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Renard P, Caccavelli L, Legendre A, Tuchmann-Durand C, Balakirouchenane D, Blanchet B, Narjoz C, Straube M, Hubas A, Garros A, Mention K, Bednarek N, Goudin N, Broissand C, Schlatter J, Cisternino S, Cagnard N, van Endert P, Diana J, de Calbiac H, de Lonlay P. Hydroxychloroquine sulfate: A novel treatment for lipin-1 deficiency? Biomed Pharmacother 2023; 163:114813. [PMID: 37150031 DOI: 10.1016/j.biopha.2023.114813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Lipin-1 deficiency is a life-threatening disease that causes severe rhabdomyolysis (RM) and chronic symptoms associated with oxidative stress. In the absence of treatment, Hydroxychloroquine sulfate (HCQ) was administered to patients off label use on a compassionate basis in order to improve their physical conditions. METHODS Eleven patients with LPIN1 mutations were treated with HCQ. Clinical and biological efficacy and tolerance were assessed, including pain and quality of life, physical capacities, cardiopulmonary parameters, creatine kinase levels and plasma proinflammatory cytokines. To explore a dose-dependent effect of HCQ, primary myoblasts from 4 patients were incubated with various HCQ concentrations in growth medium (GM) or during starvation (EBSS medium) to investigate autophagy and oxidative stress. FINDINGS Under HCQ treatment, patient physical capacities improved. Abnormal cardiac function and peripheral muscle adaptation to exercise were normalized. However, two patients who had the highest mean blood HCQ concentrations experienced RM. We hypothesized that HCQ exerts deleterious effects at high concentrations by blocking autophagy, and beneficial effects on oxidative stress at low concentrations. We confirmed in primary myoblasts from 4 patients that high in vitro HCQ concentration (10 µM) but not low concentration (1 µM and 0.1 µM) induced autophagy blockage by modifying endolysosomal pH. Low HCQ concentration (1 µM) prevented reactive oxygen species (ROS) and oxidized DNA accumulation in myoblasts during starvation. INTERPRETATION HCQ improves the condition of patients with lipin-1 deficiency, but at low concentrations. In vitro, 1 µM HCQ decreases oxidative stress in myoblasts whereas higher concentrations have a deleterious effect by blocking autophagy.
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Affiliation(s)
- Perrine Renard
- Université Paris Cité, INSERM, CNRS, Institut Necker Enfants Malades, F-75015 Paris, France
| | - Laure Caccavelli
- Université Paris Cité, INSERM, CNRS, Institut Necker Enfants Malades, F-75015 Paris, France; Centre de référence des maladies héréditaires du métabolisme, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Imagine, Filière G2M, MetabERN, F-75015 Paris, France
| | - Antoine Legendre
- Centre de référence Malformations Cardiaques Congénitales Complexes M3C - Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75015 Paris, France
| | - Caroline Tuchmann-Durand
- Centre de référence des maladies héréditaires du métabolisme, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Imagine, Filière G2M, MetabERN, F-75015 Paris, France; Institut Imagine, Centre d'Investigation Clinique pour les Thérapies innovantes, Département de Biothérapie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75015 Paris, France
| | - David Balakirouchenane
- Département de pharmacocinétique et pharmacochimie, Centre Hospitalier Universitaire Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), CARPEM, F-75014 Paris, France
| | - Benoit Blanchet
- Département de pharmacocinétique et pharmacochimie, Centre Hospitalier Universitaire Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), CARPEM, F-75014 Paris, France; Université Paris Cité, PRES Sorbonne Paris Cité, CARPEM, Faculté de Pharmacie, INSERM U-1268 / CNRS UMR-8038, FR-750006 Paris, France
| | - Céline Narjoz
- Service de Biochimie, Hôpital Universitaire Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75015 Paris, France
| | - Marjolène Straube
- Université Paris Cité, INSERM, CNRS, Institut Necker Enfants Malades, F-75015 Paris, France; Centre de référence des maladies héréditaires du métabolisme, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Imagine, Filière G2M, MetabERN, F-75015 Paris, France
| | - Arnaud Hubas
- Service de biochimie et Génétique Moléculaire, Laboratoire de culture cellulaire, Hôpital Universitaire Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75014 Paris, France
