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Bott S, Lallement J, Marino A, Daskalopoulos EP, Beauloye C, Esfahani H, Dessy C, Leclercq IA. When the liver is in poor condition, so is the heart - cardiac remodelling in MASH mouse models. Clin Sci (Lond) 2024; 138:1151-1171. [PMID: 39206703 PMCID: PMC11405860 DOI: 10.1042/cs20240833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 08/15/2024] [Accepted: 08/28/2024] [Indexed: 09/04/2024]
Abstract
Metabolic dysfunction-associated steatohepatitis (MASH) confers a risk for cardiovascular diseases in patients. Animal models may help exploring the mechanisms linking liver and heart diseases. Hence, we explored the cardiac phenotype in two MASH mouse models: foz/foz mice fed a high-fat diet (HFD) for 24 or 60 weeks and C57BL/6J mice fed a high-fat-, high-cholesterol-, and high-fructose diet for 60 weeks. Angiotensin II (AngII) was used as an additional cardiovascular stressor for 4 weeks in 10 weeks HFD-fed foz/foz mice. Foz/foz mice with fibrosing MASH developed cardiac hypertrophy with adverse cardiac remodelling not seen in WT similarly fed the HFD. AngII caused hypertension and up-regulated the expression of genes contributing to pathological cardiac hypertrophy (Nppa, Myh7) more severely so in foz/foz mice than in controls. After 60 weeks of HFD, while liver disease had progressed to burn-out non steatotic MASH with hepatocellular carcinoma in 50% of the animals, the cardiomyopathy did not. In an independent model (C57BL/6J mice fed a fat-, cholesterol- and fructose-rich diet), moderate fibrosing MASH is associated with cardiac fibrosis and dysregulation of genes involved in pathological remodelling (Col1a1, Col3a1, Vim, Myh6, Slc2a1). Thus, animals with MASH present consistent adverse structural changes in the heart with no patent alteration of cardiac function even when stressed with exogenous AngII. Liver disease, and likely not overfeeding or aging alone, is associated with this cardiac phenotype. Our findings support foz/foz mice as suitable for studying links between MASH and heart structural changes ahead of heart failure.
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Affiliation(s)
- Sebastian Bott
- Laboratory of Hepato-Gastroenterology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels
- Pole of Pharmacology and Therapeutics, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Justine Lallement
- Laboratory of Hepato-Gastroenterology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels
- Pole of Pharmacology and Therapeutics, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Alice Marino
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | | | - Christophe Beauloye
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Hrag Esfahani
- Platform of Integrated Physiology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Chantal Dessy
- Pole of Pharmacology and Therapeutics, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Isabelle Anne Leclercq
- Laboratory of Hepato-Gastroenterology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels
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McKay EJ, Luijten I, Weng X, Martinez de Morentin PB, De Frutos González E, Gao Z, Kolonin MG, Heisler LK, Semple RK. Mesenchymal-specific Alms1 knockout in mice recapitulates metabolic features of Alström syndrome. Mol Metab 2024; 84:101933. [PMID: 38583571 PMCID: PMC11047791 DOI: 10.1016/j.molmet.2024.101933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/01/2024] [Indexed: 04/09/2024] Open
Abstract
OBJECTIVE Alström Syndrome (AS), caused by biallelic ALMS1 mutations, includes obesity with disproportionately severe insulin resistant diabetes, dyslipidemia, and fatty liver. Prior studies suggest that hyperphagia is accounted for by loss of ALMS1 function in hypothalamic neurones, whereas disproportionate metabolic complications may be due to impaired adipose tissue expandability. We tested this by comparing the metabolic effects of global and mesenchymal stem cell (MSC)-specific Alms1 knockout. METHODS Global Alms1 knockout (KO) mice were generated by crossing floxed Alms1 and CAG-Cre mice. A Pdgfrα-Cre driver was used to abrogate Alms1 function selectively in MSCs and their descendants, including preadipocytes. We combined metabolic phenotyping of global and Pdgfrα+ Alms1-KO mice on a 45% fat diet with measurements of body composition and food intake, and histological analysis of metabolic tissues. RESULTS Assessed on 45% fat diet to promote adipose expansion, global Alms1 KO caused hyperphagia, obesity, insulin resistance, dyslipidaemia, and fatty liver. Pdgfrα-cre driven KO of Alms1 (MSC KO) recapitulated insulin resistance, fatty liver, and dyslipidaemia in both sexes. Other phenotypes were sexually dimorphic: increased fat mass was only present in female Alms1 MSC KO mice. Hyperphagia was not evident in male Alms1 MSC KO mice, but was found in MSC KO females, despite no neuronal Pdgfrα expression. CONCLUSIONS Mesenchymal deletion of Alms1 recapitulates metabolic features of AS, including fatty liver. This confirms a key role for Alms1 in the adipose lineage, where its loss is sufficient to cause systemic metabolic effects and damage to remote organs. Hyperphagia in females may depend on Alms1 deficiency in oligodendrocyte precursor cells rather than neurones. AS should be regarded as a forme fruste of lipodystrophy.
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Affiliation(s)
- Eleanor J McKay
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Ineke Luijten
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Xiong Weng
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Pablo B Martinez de Morentin
- The Rowett Institute, University of Aberdeen, Aberdeen, UK; School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Elvira De Frutos González
- The Rowett Institute, University of Aberdeen, Aberdeen, UK; Área de Fisiología Humana, Departamento de Ciencias básicas de la Salud, Facultad de ciencias de la Salud, Universidad Rey Juan Carlos, 28922 Alcorcón, Madrid, Spain
| | - Zhanguo Gao
- Institute of Molecular Medicine, University of Texas Health Sciences Center at Houston, Houston, TX 77030, USA
| | - Mikhail G Kolonin
- Institute of Molecular Medicine, University of Texas Health Sciences Center at Houston, Houston, TX 77030, USA
| | - Lora K Heisler
- The Rowett Institute, University of Aberdeen, Aberdeen, UK
| | - Robert K Semple
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK; MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK.
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Hanaki K, Kinoshita T, Fujimoto M, Sonoyama-Kawashima Y, Kanzaki S, Namba N. Alström Syndrome: A Review Focusing on Its Diverse Clinical Manifestations and Their Etiology as a Ciliopathy. Yonago Acta Med 2024; 67:93-99. [PMID: 38803594 PMCID: PMC11128078 DOI: 10.33160/yam.2024.05.010] [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: 04/09/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
Alström syndrome is a form of inherited obesity caused by a single gene abnormality and is inherited as an autosomal recessive trait. It is characterised by a variety of clinical manifestations, including progressive visual and hearing impairment, type 2 diabetes mellitus, dilated cardiomyopathy, and hepatic and renal dysfunction, in addition to obesity. Recent insights underline the pivotal involvement of the disease-associated gene (ALMS1) in cilia formation and function, leading to the classification of its clinical manifestations as a ciliopathy. This review delineates the diverse clinical indicators defining the syndrome and elucidates its pathological underpinnings.
