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J. S, Upadhyay Z, N. VH, Sathyanarayana SO, Palany R, J. S. Clinical Experience from a Single Tertiary Care Center: Neonatal Diabetes Mellitus with Multiple Epiphyseal Dysplasia-Wolcott-Rallison's Syndrome. J Pediatr Genet 2024; 13:185-189. [PMID: 39086446 PMCID: PMC11288704 DOI: 10.1055/s-0043-57005] [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: 05/19/2022] [Accepted: 03/11/2023] [Indexed: 08/02/2024]
Abstract
Wolcott-Rallison's syndrome (WRS) is a rare nonautoimmune autosomal recessive disorder characterized by neonatal diabetes mellitus, epiphyseal dysplasia, and growth retardation. This is the most common cause of diabetes mellitus in patients with consanguineous parents. WRS is distinguished from other types of neonatal or early-onset diabetes by clinical characteristics and genetic testing. Here, we report four cases of WRS from South India. All four children reported here were born to consanguineous parents and were diagnosed with neonatal diabetes and skeletal dysplasia. Case 1 is a 13-year-old girl with neonatal diabetes and skeletal dysplasia. Case 2 is a 6-month-old male infant who also has primary hypothyroidism. Case 3 was a girl who lived until the age of 4 years before succumbing to liver failure. Case 4 is an 8-month-old female infant born to a third-degree married couple who presented with neonatal diabetes and diabetic ketoacidosis. Genetic testing revealed that she had WRS, which helps us in the anticipation and early treatment of complications.
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Affiliation(s)
- Shantala J.
- Department of Paediatric and Adolescent Endocrinology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | | | - Vani H. N.
- Department of Paediatric and Adolescent Endocrinology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Santhosh Olety Sathyanarayana
- Department of Paediatric and Adolescent Endocrinology, Karnataka Institute of Diabetology, Bengaluru, Karnataka, India
| | - Raghupathy Palany
- Department of Paediatric and Adolescent Endocrinology, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
| | - Shruthi J.
- Department of Endocrinology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Hegarty R, Thompson RJ. Genetic aetiologies of acute liver failure. J Inherit Metab Dis 2024; 47:582-597. [PMID: 38499319 DOI: 10.1002/jimd.12733] [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: 12/01/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 03/20/2024]
Abstract
Acute liver failure (ALF) is a rare, rapidly evolving, clinical syndrome with devastating consequences where definitive treatment is by emergency liver transplantation. Establishing a diagnosis can be challenging and, historically, the cause of ALF was unidentified in up to half of children. However, recent technological and clinical advances in genomic medicine have led to an increasing proportion being diagnosed with monogenic aetiologies of ALF. The conditions encountered include a diverse group of inherited metabolic disorders each with prognostic and treatment implications. Often these disorders are clinically indistinguishable and may even mimic disorders of immune regulation or red cell disorders. Rapid genomic sequencing for children with ALF is, therefore, a key component in the diagnostic work up today. This review focuses on the monogenic aetiologies of ALF.
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Affiliation(s)
- Robert Hegarty
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK
- Institute of Liver Studies, King's College London, London, UK
| | - Richard J Thompson
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK
- Institute of Liver Studies, King's College London, London, UK
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Weerasooriya L, Howie AJ, Wakeman MP, Cavanagh S, Milford DV. Kidney biopsy findings in children with diabetes mellitus. Pediatr Nephrol 2024; 39:1865-1873. [PMID: 38123711 PMCID: PMC11026184 DOI: 10.1007/s00467-023-06254-9] [Citation(s) in RCA: 1] [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: 09/11/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Diabetic nephropathy may begin in childhood, but clinical kidney disease ascribable to this is uncommon in children with type 1 (insulin dependent) diabetes mellitus. METHODS We reviewed our experience of kidney biopsies in children with type 1 diabetes mellitus. RESULTS Between 1995 and 2022, there were biopsies in 17 children, with various clinical indications for kidney biopsy, making this the largest series of biopsies in diabetic children with clinical kidney abnormalities. Four biopsies showed diabetic nephropathy, three showed the combination of diabetic nephropathy and IgA nephropathy, and ten showed a variety of conditions other than diabetic nephropathy: minimal change disease (2), membranous nephropathy (2), thin glomerular basement membrane lesion (2), non-glomerular chronic damage in Wolcott-Rallison syndrome (2), acute pauciimmune necrotizing crescentic glomerulonephritis (1) and IgA nephropathy (1). Clinical clues of something other than diabetic nephropathy included acute kidney injury, microscopic haematuria or chronic kidney impairment with little or no proteinuria and the nephrotic syndrome after a short duration of diabetes. CONCLUSIONS We confirm that changes better known in adults with either type 1 or type 2 diabetes mellitus can occur in children with type 1 diabetes mellitus: overt diabetic nephropathy either on its own or combined with other conditions and kidney disorders other than diabetic nephropathy.
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Affiliation(s)
| | - Alexander J Howie
- Department of Histopathology, Birmingham Children's Hospital, Birmingham, B4 6NH, UK.
| | - Matthew P Wakeman
- Department of Histopathology, Birmingham Children's Hospital, Birmingham, B4 6NH, UK
| | - Susan Cavanagh
- Department of Histopathology, Birmingham Children's Hospital, Birmingham, B4 6NH, UK
| | - David V Milford
- Department of Nephrology, Birmingham Children's Hospital, Birmingham, B4 6NH, UK
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Ravindranath A, Singh S, Wadhwa R, Wadhwa M, Sengupta K. Recurrent Liver Failure Due to Wolcott Rallison Syndrome. Indian J Pediatr 2024:10.1007/s12098-024-05172-4. [PMID: 38801496 DOI: 10.1007/s12098-024-05172-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Affiliation(s)
- Aathira Ravindranath
- Division of Pediatric Gastroenterology and Hepatology, Department of Gastroenterology, Apollo BGS Hospitals, Mysore, India.
