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Alsaleh Y, Al Ghadeer HA, Aljabri A, Alhashim Z, Mohamed M, Busaleh F, Alramadhan FA, Alghazal MM. Pseudohypoaldosteronism Type 1B and Cohen Syndrome: Novel Mutation, Unusual Combination, and Presentation. Cureus 2024; 16:e57217. [PMID: 38681476 PMCID: PMC11056278 DOI: 10.7759/cureus.57217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2024] [Indexed: 05/01/2024] Open
Abstract
Pseudohypoaldosteronism type 1 (PHA1) is a rare inherited disorder of resistance to aldosterone and presents with hyponatremia, hyperkalemia, and metabolic acidosis. Cohen syndrome (CS) is another rare inherited disease. Concurrent presentation with pseudohypoaldosteronism makes it so extraordinary and implies more challenges for clinicians. We report a case of a female with Cohen syndrome (novel mutation) and systemic pseudohypoaldosteronism, as well as the challenges we have encountered in the management of this patient.
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Affiliation(s)
- Yassin Alsaleh
- Endocrinology and Diabetes, Maternity and Children's Hospital, Al-Ahsa, SAU
| | | | - Aida Aljabri
- Endocrinology and Diabetes, Almoosa Specialist Hospital, Al-Ahsa, SAU
| | - Zahra Alhashim
- Endocrinology and Diabetes, King Faisal General Hospital, Al-Ahsa, SAU
| | - Moneera Mohamed
- Endocrinology and Diabetes, Maternity and Children's Hospital, Al-Ahsa, SAU
| | - Fadi Busaleh
- Pediatrics, Maternity and Children's Hospital, Al-Ahsa, SAU
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2
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Alkhatib EH, Bartlett D, Kanakatti Shankar R, Regier D, Merchant N. Case report: Early molecular confirmation and sodium polystyrene sulfonate management of systemic pseudohypoaldosteronism type I. Front Endocrinol (Lausanne) 2024; 14:1297335. [PMID: 38288475 PMCID: PMC10822876 DOI: 10.3389/fendo.2023.1297335] [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: 09/19/2023] [Accepted: 12/15/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Type 1 pseudohypoaldosteronism (PHA) consists of resistance to aldosterone. Neonatal presentation is characterized by salt wasting, hyperkalemia, and metabolic acidosis with high risk of mortality. Type 1 PHA can be autosomal dominant (renal type 1) or autosomal recessive (systemic type 1). Renal PHA type 1 can be feasibly managed with salt supplementation; however, systemic PHA type 1 tends to have more severe electrolyte imbalance and can be more refractory to treatment. Case Presentation We present a case of a 3-year-old girl with systemic PHA type 1, diagnosed and confirmed molecularly in infancy, who has been successfully managed with sodium polystyrene sulfonate decanted into feeds along with sodium supplementation. On day 5 of life, a full-term female infant presented to the ED for 2 days of non-bloody, non-bilious emesis, along with hypothermia to 94°F. Laboratory results were notable for hyponatremia (Na) of 127, hyperkalemia (K) of 7.9, and acidosis with bicarbonate level of 11.2. Genetic testing ordered within a week of life confirmed PHA type 1 with a homozygous pathogenic frameshift variant in SCNN1A c.575delA (p.Arg192GlyfsX57). Sodium polystyrene sulfonate and feeds were decanted until the age of 16 months, and she was also continued on NaCl supplementation. She was gradually transitioned to directly administered sodium polystyrene sulfonate without any electrolyte issues. She has overall done well after gastrostomy-tube (G-tube) placement without severe hyperkalemia even with several hospitalizations for gastrointestinal or respiratory illnesses. Discussion/Conclusion A treatment approach to systemic PHA and sodium polystyrene sulfonate administration in neonates and infants is described.