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Affiliation(s)
- Keiichi Hanaki
- School of Health Sciences, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
- Division of Perinatology and Pediatrics, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Tomoe Kinoshita
- Division of Perinatology and Pediatrics, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
- Division of Pediatrics, Tottori Red Cross Hospital, Tottori 680-8517, Japan
| | - Masanobu Fujimoto
- Division of Perinatology and Pediatrics, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
| | - Yuki Sonoyama-Kawashima
- Division of Perinatology and Pediatrics, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
- Department of Pediatrics, Shimane University Faculty of Medicine, Izumo 693-8501, Japan
| | - Susumu Kanzaki
- Division of Perinatology and Pediatrics, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
- Asahigawasou Rehabilitation and Medical Center, Okayama 703-8555, Japan
| | - Noriyuki Namba
- Division of Perinatology and Pediatrics, Department of Multidisciplinary Internal Medicine, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan
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Aksoy F, Özgür T, Dundar HZ, Kaya E. Liver Transplantation in Alstrom Syndrome: A Case Report. EXP CLIN TRANSPLANT 2024; 22:244-245. [PMID: 33535939 DOI: 10.6002/ect.2020.0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Alstrom syndrome is a genetic disorder with autosomal recessive inheritance and multiple organ failure. Hearing loss, childhood obesity, diabetes mellitus, and nonalcoholic fatty liver disease are common disorders in this disease. Degree of nonalcoholic fatty liver disease ranges from benign steatosis to cirrhosis. Since it first description in 1959, 89 cases have been reported, and none in the literature underwent liver transplant. In this report, we describe a 19-year-old male patient with a diagnosis of hearingloss, obesity, anddiabetes mellitus startedsince childhood. He was evaluated for bloody vomiting, and grade 3 esophageal varices were detected, with liver cirrhosis findings made with abdominal tomography. The patient had a Model for End-Stage Liver Disease score of 23, and deceased donor liver transplant was planned. After an appropriate donor was identified, the patient underwent liver transplant with an operation lasting approximately 6 hours. Cold ischemia time was about 5 hours, and anastomosis time was about 30 minutes. The patient was extubated on posttransplant day 1. On posttransplant day 10, his vital parameters remained normal, but he had blurred consciousness and loss of orientation. Neurological examination and imaging revealed minimal subdural effusion and mild cerebral cortical dysfunction in electroencephalogram. The patient's symptoms improved after medical treatment, and the patient was discharged on day 13 posttransplant. At the month 24 outpatient follow-up, the patient had no problems. Alstrom syndrome is an autosomal recessive genetic disorder with multiple organ failure. Although various degrees of liver disease have been described in the literature that may progress to cirrhosis of the liver, our present case is considered original because of the absence of liver transplant descriptions in the literature.
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Affiliation(s)
- Fuat Aksoy
- From the Department of General Surgery, Bursa Uludag University, Bursa, Turkey
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McKay EJ, Luijten I, Weng X, Martinez de Morentin PB, De Frutos González E, Gao Z, Kolonin MG, Heisler LK, Semple RK. Mesenchymal-specific Alms1 knockout in mice recapitulates key metabolic features of Alström Syndrome. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.10.12.562074. [PMID: 37873427 PMCID: PMC10592792 DOI: 10.1101/2023.10.12.562074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background Alström Syndrome (AS), a multi-system disease caused by mutations in the ALMS1 gene, includes obesity with disproportionately severe insulin resistant diabetes, dyslipidemia, and hepatosteatosis. How loss of ALMS1 causes this phenotype is poorly understood, but prior studies have circumstancially implicated impaired adipose tissue expandability. We set out to test this by comparing the metabolic effects of selective Alms1 knockout in mesenchymal cells including preadipocytes to those of global Alms1 knockout. Methods Global Alms1 knockout (KO) mice were generated by crossing floxed Alms1 and CAG-Cre mice. A Pdgfrα -Cre driver was used to abrogate Alms1 function selectively in mesenchymal stem cells (MSCs) and their descendants, including preadipocytes. We combined metabolic phenotyping of global and Pdgfrα + Alms1 -KO mice on a 45% fat diet with measurements of body composition and food intake, and histological analysis of metabolic tissues. Results Global Alms1 KO caused hyperphagia, obesity, insulin resistance, dyslipidaemia, and fatty liver. Pdgfrα - cre driven KO of Alms1 (MSC KO) recapitulated insulin resistance, fatty liver, and dyslipidaemia in both sexes. Other phenotypes were sexually dimorphic: increased fat mass was only present in female Alms1 MSC KO mice. Hyperphagia was not evident in male Alms1 MSC KO mice, but was found in MSC KO females, despite no neuronal Pdgfr α expression. Conclusions Mesenchymal deletion of Alms1 recapitulates the metabolic features of AS, including severe fatty liver. This confirms a key role for Alms1 in the adipose lineage, where its loss is sufficient to cause systemic metabolic effects and damage to remote organs. AS should be regarded as a forme fruste of lipodystrophy. Therapies should prioritise targeting positive energy balance.
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Picazo Sánchez M, Cuxart Pérez M, Fàbregas Puigtió S, Vega Molpeceres S. Portal hypertension and gastrointestinal bleeding in a kidney transplant patient with Alström syndrome. Nefrologia 2023; 43:263-264. [PMID: 37419720 DOI: 10.1016/j.nefroe.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/16/2021] [Indexed: 07/09/2023] Open
Affiliation(s)
| | - Marc Cuxart Pérez
- Servicio de Nefrología, Fundació Salut Empordà, Figueres, Girona, Spain
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Radi S, Binmahfooz S, Nawar S, Malaikah H. Alström Syndrome: A Rare Cause of Severe Insulin Resistance. JCEM CASE REPORTS 2023; 1:luac012. [PMID: 37908279 PMCID: PMC10578372 DOI: 10.1210/jcemcr/luac012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Indexed: 11/02/2023]
Abstract
Diabetes mellitus is one of the most common diseases worldwide and is a major cause of morbidity and mortality. Type 2 diabetes, with its hallmark being insulin resistance, constitutes the majority of cases. Although usually related to modifiable risk factors, insulin resistance can have genetic causes. Here, we present one of the rare causes of insulin resistance. A 21-year-old man, who was deaf and blind, presented with a 3-week history of polyuria and polydipsia. He was found to have significant hyperglycemia, managed initially with insulin infusion, then he was transitioned to subcutaneous injections. Because he required high doses of insulin and had acanthosis nigricans, insulin resistance was suspected. Putting together his insulin resistance and chronic history of syndromic features, Alström syndrome was considered. Genetic testing revealed a mutation in the ALMS1 gene. The patient was then started on insulin sensitizers with a tapering of insulin with good response. Insulin resistance should be suspected if the insulin requirement is high and if acanthosis nigricans is present. Alström syndrome is a rare causes of insulin resistance. Affected individuals will usually have insulin-resistant diabetes by a young age and associated blindness and deafness. Insulin sensitizers are an important part of the treatment.