| | - Alexa Garros
- Centre de compétence des maladies héréditaires du métabolisme, Hôpital Universitaire Grenoble Alpes, Filière G2M, Grenoble, France
| | - Karine Mention
- Centre de référence des maladies héréditaires du métabolisme, Hôpital Universitaire Jeanne de Flandre, Filière G2M, MetabERN, Lille, France
| | - Nathalie Bednarek
- Centre de compétence des maladies héréditaires du métabolisme, Hôpital Universitaire, Filière G2M, Reims, France
| | - Nicolas Goudin
- Cell Imaging & Flow Cytometry Core Facilities, Structure Fédérative de Recherche Necker, INSERM US24/CNRS UMS3633, Paris, France
| | - Christine Broissand
- Service de Pharmacie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75015 Paris, France
| | - Joel Schlatter
- Service de Pharmacie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75015 Paris, France
| | - Salvatore Cisternino
- Service de Pharmacie, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), F-75015 Paris, France; Université Paris Cité, Optimisation Thérapeutique en Neuropsychopharmacologie, INSERM UMRS-1144, F-75006 Paris, France
| | - Nicolas Cagnard
- Université Paris Cité, Bioinformatiques, SFR Necker, INSERM US-24 / CNRS UAR-3633, F-75015 Paris, France
| | - Peter van Endert
- Université Paris Cité, INSERM, CNRS, Institut Necker Enfants Malades, F-75015 Paris, France; Service Immunologie Biologique, AP-HP, Hôpital Universitaire Necker-Enfants Malades, F-75015 Paris, France
| | - Julien Diana
- Université Paris Cité, INSERM, CNRS, Institut Necker Enfants Malades, F-75015 Paris, France
| | - Hortense de Calbiac
- Université Paris Cité, INSERM, CNRS, Institut Necker Enfants Malades, F-75015 Paris, France; Centre de référence des maladies héréditaires du métabolisme, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Imagine, Filière G2M, MetabERN, F-75015 Paris, France
| | - Pascale de Lonlay
- Université Paris Cité, INSERM, CNRS, Institut Necker Enfants Malades, F-75015 Paris, France; Centre de référence des maladies héréditaires du métabolisme, Hôpital Universitaire Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Institut Imagine, Filière G2M, MetabERN, F-75015 Paris, France.
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Tuchmann-Durand C, Roda C, Renard P, Mortamet G, Bérat CM, Altenburger L, de Larauz MH, Thevenet E, Cottart CH, Moulin F, Bouchereau J, Brassier A, Arnoux JB, Schiff M, Bednarek N, Lamireau D, Garros A, Mention K, Cano A, Finger L, Pelosi M, Brochet CS, Caccavelli L, Raphalen JH, Renolleau S, Oualha M, de Lonlay P. Systemic corticosteroids for the treatment of acute episodes of rhabdomyolysis in lipin-1-deficient patients. J Inherit Metab Dis 2023. [PMID: 36680547 DOI: 10.1002/jimd.12592] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
Mutations in the LPIN1 gene constitute a major cause of severe rhabdomyolysis (RM). The TLR9 activation prompted us to treat patients with corticosteroids in acute conditions. In patients with LPIN1 mutations, RM and at-risk situations that can trigger RM have been treated in a uniform manner. Since 2015, these patients have also received intravenous corticosteroids. We retrospectively compared data on hospital stays by corticosteroid-treated patients vs. patients not treated with corticosteroids. Nineteen patients were hospitalized. The median number of admissions per patient was 21 overall and did not differ when comparing the 10 corticosteroid-treated patients with the 9 patients not treated with corticosteroids. Four patients in the non-corticosteroid group died during a RM (mean age at death: 5.6 years). There were no deaths in the corticosteroid group. The two groups did not differ significantly in the number of RM episodes. However, for the six patients who had RM and occasionally been treated with corticosteroids, the median number of RM episodes was significantly lower when intravenous steroids had been administered. The peak plasma creatine kinase level and the area under the curve were or tended to be higher in patients treated with corticosteroids-even after the exclusion of deceased patients or focusing on the period after 2015. The median length of stay (10 days overall) was significantly longer for corticosteroid-treated patients but was similar after the exclusion of deceased patients. The absence of deaths and the higher severity of RM observed among corticosteroid-treated patients could suggest that corticotherapy is associated with greater survival.
