92834, USA
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, University of Alberta, 4-002 Li Ka Shing Centre, Edmonton, AB, Canada T6G 2E1
| | - Andrea M Haqq
- Department of Pediatrics, University of Alberta, 11405-87 Avenue, Edmonton, AB, Canada T6G 2R3.
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Abstract
Prader-Willi syndrome (PWS) results from under-expression of the paternally-derived chromosomal region 15q11-13. Growth failure is a recognized feature of PWS, and both quantitative and qualitative defects of the GH/IGF-I axis revealing GH deficiency (GHD) have been demonstrated in most children with PWS. In PWS adults, criteria for GHD are biochemically fulfilled in 8-38% of the studied cohorts. Published data support benefits of early institution of GH therapy (GHT) in PWS children, with positive effects on statural growth, body composition, metabolic homeostasis, and neurocognitive function. Like in pediatric PWS, GHT also yields beneficial effects on lean and body fat, exercise capacity, and quality of life of PWS adults. Although GHT has been generally administered safely in PWS children and adults, careful surveillance of risks is mandatory during prolonged GH replacement for all PWS individuals.
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Affiliation(s)
- Graziano Grugni
- Division of Auxology, I.R.C.C.S. Istituto Auxologico Italiano, Ospedale S. Giuseppe, Verbania, 28921, Italy.
| | - Paolo Marzullo
- Division of General Medicine, I.R.C.C.S. Istituto Auxologico Italiano, Ospedale S. Giuseppe, Verbania, 28921, Italy; Department of Translational Medicine, Università del Piemonte Orientale, Novara, 28100, Italy
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Lam MY, Rubin DA, Duran AT, Chavoya FA, White E, Rose DJ. A Characterization of Movement Skills in Obese Children With and Without Prader-Willi Syndrome. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2016; 87:245-253. [PMID: 27245849 DOI: 10.1080/02701367.2016.1182113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE The aim of this study was twofold: (a) to measure and compare motor proficiency in obese children with Prader-Willi syndrome (OB-PWS) to that in obese children without PWS (OB), and (b) to compare motor proficiency in OB-PWS and OB to normative data. METHOD Motor proficiency was measured using the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition-Complete Form, a norm-referenced assessment of motor function. Participants were 18 OB-PWS and 44 OB (8 to 11 years of age). The scores on the 8 subtests and the total motor composite were used to compare OB-PWS and OB. Furthermore, the scores on the 4 motor-area composites were used to compare OB-PWS and OB against normative data. RESULTS OB-PWS scored significantly lower than OB across all 8 subtests. OB-PWS also had significantly lower motor proficiency scores on all motor-area composites when compared with the normative sample. OB-PWS most frequently (67%-83%) scored well below average on the gross motor subtests. Although not as high as on the gross motor subtests, this finding also held true for the fine motor subtests with 39% to 45% of OB-PWS scoring well below average. CONCLUSION Motor proficiency is very poor in OB-PWS, in particular for gross motor skills. Physical, neurological, and developmental characteristics inherent to the syndrome may explain this low performance.
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Kamaludin AA, Smolarchuk C, Bischof JM, Eggert R, Greer JJ, Ren J, Lee JJ, Yokota T, Berry FB, Wevrick R. Muscle dysfunction caused by loss of Magel2 in a mouse model of Prader-Willi and Schaaf-Yang syndromes. Hum Mol Genet 2016; 25:3798-3809. [PMID: 27436578 DOI: 10.1093/hmg/ddw225] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/31/2016] [Accepted: 07/07/2016] [Indexed: 01/04/2023] Open
Abstract
Prader-Willi syndrome is characterized by severe hypotonia in infancy, with decreased lean mass and increased fat mass in childhood followed by severe hyperphagia and consequent obesity. Scoliosis and other orthopaedic manifestations of hypotonia are common in children with Prader-Willi syndrome and cause significant morbidity. The relationships among hypotonia, reduced muscle mass and scoliosis have been difficult to establish. Inactivating mutations in one Prader-Willi syndrome candidate gene, MAGEL2, cause a Prader-Willi-like syndrome called Schaaf-Yang syndrome, highlighting the importance of loss of MAGEL2 in Prader-Willi syndrome phenotypes. Gene-targeted mice lacking Magel2 have excess fat and decreased muscle, recapitulating altered body composition in Prader-Willi syndrome. We now demonstrate that Magel2 is expressed in the developing musculoskeletal system, and that loss of Magel2 causes muscle-related phenotypes in mice consistent with atrophy caused by altered autophagy. Magel2-null mice serve as a preclinical model for therapies targeting muscle structure and function in children lacking MAGEL2 diagnosed with Prader-Willi or Schaaf-Yang syndrome.