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Affiliation(s)
- Suhaib Radi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah 22384, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah 22384, Saudi Arabia
- Department of Internal Medicine, Division of Endocrinology, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Jeddah 22384, Saudi Arabia
| | - Saleh Binmahfooz
- Faculty of Medicine, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Samah Nawar
- Department of Internal Medicine, Division of Endocrinology, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Jeddah 22384, Saudi Arabia
| | - Hebah Malaikah
- Department of Pediatrics Endocrinology, King Abdulaziz Medical City, Ministry of the National Guard-Health Affairs, Jeddah 22384, Saudi Arabia
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Hearing Loss in Adults With Alström Syndrome-Experience From the UK National Alström Service. Otol Neurotol 2022; 43:e620-e627. [PMID: 35761454 DOI: 10.1097/mao.0000000000003553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize the patterns of hearing loss and methods of hearing rehabilitation in the UK national cohort of adults with Alström syndrome. STUDY DESIGN Retrospective review of electronic patient records. SETTING UK National multi-disciplinary team (MDT) Alström service held at the Queen Elizabeth Hospital, Birmingham. PATIENTS Forty one adult patients with a diagnosis of Alström syndrome, confirmed via ALMS1 gene sequencing, are under ongoing review within the UK National MDT Alström service. MAIN OUTCOME MEASURES Magnitude and type of hearing loss were analyzed using patients' audiometric data. Deterioration of hearing was calculated using serial pure tone audiograms. Methods of hearing rehabilitation used by patients and potential candidacy for cochlear implantation were analyzed. RESULTS Of 34 patients with available audiograms, all had sensorineural hearing loss (SNHL). Dual sensory (visual and hearing) loss was present in 32/34 (94%) patients. Hearing deteriorated with advancing age, at 1.23 dB/yr. Severe- profound SNHL was present in 9/34 (26%) cases. Air conduction hearing aids were used in 27/34 (79%) cases, and cochlear implants in 2/34 (5%). CONCLUSIONS Alström syndrome is an ultra-rare genetic disorder with progressive, debilitating multi-system manifestations, including SNHL. The UK National MDT Alström service represents one of the largest reported adult cohorts in the world. SNHL in this group was ubiquitous, showing a rapid decline in hearing with age. Annual audiometric assessment to enable early diagnosis of hearing loss and optimum rehabilitation are paramount to minimize the impact of hearing loss in this condition.
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Liu Z, Chen X. Whole-exome sequencing establishes a diagnosis of Alstrom syndrome: a case report. Transl Pediatr 2022; 11:589-594. [PMID: 35558979 PMCID: PMC9085958 DOI: 10.21037/tp-21-623] [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] [Received: 12/28/2021] [Accepted: 03/14/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Alstrom syndrome (ALMS) is a rare genetic disorder. ALMS is characterized by progressive bilateral sensorineural hearing impairment, cone-rod dystrophy, infantile-onset cardiomyopathy, hypertriglyceridemia, accelerated non-alcoholic fatty liver disease, renal dysfunction and insulin-resistant diabetes mellitus (DM). DM typically develop in childhood or adolescence. Dilated cardiomyopathy may arise in infancy. Clinical symptoms appear with great variability and severity. Several cases have been reported worldwide; however, diagnosis remains challenging. CASE DESCRIPTION We report an 8-year-and-11-month-old female diagnosed with ALMS who had a long history of obesity and amblyopia from infancy. We found high levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in this patient. She showed no hearing disfunction. Recently, she presented with sudden-onset insulin-resistant DM. Genetic analysis revealed the heterozygous mutations c.8366delT, p.L2789* and c.6829C>T, p.R2277*. c.8366delT, which results in premature protein termination, has not been reported previously in ALMS1. Although the patient's two sisters died of acute heart failure following infection at 4 and 14 months respectively, she showed no signs of cardiomyopathy until now. CONCLUSIONS This case provides an unusual cause of genetic syndrome associated with diabetes. A detailed medical history, physical examination and appropriate gene analysis are critical for diagnosis. Our case identifies a novel ALMS1 mutation and reaffirms the great clinical variation of this disease even within families.
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Affiliation(s)
- Ziqin Liu
- Department of Endocrinology, Children's Hospital Capital Institute of Pediatrics, Beijing, China
| | - Xiaobo Chen
- Department of Endocrinology, Children's Hospital Capital Institute of Pediatrics, Beijing, China
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Kehinde TA, Bhatia A, Olarewaju B, Shoaib MZ, Mousa J, Osundiji MA. Syndromic obesity with neurodevelopmental delay: Opportunities for targeted interventions. Eur J Med Genet 2022; 65:104443. [DOI: 10.1016/j.ejmg.2022.104443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 01/09/2022] [Accepted: 01/22/2022] [Indexed: 01/01/2023]
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Hilgendorf KI. Primary Cilia Are Critical Regulators of White Adipose Tissue Expansion. Front Physiol 2021; 12:769367. [PMID: 34759842 PMCID: PMC8573240 DOI: 10.3389/fphys.2021.769367] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/04/2021] [Indexed: 12/14/2022] Open
Abstract
The primary cilium is a microtubule-based cellular protrusion found on most mammalian cell types in diverse tissues. It functions as a cellular antenna to sense and transduce a broad range of signals, including odorants, light, mechanical stimuli, and chemical ligands. This diversity in signals requires cilia to display a context and cell type-specific repertoire of receptors. Recently, primary cilia have emerged as critical regulators of metabolism. The importance of primary cilia in metabolic disease is highlighted by the clinical features of human genetic disorders with dysfunctional ciliary signaling, which include obesity and diabetes. This review summarizes the current literature on the role of primary cilia in metabolic disease, focusing on the importance of primary cilia in directing white adipose tissue expansion during obesity.
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Affiliation(s)
- Keren I Hilgendorf
- Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, UT, United States
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Choudhury AR, Munonye I, Sanu KP, Islam N, Gadaga C. A review of Alström syndrome: a rare monogenic ciliopathy. Intractable Rare Dis Res 2021; 10:257-262. [PMID: 34877237 PMCID: PMC8630466 DOI: 10.5582/irdr.2021.01113] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/14/2021] [Accepted: 10/25/2021] [Indexed: 12/11/2022] Open
Abstract
Alström syndrome is a rare monogenic ciliopathy caused by a mutation to the Alström syndrome 1 (ALMS1) gene. Alström syndrome has an autosomal recessive nature of inheritance. Approximately 1,200 cases of Alström syndrome have been identified worldwide. Complications of the disease are likely caused by dysfunctional cilia with complications arising early in life. The known complications of Alström syndrome have been reported to impact multiple major organ systems, including the endocrine system, cardiac system, renal system, sensory system, and hepatic system. The symptoms of Alström syndrome have great variability in presentation and intensity but often lead to organ damage. This has resulted in a shortened lifespan for individuals affected by Alström syndrome. Individuals with the disease rare exceed the age of 50. Currently, there are no specific treatments for Alström syndrome that can cure the disease, prevent the complications, or reverse the complications. Current management involves management of symptoms with the goal of improving quality of life and lifespan. This review aims to summarize the current knowledge on the epidemiology, diagnosis, pathophysiology, complications, management, and prognosis of Alström syndrome. In addition to that, this review also aims to raise awareness and encourage research on Alström syndrome as the condition has a huge impact on affected individuals.