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Affiliation(s)
- Einas H. Alkhatib
- Department of Endocrinology, Children’s National Hospital, Washington, D.C., United States
| | - Deirdre Bartlett
- Department of Nephrology, Lurie Children’s Hospital, Chicago, IL, United States
| | - Roopa Kanakatti Shankar
- Department of Endocrinology, Children’s National Hospital, Washington, D.C., United States
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States
| | - Debra Regier
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States
- Department of Genetics and Metabolism, Children’s National Hospital, Washington, D.C., United States
| | - Nadia Merchant
- Department of Endocrinology, Children’s National Hospital, Washington, D.C., United States
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States
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3
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Coelho Almeida A, Bastos Gomes M, Martins SA, Marques OP, Gomes MM, Antunes AM. A case of severe systemic type 1 pseudohypoaldosteronism with 10 years of evolution. J Pediatr Endocrinol Metab 2022; 35:1448-1452. [PMID: 35918792 DOI: 10.1515/jpem-2022-0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/27/2022] [Indexed: 11/15/2022]
Abstract
Type 1 pseudohypoaldosteronism (PHA-1) is a rare genetic syndrome of unresponsiveness to aldosterone and presents in the neonatal period with hyperkalemia, hyponatremia and metabolic acidosis. The mortality rate can be high and multidisciplinary team is needed for optimal management and adequate growth and development of these patients. Many genotype-phenotype correlations remain uncertain, and the description of the evolution of cases can increase scientific knowledge about the psychomotor development and severity of the different mutations. We report the follow-up for the last 10 years of a patient, with previously unrecognized genetic findings identified. In addition, we reviewed the literature and compared it with other pediatric cases.
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Affiliation(s)
- André Coelho Almeida
- Department of Pediatrics and Neonatology, Centro Hospitalar de Trás-Os-Montes e Alto Douro, Vila Real, Portugal
| | - Mariana Bastos Gomes
- Department of Pediatrics, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - Sofia A Martins
- Pediatric Endocrinology and Diabetology Unit, Hospital de Braga, Braga, Portugal
| | | | - Maria Miguel Gomes
- Pediatric Endocrinology and Diabetology Unit, Hospital de Braga, Braga, Portugal.,School of Medicine, University of Minho, Braga, Portugal
| | - Ana M Antunes
- Pediatric Endocrinology and Diabetology Unit, Hospital de Braga, Braga, Portugal
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Huneif MA, Alhazmy ZH, Shoomi AM, Alghofely MA, Heena H, Mushiba AM, Alsaheel A. A Novel SCNN1A Variation in a Patient with Autosomal-recessive Pseudohypoaldosteronism Type 1. J Clin Res Pediatr Endocrinol 2022; 14:244-250. [PMID: 33829730 PMCID: PMC9176094 DOI: 10.4274/jcrpe.galenos.2021.2020.0175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Pseudohypoaldosteronism type 1 (PHA1) is an autosomal-recessive disorder characterized by defective regulation of body sodium (Na) levels. The abnormality results from mutations in the genes encoding subunits of the epithelial Na channel. Patients with PHA1 present in infancy as being in adrenal crisis. A 41-day-old female who presented with recurrent adrenal crisis did not adequately respond to hydrocortisone and required mineralocorticoid therapy. The patient’s demographic data and clinical features were recorded. Blood samples were collected and tested for endocrine and metabolic characteristics and for use in genetic studies. Bidirectional Sanger sequencing of SCNN1A was conducted. The entire coding region of 12 exons and 20 bp of flanking intron were sequenced. Genetic analyses revealed a new mutation - c.729_730delAG (p.Val245Glyfs*65) - in SCNN1A exon four. Adrenal crisis during the neonatal period highlights the importance of early screening for PHA1. Genetic testing could help to anticipate the prognosis, severity, onset of the disease, and the mode of inheritance, especially given its extensive phenotype.