| | - Snigdha Singh
- Division of Pediatric Gastroenterology and Hepatology, Department of Gastroenterology, Apollo BGS Hospitals, Mysore, India
| | - Rajkumar Wadhwa
- Division of Pediatric Gastroenterology and Hepatology, Department of Gastroenterology, Apollo BGS Hospitals, Mysore, India
| | | | - Kushan Sengupta
- Division of Pediatric Gastroenterology and Hepatology, Department of Gastroenterology, Apollo BGS Hospitals, Mysore, India
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Aldrian D, Bochdansky C, Kavallar AM, Mayerhofer C, Deeb A, Habeb A, Romera Rabasa A, Khadilkar A, Uçar A, Knoppke B, Zafeiriou D, Lang-Muritano M, Miqdady M, Judmaier S, McLin V, Furdela V, Müller T, Vogel GF. Natural history of Wolcott-Rallison syndrome: A systematic review and follow-up study. Liver Int 2024; 44:811-822. [PMID: 38230874 DOI: 10.1111/liv.15834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND AND AIMS To systematically review the literature for reports on Wolcott-Rallison syndrome, focusing on the spectrum and natural history, genotype-phenotype correlations, patient and native liver survival, and long-term outcomes. METHODS PubMed, Livio, Google Scholar, Scopus and Web of Science databases were searched. Data on genotype, phenotype, therapy, cause of death and follow-up were extracted. Survival and correlation analyses were performed. RESULTS Sixty-two studies with 159 patients met the inclusion criteria and additional 30 WRS individuals were collected by personal contact. The median age of presentation was 2.5 months (IQR 2) and of death was 36 months (IQR 50.75). The most frequent clinical feature was neonatal diabetes in all patients, followed by liver impairment in 73%, impaired growth in 72%, skeletal abnormalities in 59.8%, the nervous system in 37.6%, the kidney in 35.4%, insufficient haematopoiesis in 34.4%, hypothyroidism in 14.8% and exocrine pancreas insufficiency in 10.6%. Episodes of acute liver failure were frequently reported. Liver transplantation was performed in six, combined liver-pancreas in one and combined liver-pancreas-kidney transplantation in two individuals. Patient survival was significantly better in the transplant cohort (p = .0057). One-, five- and ten-year patient survival rates were 89.4%, 65.5% and 53.1%, respectively. Liver failure was reported as the leading cause of death in 17.9% of cases. Overall survival was better in individuals with missense mutations (p = .013). CONCLUSION Wolcott-Rallison syndrome has variable clinical courses. Overall survival is better in individuals with missense mutations. Liver- or multi-organ transplantation is a feasible treatment option to improve survival.
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Affiliation(s)
- Denise Aldrian
- Department of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Clemens Bochdansky
- Department of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna M Kavallar
- Department of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Mayerhofer
- Department of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Asma Deeb
- Paediatric Endocrinology Division, Sheikh Shakhbout Medical City, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Abdelhadi Habeb
- Department of Pediatrics, Prince Mohamed bin Abdulaziz Hospital, National Guard Health Affairs, Madinah, Saudi Arabia
| | - Andrea Romera Rabasa
- Department of Pediatric Anesthesia, Gregorio Marañón University Hospital, Madrid, Spain
| | - Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Ahmet Uçar
- Department of Pediatric Endocrinology & Diabetes, University of Health Sciences, Şişli Hamidiye Etfal Health Practices & Research Centre, Istanbul, Turkey
| | - Birgit Knoppke
- University Children's Hospital Regensburg (KUNO), University Medical Center Regensburg, Regensburg, Germany
| | - Dimitrios Zafeiriou
- 1st Department of Pediatrics, Hippokratio General Hospital, Aristotle University, Thessaloniki, Greece
| | - Mariarosaria Lang-Muritano
- Department of Endocrinology and Diabetology and Children's Research Centre, University Children's Hospital, Zurich, Switzerland
| | - Mohamad Miqdady
- Division of Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Sylvia Judmaier
- Department of Paediatrics, LKH Hochsteiermark/Standort Leoben, Leoben, Austria
| | - Valerié McLin
- Department of Pediatrics, Gynecology and Obstetrics, Swiss Pediatric Liver Center, University of Geneva, Geneva, Switzerland
| | - Viktoriya Furdela
- Department of Pediatrics, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
| | - Thomas Müller
- Department of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg F Vogel
- Department of Paediatrics I, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Cell Biology, Medical University of Innsbruck, Innsbruck, Austria
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Niculae AȘ, Bolba C, Grama A, Mariş A, Bodea L, Căinap S, Mititelu A, Fufezan O, Pop TL. Wolcott-Rallison Syndrome, a Rare Cause of Permanent Diabetes Mellitus in Infants-Case Report. Pediatr Rep 2023; 15:608-616. [PMID: 37873802 PMCID: PMC10594453 DOI: 10.3390/pediatric15040056] [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: 07/24/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023] Open
Abstract
Wolcott-Rallison syndrome is a rare cause of permanent neonatal diabetes mellitus caused by mutations in the eukaryotic translation initiation factor 2 alpha kinase 3 gene (EIF2AK3). Individuals affected by this disorder have severe hyperglycemia, pancreatic failure, and bone abnormalities and are prone to severe and life-threatening episodes of liver failure. This report illustrates the case of a 2-month-old infant with extreme hyperglycemia and severe diabetic ketoacidosis. Acute management was focused on correcting severe acidosis. Further management aimed to obtain stable blood glucose levels, balancing the patient's need for comfort and lack of distress with the clinicians' need for adequate information regarding the patient's glycemic control. Genetic testing of the patient and his parents confirmed the diagnosis. The follow-up for 18 months after diagnosis is detailed, illustrating both the therapeutic success of subcutaneous insulin therapy and the ongoing complications that patients with Wolcott-Rallison syndrome are subject to.