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Affiliation(s)
| | | | | | | | - John J Greer
- Department of Physiology, University of Alberta, Edmonton, AB, Canada
| | - Jun Ren
- Department of Physiology, University of Alberta, Edmonton, AB, Canada
| | | | | | - Fred B Berry
- Department of Medical Genetics
- Department of Surgery and
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Salles J, Strelnikov K, Carine M, Denise T, Laurier V, Molinas C, Tauber M, Barone P. Deficits in voice and multisensory processing in patients with Prader-Willi syndrome. Neuropsychologia 2016; 85:137-47. [PMID: 26994593 DOI: 10.1016/j.neuropsychologia.2016.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 02/10/2016] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
Prader-Willi syndrome (PWS) is a rare neurodevelopmental and genetic disorder that is characterized by various expression of endocrine, cognitive and behavioral problems, among which a true obsession for food and a deficit of satiety that leads to hyperphagia and severe obesity. Neuropsychological studies have reported that PWS display altered social interactions with a specific weakness in interpreting social information and in responding to them, a symptom closed to that observed in autism spectrum disorders (ASD). Based on the hypothesis that atypical multisensory integration such as face and voice interactions would contribute in PWS to social impairment we investigate the abilities of PWS to process communication signals including the human voice. Patients with PWS recruited from the national reference center for PWS performed a simple detection task of stimuli presented in an uni-o or bimodal condition, as well as a voice discrimination task. Compared to control typically developing (TD) individuals, PWS present a specific deficit in discriminating human voices from environmental sounds. Further, PWS present a much lower multisensory benefits with an absence of violation of the race model indicating that multisensory information do not converge and interact prior to the initiation of the behavioral response. All the deficits observed in PWS were stronger for the subgroup of patients suffering from Uniparental Disomy, a population known to be more sensitive to ASD. Altogether, our study suggests that the deficits in social behavior observed in PWS derive at least partly from an impairment in deciphering the social information carried by voice signals, face signals, and the combination of both. In addition, our work is in agreement with the brain imaging studies revealing an alteration in PWS of the "social brain network" including the STS region involved in processing human voices.
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Affiliation(s)
- Juliette Salles
- Université Toulouse, CerCo, Université Paul Sabatier, Toulouse, France; CNRS, UMR 5549, Faculté de Médecine de Purpan, Toulouse, France; Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France; Service de psychiatrie et psychologie médicale, Hôpital de psychiatrie, Toulouse, France
| | - Kuzma Strelnikov
- Université Toulouse, CerCo, Université Paul Sabatier, Toulouse, France; CNRS, UMR 5549, Faculté de Médecine de Purpan, Toulouse, France
| | - Mantoulan Carine
- Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France
| | | | | | - Catherine Molinas
- Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France
| | - Maïthé Tauber
- Centre de Référence du Syndrome de Prader-Willi, Hôpital des Enfants, Toulouse, France; INSERM, Centre de Physiopathologie de Toulouse-Purpan UMR 1043 3, Toulouse, France
| | - Pascal Barone
- Université Toulouse, CerCo, Université Paul Sabatier, Toulouse, France; CNRS, UMR 5549, Faculté de Médecine de Purpan, Toulouse, France.
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Meneghello C, Segat D, Fortunati E. Insulin-driven translational capacity is impaired in primary fibroblasts of Prader Willi. Intractable Rare Dis Res 2016; 5:17-24. [PMID: 26989644 PMCID: PMC4761579 DOI: 10.5582/irdr.2015.01041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Prader-Willi (PW) syndrome is a rare genetic disorder characterized by hypothalamic-pituitary abnormalities and severe hypotonia, hyperphagia, behavioural and psychiatric problems. Absence of satiety leads to severe obesity and frequently to diabetes. Furthermore, adult patients suffer from a severe loss of muscle mass, which severely impacts their quality of life. The mechanisms underlying alterations in muscle growth in PW remain to be clarified. In this study we explored the hypothesis that, in PW cells, alterations of protein synthesis are determined by dysfunctions in the promotion of cell growth. In order to study the molecular changes leading to dysfunction in protein translation, primary fibroblasts derived from four PW patients and five control subjects were used to study the insulin-mediated signaling pathway implicated in the control of protein synthesis by immunoblotting. Here we present, for the first time, evidences that the protein translation response to insulin is impaired in PW fibroblasts. Insulin alone has a major upregulatory effect on protein kinase B (AKT), glycogen synthase kinase (GSK3beta), while phosphorylation of p70S6K1 protein elongation factor controlled by mammalian target of rapamycin complex I (mTORC1) is reduced. In addition, we provide data that the response to insulin in PW cells can be restored by previous treatment with the amino acid L-Leucine (L-Leu). Our experiments in primary cell cultures demonstrate an impairment of insulin signaling that can be rescued by supplementation with the branched aminoacid L-Leu, indicating a possible therapeutic approach for alleviating muscle mass loss in PW patients.