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Affiliation(s)
- Mohammed Ayed Huneif
- Najran University Hospital, at Pediatric Department, Collage of Medicine, Najran University, Najran, Saudi Arabia,* Address for Correspondence: Najran University Hospital, at Pediatric Department, Collage of Medicine, Najran University, Najran, Saudi Arabia E-mail:
| | - Ziyad Hamad Alhazmy
- Al Yamammah Hospital, Clinic of Pediatric Endocrinology, Riyadh, Saudi Arabia
| | - Anas M. Shoomi
- King Fahad Medical City, Obesity, Endocrine, and Metabolism Center, Clinic of Pediatric Endocrinology, Riyadh, Saudi Arabia
| | - Mohammed A. Alghofely
- King Fahad Medical City, Obesity, Endocrine, and Metabolism Center, Clinic of Pediatric Endocrinology, Riyadh, Saudi Arabia
| | - Humariya Heena
- King Fahad Medical City, Research Center, Riyadh, Saudi Arabia
| | - Aziza M. Mushiba
- Clinical Geneticist, Pediatric Subspecialties Department, Children’s Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulhamid Alsaheel
- King Fahad Medical City, Obesity, Endocrine, and Metabolism Center, Clinic of Pediatric Endocrinology, Riyadh, Saudi Arabia
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5
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Liu Z, Wang X, Zhang Z, Yang Z, Wang J, Wang Y. Case Report: A Novel Compound Heterozygote Mutation of the SCNN1B Gene Identified in a Chinese Familial Pseudohypoaldosteronism Disease Type I With Persistent Hyperkalemia. Front Pediatr 2022; 10:831284. [PMID: 35359893 PMCID: PMC8960372 DOI: 10.3389/fped.2022.831284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/02/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Pseudohypoaldosteronism (PHA) diseases are difficult to diagnose because symptoms are often non-specific and an in-depth pathogenesis study is still lacking. CASE PRESENTATION We present the case of a 19-day-old neonate who presented with unexplained recurrent hyperkalaemia, hypovolemia and metabolic acidosis, whose parents did not have significant clinical disease characteristics. Whole-exome sequencing was performed to confirm the disease and genetic pattern of the neonate. Sanger sequencing was performed to identify the mutation sites. Secondary structure comparisons and 3D model construction were used to predict changes in protein structure. Two novel frameshift mutations in the SCNN1B gene were identified (c.1290delA and c.1348_1361del), which resulted in amino acid synthesis termination (p.Gln431ArgfsTer2 and p.Thr451AspfsTer6). Considering the clinical phenotype and genetic analysis, this case was finally identified as a PHA type I disease. Genetic analysis showed that the neonate suffered complex heterozygosity in the SCNN1B gene inherited from the parents, which is passed on in an autosomal recessive inheritance pattern. These two deleterious mutations resulted in an incomplete protein 3D structure. CONCLUSIONS Our results have confirmed the associations of mutations in the SCNN1B gene with recurrent hyperkalaemia, which can cause severe PHA type I disease, meanwhile suggested clinical attention should be paid when persistent recurrent hyperkalemia is accompanied by these types of mutations.
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Affiliation(s)
- Zongzhi Liu
- Shenzhen Key Laboratory of Synthetic Genomics, Guangdong Provincial Key Laboratory of Synthetic Genomics, CAS Key Laboratory of Quantitative Engineering Biology, Shenzhen Institute of Synthetic Biology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Central Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academic of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Xiaojiao Wang
- Department of Neonatal Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Zilong Zhang
- Tianjin Novogene Bioinformatic Technology Co., Ltd., Tianjin, China
| | - Zixin Yang
- Department of Neonatal Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Junyun Wang
- CAS Key Laboratory of Genome Sciences and Information, China National Center for Bioinformation, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, China
| | - Yajuan Wang
- Department of Neonatology, Children's Hospital, Capital Institute of Pediatrics, Beijing, China
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Karacan Küçükali G, Çetinkaya S, Tunç G, Oğuz MM, Çelik N, Akkaş KY, Şenel S, Güleray Lafcı N, Savaş Erdeve Ş. Clinical Management in Systemic Type Pseudohypoaldosteronism Due to SCNN1B Variant and Literature Review. J Clin Res Pediatr Endocrinol 2021; 13:446-451. [PMID: 32840096 PMCID: PMC8638636 DOI: 10.4274/jcrpe.galenos.2020.2020.0107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Systemic pseudohypoaldosteronism (PHA) is a rare, salt-wasting syndrome that is caused by inactivating variants in genes encoding epithelial sodium channel subunits. Hyponatremia, hyperkalemia, metabolic acidosis, increased aldosterone and renin levels are expected findings in PHA. Clinical management is challenging due to high dose oral replacement therapy. Furthermore, patients with systemic PHA require life-long therapy. Here we report a patient with systemic PHA due to SCNN1B variant whose hyponatremia and hyperkalemia was detected at the 24th hour of life. Hyperkalemia did not improve with conventional treatments and dialysis was required. He also developed myocarditis and hypertension in follow-up. Challenges for diagnosis and treatment in this patient are discussed herein. In addition, published evidence concerning common features of patients with SCNN1B variant are reviewed.