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Affiliation(s)
- Caroline Tuchmann-Durand
- Imagine Institute, Biotherapy Clinical Investigation Center, Biotherapy Department, Necker-Enfants-Malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Célina Roda
- Université Paris Cité, Health Environmental Risk Assessment (HERA) Team, CRESS, INSERM, INRAE, Paris, France
- Faculté de Pharmacie de Paris, Université Paris Cité, Paris, France
| | - Perrine Renard
- INSERM U1151, Institut Necker Enfants-Malades (INEM), Paris, France
| | - Guillaume Mortamet
- Pediatric Intensive Care Unit, Grenoble Alpes University Hospital, Grenoble, France
| | - Claire-Marine Bérat
- Reference Center for Inherited Metabolic Diseases, Necker-Enfants-Malades University Hospital, APHP, Imagine Institute, G2M, MetabERN, Paris, France
| | - Lucile Altenburger
- Reference Center for Inherited Metabolic Diseases, Necker-Enfants-Malades University Hospital, APHP, Imagine Institute, G2M, MetabERN, Paris, France
| | - Marie Hug de Larauz
- Imagine Institute, Biotherapy Clinical Investigation Center, Biotherapy Department, Necker-Enfants-Malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Eloise Thevenet
- Imagine Institute, Biotherapy Clinical Investigation Center, Biotherapy Department, Necker-Enfants-Malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Charles-Henry Cottart
- Faculté de Pharmacie de Paris, Université Paris Cité, Paris, France
- Biochemistry Unit, Biology Department, Assistance Publique Hôpitaux de Paris (AP-HP), Necker-Enfants-Malades University Hospital, Paris, France
| | - Florence Moulin
- Pediatric Intensive Care Unit for, Necker-Enfants-Malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Juliette Bouchereau
- Reference Center for Inherited Metabolic Diseases, Necker-Enfants-Malades University Hospital, APHP, Imagine Institute, G2M, MetabERN, Paris, France
| | - Anais Brassier
- Reference Center for Inherited Metabolic Diseases, Necker-Enfants-Malades University Hospital, APHP, Imagine Institute, G2M, MetabERN, Paris, France
| | - Jean-Baptiste Arnoux
- Reference Center for Inherited Metabolic Diseases, Necker-Enfants-Malades University Hospital, APHP, Imagine Institute, G2M, MetabERN, Paris, France
| | - Manuel Schiff
- Reference Center for Inherited Metabolic Diseases, Necker-Enfants-Malades University Hospital, APHP, Imagine Institute, G2M, MetabERN, Paris, France
- Medical School, Université Paris Cité, Paris, France
| | - Nathalie Bednarek
- Intensive Care Unit and Competence Center for Inherited Metabolic Diseases, Reims University Hospital, Reims, France
| | - Delphine Lamireau
- Competence Center for Inherited Metabolic Diseases, Pellegrin University Hospital, Bordeaux, France
| | - Alexa Garros
- Competence Center for Inherited Metabolic Diseases, Grenoble Alpes University Hospital, Grenoble, France
| | - Karine Mention
- Reference Center for Inherited Metabolic Diseases, Jeanne de Flandre Hospital, MetabERN, Lille, France
| | - Aline Cano
- Reference Center for Inherited Metabolic Diseases, La Timone University Hospital, MetabERN, Marseille, France
| | - Lionel Finger
- Biochemistry Unit, Biology Department, Troyes Hospital, Troyes, France
| | - Michele Pelosi
- Reference Center for Inherited Metabolic Diseases, Necker-Enfants-Malades University Hospital, APHP, Imagine Institute, G2M, MetabERN, Paris, France
| | | | - Laure Caccavelli
- INSERM U1151, Institut Necker Enfants-Malades (INEM), Paris, France
- Reference Center for Inherited Metabolic Diseases, Necker-Enfants-Malades University Hospital, APHP, Imagine Institute, G2M, MetabERN, Paris, France
| | - Jean-Herlé Raphalen
- Adult Intensive Care Unit, Necker-Enfants-Malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Sylvain Renolleau
- Pediatric Intensive Care Unit for, Necker-Enfants-Malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Medical School, Université Paris Cité, Paris, France
| | - Mehdi Oualha
- Pediatric Intensive Care Unit for, Necker-Enfants-Malades University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Medical School, Université Paris Cité, Paris, France
| | - Pascale de Lonlay
- INSERM U1151, Institut Necker Enfants-Malades (INEM), Paris, France