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Affiliation(s)
- Avijoy Roy Choudhury
- UWA Medical School, The University of Western Australia, Perth, WA, Australia
- Address correspondence to:Avijoy Roy Choudhury, UWA Medical School, The University of Western Australia, 106/151 Adelaide Terrace, East Perth, Western Australia, 6004, Australia. E-mail:
| | | | - Kevin Paul Sanu
- UWA Medical School, The University of Western Australia, Perth, WA, Australia
| | - Nipa Islam
- Dhaka Medical College, Dhaka, Bangladesh
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Picazo Sánchez M, Cuxart Pérez M, Fàbregas Puigtió S, Vega Molpeceres S. Portal hypertension and gastrointestinal bleeding in a kidney transplant patient with Alström syndrome. Nefrologia 2021; 43:S0211-6995(21)00151-X. [PMID: 34462146 DOI: 10.1016/j.nefro.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/16/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Marc Cuxart Pérez
- Servicio de Nefrología, Fundació Salut Empordà, Figueres, Girona, España
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Bettini S, Bombonato G, Dassie F, Favaretto F, Piffer L, Bizzotto P, Busetto L, Chemello L, Senzolo M, Merkel C, Angeli P, Vettor R, Milan G, Maffei P. Liver Fibrosis and Steatosis in Alström Syndrome: A Genetic Model for Metabolic Syndrome. Diagnostics (Basel) 2021; 11:diagnostics11050797. [PMID: 33924909 PMCID: PMC8170882 DOI: 10.3390/diagnostics11050797] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/18/2021] [Accepted: 04/24/2021] [Indexed: 12/27/2022] Open
Abstract
Alström syndrome (ALMS) is an ultra-rare monogenic disease characterized by insulin resistance, multi-organ fibrosis, obesity, type 2 diabetes mellitus (T2DM), and hypertriglyceridemia with high and early incidence of non-alcoholic fatty liver disease (NAFLD). We evaluated liver fibrosis quantifying liver stiffness (LS) by shear wave elastography (SWE) and steatosis using ultrasound sonographic (US) liver/kidney ratios (L/K) in 18 patients with ALMS and 25 controls, and analyzed the contribution of metabolic and genetic alterations in NAFLD progression. We also genetically characterized patients. LS and L/K values were significantly higher in patients compared with in controls (p < 0.001 versus p = 0.013). In patients, LS correlated with the Fibrosis-4 Index and age, while L/K was associated with triglyceride levels. LS showed an increasing trend in patients with metabolic comorbidities and displayed a significant correlation with waist circumference, the homeostasis model assessment, and glycated hemoglobin A1c. SWE and US represent promising tools to accurately evaluate early liver fibrosis and steatosis in adults and children with ALMS during follow-up. We described a new pathogenic variant of exon 8 in ALMS1. Patients with ALMS displayed enhanced steatosis, an early increased age-dependent LS that is associated with obesity and T2DM but also linked to genetic alterations, suggesting that ALMS1 could be involved in liver fibrogenesis.
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Affiliation(s)
- Silvia Bettini
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (F.F.); (L.B.); (R.V.); (G.M.); (P.M.)
- Correspondence: (S.B.); (F.D.); Tel.: +39-333-204-6896 (S.B.); Tel.: +39-049-821-7021 (F.D.)
| | - Giancarlo Bombonato
- Internal Medicine 5, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (G.B.); (L.P.); (P.B.); (L.C.); (C.M.); (P.A.)
| | - Francesca Dassie
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (F.F.); (L.B.); (R.V.); (G.M.); (P.M.)
- Correspondence: (S.B.); (F.D.); Tel.: +39-333-204-6896 (S.B.); Tel.: +39-049-821-7021 (F.D.)
| | - Francesca Favaretto
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (F.F.); (L.B.); (R.V.); (G.M.); (P.M.)
| | - Luca Piffer
- Internal Medicine 5, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (G.B.); (L.P.); (P.B.); (L.C.); (C.M.); (P.A.)
| | - Paola Bizzotto
- Internal Medicine 5, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (G.B.); (L.P.); (P.B.); (L.C.); (C.M.); (P.A.)
| | - Luca Busetto
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (F.F.); (L.B.); (R.V.); (G.M.); (P.M.)
| | - Liliana Chemello
- Internal Medicine 5, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (G.B.); (L.P.); (P.B.); (L.C.); (C.M.); (P.A.)
| | - Marco Senzolo
- Gastroenterology Department of Oncological and Gastroenterological Surgical Sciences, DiSCOG, University of Padua, 35128 Padua, Italy;
| | - Carlo Merkel
- Internal Medicine 5, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (G.B.); (L.P.); (P.B.); (L.C.); (C.M.); (P.A.)
| | - Paolo Angeli
- Internal Medicine 5, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (G.B.); (L.P.); (P.B.); (L.C.); (C.M.); (P.A.)
| | - Roberto Vettor
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (F.F.); (L.B.); (R.V.); (G.M.); (P.M.)
| | - Gabriella Milan
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (F.F.); (L.B.); (R.V.); (G.M.); (P.M.)
| | - Pietro Maffei
- Internal Medicine 3, Department of Medicine, DIMED, University of Padua, 35128 Padua, Italy; (F.F.); (L.B.); (R.V.); (G.M.); (P.M.)
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15
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Dassie F, Favaretto F, Bettini S, Parolin M, Valenti M, Reschke F, Danne T, Vettor R, Milan G, Maffei P. Alström syndrome: an ultra-rare monogenic disorder as a model for insulin resistance, type 2 diabetes mellitus and obesity. Endocrine 2021; 71:618-625. [PMID: 33566311 DOI: 10.1007/s12020-021-02643-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/19/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Alström syndrome (ALMS) is a monogenic ultra-rare disorder with a prevalence of one per million inhabitants caused by pathogenic variants of ALMS1 gene. ALMS1 is located on chromosome 2p13, spans 23 exons and encodes a predicted 461.2-kDa protein of 4169 amino acids. The infantile cone-rod dystrophy with nystagmus and severe visual impairment is the earliest and most consistent clinical manifestation of ALMS. In addition, infantile transient cardiomyopathy, early childhood obesity with hyperphagia, deafness, insulin resistance (IR), type 2 diabetes mellitus (T2DM), systemic fibrosis and progressive renal or liver dysfunction are common findings. ALMS1 encodes a large ubiquitously expressed protein that is associated with the centrosome and the basal body of primary cilium. CURRENT RESEARCH The localisation of ALMS1 to the ciliary basal body suggests its contribution to ciliogenesis and/or normal ciliary function, or centriolar stability. ALMS1 regulate glucose transport through the actin cytoskeleton, which plays an important role in insulin-stimulated GLUT4 transport. Both extreme IR and β-cell failure are the two determinant factors responsible for the development of glucose metabolism alterations in ALMS. TREATMENT Currently, there is no known cure for ALMS other than managing the underlying systemic diseases. When possible, individuals with ALMS and families should be referred to a centre of expertise and followed by a multidisciplinary team. Lifestyle modification, aerobic exercise and dietary induced weight loss are highly recommended as primary treatment for ALMS patients with T2DM and obesity. CONCLUSION Managing a rare disease requires not only medical care but also a support network including patient associations.
