1
|
Fu X, Yang X, Wang X, Jia B, Ma W, Xiong H, Fang F, Ren X, Lv J. HyperCKemia: An early sign of childhood-onset neutral lipid storage disease with myopathy. Neuromuscul Disord 2023; 33:81-89. [PMID: 37620213 DOI: 10.1016/j.nmd.2023.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/12/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023]
Abstract
Neutral lipid-storage disease with myopathy (NLSDM) is an autosomal recessive neuromuscular disorder caused by mutations in PNPLA2, and the average age at onset is 30 years. To date, only eight patients with childhood-onset NLSDM have been reported in detail. We investigated 3 unreported patients with NLSDM detected in childhood and reviewed 8 childhood-onset and 82 adult-onset patients with NLSDM documented in the literature. In the childhood-onset cohort, NLSDM presented initially as asymptomatic or paucisymptomatic hyperCKemia in 6/11 patients, and follow-up data showed onset of muscle weakness in 6/11 childhood-onset patients. In the adult-onset cohort, 95.1% (78/82) of patients showed muscle weakness. Cardiac involvement developed in 6/11 childhood-onset patients. Hepatomegaly was observed in 3/11 childhood-onset patients. Serum creatine kinase levels were elevated greater than five-fold of the upper limit of normal (ULN) in most childhood-onset patients and were elevated to less than ten-fold of the ULN in most adult-onset patients. Peripheral blood smears and muscle biopsies showed cytoplasmic lipid droplets in leukocytes and myocytes. NLSDM can present in children with asymptomatic or paucisymptomatic hyperCKemia before the onset of muscle weakness. The presence of lipid droplets in leucocytes (Jordans' anomaly) aids in diagnosing and confirming the pathogenicity of PNPLA2 variants of uncertain significance. There were no clear genotype-phenotype correlations in patients with NLSDM.
Collapse
Affiliation(s)
- Xiaona Fu
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Xinying Yang
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Xiaofei Wang
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Bingbing Jia
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Wenna Ma
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Hui Xiong
- Department of Pediatrics, Peking University First Hospital, Beijing, China
| | - Fang Fang
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Xiaotun Ren
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
| | - Junlan Lv
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
| |
Collapse
|
2
|
Early onset neutral lipid storage disease with myopathy presenting as congenital hypotonia and hepatomegaly. Neuromuscul Disord 2020; 31:52-55. [PMID: 33303358 DOI: 10.1016/j.nmd.2020.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 12/23/2022]
Abstract
Neutral lipid storage disease with myopathy is an ultra-rare, inherited autosomal recessive neuromuscular metabolic disorder caused by pathogenic variants in PNPLA2. It typically presents in adults as a progressive myopathy and is associated with myocardiopathy, hepatic involvement, and high creatine kinase levels. Only three children and adolescents with neutral lipid storage disease with myopathy have been reported. We report a female infant with congenital hypotonia born to consanguineous parents, whose mother presented with polyhydramnios during pregnancy. She demonstrated delayed acquisition of motor milestones, hepatomegaly, and elevated creatine kinase levels. Homozygous pathogenic variants in PNPLA2 were identified. Lipid accumulation was observed within the muscle fibers and Jordans' anomaly was observed in a blood smear. This is the first report to describe an infant with mildly symptomatic neutral lipid storage disease with myopathy and demonstrate hepatic involvement in a pediatric patient. Despite her mild symptoms, her ancillary test results were markedly abnormal.