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Affiliation(s)
| | - Daniela Segat
- “Mauro Baschirotto” Institute for Rare Diseases - B.I.R.D., Vicenza. Italy
| | - Elisabetta Fortunati
- “Mauro Baschirotto” Institute for Rare Diseases - B.I.R.D., Vicenza. Italy
- Address correspondence to: Dr. Elisabetta Fortunati, “Mauro Baschirotto” Institute for Rare Diseases - B.I.R.D., 36023 Costozza di Longare, Vicenza. Italy. E-mail:
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Obesity and Prader-Willi Syndrome Affect Heart Rate Recovery from Dynamic Resistance Exercise in Youth. Diseases 2016; 4:diseases4010004. [PMID: 28933384 PMCID: PMC5456310 DOI: 10.3390/diseases4010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 12/23/2015] [Accepted: 01/13/2016] [Indexed: 01/11/2023] Open
Abstract
Following exercise, heart rate decline is initially driven by parasympathetic reactivation and later by sympathetic withdrawal. Obesity delays endurance exercise heart rate recovery (HRR) in both children and adults. Young people with Prader-Willi Syndrome (PWS), a congenital cause for obesity, have shown a slower 60-s endurance exercise HRR compared to lean and obese children, suggesting compromised regulation. This study further evaluated effects of obesity and PWS on resistance exercise HRR at 30 and 60 s in children. PWS (8–18 years) and lean and obese controls (8–11 years) completed a weighted step-up protocol (six sets x 10 reps per leg, separated by one-minute rest), standardized using participant stature and lean body mass. HRR was evaluated by calculated HRR value (HRRV = difference between HR at test termination and 30 (HRRV30) and 60 (HRRV60) s post-exercise). PWS and obese had a smaller HRRV30 than lean (p < 0.01 for both). Additionally, PWS had a smaller HRRV60 than lean and obese (p = 0.01 for both). Obesity appears to delay early parasympathetic reactivation, which occurs within 30 s following resistance exercise. However, the continued HRR delay at 60 s in PWS may be explained by either blunted parasympathetic nervous system reactivation, delayed sympathetic withdrawal and/or poor cardiovascular fitness.
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Song KU, Nam OH, Kim MS, Choi SC, Lee HS. An 18-year-old patient with Prader-Willi syndrome: a case report on dental management under sedation and general anesthesia. J Dent Anesth Pain Med 2015; 15:251-255. [PMID: 28879288 PMCID: PMC5564163 DOI: 10.17245/jdapm.2015.15.4.251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/10/2015] [Accepted: 11/17/2015] [Indexed: 11/23/2022] Open
Abstract
Prader-Willi syndrome (PWS) is a rare genetic disorder reported rarely in dentistry. Dental practitioners should know the features of PWS because affected patients have a variety of dental symptoms. The current report describes a case of PWS. An 18-year-old male patient presented with traumatic injuries. Initial emergency treatments were performed under sedation, and further treatments were conducted under general anesthesia. After adequate healing, periodic follow-up and dietary management according to the patient's age and nutritional phase were recommended. Dental management of PWS patients consists of active preventive measures in addition to dietary consultation according to age and nutritional phase.