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Affiliation(s)
- Francesca Dassie
- Department of Medicine (DIMED), Clinica Medica 3, Padua University Hospital, Padua, Italy
| | - Francesca Favaretto
- Department of Medicine (DIMED), Clinica Medica 3, Padua University Hospital, Padua, Italy
| | - Silvia Bettini
- Department of Medicine (DIMED), Clinica Medica 3, Padua University Hospital, Padua, Italy
| | - Matteo Parolin
- Department of Medicine (DIMED), Clinica Medica 3, Padua University Hospital, Padua, Italy
| | - Marina Valenti
- Italian Association of Alström Syndrome Patients-ASS.A.I., Endo-ERN ePAG, Padua, Italy
| | - Felix Reschke
- Department of General Pediatrics, Endocrinology/Diabetology and Clinical Research, Children's Hospital Auf der Bult, Hannover, Germany
| | - Thomas Danne
- Department of General Pediatrics, Endocrinology/Diabetology and Clinical Research, Children's Hospital Auf der Bult, Hannover, Germany
| | - Roberto Vettor
- Department of Medicine (DIMED), Clinica Medica 3, Padua University Hospital, Padua, Italy
| | - Gabriella Milan
- Department of Medicine (DIMED), Clinica Medica 3, Padua University Hospital, Padua, Italy
| | - Pietro Maffei
- Department of Medicine (DIMED), Clinica Medica 3, Padua University Hospital, Padua, Italy.
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16
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Geberhiwot T, Baig S, Obringer C, Girard D, Dawson C, Manolopoulos K, Messaddeq N, Bel Lassen P, Clement K, Tomlinson JW, Steeds RP, Dollfus H, Petrovsky N, Marion V. Relative Adipose Tissue Failure in Alström Syndrome Drives Obesity-Induced Insulin Resistance. Diabetes 2021; 70:364-376. [PMID: 32994277 PMCID: PMC7881858 DOI: 10.2337/db20-0647] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/17/2020] [Indexed: 12/11/2022]
Abstract
Obesity is a major risk factor for insulin resistance (IR) and its attendant complications. The pathogenic mechanisms linking them remain poorly understood, partly due to a lack of intermediary monogenic human phenotypes. Here, we report on a monogenic form of IR-prone obesity, Alström syndrome (ALMS). Twenty-three subjects with monogenic or polygenic obesity underwent hyperinsulinemic-euglycemic clamping with concomitant adipose tissue (AT) microdialysis and an in-depth analysis of subcutaneous AT histology. We have shown a relative AT failure in a monogenic obese cohort, a finding supported by observations in a novel conditional mouse model (Alms flin/flin ) and ALMS1-silenced human primary adipocytes, whereas selective reactivation of ALMS1 gene in AT of an ALMS conditional knockdown mouse model (Alms flin/flin ; Adipo-Cre +/- ) restores systemic insulin sensitivity and glucose tolerance. Hence, we show for the first time the relative AT failure in human obese cohorts to be a major determinant of accelerated IR without evidence of lipodystrophy. These new insights into adipocyte-driven IR may assist development of AT-targeted therapeutic strategies for diabetes.
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Affiliation(s)
- Tarekegn Geberhiwot
- Department of Diabetes, Endocrinology and Metabolism, Queen Elizabeth Hospital Birmingham, Birmingham, U.K.
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, U.K
| | - Shanat Baig
- Department of Diabetes, Endocrinology and Metabolism, Queen Elizabeth Hospital Birmingham, Birmingham, U.K
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, U.K
| | - Cathy Obringer
- INSERM, UMR_U1112, Laboratoire de Génétique Médicale, Université de Strasbourg, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Dorothée Girard
- Flinders Medical Centre, Flinders University, Bedford Park, Australia
| | - Charlotte Dawson
- Department of Diabetes, Endocrinology and Metabolism, Queen Elizabeth Hospital Birmingham, Birmingham, U.K
| | | | - Nadia Messaddeq
- Institute of Genetics and Molecular and Cellular Biology, CNRS/INSERM, Collège de France, Illkirch, France
| | - Pierre Bel Lassen
- NutriOmics Unit, INSERM, Sorbonne Université, Assistance-Publique Hôpitaux de Paris, and Nutrition Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Karine Clement
- NutriOmics Unit, INSERM, Sorbonne Université, Assistance-Publique Hôpitaux de Paris, and Nutrition Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Jeremy W Tomlinson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, U.K
| | - Richard P Steeds
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, U.K
| | - Hélène Dollfus
- INSERM, UMR_U1112, Laboratoire de Génétique Médicale, Université de Strasbourg, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
- Service de Génétique Médicale et CARGO, Institut de Génétique Médicale d'Alsace, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Nikolai Petrovsky
- Flinders Medical Centre, Flinders University, Bedford Park, Australia
- Vaxine Pty Ltd, Bedford Park, Australia
| | - Vincent Marion
- INSERM, UMR_U1112, Ciliopathies Modeling and Associated Therapies Group, Laboratoire de Génétique Médicale, Fédération de Medecine Translationelle de Strasbourg, Strasbourg, France
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17
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Baig S, Paisey R, Dawson C, Barrett T, Maffei P, Hodson J, Rambhatla SB, Chauhan P, Bolton S, Dassie F, Francomano C, Marshall RP, Belal M, Skordilis K, Hayer M, Price AM, Cramb R, Edwards N, Steeds RP, Geberhiwot T. Defining renal phenotype in Alström syndrome. Nephrol Dial Transplant 2020; 35:994-1001. [PMID: 30307515 DOI: 10.1093/ndt/gfy293] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/15/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Alström syndrome (AS) is a rare autosomal recessive ciliopathy with a wide spectrum of clinical features, including cone-rod retinal dystrophy, neuronal deafness, severe insulin resistance and major organ failure. The characteristics of renal disease in the syndrome have not been systematically described. The aim of this study is to define the onset and progression of renal disease in AS. METHOD Prospective observational cohort study. SETTING AND PARTICIPANTS Thirty-two adult subjects from a national specialist clinic in UK and 86 subjects from an international AS registry were studied. OUTCOMES First, an international registry cross-sectional study across all age groups to determine change in kidney function was performed. Secondly, a detailed assessment was carried out of adult AS patients with serial follow-up to determine incidence, aetiology and progression of renal disease. ANALYTICAL APPROACH Generalized estimating equations were used to evaluate the relationship between age and estimated glomerular filtration rate (eGFR). Associations between patient factors and eGFR levels were then assessed in the adult AS cohort. RESULTS The international registry study of the renal function of 118 subjects with AS (median age 21 years) showed a rapid decline with age, at an average of -16.7 and -10.9 mL/min/1.73 m2 per decade in males and females, respectively. In a UK national cohort of 32 patients with AS (median age 22 years), 20/32 (63%) had chronic kidney disease (CKD) Stage 3 or above based on eGFR <60 mL/min/1.73 m2 or evidence of albuminuria. Hyperuricaemia was noted in 25/32 (79%). Structural abnormalities such as nephrocalcinosis without hypercalcaemia and cysts were observed in 20/32 (63%) subjects. Lower urinary tract symptoms were frequent in 17/19 (70%) of AS patients. Histological evidence showed mixed tubulo-interstitial and glomerular disease. CONCLUSIONS This is the first study to demonstrate that renal disease is the hallmark of AS, which starts early and progresses with age, leading to a high prevalence of advanced CKD at young age. AS should be considered in the differential diagnosis of rare genetic renal diseases.