Collapse
|
3
|
Zhang W, Wen B, Lu J, Zhao Y, Hong D, Zhao Z, Zhang C, Luo Y, Qi X, Zhang Y, Song X, Zhao Y, Zhao C, Hu J, Yang H, Wang Z, Yan C, Yuan Y. Neutral lipid storage disease with myopathy in China: a large multicentric cohort study. Orphanet J Rare Dis 2019; 14:234. [PMID: 31655616 PMCID: PMC6815004 DOI: 10.1186/s13023-019-1209-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 09/24/2019] [Indexed: 06/18/2023] Open
Abstract
Background Neutral lipid storage disease with myopathy (NLSDM) is a rare clinical heterogeneous disorder caused by mutations in the patatin-like phospholipase domain-containing 2 (PNPLA2) gene. NLSDM usually presents skeletal myopathy, cardiomyopathy and the multiple organs dysfunction. Around 50 cases of NLSDM have been described worldwide, whereas the comprehensive understanding of this disease are still limited. We therefore recruit NLSDM patients from 10 centers across China, summarize the clinical, muscle imaging, pathological and genetic features, and analyze the genotype-phenotype relationship. Results A total of 45 NLSDM patients (18 men and 27 women) were recruited from 40 unrelated families. Thirteen patients were born from consanguineous parents. The phenotypes were classified as asymptomatic hyperCKemia (2/45), pure skeletal myopathy (18/45), pure cardiomyopathy (4/45), and the combination of skeletal myopathy and cardiomyopathy (21/45). Right upper limb weakness was the early and prominent feature in 61.5% of patients. On muscle MRI, the long head of the biceps femoris, semimembranosus and adductor magnus on thighs, the soleus and medial head of the gastrocnemius on lower legs showed the most severe fatty infiltration. Thirty-three families were carrying homozygous mutations, while seven families were carrying compound heterozygous mutations. A total of 23 mutations were identified including 11 (47.8%) point mutations, eight (34.8%) deletions and four (17.4%) insertions. c.757 + 1G > T, c.245G > A and c.187 + 1G > A were the three most frequent mutations. Among four groups of phenotypes, significant differences were shown in disease onset (< 20 years versus ≥20 years old, p = 0.003) and muscle pathology (with rimmed vacuoles versus without rimmed vacuoles, p = 0.001). PNPLA2 mutational type or functional defects did not show great impact on phenotypes. Conclusion We outline the clinical and genetic spectrum in a large cohort of NLSDM patients. Selective muscle fatty infiltration on posterior compartment of legs are characteristic of NLSDM. Chinese patients present with distinctive and relative hotspot PNPLA2 mutations. The disease onset age and pathological appearance of rimmed vacuoles are proved to be related with the clinical manifestations. The phenotypes are not strongly influenced by genetic defects, suggesting the multiple environmental risk factors in the development of NLSDM.
Collapse
Affiliation(s)
- Wei Zhang
- Department of Neurology, Peking University First Hospital, No.8 Xishiku Street, West District, Beijing, 100034, China
| | - Bing Wen
- Department of Neurology, Qilu Hospital of Shandong University, No. 107, West Wenhua Road, Jinan, 250012, Shandong, China
| | - Jun Lu
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Yawen Zhao
- Department of Neurology, Peking University First Hospital, No.8 Xishiku Street, West District, Beijing, 100034, China
| | - Daojun Hong
- Department of Neurology, Peking University People's Hospital, Beijing, People's Republic of China
| | - Zhe Zhao
- Department of Neurology, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei province, People's Republic of China
| | - Cheng Zhang
- Department of Neurology, the First Affiliated Hospital of Sun yat-sen University, Guangzhou, Guangdong province, People's Republic of China
| | - Yuebei Luo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan province, People's Republic of China
| | - Xueliang Qi
- Department of Neurology, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi province, People's Republic of China
| | - Yingshuang Zhang
- Department of Neurology, Third Hospital, Peking University, Beijing, People's Republic of China
| | - Xueqin Song
- Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang, Hebei province, People's Republic of China
| | - Yuying Zhao
- Department of Neurology, Qilu Hospital of Shandong University, No. 107, West Wenhua Road, Jinan, 250012, Shandong, China
| | - Chongbo Zhao
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Jing Hu
- Department of Neurology, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei province, People's Republic of China
| | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan province, People's Republic of China
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, No.8 Xishiku Street, West District, Beijing, 100034, China
| | - Chuanzhu Yan
- Department of Neurology, Qilu Hospital of Shandong University, No. 107, West Wenhua Road, Jinan, 250012, Shandong, China.
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, No.8 Xishiku Street, West District, Beijing, 100034, China.
