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Iotova V, Karamfilova T, Levkova M, Gaydarova M, Galcheva S, Bliznakova D. Initial Effect of Recombinant Human Growth Hormone Treatment in a Patient with Löwe Syndrome. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1166. [PMID: 37508663 PMCID: PMC10378625 DOI: 10.3390/children10071166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/02/2023] [Accepted: 07/03/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVES Löwe syndrome (the oculocerebrorenal syndrome of Löwe, OCRL, OMIM #309000, ORPHA: 534) is a very rare multisystem X-linked disorder characterized by ocular, kidney and nervous system anomalies. CASE PRESENTATION We present the first Bulgarian genetically confirmed patient with OCRL. The patient had facial dysmorphism, cryptorchidism, congenital cataracts, nystagmus, delayed physical and mental development, and poor nutritional status. He had severe rickets, metabolic acidosis, hypokalaemia, hypophosphataemia, and low IGF-1 levels at the age of three, in addition to his developmental delay. The molecular-genetic analysis reported a pathogenic variant c.1124A>G, p.H375R in the OCRL gene. This variant was inherited from the mother, who was a carrier. Following the diagnosis of OCRL, treatment with potassium citrate, phosphate, and calcitriol was initiated, along with an increase in caloric intake. Following general physical and biochemical improvement, therapy with rhGH started 4 years ago, and current results are presented. CONCLUSIONS The patient with Löwe syndrome who was presented with a 6-year follow-up demonstrates the complexity of rare disease cases and the value of multidisciplinary care together with growth hormone treatment for better results in these patients.
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Affiliation(s)
- Violeta Iotova
- Department of Pediatrics, Medical University Varna, 9000 Varna, Bulgaria
| | | | - Mariya Levkova
- Department of Medical Genetics, Medical University Varna, 9000 Varna, Bulgaria
| | - Mariya Gaydarova
- Department of Pediatrics Nephrology and Dialysis, Medical University Sofia, 1000 Sofia, Bulgaria
| | - Sonya Galcheva
- Department of Pediatrics, Medical University Varna, 9000 Varna, Bulgaria
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Chen KJ, Wu HR, Chao MC, Chang TM, Chien JW, Chen M, Ma GC, Ke YY. Genotype and phenotype studies of Lowe syndrome in three families in Taiwan. Pediatr Neonatol 2021; 62:327-328. [PMID: 33745830 DOI: 10.1016/j.pedneo.2021.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/07/2021] [Accepted: 01/27/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kuan-Jung Chen
- Division of Pediatric Genetics and Metabolism, Changhua Christian Children's Hospital, Changhua, Taiwan
| | - Hsin-Ru Wu
- Division of Pediatric Genetics and Metabolism, Changhua Christian Children's Hospital, Changhua, Taiwan
| | - Mei-Chyn Chao
- Division of Pediatric Genetics and Metabolism, Changhua Christian Children's Hospital, Changhua, Taiwan.
| | - Tung-Ming Chang
- Division of Pediatric Neurology, Changhua Christian Children's Hospital, Changhua, Taiwan
| | - Jien-Wen Chien
- Division of Pediatric Nephrology, Changhua Christian Children's Hospital, Changhua, Taiwan
| | - Ming Chen
- Department of Genomic Medicine and Center for Medical Genetics, Changhua Christian Hospital, Changhua, Taiwan
| | - Gwo-Chin Ma
- Department of Genomic Medicine and Center for Medical Genetics, Changhua Christian Hospital, Changhua, Taiwan
| | - Yu-Yuan Ke
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
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Parikh AC, Gadgil P. Lowe Syndrome: A Complex Clinical Diagnosis with a Novel Mutation in the OCRL Gene. JOURNAL OF CHILD SCIENCE 2021. [DOI: 10.1055/s-0041-1724042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractLowe syndrome (LS) is a rare X-linked condition having a clinical triad of congenital cataracts, intellectual disability, and progressive tubular nephropathy. Although the easily recognizable symptom complex usually evolves by infancy, a unifying diagnosis is often missed. We present a young boy with a prolonged history of multisystem affection, finally leading to the clinical suspicion of LS. The diagnosis was confirmed on genetic analysis as well as a previously unreported mutation in the OCRL gene was discovered. A 9-year-old boy with intellectual disability and recent onset seizures was referred for the evaluation of rickets. In addition, there was a significant past history of neonatal cataracts, infantile glaucoma, persistent albuminuria, and severe short stature with growth hormone deficiency. The characteristic involvement of eyes, brain, and kidneys along with a family history of a maternal uncle being similarly affected led to the clinical suspicion of LS. A whole exome sequencing was performed, which not only confirmed a nonsense mutation, c.2530C > T, in exon 23 of the Lowe gene (OCRL) but also revealed it to be a novel pathogenic variant. This case highlights the importance of piecing together the different facets of a complex clinical syndrome in reaching a challenging diagnosis. Also, LS must be kept as a differential in any child with neonatal cataracts and intellectual disability. Genetic confirmation of LS in our patient partly relieved the parental anxiety, and the child continued to remain under follow-up with multiple specialists, only now with a definite diagnosis.