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Affiliation(s)
- Shanat Baig
- Department of Endocrinology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, UK.,Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Richard Paisey
- Diabetes Research Unit, Horizon Centre, Torbay Hospital, Torquay, UK
| | - Charlotte Dawson
- Department of Endocrinology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.,Department of Pathology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Timothy Barrett
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Pietro Maffei
- Department of Medical and Surgical Sciences (DIMED), Clinica Medica 3, Padua University Hospital, Padua, Italy
| | - James Hodson
- Institute of Translational Medicine, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | | | - Priyesh Chauhan
- Department of Endocrinology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Shaun Bolton
- Department of Endocrinology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Francesca Dassie
- Department of Medical and Surgical Sciences (DIMED), Clinica Medica 3, Padua University Hospital, Padua, Italy
| | - Clair Francomano
- Adult Genetics, Harvey Institute of Human Genetics, Greater Baltimore Medical Center, Baltimore, MD, USA
| | | | - Mohammed Belal
- Department of Urology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Kassiani Skordilis
- Department of Pathology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Manvir Hayer
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, UK.,Department of Nephrology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Anna M Price
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, UK.,Department of Nephrology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Robert Cramb
- Department of Pathology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Nicola Edwards
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, UK.,Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Richard P Steeds
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, UK.,Department of Cardiology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Tarekegn Geberhiwot
- Department of Endocrinology, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK.,Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, Birmingham, UK
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18
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Tahani N, Maffei P, Dollfus H, Paisey R, Valverde D, Milan G, Han JC, Favaretto F, Madathil SC, Dawson C, Armstrong MJ, Warfield AT, Düzenli S, Francomano CA, Gunay-Aygun M, Dassie F, Marion V, Valenti M, Leeson-Beevers K, Chivers A, Steeds R, Barrett T, Geberhiwot T. Consensus clinical management guidelines for Alström syndrome. Orphanet J Rare Dis 2020; 15:253. [PMID: 32958032 PMCID: PMC7504843 DOI: 10.1186/s13023-020-01468-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022] Open
Abstract
Alström Syndrome (ALMS) is an ultra-rare multisystem genetic disorder caused by autosomal recessive variants in the ALMS1 gene, which is located on chromosome 2p13. ALMS is a multisystem, progressive disease characterised by visual disturbance, hearing impairment, cardiomyopathy, childhood obesity, extreme insulin resistance, accelerated non-alcoholic fatty liver disease (NAFLD), renal dysfunction, respiratory disease, endocrine and urologic disorders. Clinical symptoms first appear in infancy with great variability in age of onset and severity. ALMS has an estimated incidence of 1 case per 1,000,000 live births and ethnically or geographically isolated populations have a higher-than-average frequency. The rarity and complexity of the syndrome and the lack of expertise can lead to delayed diagnosis, misdiagnosis and inadequate care. Multidisciplinary and multiprofessional teams of experts are essential for the management of patients with ALMS, as early diagnosis and intervention can slow the progression of multi-organ dysfunctions and improve patient quality of life.These guidelines are intended to define standard of care for patients suspected or diagnosed with ALMS of any age. All information contained in this document has originated from a systematic review of the literature and the experiences of the authors in their care of patients with ALMS. The Appraisal of Guidelines for Research & Evaluation (AGREE II) system was adopted for the development of the guidelines and for defining the related levels of evidence and strengths of recommendations.These guidelines are addressed to: a) specialist centres, other hospital-based medical teams and staffs involved with the care of ALMS patients, b) family physicians and other primary caregivers and c) patients and their families.
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Affiliation(s)
- Natascia Tahani
- Department of Diabetes, Endocrinology and Metabolism, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK
| | - Pietro Maffei
- Department of Medicine (DIMED), Padua University Hospital, Padua, Italy.,Adult MTG3 Chair of ENDO-ERN, Azienda Ospedaliera Padova, Padua, Italy
| | - Hélène Dollfus
- Centre de référence pour les affections rares ophtalmologiques CARGO, FSMR SENSGENE, ERN-EYE, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Laboratoire de Génétique Médicale, UMRS_1112, Institut de Génétique Médicale d'Alsace, Université de Strasbourg, Strasbourg, France
| | - Richard Paisey
- Diabetes Research Unit, Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Diana Valverde
- CINBIO (Centro de Investigacion Biomedica), Universidad de Vigo, Vigo, Spain
| | - Gabriella Milan
- Department of Medicine (DIMED), Padua University Hospital, Padua, Italy
| | - Joan C Han
- Departments of Pediatrics and Physiology, College of Medicine, University of Tennessee Health Science Center and Pediatric Obesity Program, Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA
| | | | - Shyam C Madathil
- Department of Respiratory Medicine, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Charlotte Dawson
- Department of Diabetes, Endocrinology and Metabolism, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK
| | - Matthew J Armstrong
- Liver and Hepatobiliary Unit, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Adrian T Warfield
- Department of Cellular Pathology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Selma Düzenli
- Department of Medical Genetics, Abant İzzet Baysal University, Bolu, Turkey
| | - Clair A Francomano
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Meral Gunay-Aygun
- Departments of Genetic Medicine and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Francesca Dassie
- Department of Medicine (DIMED), Padua University Hospital, Padua, Italy
| | - Vincent Marion
- Laboratoire de Génétique Médicale, UMRS_1112, Institut de Génétique Médicale d'Alsace, Université de Strasbourg, Strasbourg, France
| | - Marina Valenti
- Italian Association Alström Syndrome, Padua, Italy.,ENDO-ERN ePAG representative in MTG3, Padua, Italy
| | | | | | - Richard Steeds
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Timothy Barrett
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Tarekegn Geberhiwot
- Department of Diabetes, Endocrinology and Metabolism, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK. .,Institute of Metabolism and System Research, University of Birmingham, Birmingham, UK.
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19
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Engle SE, Bansal R, Antonellis PJ, Berbari NF. Cilia signaling and obesity. Semin Cell Dev Biol 2020; 110:43-50. [PMID: 32466971 DOI: 10.1016/j.semcdb.2020.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 12/11/2022]
Abstract
An emerging number of rare genetic disorders termed ciliopathies are associated with pediatric obesity. It is becoming clear that the mechanisms associated with cilia dysfunction and obesity in these syndromes are complex. In addition to ciliopathic syndromic forms of obesity, several cilia-associated signaling gene mutations also lead to morbid obesity. While cilia have critical and diverse functions in energy homeostasis including their roles in centrally mediated food intake as well as in peripheral tissues, many questions remain. Here, we briefly discuss the syndromic ciliopathies and monoallelic cilia signaling gene mutations associated with obesity. We also describe potential ways cilia may be involved in common obesity. We discuss how neuronal cilia impact food intake potentially through leptin signaling and changes in ciliary G protein-coupled receptor (GPCR) signaling. We highlight several recent studies that have implicated the potential for cilia in peripheral tissues such as adipose and the pancreas to contribute to metabolic dysfunction. Then we discuss the potential for cilia to impact energy homeostasis through their roles in both development and adult tissue homeostasis. The studies discussed in this review highlight how a comprehensive understanding of the requirement of cilia for the regulation of diverse biological functions will contribute to our understanding of common forms of obesity.