| |
Collapse
|
4
|
Inaba T, Okumura K, Fujita N, Suzuki A, Hirano KI. Detection of Jordans' anomaly using compact-type automated hematology analyzer. Int J Hematol 2019; 110:129-130. [PMID: 31183815 DOI: 10.1007/s12185-019-02689-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 05/29/2019] [Accepted: 05/30/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Tohru Inaba
- Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Keita Okumura
- Faculty of Clinical Laboratory, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Naohisa Fujita
- Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Akira Suzuki
- Laboratory of Cardiovascular Disease, Novel, Non-invasive, and Nutritional Therapeutics (CNT), Department of Cardiovascular Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0874, Japan
| | - Ken-Ichi Hirano
- Laboratory of Cardiovascular Disease, Novel, Non-invasive, and Nutritional Therapeutics (CNT), Department of Cardiovascular Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, 565-0874, Japan
| |
Collapse
|
5
|
Zheng S, Liao W. Novel PNPLA2 gene mutation in a child causing neutral lipid storage disease with myopathy. BMC MEDICAL GENETICS 2018; 19:172. [PMID: 30223778 PMCID: PMC6142338 DOI: 10.1186/s12881-018-0683-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/09/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND PNPLA2 gene mutations cause neutral lipid storage disease with myopathy (NLSD-M) or cardiomyopathies. The clinical phenotype, blood test results, imaging examination and gene analysis can be used to improve the understanding of NLSD-M, reduce the misdiagnosis rate and prevent physical disability and even premature death. CASE PRESENTATION We report a Chinese child with NLSD-M presenting with marked asymmetric skeletal myopathy and hypertrophic cardiomyopathy. Blood biochemical tests revealed increased creatine kinase levels, and echocardiography revealed a diffuse and thick left ventricular wall. Gene analysis revealed a homozygous mutation c.155C > G (p.Thr52Arg) in PNPLA2. CONCLUSIONS An understanding of the characteristic features is essential for the early diagnosis of NLSD-M. Our data expand the allelic spectrum of PNPLA2 mutations, providing further evidence for genetic and clinical NLSD-M heterogeneity in younger individuals.
Collapse
Affiliation(s)
- Shouyan Zheng
- Department of Pediatrics, First Affiliated Hospital to Army Medical University, No. 30, Gaotanyan Street, Chongqing, 400038, China
| | - Wei Liao
- Department of Pediatrics, First Affiliated Hospital to Army Medical University, No. 30, Gaotanyan Street, Chongqing, 400038, China.
| |
Collapse
|
6
|
Vasiljevski ER, Summers MA, Little DG, Schindeler A. Lipid storage myopathies: Current treatments and future directions. Prog Lipid Res 2018; 72:1-17. [PMID: 30099045 DOI: 10.1016/j.plipres.2018.08.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/20/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Abstract
Lipid storage myopathies (LSMs) are a heterogeneous group of genetic disorders that present with abnormal lipid storage in multiple body organs, typically muscle. Patients can clinically present with cardiomyopathy, skeletal muscle weakness, myalgia, and extreme fatigue. An early diagnosis is crucial, as some LSMs can be managed by simple nutraceutical supplementation. For example, high dosage l-carnitine is an effective intervention for patients with Primary Carnitine Deficiency (PCD). This review discusses the clinical features and management practices of PCD as well as Neutral Lipid Storage Disease (NLSD) and Multiple Acyl-CoA Dehydrogenase Deficiency (MADD). We provide a detailed summary of current clinical management strategies, highlighting issues of high-risk contraindicated treatments with case study examples not previously reviewed. Additionally, we outline current preclinical studies providing disease mechanistic insight. Lastly, we propose that a number of other conditions involving lipid metabolic dysfunction that are not classified as LSMs may share common features. These include Neurofibromatosis Type 1 (NF1) and autoimmune myopathies, including Polymyositis (PM), Dermatomyositis (DM), and Inclusion Body Myositis (IBM).
Collapse
Affiliation(s)
- Emily R Vasiljevski
- Orthopaedic Research & Biotechnology, The Children's Hospital at Westmead, Westmead, NSW, Australia.; Discipline of Paediatrics & Child Heath, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia
| | - Matthew A Summers
- Bone Biology Division, The Garvan Institute of Medical Research, Darlinghurst, NSW, Australia; St Vincent's Clinical School, University of New South Wales, Faculty of Medicine, Sydney, NSW, Australia
| | - David G Little
- Orthopaedic Research & Biotechnology, The Children's Hospital at Westmead, Westmead, NSW, Australia.; Discipline of Paediatrics & Child Heath, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia
| | - Aaron Schindeler
- Orthopaedic Research & Biotechnology, The Children's Hospital at Westmead, Westmead, NSW, Australia.; Discipline of Paediatrics & Child Heath, Faculty of Medicine, University of Sydney, Camperdown, NSW, Australia.