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Affiliation(s)
- Ki Un Song
- Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Ok Hyung Nam
- Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Mi Sun Kim
- Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Sung Chul Choi
- Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Hyo-Seol Lee
- Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea
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Cohen M, Harrington J, Narang I, Hamilton J. Growth hormone secretion decreases with age in paediatric Prader-Willi syndrome. Clin Endocrinol (Oxf) 2015; 83:212-5. [PMID: 25495188 DOI: 10.1111/cen.12694] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 10/02/2014] [Accepted: 12/04/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Growth hormone deficiency is a common feature of Prader-Willi syndrome; however, biochemical deficiency is not uniformly demonstrated. Criteria for GH treatment in paediatric PWS vary with some countries requiring documentation of biochemical GH deficiency. Data regarding the significance of age in the interpretation of GH stimulation test results, particularly in infants, are lacking. We aimed to assess age-related trends in the prevalence of biochemical GH deficiency in infants and children with PWS. DESIGN A retrospective chart review was conducted. Data from children with Prader-Willi syndrome that had GH stimulation tests performed at the Hospital for Sick Children in Toronto between the years 2000 and 2012 were collected. PATIENT Charts of 47 children 0·4-15·5 years of age with PWS that had GH stimulation tests were reviewed. MEASUREMENTS Biochemical GH status in relation to age and body mass index. RESULTS Thirty-two of 47 patients (68%) were biochemically GH deficient. GH deficiency was significantly associated with older age (r = 0·45, P = 0·02) and higher body-mass-index z-score (r = 0·45, P = 0·02). Biochemical GH deficiency was less prevalent up to 18 months of age (3/11 27%) compared with older children (29/36 [81%]; P = 0·001). A higher prevalence of GH deficiency was also detected in obese patients (14/16 [88%]) compared with nonobese patients (18/31 [58%]; P = 0·04). CONCLUSIONS The utility of performing GH stimulation tests as an indication of GH status under 18 months of age in Prader-Willi syndrome is questionable. If performed, results should be carefully interpreted in the context of age.
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Affiliation(s)
- M Cohen
- Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - J Harrington
- Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - I Narang
- Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - J Hamilton
- Division of Endocrinology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Stagi S, Iurato C, Lapi E, Cavalli L, Brandi ML, de Martino M. Bone status in genetic syndromes: a review. Hormones (Athens) 2015; 14:19-31. [PMID: 25885101 DOI: 10.1007/bf03401378] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
More and more data seem to indicate the presence of an increasing number of syndromes and genetic diseases characterized by impaired bone mass and quality. Meanwhile, the improvement of etiopathogenetic knowledge and the employment of more adequate treatments have generated a significant increase in survival related to these syndromes and diseases. It is thus important to identify and treat bone impairment in these patients in order to assure a better quality of life. This review provides an updated overview of bone pathophysiology and characteristics in patients with Down, Turner, Klinefelter, Marfan, Williams, Prader-Willi, Noonan, and 22q11 deletions syndrome. In addition, some options for the treatment of the bone status impairment in these patients will be briefly discussed.
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Affiliation(s)
- Stefano Stagi
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Chiara Iurato
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Elisabetta Lapi
- Genetics and Molecular Medicine Unit, Anna Meyer Children's University Hospital, University of Florence, Florence, Italy
| | - Loredana Cavalli
- Department of Internal Medicine, Endocrinology Unit, University of Florence, Florence, Italy
| | - Maria Luisa Brandi
- Department of Internal Medicine, Endocrinology Unit, University of Florence, Florence, Italy
| | - Maurizio de Martino
- Health Sciences Department, University of Florence, Anna Meyer Children's University Hospital, University of Florence, Florence, Italy
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Almuhtaseb S, Oppewal A, Hilgenkamp TIM. Gait characteristics in individuals with intellectual disabilities: a literature review. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:2858-2883. [PMID: 25105568 DOI: 10.1016/j.ridd.2014.07.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 07/07/2014] [Indexed: 06/03/2023]
Abstract
Gait is a functionally highly relevant aspect of motor performance. In the general population poorer gait increases the risk of falls and is a predictor for future disability, cognitive impairment, institutionalization and/or mortality. People with intellectual disabilities (ID) show a delayed motor development, which brings to attention the abnormalities that might accompany gait in this population throughout childhood and adulthood. Therefore, this paper aims (a) to provide a focused review of the available literature on gait characteristics in individuals with ID and (b) to gain insight into available instrumentations measuring gait in this population. We searched the database of PubMed for relevant articles and the reference lists of included articles, resulting in 44 included articles. Forty one studies reported gait characteristics during over-ground walking and six studies during perturbed walking conditions. Most studies investigated syndrome-specific ID populations, only five studies investigated the general ID population. The studies show that gait abnormalities are evident during over-ground walking in the ID population, both in people with genetic syndromes and with ID without genetic syndromes. During perturbed conditions people with ID altered their gait with stability-enhancing adaptations. Abnormalities in gait may be partly explained by physical features, but the interrelatedness between gait and cognition may also be an explanation for the gait abnormalities seen in the ID population. Further research regarding gait characteristics of the ID population, and its relation to cognitive functioning, and adverse health outcomes is needed.
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Affiliation(s)
- Sanaa Almuhtaseb
- Institute of Sport Science and Sport, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Alyt Oppewal
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; Ipse de Bruggen, P.O. Box 7027, 2701 AA Zoetermeer, The Netherlands.
| | - Thessa I M Hilgenkamp
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands; Abrona, Amersfoortseweg 56, 3712 BE Huis ter Heide, The Netherlands
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