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Affiliation(s)
- Alexandru-Ștefan Niculae
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400177 Cluj-Napoca, Romania; (A.-Ș.N.); (S.C.); (A.M.); (T.L.P.)
| | - Claudia Bolba
- 2nd Pediatric Clinic, Emergency Clinical Hospital for Children Cluj-Napoca, 400177 Cluj-Napoca, Romania;
| | - Alina Grama
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400177 Cluj-Napoca, Romania; (A.-Ș.N.); (S.C.); (A.M.); (T.L.P.)
- 2nd Pediatric Clinic, Emergency Clinical Hospital for Children Cluj-Napoca, 400177 Cluj-Napoca, Romania;
| | - Alexandra Mariş
- Intesive Care Unit, Emergency Clinical Hospital for Children Cluj-Napoca, 400370 Cluj-Napoca, Romania; (A.M.); (L.B.)
| | - Laura Bodea
- Intesive Care Unit, Emergency Clinical Hospital for Children Cluj-Napoca, 400370 Cluj-Napoca, Romania; (A.M.); (L.B.)
| | - Simona Căinap
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400177 Cluj-Napoca, Romania; (A.-Ș.N.); (S.C.); (A.M.); (T.L.P.)
- 2nd Pediatric Clinic, Emergency Clinical Hospital for Children Cluj-Napoca, 400177 Cluj-Napoca, Romania;
| | - Alexandra Mititelu
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400177 Cluj-Napoca, Romania; (A.-Ș.N.); (S.C.); (A.M.); (T.L.P.)
| | - Otilia Fufezan
- Department of Imaging, Emergency Clinical Hospital for Children Cluj-Napoca, 400370 Cluj-Napoca, Romania;
| | - Tudor Lucian Pop
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400177 Cluj-Napoca, Romania; (A.-Ș.N.); (S.C.); (A.M.); (T.L.P.)
- 2nd Pediatric Clinic, Emergency Clinical Hospital for Children Cluj-Napoca, 400177 Cluj-Napoca, Romania;
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Pediatric acute liver failure in Saudi Arabia: prognostic indicators, outcomes and the role of genetic testing. Eur J Gastroenterol Hepatol 2023; 35:420-430. [PMID: 36574286 DOI: 10.1097/meg.0000000000002499] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
OBJECTIVE The objective of this study was to determine the etiologies, outcomes, prognostic indicators and the role of genetic testing in children with acute liver failure (ALF). METHODS This retrospective study included 46 patients with pediatric acute liver failure (PALF) according to the PALF study group definition, admitted to King Fahad Specialist Hospital-Dammam, Saudi Arabia, between January 2014 and December 2021. Patients who survived with supportive therapy were designated as the recovery group, whereas those who died or underwent liver transplantation were designated as the death/transplant group. RESULTS There were 26 (56.5%) patients in the recovery group and 20 (43.5%) patients in the death/transplant group. Four patients (8.7%) underwent liver transplantation. After indeterminate causes (45.6%), genetic-metabolic diseases and drug-induced liver injury (DILI) were the most common cause with 15.2 and 13%, respectively. Genetic testing had a high yield of (6/31) in identifying monogenic disease associated with ALF. Younger age, lower Glasgow Coma Scale and higher international normalized ratio (INR) on admission were predictors for poor prognosis. The death/transplant group had longer intensive care unit stay ( P < 0.001), and on admission they had more advanced hepatic encephalopathy ( P < 0.005), more prolonged prothrombin time ( P < 0.001), higher lactate ( P < 0.006), higher total and direct bilirubin ( P < 0.008) and ( P < 0.001), respectively. CONCLUSION Genetic, metabolic and DILI causes constituted the most common cause of PALF after indeterminate causes. The use of genetic testing can improve diagnostic rates in special cases, but we could not assess the effect of genetic testing on prognosis. The overall survival rate in our study was 65.2%. Younger age, higher admission INR and lower Glasgow coma scale were indicators of poor prognosis.
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Greeley SAW, Polak M, Njølstad PR, Barbetti F, Williams R, Castano L, Raile K, Chi DV, Habeb A, Hattersley AT, Codner E. ISPAD Clinical Practice Consensus Guidelines 2022: The diagnosis and management of monogenic diabetes in children and adolescents. Pediatr Diabetes 2022; 23:1188-1211. [PMID: 36537518 PMCID: PMC10107883 DOI: 10.1111/pedi.13426] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Siri Atma W. Greeley
- Section of Pediatric and Adult Endocrinology, Diabetes and Metabolism, Kovler Diabetes Center and Comer Children's HospitalUniversity of Chicago MedicineChicagoIllinoisUSA
| | - Michel Polak
- Hôpital Universitaire Necker‐Enfants MaladesUniversité de Paris Cité, INSERM U1016, Institut IMAGINEParisFrance
| | - Pål R. Njølstad
- Department of Clinical ScienceUniversity of Bergen, and Children and Youth Clinic, Hauk eland University HospitalBergenNorway
| | - Fabrizio Barbetti
- Clinical Laboratory UnitBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Rachel Williams
- National Severe Insulin Resistance ServiceCambridge University Hospitals NHS TrustCambridgeUK
| | - Luis Castano
- Endocrinology and Diabetes Research Group, Biocruces Bizkaia Health Research InstituteCruces University Hospital, CIBERDEM, CIBERER, Endo‐ERN, UPV/EHUBarakaldoSpain
| | - Klemens Raile
- Department of Paediatric Endocrinology and DiabetologyCharité – UniversitätsmedizinBerlinGermany
| | - Dung Vu Chi
- Center for Endocrinology, Metabolism, Genetics and Molecular Therapy, Departement of Pediatric Endocrinology and DiabetesVietnam National Children's HospitalHanoiVietnam
- Department of Pediatrics and Department of Biology and Medical GeneticsHanoi Medical UniversityHanoiVietnam
| | - Abdelhadi Habeb
- Department of PediatricsPrince Mohamed bin Abdulaziz Hopsital, National Guard Health AffairsMadinahSaudi Arabia
| | - Andrew T. Hattersley
- Institute of Biomedical and Clinical SciencesUniversity of Exeter Medical SchoolExeterUK
| | - Ethel Codner
- Institute of Maternal and Child ResearchSchool of Medicine, University of ChileSantiagoChile