| |
Collapse
|
7
|
Inaba T, Ishizuka K, Suzuki A, Yuasa S, Saito K, Kodama M, Hongo F, Fujita N, Hirano K. Comparison of neutrophil distribution patterns in Jordans' anomaly among major automated hematology analyzers. Int J Lab Hematol 2018; 40:e78-e81. [PMID: 29708306 DOI: 10.1111/ijlh.12842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/22/2018] [Indexed: 01/14/2023]
Affiliation(s)
- T Inaba
- Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - K Ishizuka
- Department of Medical Instrumental Research and Technology, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Horiba, Ltd., Kyoto, Japan
| | - A Suzuki
- Laboratory of Cardiovascular Disease, Novel, Non-invasive, and Nutritional Therapeutics (CNT), Department of Cardiovascular Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - S Yuasa
- Department of Medical Instrumental Research and Technology, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Horiba, Ltd., Kyoto, Japan
| | - K Saito
- Department of Medical Instrumental Research and Technology, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Horiba, Ltd., Kyoto, Japan
| | - M Kodama
- Department of Medical Instrumental Research and Technology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - F Hongo
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - N Fujita
- Department of Infection Control and Laboratory Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - K Hirano
- Laboratory of Cardiovascular Disease, Novel, Non-invasive, and Nutritional Therapeutics (CNT), Department of Cardiovascular Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| |
Collapse
|
8
|
Latimer CS, Schleit J, Reynolds A, Marshall DA, Podemski B, Wang LH, Gonzalez-Cuyar LF. Neutral lipid storage disease with myopathy: Further phenotypic characterization of a rare PNPLA2 variant. Neuromuscul Disord 2018; 28:606-609. [PMID: 29779757 DOI: 10.1016/j.nmd.2018.04.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 03/31/2018] [Accepted: 04/15/2018] [Indexed: 11/19/2022]
Abstract
Neutral lipid storage disease with myopathy is a rare disorder of lipid metabolism caused by variants in the Patatin-Like Phospholipase Domain Containing 2 (PNPLA2) gene. Diagnosis is often delayed due to variable presentations, which is of concern due to increased risk of cardiomyopathy. Better phenotype-genotype characterization is necessary to improve speed and accuracy of diagnosis. Here, we describe a 32-year-old woman of Hmong descent with progressive muscle pain and weakness who had a muscle biopsy with characteristic features of a lipid storage myopathy. Genetic testing revealed a homozygous splice site variant in PNPLA2, c.757 + 1G > T. This case, in combination with the one previously reported case of this PNPLA2 variant, also in a family of Hmong descent, suggests this particular variant may be unique to the Hmong population, a Southeast Asian minority group living in the United States, who immigrated to the United States as refugees after the Vietnam War.
Collapse
Affiliation(s)
- Caitlin S Latimer
- Department of Pathology, Neuropathology Division, University of Washington Medical Center, Seattle, WA
| | - Jennifer Schleit
- Department of Pathology, Center for Precision Diagnostics, University of Washington Medical Center, Seattle, WA
| | - Adam Reynolds
- Department of Neurology, University of Washington Medical Center, Seattle, WA
| | - Desiree A Marshall
- Department of Pathology, Neuropathology Division, University of Washington Medical Center, Seattle, WA
| | | | - Leo H Wang
- Department of Neurology, University of Washington Medical Center, Seattle, WA
| | - Luis F Gonzalez-Cuyar
- Department of Pathology, Neuropathology Division, University of Washington Medical Center, Seattle, WA.
| |
Collapse
|
9
|
Pennisi EM, Arca M, Bertini E, Bruno C, Cassandrini D, D'amico A, Garibaldi M, Gragnani F, Maggi L, Massa R, Missaglia S, Morandi L, Musumeci O, Pegoraro E, Rastelli E, Santorelli FM, Tasca E, Tavian D, Toscano A, Angelini C. Neutral Lipid Storage Diseases: clinical/genetic features and natural history in a large cohort of Italian patients. Orphanet J Rare Dis 2017; 12:90. [PMID: 28499397 PMCID: PMC5427600 DOI: 10.1186/s13023-017-0646-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 05/03/2017] [Indexed: 12/20/2022] Open
Abstract
Background A small number of patients affected by Neutral Lipid Storage Diseases (NLSDs: NLSD type M with Myopathy and NLSD type I with Ichthyosis) have been described in various ethnic groups worldwide. However, relatively little is known about the progression and phenotypic variability of the disease in large specific populations. The aim of our study was to assess the natural history, disability and genotype-phenotype correlations in Italian patients with NLSDs. Twenty-one patients who satisfied the criteria for NLSDs were enrolled in a retrospective cross-sectional study to evaluate the genetic aspects, clinical signs at onset, disability progression and comorbidities associated with this group of diseases. Results During the clinical follow-up (range: 2–44 years, median: 17.8 years), two patients (9.5%, both with NLSD-I) died of hepatic failure, and a further five (24%) lost their ability to walk or needed help when walking after a mean period of 30.6 years of disease. None of the patients required mechanical ventilation. No patient required a heart transplant, one patient with NLSD-M was implanted with a cardioverter defibrillator for severe arrhythmias. Conclusion The genotype/phenotype correlation analysis in our population showed that the same gene mutations were associated with a varying clinical onset and course. This study highlights peculiar aspects of Italian NLSD patients that differ from those observed in Japanese patients, who were found to be affected by a marked hypertrophic cardiopathy. Owing to the varying phenotypic expression of the same mutations, it is conceivable that some additional genetic or epigenetic factors affect the symptoms and progression in this group of diseases.