- Reference Center for Inherited Metabolic Diseases, Necker-Enfants-Malades University Hospital, APHP, Imagine Institute, G2M, MetabERN, Paris, France
- Medical School, Université Paris Cité, Paris, France
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Kahraman AB, Karakaya B, Yıldız Y, Kamaci S, Kesici S, Simsek-Kiper PO, Kurt-Sukur ED, Bayrakcı B, Haliloglu G. Two tales of LPIN1 deficiency: from fatal rhabdomyolysis to favorable outcome of acute compartment syndrome. Neuromuscul Disord 2022; 32:931-934. [PMID: 36195520 DOI: 10.1016/j.nmd.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/03/2022] [Accepted: 06/24/2022] [Indexed: 12/31/2022]
Abstract
LPIN1 deficiency is an autosomal recessive disease caused by biallelic mutations in LPIN1, where impaired fatty acid metabolism leads to stress in skeletal muscle, resulting in severe rhabdomyolysis, often triggered by fever, exercise, fasting, and anesthesia. It is the second most common cause of severe, recurrent episodes of rhabdomyolysis in early childhood which can result in serious morbidity and mortality. To date, 71 patients have been published in 20 clinical studies in the form of case series. We describe two previously unreported cases, one with a novel LPIN1 mutation that resulted in mortality, and another, to the best of our knowledge, with the first reported compartment syndrome managed with a favorable outcome in this disorder. Recognition of the complications including ventricular arrythmias, acute renal failure and compartment syndrome on the severe end of the spectrum may change the outcome and prognosis of this devastating condition.
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Affiliation(s)
- Ayca Burcu Kahraman
- Department of Pediatrics, Division of Metabolism and Nutrition, Hacettepe University Faculty of Medicine, Ankara TR06230, Turkey.
| | - Bekir Karakaya
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yılmaz Yıldız
- Department of Pediatrics, Division of Metabolism and Nutrition, Hacettepe University Faculty of Medicine, Ankara TR06230, Turkey
| | - Saygin Kamaci
- Department of Orthopedics and Travmatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Selman Kesici
- Division of Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | | | - Eda Didem Kurt-Sukur
- Division of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Benan Bayrakcı
- Division of Intensive Care Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Goknur Haliloglu
- Division of Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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4
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Wang H, Chan TW, Vashisht AA, Drew BG, Calkin AC, Harris TE, Wohlschlegel JA, Xiao X, Reue K. Lipin 1 modulates mRNA splicing during fasting adaptation in liver. JCI Insight 2021; 6:e150114. [PMID: 34494556 PMCID: PMC8492312 DOI: 10.1172/jci.insight.150114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/23/2021] [Indexed: 01/03/2023] Open
Abstract
Lipin 1 regulates cellular lipid homeostasis through roles in glycerolipid synthesis (through phosphatidic acid phosphatase activity) and transcriptional coactivation. Lipin 1-deficient individuals exhibit episodic disease symptoms that are triggered by metabolic stress, such as stress caused by prolonged fasting. We sought to identify critical lipin 1 activities during fasting. We determined that lipin 1 deficiency induces widespread alternative mRNA splicing in liver during fasting, much of which is normalized by refeeding. The role of lipin 1 in mRNA splicing was largely independent of its enzymatic function. We identified interactions between lipin 1 and spliceosome proteins, as well as a requirement for lipin 1 to maintain homeostatic levels of spliceosome small nuclear RNAs and specific RNA splicing factors. In fasted Lpin1-/- liver, we identified a correspondence between alternative splicing of phospholipid biosynthetic enzymes and dysregulated phospholipid levels; splicing patterns and phospholipid levels were partly normalized by feeding. Thus, lipin 1 influences hepatic lipid metabolism through mRNA splicing, as well as through enzymatic and transcriptional activities, and fasting exacerbates the deleterious effects of lipin 1 deficiency on metabolic homeostasis.