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Abdelmeguid Y, Mowafy EW, Marzouk I, Franco ED, ElSayed S. Clinical and molecular characteristics of infantile-onset diabetes mellitus in Egypt. Ann Pediatr Endocrinol Metab 2022; 27:214-222. [PMID: 35114785 PMCID: PMC9537677 DOI: 10.6065/apem.2142184.092] [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: 09/08/2021] [Accepted: 12/17/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In patients diagnosed with diabetes mellitus (DM) before the age of 12 months, there is an increasing recognition of diabetes caused by single-gene mutations, also known as monogenic diabetes of infancy or neonatal DM (NDM). This study aimed to classify patients at Alexandria University Children's Hospital (AUCH) diagnosed with infantile-onset DM into type 1 DM (T1DM) or NDM and to detect differences in molecular characteristics of NDM patients at our center in comparison to other countries. METHODS This retrospective/prospective observational study was conducted on 39 patients diagnosed with infantile-onset DM (age of onset ≤1 year) at AUCH from January 2003 to November 2020. The patients were divided into 2 groups according to age at the onset of DM: ≤6 months and >6-12 months. Molecular testing was done in patients diagnosed with DM at ≤6 months and those with negative autoantibodies. RESULTS Twelve patients were diagnosed with DM at age ≤6 months and 27 patients were diagnosed between 6-12 months. Seventeen patients (43.6%) had T1DM, whereas 9 patients (23.1%) had genetically confirmed NDM, including 3 harboring novel mutations. The most common genetic causes of NDM were EIF2AK3 mutations (n=3), followed by KCNJ11 (n=2) and ABCC8 (n=2). Other mutations included SLC19A2 (n=1) and INS (n=1). Three patients with potassium ATP channel mutations were transferred from insulin to sulfonylurea treatment. CONCLUSION It is essential to identify patients with NDM clinically and confirm the diagnosis by molecular testing to distinguish them from T1DM as it helps in refining their management, predicting prognosis, and guiding genetic counseling.
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Affiliation(s)
- Yasmine Abdelmeguid
- Faculty of Medicine, Alexandria University, Alexandria, Egypt,Address for correspondence: Yasmine Abdelmeguid Faculty of Medicine, Alexandria University, Champollion Street, El-Khartoum Square, El Azareeta Medical Campus, Alexandria, Egypt
| | | | - Iman Marzouk
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Elisa De Franco
- University of Exeter Medical School, Institute of Biomedical and Clinical Science, Exeter, UK
| | - Shaymaa ElSayed
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Memon F, Arif M, Kirmani S, Humayun KN. Wolcott-Rallison syndrome: a case series of three patients. Pediatr Endocrinol Diabetes Metab 2022; 28:238-240. [PMID: 36106422 PMCID: PMC10214929 DOI: 10.5114/pedm.2022.118325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/28/2022] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Neonatal diabetes is a rare disease with incidence estimated at 1 in 300,000 to 1 in 400,000 live births. Walcott-Rallison syndrome has been identified as the most common cause of permanent neonatal diabetes in consanguineous families caused by mutations in eukaryotic translation initiation factor 2-α kinase 3 (EIF2AK3), characterized by permanent neonatal diabetes associated with liver dysfunction, multiple epiphyseal dysplasia, and developmental delay. We herein report 3 cases of genetically proven Wolcott-Rallison syndrome with variable phenotype presentation. CASE SERIES All cases presented with high glucose levels and were treated with insulin. EIF2AK3 homozygous mutation was identified in all 3 on genetic analysis. Initial screening testing for associated comorbidities was normal, including X-ray examination, which did not show any signs of epiphyseal dysplasia in all cases. Case 2 and case 3 were both lost to follow-up and were later found to have expired at the ages of 18 months and 2 years, respectively, due to liver failure associated with intercurrent respiratory illness in hospitals in their native towns. Case one is now 2 years old on regular follow-up in paediatric Endocrine and neurology clinics and doing well so far. CONCLUSIONS Morbidity, as well as mortality, is high among children with WRS neonatal diabetes. It is crucial to screen for gene mutation in patients with diabetes diagnosed before 6 months. Close therapeutic monitoring is recommended in WRS because of the risk of acute episodes of hypoglycaemia and ketoacidosis.
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Affiliation(s)
- Fozia Memon
- Fozia Memon Pediatric and Child Health Section of Pediatric Endocrinology Aga Khan University Pakistan e-mail:
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English AM, Green KM, Moon SL. A (dis)integrated stress response: Genetic diseases of eIF2α regulators. WILEY INTERDISCIPLINARY REVIEWS-RNA 2021; 13:e1689. [PMID: 34463036 DOI: 10.1002/wrna.1689] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/03/2021] [Accepted: 08/04/2021] [Indexed: 01/28/2023]
Abstract
The integrated stress response (ISR) is a conserved mechanism by which eukaryotic cells remodel gene expression to adapt to intrinsic and extrinsic stressors rapidly and reversibly. The ISR is initiated when stress-activated protein kinases phosphorylate the major translation initiation factor eukaryotic translation initiation factor 2ɑ (eIF2ɑ), which globally suppresses translation initiation activity and permits the selective translation of stress-induced genes including important transcription factors such as activating transcription factor 4 (ATF4). Translationally repressed messenger RNAs (mRNAs) and noncoding RNAs assemble into cytoplasmic RNA-protein granules and polyadenylated RNAs are concomitantly stabilized. Thus, regulated changes in mRNA translation, stability, and localization to RNA-protein granules contribute to the reprogramming of gene expression that defines the ISR. We discuss fundamental mechanisms of RNA regulation during the ISR and provide an overview of a growing class of genetic disorders associated with mutant alleles of key translation factors in the ISR pathway. This article is categorized under: RNA Interactions with Proteins and Other Molecules > Protein-RNA Interactions: Functional Implications RNA in Disease and Development > RNA in Disease Translation > Translation Regulation RNA in Disease and Development > RNA in Development.