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Affiliation(s)
- Gülin Karacan Küçükali
- University of Health Sciences Turkey, Dr. Sami Ulus Maternity, Child Health and Diseases Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey,* Address for Correspondence: University of Health Sciences Turkey, Dr. Sami Ulus Maternity, Child Health and Diseases Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey Phone: +90 533 764 84 26 E-mail:
| | - Semra Çetinkaya
- University of Health Sciences Turkey, Dr. Sami Ulus Maternity, Child Health and Diseases Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
| | - Gaffari Tunç
- Sivas Cumhuriyet University Faculty of Medicine, Department of Child Health and Diseases, Division of Neonatalogy, Sivas, Turkey
| | - M. Melek Oğuz
- University of Health Sciences Turkey, Dr. Sami Ulus Maternity, Child Health and Diseases Training and Research Hospital, Clinic of Pediatric, Ankara, Turkey
| | - Nurullah Çelik
- Sivas Cumhuriyet University Faculty of Medicine, Department of Child Health and Diseases, Division of Pediatric Endocrinology, Sivas, Turkey
| | - Kardelen Yağmur Akkaş
- University of Health Sciences Turkey, Dr. Sami Ulus Maternity, Child Health and Diseases Training and Research Hospital, Clinic of Pediatric, Ankara, Turkey
| | - Saliha Şenel
- University of Health Sciences Turkey, Dr. Sami Ulus Maternity, Child Health and Diseases Training and Research Hospital, Clinic of Pediatric, Ankara, Turkey
| | - Naz Güleray Lafcı
- University of Health Sciences Turkey, Dr. Sami Ulus Maternity, Child Health and Diseases Training and Research Hospital, Clinic of Medical Genetics, Ankara, Turkey
| | - Şenay Savaş Erdeve
- University of Health Sciences Turkey, Dr. Sami Ulus Maternity, Child Health and Diseases Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
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7
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Goda T, Komatsu H, Nozu K, Nakajima H. An infantile case of pseudohypoaldosteronism type 1 (PHA1) caused by a novel mutation of NR3C2. Clin Pediatr Endocrinol 2020; 29:127-130. [PMID: 32694891 PMCID: PMC7348633 DOI: 10.1297/cpe.29.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/21/2020] [Indexed: 11/23/2022] Open
Affiliation(s)
- Takeshi Goda
- Department of Pediatrics, Kyoto Chubu Medical Center, Kyoto, Japan.,Department of Pediatrics, National Hospital Organization Maizuru Medical Center, Kyoto, Japan
| | - Hiroshi Komatsu
- Department of Pediatrics, National Hospital Organization Maizuru Medical Center, Kyoto, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Hisakazu Nakajima
- Department of Pediatrics, National Hospital Organization Maizuru Medical Center, Kyoto, Japan.,Department of Pediatrics, North Medical Center Kyoto Prefectural University of Medicine, Kyoto, Japan
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Almughem FA, Aldossary AM, Tawfik EA, Alomary MN, Alharbi WS, Alshahrani MY, Alshehri AA. Cystic Fibrosis: Overview of the Current Development Trends and Innovative Therapeutic Strategies. Pharmaceutics 2020; 12:E616. [PMID: 32630625 PMCID: PMC7407299 DOI: 10.3390/pharmaceutics12070616] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022] Open
Abstract
Cystic Fibrosis (CF), an autosomal recessive genetic disease, is caused by a mutation in the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR). This mutation reduces the release of chloride ions (Cl-) in epithelial tissues, and hyperactivates the epithelial sodium channels (ENaC) which aid in the absorption of sodium ions (Na+). Consequently, the mucus becomes dehydrated and thickened, making it a suitable medium for microbial growth. CF causes several chronic lung complications like thickened mucus, bacterial infection and inflammation, progressive loss of lung function, and ultimately, death. Until recently, the standard of clinical care in CF treatment had focused on preventing and treating the disease complications. In this review, we have summarized the current knowledge on CF pathogenesis and provided an outlook on the current therapeutic approaches relevant to CF (i.e., CFTR modulators and ENaC inhibitors). The enormous potential in targeting bacterial biofilms using antibiofilm peptides, and the innovative therapeutic strategies in using the CRISPR/Cas approach as a gene-editing tool to repair the CFTR mutation have been reviewed. Finally, we have discussed the wide range of drug delivery systems available, particularly non-viral vectors, and the optimal properties of nanocarriers which are essential for successful drug delivery to the lungs.
