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Tantawy AAG, Adly AAM, Atif HM, Madkour SS, Salah NY. Abdominal lymphadenopathy in children with Gaucher disease: Relation to disease severity and glucosylsphingosine. Pediatr Hematol Oncol 2022; 39:304-317. [PMID: 34668825 DOI: 10.1080/08880018.2021.1989098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Few case reports and series reported abdominal lymphadenopathy (ALN) in people with Gaucher disease (GD). However, it's prevalence among Gaucher population, clinical implications and potential biomarkers are unknown. Hence this study aims to assess the prevalence of ALN among children with GD & to correlate it to neutrophil-lymphocytic-ratio (NLR), platelet-lymphocytic-ratio (PLR) and glucosylsphingosine (Lyso-GL1). Fifty children with GD (14 type-1 and 36 type-3) on enzyme-replacement therapy (ERT) were compared to 50 matched healthy controls, focusing on history of pressure manifestations by ALN (diarrhea, constipation, abdominal pain, intestinal obstruction), and history of splenectomy, with calculation of severity scoring index (SSI). NLR, PLR and Lyso-GL1 were measured. Abdominal-ultrasound was done with assessment of liver and spleen volumes and ALN. CT-scan was done for those having significant lymphadenopathy. Twenty-six children with GD had ALN (52%). The most common presentations were abdominal-pain (22%) & constipation (18%), with intestinal-obstruction in 3 children (6%). Children with GD had significantly higher NLR (p < .001) and decreased PLR (p = .024) compared to controls. Interestingly, children with GD having ALN had significantly higher SSI (.012), Lyso-GL1 (p = .002) and NLR (p = .001) than those without ALN. Multivariate-logistic regression showed that ALN was independently related to Lyso-GL1 (p = .027), NLR (p = .023) and SSI (p = .032). Thus, ALN is a prevalent GD morbidity with wide clinical-spectrum ranging from asymptomatic cases to intestinal obstruction. ALN is related to SSI, NLR and Lyso-GL1 in children with GD.HighlightsChildren with GD had significantly higher NLR and lower PLR compared to controls.Children with GD having ALN had significantly higher SSI, Lyso-GL1 and NLR than those without ALN.ALN was independently related to Lyso-GL1, NLR and SSI in children with GD.
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Affiliation(s)
| | | | - Heba Mohamed Atif
- Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Nouran Yousef Salah
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Ramaswami U, Mengel E, Berrah A, AlSayed M, Broomfield A, Donald A, Seif El Dein HM, Freisens S, Hwu WL, Peterschmitt MJ, Yoo HW, Abdelwahab M. Throwing a spotlight on under-recognized manifestations of Gaucher disease: Pulmonary involvement, lymphadenopathy and Gaucheroma. Mol Genet Metab 2021; 133:335-344. [PMID: 34229967 DOI: 10.1016/j.ymgme.2021.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/14/2021] [Accepted: 06/22/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Gaucher disease (GD) is a rare lysosomal storage disorder classically subdivided into type 1 (non-neuronopathic) GD, and types 2 and 3 (neuronopathic) GD. It is typically characterized by clinical manifestations including anemia, thrombocytopenia, hepatosplenomegaly, bone lesions, and (in more severe forms) neurological impairment. However, less-commonly reported and often under-recognized manifestations exist, which potentially have a significant impact on patient outcomes. Greater efforts are needed to understand, recognize, and manage these manifestations. OBJECTIVES This review provides a synthesis of published information about three under-recognized GD manifestations (pulmonary involvement, lymphadenopathy, and Gaucheroma) and recommends diagnostic, management, and treatment strategies based on the available literature and author experience. The authors aim to raise awareness about these serious, progressive, and sometimes life-threatening conditions, which are often diagnosed late in life. CONCLUSIONS Little is known about the incidence, pathophysiology, prognostic factors, and optimal management of pulmonary involvement, lymphadenopathy, and Gaucheroma in patients with GD. Enzyme replacement therapy (ERT) has shown limited efficacy for the prevention and treatment of these manifestations. More research is needed to evaluate the potential effect of substrate reduction therapy (SRT) with glucosylceramide synthase (GCS) inhibitors, and to develop additional approaches to treat these GD manifestations. Improvements in data collection registries and international data-sharing are required to better understand the impact of these manifestations on GD patients, help develop effective management strategies, and, ultimately, improve patient outcomes.