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Affiliation(s)
- Alyssa M English
- Department of Human Genetics, Center for RNA Biomedicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Katelyn M Green
- Department of Chemistry, Department of Human Genetics, Center for RNA Biomedicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Stephanie L Moon
- Department of Human Genetics, Center for RNA Biomedicine, University of Michigan, Ann Arbor, Michigan, USA
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Shah N, Karguppikar MB, Khadilkar V, Khadilkar A. Long-term follow-up of a child with Wolcott-Rallison syndrome. BMJ Case Rep 2021; 14:e242376. [PMID: 33986015 PMCID: PMC8126271 DOI: 10.1136/bcr-2021-242376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 11/04/2022] Open
Abstract
Wolcott-Rallison syndrome (WRS), the most common cause of permanent neonatal diabetes mellitus (DM) in consanguineous families, has a poor prognosis, with a mean survival of 5.8 years. Majority of children with WRS succumb to the disease in the first decade of life. We present the long-term follow-up of an 8-year-2-month-old girl with genetically proven WRS who was born to a non-consanguineous parentage. She is on basal bolus regimen of insulin therapy for DM. In addition, she was noted to have features of skeletal dysplasia at 3 years and 3 months of age, which has led to her short stature. Surprisingly, she has had no episodes of hepatitis or liver dysfunction so far, which is frequently seen in children with WRS. To the best of our knowledge, she is the oldest surviving patient with WRS reported in India and South Asia.
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Affiliation(s)
- Nikhil Shah
- Paediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hopsital, Pune, Maharashtra, India
- Paediatrics, Cloudnine Hopsital, Malad, Mumbai, Maharashtra, India
| | - Madhura Bharat Karguppikar
- Paediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hopsital, Pune, Maharashtra, India
| | - Vaman Khadilkar
- Paediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hopsital, Pune, Maharashtra, India
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Anuradha Khadilkar
- Paediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hopsital, Pune, Maharashtra, India
- Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
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13
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Welters A, Meissner T, Konrad K, Freiberg C, Warncke K, Judmaier S, Kordonouri O, Wurm M, Papsch M, Fitzke G, Schmidt SC, Tittel SR, Holl RW. Diabetes management in Wolcott-Rallison syndrome: analysis from the German/Austrian DPV database. Orphanet J Rare Dis 2020; 15:100. [PMID: 32321554 PMCID: PMC7178620 DOI: 10.1186/s13023-020-01359-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/17/2020] [Indexed: 01/17/2023] Open
Abstract
Background Wolcott-Rallison syndrome (WRS) is characterized by permanent early-onset diabetes, skeletal dysplasia and several additional features, e.g. recurrent liver failure. This is the first multicentre approach that focuses on diabetes management in WRS. We searched the German/Austrian Diabetes-Patienten-Verlaufsdokumentation (DPV) registry and studied anthropometric characteristics, diabetes treatment, glycaemic control and occurrence of severe hypoglycaemia (SH) and diabetic ketoacidosis (DKA) in 11 patients with WRS. Furthermore, all local treatment centres were personally contacted to retrieve additional information on genetic characteristics, migration background and rate of consanguinity. Results Data were analysed at diabetes onset and after a median follow-up period of 3 (1.5–9.0) years (time from diagnosis to latest follow-up). Median age at diabetes onset was 0.2 (0.1–0.3) years, while onset was delayed in one patient (aged 16 months). Seventy percent of patients manifested with DKA. At follow-up, 90% of patients were on insulin pump therapy requiring 0.7 [0.5–1.0] IU of insulin/kg/d. More than two third of patients had HbA1c level ≥ 8%, 40% experienced at least one episode of SH in the course of the disease. Three patients died at 0.6, 5 and 9 years of age, respectively. To the best of our knowledge three patients carried novel mutations in EIF2AK3. Conclusion Insulin requirements of individuals with WRS registered in DPV appear to be comparable to those of preschool children with well-controlled type 1 diabetes, while glycaemic control tends to be worse and episodes of SH tend to be more common. The majority of individuals with WRS in the DPV registry does not reach glycaemic target for HbA1c as defined for preschool children (< 7.5%). International multicentre studies are required to further improve our knowledge on the care of children with WRS.
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Affiliation(s)
- Alena Welters
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany.