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Affiliation(s)
- Huan Wang
- Human Genetics, David Geffen School of Medicine at UCLA
| | | | - Ajay A Vashisht
- Biological Chemistry, University of California, Los Angeles, California, USA
| | - Brian G Drew
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Anna C Calkin
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Baker Department of Cardiometabolic Health, University of Melbourne, Parkville, Victoria, Australia
| | - Thurl E Harris
- Pharmacology, University of Virginia, Charlottesville, Virginia, USA
| | - James A Wohlschlegel
- Biological Chemistry, University of California, Los Angeles, California, USA.,Molecular Biology Institute and
| | - Xinshu Xiao
- Bioinformatics Interdepartmental Program and.,Molecular Biology Institute and.,Integrative Biology and Physiology, University of California, Los Angeles, California, USA
| | - Karen Reue
- Human Genetics, David Geffen School of Medicine at UCLA,,Molecular Biology Institute and
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5
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Tong K, Yu GS. Acute recurrent rhabdomyolysis in a Chinese boy associated with a novel compound heterozygous LPIN1 variant: a case report. BMC Neurol 2021; 21:42. [PMID: 33514355 PMCID: PMC7844980 DOI: 10.1186/s12883-021-02050-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/07/2021] [Indexed: 01/04/2023] Open
Abstract
Background LPIN1-related acute recurrent rhabdomyolysis (RM), first reported in 2008, is an autosomal recessive inherited metabolic disease. In recent years, LPIN1 gene variants have been identified as one of the main causes of severe RM in children in Western countries. The disease is extremely rare in China, and we report a case of acute recurrent RM caused by a novel compound heterozygous LPIN1 variant. Case presentation A 15-year-old Chinese boy presented with myalgia after strenuous exercise, accompanied by transient increases in serum creatine kinase and myoglobin and persistent hyperuricaemia and hyperbilirubinaemia. Genetic analysis using high-throughput genomic sequencing and Sanger sequencing revealed that there was a compound heterozygous variant in the LPIN1 gene of the proband: the paternal c.2047A > G(p.I683V) was an unreported missense variant, and the maternal c.2107_2108 insAGG(p.Q703delin sQE) was an unreported in-frame variant. Conclusions In children with RM, LPIN1 variants should always be considered in the differential diagnosis. The clinical features of our case are atypical, which highlights the importance of an accurate diagnosis by genetic testing. If detected early, the condition may be controlled, and the prognosis may be improved.
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Affiliation(s)
- Ke Tong
- Department of Cardiovascular Disease, Children's Hospital of Chongqing Medical University, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Ministry of Education Key Laboratory of Child Development and Disorders, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,National Clinical Research Center for Child Health and Disorders (Chongqing), 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.,Chongqing Key Laboratory of Pediatrics, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China
| | - Geng-Sheng Yu
- Department of Cardiovascular Disease, Children's Hospital of Chongqing Medical University, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China. .,Ministry of Education Key Laboratory of Child Development and Disorders, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China. .,National Clinical Research Center for Child Health and Disorders (Chongqing), 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China. .,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China. .,Chongqing Key Laboratory of Pediatrics, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.