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Affiliation(s)
- Akanksha C. Parikh
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Pradnya Gadgil
- Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
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Dai C, Wang L, Li Y, Zheng Z, Qian J, Wang C, Liu Z, Shan X. Lowe syndrome with extremely short stature: growth hormone deficiency may be the pathogeny. Growth Factors 2019; 37:170-177. [PMID: 31576764 DOI: 10.1080/08977194.2019.1669589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Lowe syndrome is an x-linked disorder characterized by congenital cataracts, nervous system abnormalities and renal tubular dysfunction. With the rising number of reported cases, more patients are found to suffer from endocrine abnormalities. Hereby, three Chinese patients with typical symptoms and extremely short stature were described. The OCRL gene was analyzed. A combination of blood biochemistry and radiological examinations were performed. Growth hormone provocation test was taken in one patient. Nucleotide sequence analysis revealed a de novo novel hemizygous mutation (c.2290_2291delinsCT) in exon 21 in an adolescent boy. As indicated by the growth hormone provocation test, the boy had growth hormone deficiency. The other two patients were brothers with extremely short stature, and manifested the same hemizygous mutation (c.2581G > A) in exon 23. It was speculated that the mutation of OCRL gene could lead to deficiency of growth hormone, for which an early growth hormone intervention may be beneficial.
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Affiliation(s)
- Chengjun Dai
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Liying Wang
- Beijing Tongren Hospital, Capital Medical University, Beijing, PR China
| | - Youli Li
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Zhichao Zheng
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Jieqi Qian
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Chaoban Wang
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Zishuo Liu
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
| | - Xiaoou Shan
- Department of Pediatrics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou Medical University, Wenzhou, Zhejiang, PR China
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Abdalla E, El‐Beheiry A, Dieterich K, Thevenon J, Fauré J, Rendu J. “Lowe syndrome: A particularly severe phenotype without clinical kidney involvement”. Am J Med Genet A 2017; 176:460-464. [DOI: 10.1002/ajmg.a.38572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 11/02/2017] [Accepted: 11/13/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Ebtesam Abdalla
- Department of Human GeneticsMedical Research InstituteAlexandria UniversityAlexandriaEgypt
| | - Ahmed El‐Beheiry
- Department of RadiologyAlexandria Faculty of MedicineAlexandria UniversityAlexandriaEgypt
| | - Klaus Dieterich
- Département de Génétique et ProcréationCHU Grenoble AlpesUniversité Grenoble AlpesGrenobleFrance
| | - Julien Thevenon
- Département de Génétique et ProcréationCHU Grenoble AlpesUniversité Grenoble AlpesGrenobleFrance
| | - Julien Fauré
- Département de Biochimie Pharmacologie ToxicologieBiochimie et Génétique MoléculaireCentre Hospitalier Universitaire Grenoble AlpesUniversité Grenoble AlpesGrenobleFrance
- Grenoble Institut des NeurosciencesInserm U1216–Eq. 4 C‐MyPathLaTroncheFrance
| | - John Rendu
- Département de Biochimie Pharmacologie ToxicologieBiochimie et Génétique MoléculaireCentre Hospitalier Universitaire Grenoble AlpesUniversité Grenoble AlpesGrenobleFrance
- Grenoble Institut des NeurosciencesInserm U1216–Eq. 4 C‐MyPathLaTroncheFrance
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Abstract
The oculocerebrorenal syndrome of Lowe is a rare X-linked multisystemic disorder characterized by the triad of congenital cataracts, intellectual disability, and proximal renal tubular dysfunction. Whereas the ocular manifestations and severe muscular hypotonia are the typical first diagnostic clues apparent at birth, the manifestations of incomplete renal Fanconi syndrome are often recognized only later in life. Other characteristic features are progressive severe growth retardation and behavioral problems, with tantrums. Many patients develop a debilitating arthropathy. Treatment is symptomatic, and the life span rarely exceeds 40 years. The causative oculocerebrorenal syndrome of Lowe gene (OCRL) encodes the inositol polyphosphate 5-phosphatase OCRL-1. OCRL variants have not only been found in classic Lowe syndrome, but also in patients with a predominantly renal phenotype classified as Dent disease type 2 (Dent-2). Recent data indicate that there is a phenotypic continuum between Dent-2 disease and Lowe syndrome, suggesting that there are individual differences in the ability to compensate for the loss of enzyme function. Extensive research has demonstrated that OCRL-1 is involved in multiple intracellular processes involving endocytic trafficking and actin skeleton dynamics. This explains the multi-organ manifestations of the disease. Still, the mechanisms underlying the wide phenotypic spectrum are poorly understood, and we are far from a causative therapy. In this review, we provide an update on clinical and molecular genetic findings in Lowe syndrome and the cellular and physiological functions of OCRL-1.