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Affiliation(s)
| | | | | | - Moeenaldeen AlSayed
- Alfaisal University and King Faisal Specialist Hospital, Riyadh, Saudi Arabia
| | - Alex Broomfield
- Willink Biochemical Genetics Unit, Manchester Center for Genomic Medicine, Manchester Foundation NHS Trust, UK
| | - Aimee Donald
- Willink Unit, Saint Mary's Hospital, Manchester, UK
| | | | | | | | | | - Han-Wook Yoo
- Asan Medical Center Children's Hospital, Seoul, South Korea; University of Ulsan College of Medicine, Seoul, South Korea
| | - Magy Abdelwahab
- Cairo University Pediatric Hospital, Cairo, Egypt; Social and Preventive Medicine Center, Kasr Elainy Hospital, Cairo, Egypt.
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Tseng SY, Niu DM, Chu TH, Yeh YC, Huang MH, Yang TF, Liao HC, Chiang CC, Ho HC, Soong WJ, Yang CF. Very rare condition of multiple Gaucheroma: A case report and review of the literature. Mol Genet Metab Rep 2019; 20:100473. [PMID: 31193028 PMCID: PMC6514358 DOI: 10.1016/j.ymgmr.2019.100473] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/19/2019] [Accepted: 04/19/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study presented a 3 years old boy with Gaucher disease (GD) who was treated with enzyme replacement therapy (ERT) for 19 months and then developed multiple Gaucheroma. Review of literature was performed simultaneously. METHODS The medical chart and literature were reviewed. A boy presented at the age of 15 months with anemia, thrombocytopenia, and hepatosplenomegaly. GD was confirmed by enzyme assay and gene mutations. ERT was administered right after the diagnosis. When the boy was 3 years old, multiple masses were discovered during a regular checkup abdominal MRI and biopsy revealed Gaucheroma. We also reviewed 20 GD patients with Gaucheroma and Gaucher cell infiltrated lymphadenopathies. CONCLUSION Gaucheroma is a rare condition of regularly treated GD patients. This patient even showed poor response to doubled ERT doses. The imaging studies are necessary for Gaucher patients to detect Gaucheroma and determine their malignancy. Regular checkups are recommended in all GD patients even with regular treatment, due to the possibility of having deteriorating change, like Gaucheroma.
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Affiliation(s)
- Szu-Yin Tseng
- Department of Pediatrics, Taipei Veterans General Hospital, Taiwan
- Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Dau-Ming Niu
- Department of Pediatrics, Taipei Veterans General Hospital, Taiwan
- Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzu-Hung Chu
- Department of Pediatrics, Taipei Veterans General Hospital, Taiwan
- Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Chen Yeh
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taiwan
| | - Man-Hsu Huang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taiwan
| | - Tsui-Feng Yang
- Physical Medicine and Rehabilitation Department, Taipei Veterans General Hospital, Taiwan
| | - Hsuan-Chieh Liao
- The Chinese Foundation of Health Neonatal Screening Center, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, Taiwan
| | - Chuan-Chi Chiang
- The Chinese Foundation of Health Neonatal Screening Center, Taiwan
| | | | - Wen-Jue Soong
- Department of Pediatrics, Taipei Veterans General Hospital, Taiwan
| | - Chia-Feng Yang
- Department of Pediatrics, Taipei Veterans General Hospital, Taiwan
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, Taiwan
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Tseng SY, Niu DM, Chu TH, Yeh YC, Huang MH, Yang TF, Liao HC, Chiang CC, Ho HC, Soong WJ, Yang CF. Very rare condition of multiple Gaucheroma: A case report and review of the literature. Mol Genet Metab Rep 2019; 20:100489. [PMID: 31341788 PMCID: PMC6629585 DOI: 10.1016/j.ymgmr.2019.100489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/23/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study presented a 3 years old boy with Gaucher disease (GD) who was treated with enzyme replacement therapy(ERT) for 19 months and developed multiple Gaucheroma. The literature was reviewed. METHODS The medical chart and literature were reviewed. A boy presented at the age of 15 months with anemia, thrombocytopenia, and hepatosplenomegaly. Enzyme assay and gene mutations confirmed GD. ERT was administered. When the boy was 3 years old, multiple masses were discovered from abdominal MRI and biopsy revealed Gaucheroma. We reviewed 20 GD patients with Gaucheroma and Gaucher cell infiltrated lymphadenopathies. CONCLUSION Gaucheroma is a rare condition in regularly treated GD patients. This patient showed poor response to doubled ERT doses. The imaging studies are necessary for Gaucher patients to detect Gaucheroma and determine their malignancy. Regular checkups are recommended in all GD patients even with ERT treatment, due to the possibility of having a deteriorating change, like Gaucheroma.