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Affiliation(s)
- Fahad A. Almughem
- National Centre for Pharmaceutical Technology, King Abdulaziz City for Science and Technology (KACST), P.O. Box 6086, Riyadh 11442, Saudi Arabia; (F.A.A.); (E.A.T.)
| | - Ahmad M. Aldossary
- National Centre for Biotechnology, King Abdulaziz City for Science and Technology (KACST), P.O. Box 6086, Riyadh 11442, Saudi Arabia; (A.M.A.); (M.N.A.)
| | - Essam A. Tawfik
- National Centre for Pharmaceutical Technology, King Abdulaziz City for Science and Technology (KACST), P.O. Box 6086, Riyadh 11442, Saudi Arabia; (F.A.A.); (E.A.T.)
| | - Mohammad N. Alomary
- National Centre for Biotechnology, King Abdulaziz City for Science and Technology (KACST), P.O. Box 6086, Riyadh 11442, Saudi Arabia; (A.M.A.); (M.N.A.)
| | - Waleed S. Alharbi
- Department of Pharmaceutics, Faculty of Pharmacy, King Abdulaziz University, P.O. Box 80260, Jeddah 21589, Saudi Arabia;
| | - Mohammad Y. Alshahrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, P.O. Box 61413, Abha 9088, Saudi Arabia;
| | - Abdullah A. Alshehri
- National Centre for Pharmaceutical Technology, King Abdulaziz City for Science and Technology (KACST), P.O. Box 6086, Riyadh 11442, Saudi Arabia; (F.A.A.); (E.A.T.)
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9
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Recent insights into sodium and potassium handling by the aldosterone-sensitive distal nephron: implications on pathophysiology and drug discovery. J Nephrol 2020; 33:447-466. [DOI: 10.1007/s40620-020-00700-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 01/02/2020] [Indexed: 12/31/2022]
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Cayir A, Demirelli Y, Yildiz D, Kahveci H, Yarali O, Kurnaz E, Vuralli D, Demirbilek H. Systemic Pseudohypoaldosteronism Type 1 due to 3 Novel Mutations in SCNN1Aand SCNN1BGenes. Horm Res Paediatr 2019; 91:175-185. [PMID: 31018202 DOI: 10.1159/000498860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 02/12/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The systemic form of pseudohypoaldosteronism type 1 (PHA1) is an autosomal recessive disorder characterized by defective sodium transport in multi-organ systems. Mutations in the genes encoding the amiloride-sensitive epithelial sodium channel, ENaC, account for genetic causes of systemic PHA1. We describe systemic PHA1 due to 4 novel variants detected in SCNN1A and SCNN1B in 3 cases from 3 unrelated consanguineous families. PATIENTS AND METHODS We evaluated the clinical presentations, biochemical and hormonal characteristics, and molecular genetic analysis results of 3 patients from 3 unrelated consanguineous families and parents from whom samples were available. RESULTS The ages at presentation were postnatal days 9, 10, and 5. The main presentation symptoms were vomiting, poor feeding, weakness, weight loss, and skin rash. All patients exhibited laboratory characteristics including severe hyponatremia, hyperkalemia, metabolic acidosis, elevated plasma renin, elevated aldosterone, and positive sweat tests, suggesting a diagnosis of systemic PHA1. Molecular genetic analysis revealed 2 novel pathogenic variants [c.87C>A(p.Tyr29*)/IVS9 + 1G>A (c.1346 + 1G>A)] in SCNN1Bin case 1, a novel homozygous pathogenic variant [p.His69Arg(c.206A>G] in SCNN1Ain case 2, and a homozygous one-base duplication, p.A200Gfs*6 (c.598dupG), in SCNN1A in case 3. CONCLUSION PHA1 should be considered at differential diagnosis in patients presenting with hyponatremia, hyperkalemia, and metabolic acidosis. The cases in this report involving 4 novel variants will add valuable insights into the phenotype-genotype relationship and will expand the mutation database.