Collapse
Affiliation(s)
- Elena Maria Pennisi
- UOC of Neurology, San Filippo Neri Hospital, via Martinotti 20, 00135, Rome, Italy.
| | - Marcello Arca
- Department of Internal Medicine and Allied Sciences, Atherosclerosis Unit, Sapienza University of Rome, Rome, Italy
| | | | | | | | | | | | | | - Lorenzo Maggi
- Neuroimmunology and Neuromuscular Diseases Unit, Foundation IRCCS Neurological Institute "Carlo Besta", Milan, Italy
| | - Roberto Massa
- Department of Systems Medicine, Centre of Neuromuscular Disorders, Tor Vergata University, Rome, Italy
| | - Sara Missaglia
- CRIBENS, Catholic University of the Sacred Heart, Milan, Italy
| | - Lucia Morandi
- Neuroimmunology and Neuromuscular Diseases Unit, Foundation IRCCS Neurological Institute "Carlo Besta", Milan, Italy
| | - Olimpia Musumeci
- Department of Neurosciences, University of Messina, Messina, Italy
| | - Elena Pegoraro
- Department of Neurology, University of Padova, Padova, Italy
| | - Emanuele Rastelli
- Department of Systems Medicine, Centre of Neuromuscular Disorders, Tor Vergata University, Rome, Italy
| | | | | | - Daniela Tavian
- CRIBENS, Catholic University of the Sacred Heart, Milan, Italy
| | - Antonio Toscano
- Department of Neurosciences, University of Messina, Messina, Italy
| | | | | |
Collapse
|
10
|
Missaglia S, Maggi L, Mora M, Gibertini S, Blasevich F, Agostoni P, Moro L, Cassandrini D, Santorelli FM, Gerevini S, Tavian D. Late onset of neutral lipid storage disease due to novel PNPLA2 mutations causing total loss of lipase activity in a patient with myopathy and slight cardiac involvement. Neuromuscul Disord 2017; 27:481-486. [PMID: 28258942 PMCID: PMC5424884 DOI: 10.1016/j.nmd.2017.01.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 11/19/2016] [Accepted: 01/15/2017] [Indexed: 01/16/2023]
Abstract
Two novel mutations in PNPLA2 gene have been identified in a neutral lipid storage disease with myopathy (NLSDM) female patient. The mutations are located in exon 5 of PNPLA2 and abrogate lipase function. The patient showed late onset skeletal muscle myopathy and mild cardiac impairment. Clinical cardiac phenotype is milder in NLSDM female patients, beyond genetics.
Neutral lipid storage disease with myopathy (NLSDM) presents with skeletal muscle myopathy and severe dilated cardiomyopathy in nearly 40% of cases. NLSDM is caused by mutations in the PNPLA2 gene, which encodes the adipose triglyceride lipase (ATGL). Here we report clinical and genetic findings of a patient carrying two novel PNPLA2 mutations (c.696+4A>G and c.553_565delGTCCCCCTTCTCG). She presented at age 39 with right upper limb abduction weakness slowly progressing over the years with asymmetric involvement of proximal upper and lower limb muscles. Cardiological evaluation through ECG and heart echo scan was normal until the age 53, when mild left ventricular diastolic dysfunction was detected. Molecular analysis revealed that only one type of PNPLA2 transcript, with exon 5 skipping, was expressed in patient cells. Such aberrant mRNA causes the production of a shorter ATGL protein, lacking part of the catalytic domain. This is an intriguing case, displaying severe PNPLA2 mutations with clinical presentation characterized by slight cardiac impairment and full expression of severe asymmetric myopathy.