| | - Thomas Meissner
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, University Children's Hospital Düsseldorf, Düsseldorf, Germany
| | - Katja Konrad
- Department of Paediatric and Adolescent Medicine, Elisabeth-Hospital Essen, Essen, Germany
| | - Clemens Freiberg
- Department of Paediatrics, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Katharina Warncke
- Department of Paediatrics, Kinderklinik München Schwabing, Technical University of Munich School of Medicine, Munich, Germany
| | - Sylvia Judmaier
- Department of Paediatrics, LKH Hochsteiermark/Standort Leoben, Leoben, Austria
| | - Olga Kordonouri
- Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Germany
| | - Michael Wurm
- Department of Paediatrics, St. Hedwigs Campus, University Children's Hospital Regensburg, Regensburg, Germany
| | - Matthias Papsch
- Department of Paediatrics, Marienhospital, Gelsenkirchen, Germany
| | - Gisela Fitzke
- Department of Paediatrics, Ostalbklinikum Aalen, Aalen, Germany
| | | | - Sascha R Tittel
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
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14
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Sümegi A, Hendrik Z, Gáll T, Felszeghy E, Szakszon K, Antal-Szalmás P, Beke L, Papp Á, Méhes G, Balla J, Balla G. A novel splice site indel alteration in the EIF2AK3 gene is responsible for the first cases of Wolcott-Rallison syndrome in Hungary. BMC MEDICAL GENETICS 2020; 21:61. [PMID: 32216767 PMCID: PMC7099831 DOI: 10.1186/s12881-020-0985-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 02/25/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Wolcott-Rallison Syndrome (WRS) is a rare autosomal recessive disease that is the most common cause of neonatal diabetes in consanguineous families. WRS is caused by various genetic alterations of the Eukaryotic Translation Initiation Factor 2-Alpha Kinase 3 (EIF2AK3) gene. METHODS Genetic analysis of a consanguineous family where two children were diagnosed with WRS was performed by Sanger sequencing. The altered protein was investigated by in vitro cloning, expression and immunohistochemistry. RESULTS The first cases in Hungary, - two patients in one family, where the parents were fourth-degree cousins - showed the typical clinical features of WRS: early onset diabetes mellitus with hyperglycemia, growth retardation, infection-induced multiple organ failure. The genetic background of the disease was a novel alteration in the EIF2AK3 gene involving the splice site of exon 11- intron 11-12 boundary: g.53051_53062delinsTG. According to cDNA sequencing this created a new splice site and resulted in a frameshift and the development of an early termination codon at amino acid position 633 (p.Pro627AspfsTer7). Based on in vitro cloning and expression studies, the truncated protein was functionally inactive. Immunohistochemistry revealed that the intact protein was absent in the islets of pancreas, furthermore insulin expressing cells were also dramatically diminished. Elevated GRP78 and reduced CHOP protein expression were observed in the liver. CONCLUSIONS The novel genetic alteration causing the absence of the EIF2AK3 protein resulted in insufficient handling of severe endoplasmic reticulum stress, leading to liver failure and demise of the patients.
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Affiliation(s)
- Andrea Sümegi
- HAS-UD Vascular Biology and Myocardial Pathophysiology Research Group, Hungarian Academy of Sciences, 98, Nagyerdei krt, Debrecen, H-4032, Hungary
| | - Zoltán Hendrik
- Department of Pathology, Faculty of Medicine, University of Debrecen, 98, Nagyerdei krt, Debrecen, H-4032, Hungary
| | - Tamás Gáll
- HAS-UD Vascular Biology and Myocardial Pathophysiology Research Group, Hungarian Academy of Sciences, 98, Nagyerdei krt, Debrecen, H-4032, Hungary
| | - Enikő Felszeghy
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, 98, Nagyerdei krt, Debrecen, H-4032, Hungary
| | - Katalin Szakszon
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, 98, Nagyerdei krt, Debrecen, H-4032, Hungary
| | - Péter Antal-Szalmás
- Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, 98, Nagyerdei krt, Debrecen, H-4032, Hungary
| | - Lívia Beke
- Department of Pathology, Faculty of Medicine, University of Debrecen, 98, Nagyerdei krt, Debrecen, H-4032, Hungary
| | - Ágnes Papp
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, 98, Nagyerdei krt, Debrecen, H-4032, Hungary
| | - Gábor Méhes
- Department of Pathology, Faculty of Medicine, University of Debrecen, 98, Nagyerdei krt, Debrecen, H-4032, Hungary
| | - József Balla
- HAS-UD Vascular Biology and Myocardial Pathophysiology Research Group, Hungarian Academy of Sciences, 98, Nagyerdei krt, Debrecen, H-4032, Hungary.,Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Debrecen, 98, Nagyerdei krt, Debrecen, H-4032, Hungary
| | - György Balla
- HAS-UD Vascular Biology and Myocardial Pathophysiology Research Group, Hungarian Academy of Sciences, 98, Nagyerdei krt, Debrecen, H-4032, Hungary. .,Department of Pediatrics, Faculty of Medicine, University of Debrecen, 98, Nagyerdei krt, Debrecen, H-4032, Hungary.
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15
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Abali ZY, De Franco E, Ozturan EK, Poyrazoglu S, Bundak R, Bas F, Flanagan SE, Darendeliler F. Clinical Characteristics, Molecular Features, and Long-Term Follow-Up of 15 Patients with Neonatal Diabetes: A Single-Centre Experience. Horm Res Paediatr 2020; 93:423-432. [PMID: 33498041 PMCID: PMC7611806 DOI: 10.1159/000512247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/09/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Diabetes diagnosed within the first 6 months of life is defined as neonatal diabetes mellitus (NDM). Mutations in the KCNJ11, ABCC8, and INS genes are the most common cause of permanent NDM. In populations with a high rate of consanguinity, Wolcott-Rallison syndrome caused by biallelic EIF2AK3 mutations is common. METHODS We studied the clinical characteristics and underlying genetic cause of disease in 15 individuals with diabetes onset before 6 months of age as defined by sustained hyperglycaemia requiring insulin treatment. Patients who had a remission of the diabetes, defined by a normal blood glucose and HbA1c value without insulin or sulphonylurea (SU) treatment, within the first 18 months of life were classified as having transient NDM (TNDM). RESULTS We report 15 patients with NDM from 14 unrelated families, including 10 with reported parental consanguinity. 1/15 patients had a remission of diabetes, leading to a diagnosis of TNDM. Mutations were detected in 80% (n = 12/15) of the cohort (ABCC8 [n = 4], PTF1A-distal enhancer [n = 3], KCNJ11 [n = 2], EIF2AK3 [n = 1], INS [n = 1], and SLC19A2 [n = 1]). All cases were initially treated with multiple dose insulin injections. One patient with an ABCC8 mutation transitioned from insulin to SU resulting in improved metabolic control at the age of 20 years. CONCLUSION Although the number of individuals born to consanguineous parents was considerably high in this cohort, KATP channel mutations (ABCC8/KCNJ11) were more common than EIF2AK3 mutations (n = 6 vs. n = 1). Genetic analyses should be performed in all NDM cases due to the potential impact on treatment and prognosis.