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Affiliation(s)
- Staci E Engle
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Ruchi Bansal
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Patrick J Antonellis
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Nicolas F Berbari
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA; Stark Neurosciences Research Institute, Indiana University, Indianapolis, IN, USA; Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine, Indianapolis, IN, USA.
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20
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Grochowsky A, Gunay-Aygun M. Clinical characteristics of individual organ system disease in non-motile ciliopathies. TRANSLATIONAL SCIENCE OF RARE DISEASES 2019; 4:1-23. [PMID: 31763176 PMCID: PMC6864414 DOI: 10.3233/trd-190033] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Non-motile ciliopathies (disorders of the primary cilia) include autosomal dominant and recessive polycystic kidney diseases, nephronophthisis, as well as multisystem disorders Joubert, Bardet-Biedl, Alström, Meckel-Gruber, oral-facial-digital syndromes, and Jeune chondrodysplasia and other skeletal ciliopathies. Chronic progressive disease of the kidneys, liver, and retina are common features in non-motile ciliopathies. Some ciliopathies also manifest neurological, skeletal, olfactory and auditory defects. Obesity and type 2 diabetes mellitus are characteristic features of Bardet-Biedl and Alström syndromes. Overlapping clinical features and molecular heterogeneity of these ciliopathies render their diagnoses challenging. In this review, we describe the clinical characteristics of individual organ disease for each ciliopathy and provide natural history data on kidney, liver, retinal disease progression and central nervous system function.
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Affiliation(s)
- Angela Grochowsky
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Meral Gunay-Aygun
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Pediatrics and The McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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21
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Karaivazoglou K, Kalogeropoulou M, Assimakopoulos S, Triantos C. Psychosocial Issues in Pediatric Nonalcoholic Fatty Liver Disease. PSYCHOSOMATICS 2019; 60:10-17. [PMID: 30318268 DOI: 10.1016/j.psym.2018.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/04/2018] [Accepted: 09/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND In recent years, the adoption of unhealthy dietary habits and a sedentary lifestyle has led to an alarming increase in the prevalence of non-alcoholic fatty liver disease (NAFLD) in pediatric populations. Hepatic steatosis is now considered the most common cause of chronic liver disease in children and adolescents and may progress to liver fibrosis and even cirrhosis, increasing long-term mortality rates. Apart from its severe medical co-morbidities, pediatric NAFLD is associated with a variety of psychosocial factors which act either as precipitants or consequences of the disease. OBJECTIVE Studying these parameters might expand our understanding of NAFLD pathogenesis and provide a framework for more effective management. METHOD In this context, we performed a literature review focusing on the associations of pediatric NAFLD with psychosocial parameters to detect and integrate the most recent data on this topic and provide a scaffold for further conceptualization and research. RESULTS There are a limited number of studies addressing issues of psychosocial functioning in children with NAFLD. Pediatric NAFLD is frequently accompanied by neuropsychiatric symptoms and poor quality of life and the level of impairment does not correlate with the degree of hepatic damage. In addition, mentally and intellectually-impaired youth appear at greater risk for developing liver steatosis. CONCLUSIONS Pediatric NAFLD is associated with psychosocial parameters in a bidirectional way. Further research is needed on NAFLD's psychosocial correlates and on the effect of treatment on patients' well-being.
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Affiliation(s)
| | - Maria Kalogeropoulou
- Department of Psychiatry, School of Medicine, University of Patras, Patras, Greece
| | - Stelios Assimakopoulos
- Division of Infectious Diseases, Department of Internal Medicine, University General Hospital of Patras, Patras, Greece
| | - Christos Triantos
- Department of Gastroenterology, School of Medicine, University of Patras, Patras, Greece.
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22
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Han JC, Reyes-Capo DP, Liu CY, Reynolds JC, Turkbey E, Turkbey IB, Bryant J, Marshall JD, Naggert JK, Gahl WA, Yanovski JA, Gunay-Aygun M. Comprehensive Endocrine-Metabolic Evaluation of Patients With Alström Syndrome Compared With BMI-Matched Controls. J Clin Endocrinol Metab 2018; 103:2707-2719. [PMID: 29718281 PMCID: PMC6276679 DOI: 10.1210/jc.2018-00496] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/24/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Alström syndrome (AS), a monogenic form of obesity, is caused by recessive mutations in the centrosome- and basal body-associated gene ALMS1. AS is characterized by retinal dystrophy, sensory hearing loss, cardiomyopathy, childhood obesity, and metabolic derangements. OBJECTIVE We sought to characterize the endocrine and metabolic features of AS while accounting for obesity as a confounder by comparing patients with AS to body mass index (BMI)-matched controls. METHODS We evaluated 38 patients with AS (age 2 to 38 years) who were matched with 76 controls (age 2 to 48 years) by age, sex, race, and BMI. Fasting biochemistries, mixed meal test (MMT), indirect calorimetry, dual-energy X-ray absorptiometry, and MRI/magnetic resonance spectroscopy were performed. RESULTS Frequent abnormalities in AS included 76% obesity, 37% type 2 diabetes mellitus (T2DM), 29% hypothyroidism (one-third central, two-thirds primary), 3% central adrenal insufficiency, 57% adult hypogonadism (one-third central, two-thirds primary), and 25% female hyperandrogenism. Patients with AS and controls had similar BMI z scores, body fat, waist circumference, abdominal visceral fat, muscle fat, resting energy expenditure (adjusted for lean mass), free fatty acids, glucagon, prolactin, ACTH, and cortisol. Compared with controls, patients with AS were shorter and had lower IGF-1 concentrations (Ps ≤ 0.001). Patients with AS had significantly greater fasting and MMT insulin resistance indices, higher MMT glucose, insulin, and C-peptide values, higher HbA1c, and higher prevalence of T2DM (Ps < 0.001). Patients with AS had significantly higher triglycerides, lower high-density lipoprotein cholesterol, and a 10-fold greater prevalence of metabolic syndrome (Ps < 0.001). Patients with AS demonstrated significantly greater liver triglyceride accumulation and higher transaminases (P < 0.001). CONCLUSION Severe insulin resistance and T2DM are the hallmarks of AS. However, patients with AS may present with multiple other endocrinopathies affecting growth and development.