Collapse
Affiliation(s)
- Sara Missaglia
- Laboratory of Cellular Biochemistry and Molecular Biology, CRIBENS, Catholic University of the Sacred Heart, pz Buonarroti 30, Milan 20145, Italy; Department of Psychology, Catholic University of the Sacred Heart, Largo Gemelli, 1, Milan 20123, Italy
| | - Lorenzo Maggi
- Neuromuscular Diseases and Neuroimmunology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - Marina Mora
- Neuromuscular Diseases and Neuroimmunology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - Sara Gibertini
- Neuromuscular Diseases and Neuroimmunology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - Flavia Blasevich
- Neuromuscular Diseases and Neuroimmunology Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - Piergiuseppe Agostoni
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Laura Moro
- Department of Pharmaceutical Sciences, University of Piemonte Orientale "Amedeo-Avogadro", Novara, Italy
| | | | | | | | - Daniela Tavian
- Laboratory of Cellular Biochemistry and Molecular Biology, CRIBENS, Catholic University of the Sacred Heart, pz Buonarroti 30, Milan 20145, Italy; Department of Psychology, Catholic University of the Sacred Heart, Largo Gemelli, 1, Milan 20123, Italy.
| |
Collapse
|
11
|
Jousserand G, Streichenberger N, Petiot P. [Unusual phenotype of myopathy associated with a new PNPLA2 mutation]. Med Sci (Paris) 2016; 32 Hors série n°2:10-11. [PMID: 27869069 DOI: 10.1051/medsci/201632s203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
La myopathie due à des mutations du gène PNPLA2 est une entité rare entraînant une accumulation de gouttelettes lipidiques dans différents tissus dont le muscle et les leucocytes. Ce gène code l’ATGL (adipose triacylglycerol lipase), une enzyme qui catalyse l’hydrolyse des triglycérides. Nous rapportons ici le cas d’un patient de 54 ans présentant une myopathie distale et une cardiomyopathie. La biopsie musculaire met en évidence une accumulation de gouttelettes lipidiques dans les myocytes. Malgré l’absence de corps de Jordan dans les leucocytes, le diagnostic de myopathie par mutation du gène PNPLA2 est quand même envisagé, diagnostic que la biologie moléculaire confirmera avec l’identification d’une nouvelle mutation (c.798_799insC ; p.Ala267Argfsx40) dans l’exon 7 du gène PNPLA2.
Collapse
Affiliation(s)
- Guillemette Jousserand
- Service d'explorations fonctionnelles neurologiques, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Centre de Référence Maladies Neuromusculaires Rares Rhône Alpes, FILNEMUS
| | - Nathalie Streichenberger
- Service d'explorations fonctionnelles neurologiques, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Centre de Référence Maladies Neuromusculaires Rares Rhône Alpes, FILNEMUS
| | - Philippe Petiot
- Service d'explorations fonctionnelles neurologiques, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Centre de Référence Maladies Neuromusculaires Rares Rhône Alpes, FILNEMUS
| |
Collapse
|
12
|
Whole exome sequence analysis reveals a homozygous mutation in PNPLA2 as the cause of severe dilated cardiomyopathy secondary to neutral lipid storage disease. Int J Cardiol 2016; 210:41-4. [DOI: 10.1016/j.ijcard.2016.02.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/21/2016] [Accepted: 02/01/2016] [Indexed: 11/19/2022]
|
13
|
Massa R, Pozzessere S, Rastelli E, Serra L, Terracciano C, Gibellini M, Bozzali M, Arca M. Neutral lipid-storage disease with myopathy and extended phenotype with novel PNPLA2 mutation. Muscle Nerve 2016; 53:644-8. [PMID: 26600210 DOI: 10.1002/mus.24983] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Neutral lipid-storage disease with myopathy is caused by mutations in PNPLA2, which produce skeletal and cardiac myopathy. We report a man with multiorgan neutral lipid storage and unusual multisystem clinical involvement, including cognitive impairment. METHODS Quantitative brain MRI with voxel-based morphometry and extended neuropsychological assessment were performed. In parallel, the coding sequences and intron/exon boundaries of the PNPLA2 gene were screened by direct sequencing. RESULTS Neuropsychological assessment revealed global cognitive impairment, and brain MRI showed reduced gray matter volume in the temporal lobes. Molecular characterization revealed a novel homozygous mutation in exon 5 of PNPLA2 (c.714C>A), resulting in a premature stop codon (p.Cys238*). CONCLUSIONS Some PNPLA2 mutations, such as the one described here, may present with an extended phenotype, including brain involvement. In these cases, complete neuropsychological testing, combined with quantitative brain MRI, may help to characterize and quantify cognitive impairment.