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Affiliation(s)
- Zehra Yavas Abali
- Department of Paediatric Endocrinology and Diabetes, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey,
| | - Elisa De Franco
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Esin Karakilic Ozturan
- Department of Paediatric Endocrinology and Diabetes, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sukran Poyrazoglu
- Department of Paediatric Endocrinology and Diabetes, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ruveyde Bundak
- Department of Paediatric Endocrinology and Diabetes, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Firdevs Bas
- Department of Paediatric Endocrinology and Diabetes, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sarah E Flanagan
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Feyza Darendeliler
- Department of Paediatric Endocrinology and Diabetes, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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16
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Valamparampil JJ, Shanmugam N, Rela M. Wolcott-Rallison Syndrome-Endocrinopathy with Recurrent Acute Liver Failure. Indian Pediatr 2019. [DOI: 10.1007/s13312-019-1688-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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17
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Al-Khawaga S, Mohammed I, Saraswathi S, Haris B, Hasnah R, Saeed A, Almabrazi H, Syed N, Jithesh P, El Awwa A, Khalifa A, AlKhalaf F, Petrovski G, Abdelalim EM, Hussain K. The clinical and genetic characteristics of permanent neonatal diabetes (PNDM) in the state of Qatar. Mol Genet Genomic Med 2019; 7:e00753. [PMID: 31441606 PMCID: PMC6785445 DOI: 10.1002/mgg3.753] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/04/2019] [Accepted: 04/27/2019] [Indexed: 02/06/2023] Open
Abstract
Background Neonatal diabetes mellitus (NDM) is a rare condition that occurs within the first six months of life. Permanent NDM (PNDM) is caused by mutations in specific genes that are known for their expression at early and/or late stages of pancreatic beta‐ cell development, and are either involved in beta‐cell survival, insulin processing, regulation, and release. The native population in Qatar continues to practice consanguineous marriages that lead to a high level of homozygosity. To our knowledge, there is no previous report on the genomics of NDM among the Qatari population. The aims of the current study are to identify patients with NDM diagnosed between 2001 and 2016, and examine their clinical and genetic characteristics. Methods To calculate the incidence of PNDM, all patients with PNDM diagnosed between 2001 and 2016 were compared to the total number of live births over the 16‐year‐period. Whole Genome Sequencing (WGS) was used to investigate the genetic etiology in the PNDM cohort. Results PNDM was diagnosed in nine (n = 9) patients with an estimated incidence rate of 1:22,938 live births among the indigenous Qatari. Seven different mutations in six genes (PTF1A, GCK, SLC2A2, EIF2AK3, INS, and HNF1B) were identified. In the majority of cases, the genetic etiology was part of a previously identified autosomal recessive disorder. Two novel de novo mutations were identified in INS and HNF1B. Conclusion Qatar has the second highest reported incidence of PNDM worldwide. A majority of PNDM cases present as rare familial autosomal recessive disorders. Pancreas associated transcription factor 1a (PTF1A) enhancer deletions are the most common cause of PNDM in Qatar, with only a few previous cases reported in the literature.
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Affiliation(s)
- Sara Al-Khawaga
- College of Health & Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar.,Division of Endocrinology, Department of Pediatric Medicine, Sidra Medicine, Doha, Qatar.,Diabetes Research Center, Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Idris Mohammed
- College of Health & Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar.,Division of Endocrinology, Department of Pediatric Medicine, Sidra Medicine, Doha, Qatar
| | - Saras Saraswathi
- Division of Endocrinology, Department of Pediatric Medicine, Sidra Medicine, Doha, Qatar
| | - Basma Haris
- Division of Endocrinology, Department of Pediatric Medicine, Sidra Medicine, Doha, Qatar
| | - Reem Hasnah
- Division of Endocrinology, Department of Pediatric Medicine, Sidra Medicine, Doha, Qatar
| | - Amira Saeed
- Division of Endocrinology, Department of Pediatric Medicine, Sidra Medicine, Doha, Qatar
| | | | - Najeeb Syed
- Biomedical Informatics Division, Sidra Medicine, Doha, Qatar
| | - Puthen Jithesh
- Biomedical Informatics Division, Sidra Medicine, Doha, Qatar
| | - Ahmed El Awwa
- Division of Endocrinology, Department of Pediatric Medicine, Sidra Medicine, Doha, Qatar.,Faculty of medicine, Alexandria University, Alexandria, Egypt
| | - Amal Khalifa
- Division of Endocrinology, Department of Pediatric Medicine, Sidra Medicine, Doha, Qatar
| | - Fawziya AlKhalaf
- Division of Endocrinology, Department of Pediatric Medicine, Sidra Medicine, Doha, Qatar
| | - Goran Petrovski
- Division of Endocrinology, Department of Pediatric Medicine, Sidra Medicine, Doha, Qatar
| | - Essam M Abdelalim
- College of Health & Life Sciences, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar.,Diabetes Research Center, Qatar Biomedical Research Institute, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Khalid Hussain
- Division of Endocrinology, Department of Pediatric Medicine, Sidra Medicine, Doha, Qatar
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18
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First European Case of Simultaneous Liver and Pancreas Transplantation as Treatment of Wolcott-Rallison Syndrome in a Small Child. Transplantation 2019; 104:522-525. [PMID: 31335762 DOI: 10.1097/tp.0000000000002869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The concept of organ transplantation as treatment for complex genetic conditions, including Wolcott-Rallison syndrome (WRS), continues to show promise. Liver transplantation is essential for survival of patients with WRS, and pancreas transplantation cures their type I diabetes mellitus. METHODS The recipient, a 3-year-old girl weighing 14 kg at the time of transplantation, suffered from major complications of WRS, including repetitive liver failure episodes and poorly controlled diabetes. The patient underwent a nonacute, combined, simultaneous liver and pancreas transplantation from a pediatric donor without using the en bloc technique. RESULTS Well-preserved graft functions at 2-year follow-up with normal liver and pancreas function. CONCLUSIONS This is the first case report of simultaneous liver and pancreas transplantation as treatment of WRS in a small child in Europe. Two-year follow-up demonstrates that organ transplantation can halt life-threating recurrent liver failure episodes and cure type 1 diabetes.