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Affiliation(s)
- Atilla Cayir
- Department of Paediatric Endocrinology, Erzurum Regional Research and Training Hospital, Erzurum, Turkey,
| | - Yasar Demirelli
- Department of Neonatology, Erzurum Regional Research and Training Hospital, Erzurum, Turkey
| | - Duran Yildiz
- Department of Neonatology, Erzurum Regional Research and Training Hospital, Erzurum, Turkey
| | - Hasan Kahveci
- Department of Neonatology, Erzurum Regional Research and Training Hospital, Erzurum, Turkey
| | - Oguzhan Yarali
- Department of Medical Genetics, Erzurum Regional Research and Training Hospital, Erzurum, Turkey
| | - Erdal Kurnaz
- Department of Paediatric Endocrinology, Erzurum Regional Research and Training Hospital, Erzurum, Turkey
| | - Doğuş Vuralli
- Department of Paediatric Endocrinology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Huseyin Demirbilek
- Department of Paediatric Endocrinology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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11
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Mezger A, Ruland A, Ruef P. Pseudohypoaldosteronismus Typ I. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-019-00787-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Shei RJ, Peabody JE, Kaza N, Rowe SM. The epithelial sodium channel (ENaC) as a therapeutic target for cystic fibrosis. Curr Opin Pharmacol 2018; 43:152-165. [PMID: 30340955 PMCID: PMC6294660 DOI: 10.1016/j.coph.2018.09.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 09/11/2018] [Indexed: 01/28/2023]
Abstract
Cystic fibrosis (CF) is a monogenic disease caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. CFTR dysfunction is characterized by abnormal mucociliary transport due to a dehydrated airway surface liquid (ASL) and hyperviscous mucus, among other pathologies of host defense. ASL depletion is caused by the absence of CFTR mediated chloride secretion along with continued activity of the epithelial sodium channel (ENaC) activity, which can also be affected by CFTR mediated anion conductance. Therefore, ENaC has been proposed as a therapeutic target to ameliorate ASL dehydration and improve mucus transport. Inhibition of ENaC has been shown to restore ASL hydration and enhance mucociliary transport in induced models of CF lung disease. To date, no therapy inhibiting ENaC has successfully translated to clinical efficacy, in part due to concerns regarding off-target effects, systemic exposure, durability of effect, and adverse effects. Recent efforts have been made to develop novel, rationally designed therapeutics to produce-specific, long-lasting inhibition of ENaC activity in the airways while simultaneously minimizing off target fluid transport effects, systemic exposure and side effects. Such approaches comprise next-generation small molecule direct inhibitors, indirect channel-activating protease inhibitors, synthetic peptide analogs, and oligonucleotide-based therapies. These novel therapeutics represent an exciting step forward in the development of ENaC-directed therapies for CF.
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Affiliation(s)
- Ren-Jay Shei
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; The Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jacelyn E Peabody
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Medical Scientist (MD/PhD) Training Program, University of Alabama at Birmingham, Birmingham, AL, USA; The Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Niroop Kaza
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; The Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Steven M Rowe
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA; Department of Cell Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL, USA; The Gregory Fleming James Cystic Fibrosis Research Center, University of Alabama at Birmingham, Birmingham, AL, USA.
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