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Affiliation(s)
- Szu-Yin Tseng
- Department of Pediatrics, Taipei Veterans General Hospital, Taiwan, ROC
- Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Dau-Ming Niu
- Department of Pediatrics, Taipei Veterans General Hospital, Taiwan, ROC
- Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Tzu-Hung Chu
- Department of Pediatrics, Taipei Veterans General Hospital, Taiwan, ROC
- Department of Pediatrics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yi-Chen Yeh
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taiwan, ROC
| | - Man-Hsu Huang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taiwan, ROC
| | - Tsui-Feng Yang
- Physical Medicine and Rehabilitation Department, Taipei Veterans, General Hospital, Taiwan, ROC
| | - Hsuan-Chieh Liao
- The Chinese Foundation of Health Neonatal Screening Center, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taiwan, ROC
| | - Chuan-Chi Chiang
- The Chinese Foundation of Health Neonatal Screening Center, Taiwan, ROC
| | | | - Wen-Jue Soong
- Department of Pediatrics, Taipei Veterans General Hospital, Taiwan, ROC
| | - Chia-Feng Yang
- Department of Pediatrics, Taipei Veterans General Hospital, Taiwan, ROC
- Institute of Environmental and Occupational Health Sciences, National Yang-Ming University, Taiwan, ROC
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Mhanni AA, Kozenko M, Hartley JN, Deneau M, El-Matary W, Rockman-Greenberg C. Successful therapy for protein-losing enteropathy caused by chronic neuronopathic Gaucher disease. Mol Genet Metab Rep 2015; 6:13-5. [PMID: 27014572 PMCID: PMC4789350 DOI: 10.1016/j.ymgmr.2015.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 12/01/2015] [Accepted: 12/01/2015] [Indexed: 11/25/2022] Open
Abstract
Gaucher disease (OMIM #230800) is caused by β-glucosidase deficiency and primarily involves the mononuclear phagocyte system (also called Reticuloendothelial System or Macrophage System). The disease is classified into three main phenotypes based on the presence or absence of neurological manifestations: non-neuronopathic (type 1), acute neuronopathic (type 2) and chronic neuronopathic (type 3). Typical manifestations include hepatosplenomegaly, skeletal deformities, hematological abnormalities, interstitial lung fibrosis and neurodegeneration in neuronopathic cases. Mesenteric lymphadenopathy with resultant protein losing enteropathy (PLE) has only been rarely described. Mesenteric lymphadenopathy may lead to intestinal lymphatic obstruction and secondary lymphangiectasia resulting in chronic diarrhea, abdominal pain and weight loss. Fecal protein loss with secondary hypoalbuminemia can be significant. We report a male with Chronic Neuronopathic Gaucher disease (GD) (homozygous for c.1448T > C (NM_000157.3) GBA mutation) who at 16 years of age developed intractable abdominal pain, diarrhea and weight loss. This was caused by PLE secondary to intestinal lymphangiectasia caused by calcified mesenteric lymphadenopathy despite prior long term enzyme replacement therapy (ERT) and/or substrate reduction therapy (SRT). His older similarly affected sister who had been receiving treatment with ERT and/or SRT remains stable on these treatments with no evidence of mesenteric lymphadenopathy. Medical management with total parenteral nutrition, daily medium chain triglyceride-oil (MCT) supplementation, low dose oral budesonide, continued oral SRT and an increased dose of parenteral ERT has stabilized his condition with resolution of the gastrointestinal symptoms and appropriate weight gain.
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Affiliation(s)
- A A Mhanni
- Department of Pediatrics and Child Health, University of Manitoba, Canada; Department of Biochemistry and Medical Genetics, University of Manitoba, Canada
| | - M Kozenko
- Department of Pediatrics, McMaster University, Canada
| | - J N Hartley
- Department of Biochemistry and Medical Genetics, University of Manitoba, Canada
| | - M Deneau
- Department of Pediatrics, University of Utah, Canada
| | - W El-Matary
- Department of Pediatrics and Child Health, University of Manitoba, Canada
| | - C Rockman-Greenberg
- Department of Pediatrics and Child Health, University of Manitoba, Canada; Department of Biochemistry and Medical Genetics, University of Manitoba, Canada
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Mesenteric and Mediastinal Lymphadenopathy in Egyptian Children With Gaucher Disease Types 1 and 3 Treated With Enzyme Replacement Therapy. J Pediatr Hematol Oncol 2015; 37:e316-22. [PMID: 25521082 DOI: 10.1097/mph.0000000000000297] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Gaucher disease (GD) is characterized by 3 clinical subtypes; type 1 GD (non-neuronopathic) and types 2 and 3 GD (acute and chronic neuronopathic forms, respectively). There are few reports of mesenteric and mediastinal lymphadenopathy, and none in type 1 GD or in African people. We report 8 Egyptian GD children (3 type 1 GD and 5 type 3 GD) who developed mesenteric and mediastinal lymphadenopathy despite receiving enzyme replacement therapy. Biopsy showed infiltration with Gaucher cells and no malignant changes. Pediatric physicians should be aware of possible lymphadenopathy associated with both types 1 and 3 GD as it can mimic malignancy.