Collapse
Affiliation(s)
- Roberto Massa
- Department of Systems Medicine (Neurology), University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Simone Pozzessere
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| | - Emanuele Rastelli
- Department of Systems Medicine (Neurology), University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Laura Serra
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Chiara Terracciano
- Department of Systems Medicine (Neurology), University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Manuela Gibellini
- Department of Systems Medicine (Neurology), University of Rome Tor Vergata, Via Montpellier 1, 00133, Rome, Italy
| | - Marco Bozzali
- Neuroimaging Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Marcello Arca
- Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
| |
Collapse
|
14
|
Missaglia S, Tasca E, Angelini C, Moro L, Tavian D. Novel missense mutations in PNPLA2 causing late onset and clinical heterogeneity of neutral lipid storage disease with myopathy in three siblings. Mol Genet Metab 2015; 115:110-7. [PMID: 25956450 DOI: 10.1016/j.ymgme.2015.05.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/01/2015] [Indexed: 12/18/2022]
Abstract
Neutral lipid storage disease with myopathy (NLSD-M) is a rare autosomal recessive disorder characterised by an abnormal accumulation of triacylglycerol into cytoplasmic lipid droplets (LDs). NLSD-M patients are mainly affected by progressive myopathy, cardiomyopathy and hepatomegaly. Mutations in the PNPLA2 gene cause variable phenotypes of NLSD-M. PNPLA2 codes for adipose triglyceride lipase (ATGL), an enzyme that hydrolyses fatty acids from triacylglycerol. This report outlines the clinical and genetic findings in a NLSD-M Italian family with three affected members. In our patients, we identified two novel PNPLA2 missense mutations (p.L56R and p.I193F). Functional data analysis demonstrated that these mutations caused the production of ATGL proteins able to bind to LDs, but with decreased lipase activity. The oldest brother, at the age of 38, had weakness and atrophy of the right upper arm and kyphosis. Now he is 61 years old and is unable to raise arms in the horizontal position. The second brother, from the age of 44, had exercise intolerance, cramps and pain in lower limbs. He is currently 50 years old and has an asymmetric distal amyotrophy. One of the two sisters, 58 years old, presents the same PNPLA2 mutations, but she is still oligo-symptomatic on neuromuscular examination with slight triceps muscle involvement. She suffered from diabetes and liver steatosis. This NLSD-M family shows a wide range of intra-familial phenotypic variability in subjects carrying the same mutations, both in terms of target-organs and in terms of rate of disease progression.
Collapse
Affiliation(s)
- Sara Missaglia
- Laboratory of Cellular Biochemistry and Molecular Biology, CRIBENS, Catholic University of the Sacred Heart, Milan, Italy
| | | | | | - Laura Moro
- Department of Pharmaceutical Sciences, University of Piemonte Orientale "A. Avogadro", Novara, Italy
| | - Daniela Tavian
- Laboratory of Cellular Biochemistry and Molecular Biology, CRIBENS, Catholic University of the Sacred Heart, Milan, Italy; Psychology Department, Catholic University of the Sacred Heart, Milan, Italy.
| |
Collapse
|
15
|
Wu JW, Yang H, Wang SP, Soni KG, Brunel-Guitton C, Mitchell GA. Inborn errors of cytoplasmic triglyceride metabolism. J Inherit Metab Dis 2015; 38:85-98. [PMID: 25300978 DOI: 10.1007/s10545-014-9767-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Accepted: 08/25/2014] [Indexed: 01/14/2023]
Abstract
Triglyceride (TG) synthesis, storage, and degradation together constitute cytoplasmic TG metabolism (CTGM). CTGM is mostly studied in adipocytes, where starting from glycerol-3-phosphate and fatty acyl (FA)-coenzyme A (CoA), TGs are synthesized then stored in cytoplasmic lipid droplets. TG hydrolysis proceeds sequentially, producing FAs and glycerol. Several reactions of CTGM can be catalyzed by more than one enzyme, creating great potential for complex tissue-specific physiology. In adipose tissue, CTGM provides FA as a systemic energy source during fasting and is related to obesity. Inborn errors and mouse models have demonstrated the importance of CTGM for non-adipose tissues, including skeletal muscle, myocardium and liver, because steatosis and dysfunction can occur. We discuss known inborn errors of CTGM, including deficiencies of: AGPAT2 (a form of generalized lipodystrophy), LPIN1 (childhood rhabdomyolysis), LPIN2 (an inflammatory condition, Majeed syndrome, described elsewhere in this issue), DGAT1 (protein loosing enteropathy), perilipin 1 (partial lipodystrophy), CGI-58 (gene ABHD5, neutral lipid storage disease (NLSD) with ichthyosis and "Jordan's anomaly" of vacuolated polymorphonuclear leukocytes), adipose triglyceride lipase (ATGL, gene PNPLA2, NLSD with myopathy, cardiomyopathy and Jordan's anomaly), hormone-sensitive lipase (HSL, gene LIPE, hypertriglyceridemia, and insulin resistance). Two inborn errors of glycerol metabolism are known: glycerol kinase (GK, causing pseudohypertriglyceridemia) and glycerol-3-phosphate dehydrogenase (GPD1, childhood hepatic steatosis). Mouse models often resemble human phenotypes but may diverge markedly. Inborn errors have been described for less than one-third of CTGM enzymes, and new phenotypes may yet be identified.