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Khakhariya R, Rathod SP, Gandhi H, Variya B, Trivedi J, Bhamre P, Rajput SJ. Carboplatin-induced Fanconi-like syndrome in rats: amelioration by pentoxifylline. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2014; 37:185-194. [PMID: 24361643 DOI: 10.1016/j.etap.2013.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 11/22/2013] [Accepted: 11/27/2013] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Carboplatin is a congener of cisplatin used in the treatment of ovarian, head and neck and small-cell lung cancer. However, the clinical efficacy of carboplatin is marred by the development of ROS-dependent nephrotoxicity. The pathophysiological damage inflicted upon the kidney by carboplatin closely resembles to that of Fanconi syndrome. AIMS AND OBJECTIVES The present study aimed at inducing Fanconi-like syndrome in rats by administration of carboplatin. Objectives of the study involved evaluation of biochemical parameters coherent to Fanconi-like syndrome. Further, an attempt was made to evaluate the potential therapeutic effect of pentoxifylline in this condition. RESULTS The results of the study demonstrated that the urinary excretion profile of carboplatin treated rats closely resembled to that of patients suffering from Fanconi-like condition. Pentoxifylline was able to ameliorate this nephrotoxic condition as suggested by the change in levels of membrane bound ATPases, MDA and GSH. The urinary levels of tyrosine and cysteine correlate well with that of Fanconi-like condition in animals and humans. CONCLUSION In lieu of these observations, our study suggested that carboplatin-induced renovascular damage resembles to Fanconi-like condition which can be mitigated by pentoxifylline.
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Affiliation(s)
- Ravi Khakhariya
- Pharmacology Laboratory, Pharmacy Department, Faculty of Technology and Engineering, The M.S. University of Baroda, India
| | - S P Rathod
- Pharmacology Laboratory, Pharmacy Department, Faculty of Technology and Engineering, The M.S. University of Baroda, India
| | - Hardik Gandhi
- Pharmacology Laboratory, Pharmacy Department, Faculty of Technology and Engineering, The M.S. University of Baroda, India.
| | - Bhavesh Variya
- Pharmacology Laboratory, Pharmacy Department, Faculty of Technology and Engineering, The M.S. University of Baroda, India
| | - Jinal Trivedi
- Pharmacology Laboratory, Pharmacy Department, Faculty of Technology and Engineering, The M.S. University of Baroda, India
| | - Prachi Bhamre
- Pharmaceutical Quality Assurance Laboratory, Pharmacy Department, Faculty of Technology and Engineering, The M.S. University of Baroda, India
| | - S J Rajput
- Pharmaceutical Quality Assurance Laboratory, Pharmacy Department, Faculty of Technology and Engineering, The M.S. University of Baroda, India
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Lee JH, Park JH, Ha TS, Han HS. Refractory rickets caused by mild distal renal tubular acidosis. Ann Pediatr Endocrinol Metab 2013; 18:152-5. [PMID: 24904870 PMCID: PMC4027071 DOI: 10.6065/apem.2013.18.3.152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 09/24/2013] [Accepted: 09/25/2013] [Indexed: 12/04/2022] Open
Abstract
Type I (distal) renal tubular acidosis (RTA) is a disorder associated with the failure to excrete hydrogen ions from the distal renal tubule. It is characterized by hyperchloremic metabolic acidosis, an abnormal increase in urine pH, reduced urinary excretion of ammonium and bicarbonate ions, and mild deterioration in renal function. Hypercalciuria is common in distal RTA because of bone resorption, which increases as a buffer against metabolic acidosis. This can result in intractable rickets. We describe a case of distal RTA with nephrocalcinosis during follow-up of rickets in a patient who presented with clinical manifestations of short stature, failure to thrive, recurrent vomiting, dehydration, and irritability.
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Affiliation(s)
- Ji-Ho Lee
- Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Joo Hyun Park
- Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Tae-Sun Ha
- Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Heon-Seok Han
- Department of Pediatrics, Chungbuk National University College of Medicine, Cheongju, Korea
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