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Outcome of early-treated type III Gaucher disease patients. Blood Cells Mol Dis 2014; 53:105-9. [PMID: 24984925 DOI: 10.1016/j.bcmd.2014.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 02/06/2014] [Accepted: 05/14/2014] [Indexed: 12/21/2022]
Abstract
Recombinant human acid β-glucosidase GBA (rhGBA) infusion is an effective therapy for non-neuropathic (type I) Gaucher disease (GD), but its effect on subacute neuropathic (type III) GD is still controversial. The most common genotype for type III GD is homozygous c.1448T>C (p.L444P) mutation, and in this study, we treated seven such patients starting from an early age (median 2.1 years; range 1-2.9 years). Before the start of treatment, all patients presented hepatosplenomegaly, anemia, and thrombocytopenia, but with no neurological signs. Normalization of hemoglobin levels and platelet numbers was achieved in all patients in one year. However, after a median treatment period of 7.6 years (2.2-12.0 years), two patients developed horizontal gaze palsy, one had seizures, four demonstrated mental retardation, and five showed kyphosis. Moreover, lymphadenopathy in the neck, thorax, or abdomen was observed in four patients. Therefore, the progression of neurological symptoms in these patients probably reflected the neurologic natural history of type III GD. Residual somatic symptoms, including kyphosis and lymphadenopathy, may be more common than what we thought. An additional treatment will be necessary to improve the outcome of type III GD.
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Insights into cell entry and intracellular trafficking of peptide and protein drugs provided by electron microscopy. Adv Drug Deliv Rev 2013; 65:1031-8. [PMID: 23624037 DOI: 10.1016/j.addr.2013.04.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 03/22/2013] [Accepted: 04/09/2013] [Indexed: 01/06/2023]
Abstract
For widening the arsenal of protein and peptide therapeutics that act within cells, their cell-entry mechanisms, intracellular trafficking and distribution need to be characterized in detail. Immunofluorescence microscopy has been a prevalent tool for these studies. However, due to the limited resolution, it is often complemented with other methods. This article focuses on the perspectives of electron microscopy in tracking the intracellular delivery and trafficking of proteins, peptides and their carriers. This review introduces the electron microscopy techniques and labeling methods currently used for studying the cellular whereabouts of peptides and proteins with a focus on their intracellular trafficking. Since cell-penetrating peptides have widely been harnessed as carriers for proteins and peptides, and their usage is rapidly expanding, a particular emphasis has been placed on their applications and cell-entry mechanisms.
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Lee BH, Kim DY, Kim GH, Cho KJ, Yoon HK, Yoo HW. Progressive mesenteric lymphadenopathy with protein-losing enteropathy; a devastating complication in Gaucher disease. Mol Genet Metab 2012; 105:522-4. [PMID: 22227073 DOI: 10.1016/j.ymgme.2011.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 12/12/2011] [Accepted: 12/12/2011] [Indexed: 11/17/2022]
Abstract
Mesenteric lymphadenopathy has been rarely reported in pediatric patients with Gaucher disease, developing despite the enzyme replacement therapy. The clinical implication of this condition is undetermined, with no consensus on treatment strategies. However, this condition can reflect the progression of Gaucher disease. Moreover, it can be accompanied by the serious complication, protein-losing enteropathy. Our experience underlines the importance of careful monitoring and early intervention for mesenteric lymphadenopathy, especially in pediatric patients with neuronopathic Gaucher disease.
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Affiliation(s)
- Beom Hee Lee
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
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Yağci B, Salor O, Yalçin B, Gürakan F, Güçer S, Büyükpamukçu M. Giant lymphadenopathy infiltrated by gaucher cells mimicking lymphoma. Pediatr Blood Cancer 2009; 52:870-1. [PMID: 19213078 DOI: 10.1002/pbc.21948] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Gaucher disease (GD) is a lysosomal storage disease characterized by deficiency of beta-glucocerebrosidase, which results in accumulation of glucocerebroside in reticuloendothelial system, bone marrow infiltration, progressive hepatosplenomegaly, and skeletal complications. Herein we report a 5-year-old female with GD receiving enzyme replacement therapy who had giant mesenteric lymphadenopathies.
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Affiliation(s)
- Begül Yağci
- Department of Pediatric Oncology, Hacettepe University Institute of Oncology, Ankara, Turkey.
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