Collapse
Affiliation(s)
- Jiang Wei Wu
- Division of Medical Genetics, Department of Pediatrics, Université de Montréal and CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Montreal, QC, H3T 1C5, Canada
| | | | | | | | | | | |
Collapse
|
16
|
Kaneko K, Kuroda H, Izumi R, Tateyama M, Kato M, Sugimura K, Sakata Y, Ikeda Y, Hirano KI, Aoki M. A novel mutation in PNPLA2 causes neutral lipid storage disease with myopathy and triglyceride deposit cardiomyovasculopathy: A case report and literature review. Neuromuscul Disord 2014; 24:634-41. [DOI: 10.1016/j.nmd.2014.04.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 04/05/2014] [Accepted: 04/09/2014] [Indexed: 12/18/2022]
|
17
|
Suzuki A, Nagasaka H, Ochi Y, Kobayashi K, Nakamura H, Nakatani D, Yamaguchi S, Yamaki S, Wada A, Shirata Y, Hui SP, Toda T, Kuroda H, Chiba H, Hirano KI. Peripheral leukocyte anomaly detected with routine automated hematology analyzer sensitive to adipose triglyceride lipase deficiency manifesting neutral lipid storage disease with myopathy/triglyceride deposit cardiomyovasculopathy. Mol Genet Metab Rep 2014; 1:249-253. [PMID: 27896096 PMCID: PMC5121313 DOI: 10.1016/j.ymgmr.2014.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 05/05/2014] [Accepted: 05/05/2014] [Indexed: 01/10/2023] Open
Abstract
Adipose triglyceride lipase (ATGL) deficiency manifesting neutral lipid storage disease with myopathy/triglyceride deposit cardiomyovasculopathy presents distinct fat-containing vacuoles known as Jordans' anomaly in peripheral leucocytes. To develop an automatic notification system for Jordans' anomaly in ATGL-deficient patients, we analyzed circulatory leukocyte scattergrams on automated hematology analyzer XE-5000. The BASO-WX and BASO-WY values were found to be significantly higher in patients than those in non-affected subjects. The two parameters measured by automated hematology analyzer may be expected to provide an important diagnostic clue for homozygous ATGL deficiency.
Collapse
Affiliation(s)
- Akira Suzuki
- Laboratory of Cardiovascular Disease, Novel, Non-invasive, and Nutritional Therapeutics (CNT), Graduate School of Medicine, Osaka University, Suita, Osaka 565-0874, Japan
| | - Hironori Nagasaka
- Department of Pediatrics, Takarazuka City Hospital, Takarazuka 665-0827, Japan
| | - Yasuhiro Ochi
- Scientific Affairs, Sysmex Corporation, Kobe 651-2241, Japan
| | - Kazuhiro Kobayashi
- Division of Neurology/Molecular Brain Science, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Hiroshi Nakamura
- Department of Community Health and Medicine, Yamaguchi University, School of Medicine, Ube 755-8505, Japan
| | - Daisaku Nakatani
- Laboratory of Cardiovascular Disease, Novel, Non-invasive, and Nutritional Therapeutics (CNT), Graduate School of Medicine, Osaka University, Suita, Osaka 565-0874, Japan
| | - Satoshi Yamaguchi
- Laboratory of Cardiovascular Disease, Novel, Non-invasive, and Nutritional Therapeutics (CNT), Graduate School of Medicine, Osaka University, Suita, Osaka 565-0874, Japan
| | - Shinobu Yamaki
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
| | - Atsushi Wada
- Scientific Affairs, Sysmex Corporation, Kobe 651-2241, Japan
| | | | - Shu-Ping Hui
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
| | - Tatsushi Toda
- Division of Neurology/Molecular Brain Science, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan
| | - Hiroshi Kuroda
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Hitoshi Chiba
- Faculty of Health Sciences, Hokkaido University, Sapporo 060-0812, Japan
| | - Ken-Ichi Hirano
- Laboratory of Cardiovascular Disease, Novel, Non-invasive, and Nutritional Therapeutics (CNT), Graduate School of Medicine, Osaka University, Suita, Osaka 565-0874, Japan
| |
Collapse
|