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6
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Lu S, Lyu Z, Wang Z, Kou Y, Liu C, Li S, Hu M, Zhu H, Wang W, Zhang C, Kuan YS, Liu YW, Chen J, Tian J. Lipin 1 deficiency causes adult-onset myasthenia with motor neuron dysfunction in humans and neuromuscular junction defects in zebrafish. Theranostics 2021; 11:2788-2805. [PMID: 33456573 PMCID: PMC7806489 DOI: 10.7150/thno.53330] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/12/2020] [Indexed: 12/03/2022] Open
Abstract
Lipin 1 is an intracellular protein acting as a phosphatidic acid phosphohydrolase enzyme controlling lipid metabolism. Human recessive mutations in LPIN1 cause recurrent, early-onset myoglobinuria, a condition normally associated with muscle pain and weakness. Whether and how lipin 1 deficiency in humans leads to peripheral neuropathy is yet unclear. Herein, two novel compound heterozygous mutations in LPIN1 with neurological disorders, but no myoglobinuria were identified in an adult-onset syndromic myasthenia family. The present study sought to explore the pathogenic mechanism of LPIN1 in muscular and neural development. Methods: The clinical diagnosis of the proband was compared to the known 48 cases of LPIN1 recessive homozygous mutations. Whole-exome sequencing was carried out on the syndromic myasthenia family to identify the causative gene. The pathogenesis of lipin 1 deficiency during somitogenesis and neurogenesis was investigated using the zebrafish model. Whole-mount in situ hybridization, immunohistochemistry, birefringence analysis, touch-evoke escape response and locomotion assays were performed to observe in vivo the changes in muscles and neurons. The conservatism of the molecular pathways regulated by lipin 1 was evaluated in human primary glioblastoma and mouse myoblast cells by siRNA knockdown, drug treatment, qRT-PCR and Western blotting analysis. Results: The patient exhibited adult-onset myasthenia accompanied by muscle fiber atrophy and nerve demyelination without myoglobinuria. Two novel heterozygous mutations, c.2047A>C (p.I683L) and c.2201G>A (p.R734Q) in LPIN1, were identified in the family and predicted to alter the tertiary structure of LPIN1 protein. Lipin 1 deficiency in zebrafish embryos generated by lpin1 morpholino knockdown or human LPIN1 mutant mRNA injections reproduced the myotomes defects, a reduction both in primary motor neurons and secondary motor neurons projections, morphological changes of post-synaptic clusters of acetylcholine receptors, and myelination defects, which led to reduced touch-evoked response and abnormalities of swimming behaviors. Loss of lipin 1 function in zebrafish and mammalian cells also exhibited altered expression levels of muscle and neuron markers, as well as abnormally enhanced Notch signaling, which was partially rescued by the specific Notch pathway inhibitor DAPT. Conclusions: These findings pointed out that the compound heterozygous mutations in human LPIN1 caused adult-onset syndromic myasthenia with peripheral neuropathy. Moreover, zebrafish could be used to model the neuromuscular phenotypes due to the lipin 1 deficiency, where a novel pathological role of over-activated Notch signaling was discovered and further confirmed in mammalian cell lines.
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Al Badi A, Al Rasbi S, Alalawi AM. Exercise-Induced Rhabdomyolysis: A Case Report and Literature Review. Cureus 2020; 12:e10037. [PMID: 32983728 PMCID: PMC7515789 DOI: 10.7759/cureus.10037] [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: 08/11/2020] [Accepted: 08/26/2020] [Indexed: 01/04/2023] Open
Abstract
A 19-year-old man presented to the ED with bilateral leg pain and dark discoloration of the urine after he started an intense aerobic exercise. Blood workup showed significantly elevated creatine kinase (CK), acute kidney injury (AKI), and disseminated intravascular coagulation (DIC). The patient had a double-incision, bilateral fasciotomy with debridement to relieve the bilateral, lower-limb, compartment syndrome following admission. Also, his kidney function deteriorated, requiring several sessions of hemodialysis. His hospital stay was complicated by multidrug-resistant (MDR) Acinetobacter baumannii bacteremia. After three weeks of hospital admission, the patient was discharged home with a follow-up outpatient physiotherapy for bilateral foot drop, which showed a remarkable recovery eventually. This case highlights the potentially life-threatening risks associated with unaccustomed physical exercise and emphasizing the essential preventive measures to reduce the risk of developing exercise-induced rhabdomyolysis. We present the pathophysiology of exercise-induced rhabdomyolysis, clinical presentation, diagnosis, treatment, and prognosis.