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Affiliation(s)
- Joan C Han
- Unit on Metabolism and Neuroendocrinology, Eunice Kennedy Shriver National
Institute of Child Health and Human Development, National Institutes of Health, Bethesda,
Maryland
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of
Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
- Departments of Pediatrics and Physiology, University of Tennessee Health
Science Center and Le Bonheur Children’s Foundation Research Institute, Memphis,
Tennessee
- Correspondence and Reprint Requests: Joan C. Han, MD, Departments of Pediatrics and Physiology, University of Tennessee
Health Science Center and Le Bonheur Children’s Foundation Research Institute, 50 North
Dunlap Street, Room 454R, Memphis, Tennessee 38103. E-mail:
| | - Daniela P Reyes-Capo
- Unit on Metabolism and Neuroendocrinology, Eunice Kennedy Shriver National
Institute of Child Health and Human Development, National Institutes of Health, Bethesda,
Maryland
| | - Chia-Ying Liu
- Radiology and Imaging Sciences, National Institutes of Health Clinical Research
Center, Bethesda, Maryland
| | - James C Reynolds
- Radiology and Imaging Sciences, National Institutes of Health Clinical Research
Center, Bethesda, Maryland
| | - Evrim Turkbey
- Radiology and Imaging Sciences, National Institutes of Health Clinical Research
Center, Bethesda, Maryland
| | - Ismail Baris Turkbey
- Center for Cancer Research, National Cancer Institute, National Institutes of
Health, Bethesda, Maryland
| | - Joy Bryant
- Human Biochemical Genetics Section, Medical Genetics Branch, National Human
Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | | | | | - William A Gahl
- Human Biochemical Genetics Section, Medical Genetics Branch, National Human
Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Jack A Yanovski
- Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of
Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Meral Gunay-Aygun
- Human Biochemical Genetics Section, Medical Genetics Branch, National Human
Genome Research Institute, National Institutes of Health, Bethesda, Maryland
- The McKusick-Nathans Institute of Genetic Medicine, Department of Pediatrics,
Johns Hopkins School of Medicine, Baltimore, Maryland
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23
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Kılınç S, Yücel-Yılmaz D, Ardagil A, Apaydın S, Valverde D, Özgül RK, Güven A. Five novel ALMS1 gene mutations in six patients with Alström syndrome. J Pediatr Endocrinol Metab 2018; 31:681-687. [PMID: 29715191 DOI: 10.1515/jpem-2017-0418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 03/12/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alström syndrome is a rare autosomal recessive inherited disorder caused by mutations in the ALMS1 gene. METHODS We describe the clinical and five novel mutational screening findings in six patients with Alström syndrome from five families in a single center with distinct clinical presentations of this condition. RESULTS Five novel mutations in ALMS1 in exon 8 and intron 17 were identified, one of them was a compound heterozygous: c.2259_2260insT, p.Glu754*; c.2035C>T p.Arg679*; c.2259_2260insT, p.Glu754*; c.5969C>G, p.Ser1990*; c.6541C>T, p. Gln2181*/c.11666-2A>G, splicing. One patient had gallstones, this association, to our knowledge, has not been reported in Alström syndrome previously. CONCLUSIONS Early diagnosis of Alström syndrome is often difficult in children and adolescents, because many of the clinical features develop over time. Early diagnosis can initiate an effective managemen of this condition, and it will help to reduce future damage.
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Affiliation(s)
- Suna Kılınç
- Department of Pediatric Endocrinology, Göztepe Education and Research Hospital, Pediatric Endocrinology Clinic, Istanbul, Turkey
| | - Didem Yücel-Yılmaz
- Hacettepe University, Institute of Child Health, Department of Pediatric Metabolism, Ankara, Turkey
| | - Aylin Ardagil
- Department of Ophthalmology, Göztepe Education and Research Hospital, Ophthalmology Clinics, Istanbul, Turkey
| | - Süheyla Apaydın
- Department of Nephrology, Nephrologist, Bakirkoy Sadi Konuk Education and Research Hospital, Nephrology Clinics, Istanbul, Turkey
| | - Diana Valverde
- Departamento de Bioquímica, Genética e Inmunología, Facultad de Biología, Universidad de Vigo, Pontevedra, Spain
| | - Rıza Köksal Özgül
- Hacettepe University, Institute of Child Health, Department of Pediatric Metabolism, Ankara, Turkey
| | - Ayla Güven
- Zeynep Kamil Kadın ve Çocuk Hastalıkları Eğitim ve Araştırma Hastanesi, Dr. Burhanettin Üstünel sokak, 34668, Üsküdar, Istanbul, Turkey, Phone: +905322380300
- Pediatric Endocrinologist, Göztepe Education and Research Hospital, Pediatric Endocrinology Clinic, Istanbul, Turkey
- Amasya University Medical Faculty, Department of Pediatrics, Amasya, Turkey
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24
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Hegarty R, Deheragoda M, Fitzpatrick E, Dhawan A. Paediatric fatty liver disease (PeFLD): All is not NAFLD - Pathophysiological insights and approach to management. J Hepatol 2018; 68:1286-1299. [PMID: 29471012 DOI: 10.1016/j.jhep.2018.02.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/11/2018] [Accepted: 02/13/2018] [Indexed: 12/14/2022]
Abstract
The recognition of a pattern of steatotic liver injury where histology mimicked alcoholic liver disease, but alcohol consumption was denied, led to the identification of non-alcoholic fatty liver disease (NAFLD). Non-alcoholic fatty liver disease has since become the most common chronic liver disease in adults owing to the global epidemic of obesity. However, in paediatrics, the term NAFLD seems incongruous: alcohol consumption is largely not a factor and inherited metabolic disorders can mimic or co-exist with a diagnosis of NAFLD. The term paediatric fatty liver disease may be more appropriate. In this article, we summarise the known causes of steatosis in children according to their typical, clinical presentation: i) acute liver failure; ii) neonatal or infantile jaundice; iii) hepatomegaly, splenomegaly or hepatosplenomegaly; iv) developmental delay/psychomotor retardation and perhaps most commonly; v) the asymptomatic child with incidental discovery of abnormal liver enzymes. We offer this model as a means to provide pathophysiological insights and an approach to management of the ever more complex subject of fatty liver.
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Affiliation(s)
- Robert Hegarty
- Paediatric Liver, GI and Nutrition Centre and Mowatlabs, King's College Hospital, London, United Kingdom
| | - Maesha Deheragoda
- Liver Histopathology, Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Emer Fitzpatrick
- Paediatric Liver, GI and Nutrition Centre and Mowatlabs, King's College Hospital, London, United Kingdom
| | - Anil Dhawan
- Paediatric Liver, GI and Nutrition Centre and Mowatlabs, King's College Hospital, London, United Kingdom.
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25
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Defective adaptive thermogenesis contributes to metabolic syndrome and liver steatosis in obese mice. Clin Sci (Lond) 2016; 131:285-296. [PMID: 27803297 DOI: 10.1042/cs20160469] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 02/06/2023]
Abstract
Fatty liver diseases are complications of the metabolic syndrome associated with obesity, insulin resistance and low grade inflammation. Our aim was to uncover mechanisms contributing to hepatic complications in this setting. We used foz/foz mice prone to obesity, insulin resistance and progressive fibrosing non-alcoholic steatohepatitis (NASH). Foz/foz mice are hyperphagic but wild-type (WT)-matched calorie intake failed to protect against obesity, adipose inflammation and glucose intolerance. Obese foz/foz mice had similar physical activity level but reduced energy expenditure. Thermogenic adaptation to high-fat diet (HFD) or to cold exposure was severely impaired in foz/foz mice compared with HFD-fed WT littermates due to lower sympathetic tone in their brown adipose tissue (BAT). Intermittent cold exposure (ICE) restored BAT function and thereby improved glucose tolerance, decreased fat mass and liver steatosis. We conclude that failure of BAT adaptation drives the metabolic complications of obesity in foz/foz mice, including development of liver steatosis. Induction of endogenous BAT function had a significant therapeutic impact on obesity, glucose tolerance and liver complications and is a potential new avenue for therapy of non-alcoholic fatty liver disease (NAFLD).
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