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Affiliation(s)
- Amira Al Badi
- Medicine, Sultan Qaboos University Hospital, Muscat, OMN
| | - Sara Al Rasbi
- Medicine, Sultan Qaboos University Hospital, Muscat, OMN
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8
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Lipin-1 Deficiency-Associated Recurrent Rhabdomyolysis and Exercise-Induced Myalgia Persisting into Adulthood: A Case Report and Review of Literature. Case Rep Med 2020; 2020:7904190. [PMID: 32549891 PMCID: PMC7275236 DOI: 10.1155/2020/7904190] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 03/08/2020] [Accepted: 03/12/2020] [Indexed: 12/18/2022] Open
Abstract
Phosphatidate phosphatase-1 (lipin-1) is encoded by LPIN1 gene. Lipin-1 deficiency has been reported as the second most common cause of early-onset rhabdomyolysis after primary fatty acid oxidation disorders. We report a case of a 32-year-old Sri Lankan female with a history of more than 10 episodes of rhabdomyolysis and exercise intolerance since childhood. These episodes were triggered by infections and exercise. A temporal relationship between the acute episodes and use of drugs such as theophylline, mefenamic acid, co-trimoxazole, and combined oral contraceptive pills was also noted. There was marked elevation of serum creatine kinase and transaminases during acute episodes. Family history revealed parental consanguinity and an affected sibling who died of an acute episode associated with muscle weakness, dark coloured urine, and cyanosis, at the age of 2 years. The histochemical findings of the patient under discussion were consistent with a metabolic myopathy affecting membrane integrity. A homozygous, likely pathogenic variant c.1684G>T encoding p.(Glu562∗) was identified by clinical exome sequencing. Even though the studies to date give no convincing evidence of a possible causal or contributory relationship between the drugs under discussion and lipin-1 related rhabdomyolysis, this case highlights the importance of pharmacovigilance and reporting adverse drug reactions in patients with lipin-1 deficiency.
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Pizzamiglio C, Lahiri N, Nirmalananthan N, Sood B, Somalanka S, Ostrowski P, Phadke R, O'Donovan DG, Muntoni F, Quinlivan R. First presentation of LPIN1 acute rhabdomyolysis in adolescence and adulthood. Neuromuscul Disord 2020; 30:566-571. [PMID: 32522502 DOI: 10.1016/j.nmd.2020.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 02/08/2023]
Abstract
LPIN1 mutations are a known common cause of autosomal recessive, recurrent and life-threatening acute rhabdomyolysis of childhood-onset. The first episode of rhabdomyolysis usually happens in nearly all cases before the age of 5 and death is observed in 1/3 of patients. Here we present two cases of acute rhabdomyolysis with a milder phenotype caused by LPIN1 mutation presenting in adolescence (11 years old) and adulthood (40 years old) after Parvovirus infection and metabolic stress, respectively. In our opinion, the mutation types, epigenetic factors, the environment exposition to triggers or the existence of proteins with a similar structure of LPIN1, may have a role in modulating the onset of rhabdomyolysis. LPIN1 should be included on a panel of genes analysed in the investigation of adult individuals with rhabdomyolysis. Metabolic and viral stressors should be included in the list of possible rhabdomyolysis precipitant.
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Affiliation(s)
- Chiara Pizzamiglio
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom.
| | - Nayana Lahiri
- Clinical Genetics Department, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Niranjanan Nirmalananthan
- Departments of Neurology and Neuroradiology, Atkinson Morley Regional Neurosciences Centre, St George's Hospital, London, United Kingdom
| | - Bhrigu Sood
- South West Thames Renal and Transplantation Unit and South West Thames Institute for Renal Research, Saint Helier Hospital, Carshalton, Surrey, United Kingdom
| | - Subash Somalanka
- South West Thames Renal and Transplantation Unit and South West Thames Institute for Renal Research, Saint Helier Hospital, Carshalton, Surrey, United Kingdom
| | - Philip Ostrowski
- South West Thames Regional Genetics Service, St George's University NHS Foundation Trust, London, United Kingdom
| | - Rahul Phadke
- Division of Neuropathology, Dubowitz Neuromuscular Centre, UCL Great Ormond Street Hospital for Children, United Kingdom; Division of Neuropathology, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Dominic Gerard O'Donovan
- Neuropathology, Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Francesco Muntoni
- Paediatric Neurology, Dubowitz Neuromuscular Centre, UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Rosaline Quinlivan
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
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