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19
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Lundgren M, De Franco E, Arnell H, Fischler B. Practical management in Wolcott-Rallison syndrome with associated hypothyroidism, neutropenia, and recurrent liver failure: A case report. Clin Case Rep 2019; 7:1133-1138. [PMID: 31183082 PMCID: PMC6552956 DOI: 10.1002/ccr3.2168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 02/16/2019] [Accepted: 04/08/2019] [Indexed: 01/07/2023] Open
Abstract
Wolcott‐Rallison syndrome is a rare genetic syndrome of neonatal diabetes, liver failure, and growth retardation. We present a case with a EIF2AK3 p.(Arg902Ter) mutation, additionally complicated by hypothyroidism, impaired renal function, and exocrine pancreas insufficiency, focusing on clinical management. For its optimization, thorough care of multiple organ systems is needed.
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Affiliation(s)
- Markus Lundgren
- Department of Clinical Sciences, CRC Malmö Lund University Malmö Sweden.,Department of Pediatrics Kristianstad Central Hospital Kristianstad Sweden
| | - Elisa De Franco
- Institute of Biomedical & Clinical Science University of Exeter Exeter UK
| | - Henrik Arnell
- Department of Pediatric Gastroenterology, Hepatology and Nutrition Karolinska University Hospital Stockholm Sweden.,Division of Pediatrics CLINTEC, Karolinska Institutet Stockholm Sweden
| | - Björn Fischler
- Department of Pediatric Gastroenterology, Hepatology and Nutrition Karolinska University Hospital Stockholm Sweden.,Division of Pediatrics CLINTEC, Karolinska Institutet Stockholm Sweden
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20
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Fatani TH. EIF2AK3 novel mutation in a child with early-onset diabetes mellitus, a case report. BMC Pediatr 2019; 19:85. [PMID: 30922274 PMCID: PMC6438019 DOI: 10.1186/s12887-019-1432-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 02/11/2019] [Indexed: 11/10/2022] Open
Abstract
Background Wolcott-Rallison syndrome (WRS) is caused by a biallelic mutation in the gene encoding eukaryotic translation initiation factor 2-alpha kinase 3 (EIF2AK3) on chromosome 2p11.2. This condition is characterized by permanent early-onset diabetes mellitus, epiphyseal dysplasia, and hepatic dysfunction. We report a patient with WRS born to a consanguineous marriage due to a novel biallelic frameshift mutation in the EIF2AK3 gene. Case presentation Our patient was a 2-year-and-6-month-old Yemeni girl born to consanguineous parents who was diagnosed with neonatal diabetes at 20 days of age. She presented with chronic diarrhea and liver dysfunction. The child was normocephalic and exhibited failure to thrive and hepatomegaly with no skeletal deformities. Further investigations revealed microcytic anemia, liver impairment and primary hypothyroidism. Genetic testing confirmed the diagnosis of WRS via identification of a novel biallelic frameshift mutation in the EIF2AK3 gene. During her hospital stay, she went into septic shock and developed multi-organ failure, including fulminant hepatic failure. She unfortunately died within 2 weeks of her hospital stay. Conclusions Wolcott-Rallison syndrome is recognized as the most common cause of early-onset diabetes in infants born to consanguineous marriages. Screening for genetic mutations in EIF2AK3 is recommended for establishing early diagnosis, providing genetic counselling, and predicting the development of additional clinical features, most importantly hepatic failure. Hence, this screening is important for guiding optimal management and improving patient outcome. Electronic supplementary material The online version of this article (10.1186/s12887-019-1432-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tarah H Fatani
- Department of Pediatrics, Section of Pediatric Endocrinology, King Abdulaziz University, Jeddah, 21589, Saudi Arabia.
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21
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Wolcott-Rallison Syndrome With Different Clinical Presentations and Genetic Patterns in 2 Infants. Health Care Manag (Frederick) 2018; 37:354-357. [DOI: 10.1097/hcm.0000000000000238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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22
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Abbasi F, Habibi M, Enayati S, Bitarafan F, Razzaghy-Azar M, Sotodeh A, Omran SP, Maroofian R, Amoli MM. A Genotype-First Approach for Clinical and Genetic Evaluation of Wolcott-Rallison Syndrome in a Large Cohort of Iranian Children With Neonatal Diabetes. Can J Diabetes 2018; 42:272-275. [DOI: 10.1016/j.jcjd.2017.06.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/12/2017] [Accepted: 06/21/2017] [Indexed: 11/15/2022]
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23
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Elsabbagh AM, Hawksworth J, Khan KM, Yazigi N, Matsumoto CS, Fishbein TM. World's smallest combined en bloc liver-pancreas transplantation. Pediatr Transplant 2018; 22:10.1111/petr.13082. [PMID: 29139617 PMCID: PMC6433131 DOI: 10.1111/petr.13082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2017] [Indexed: 11/30/2022]
Abstract
We present a case of a 2-year-old child who underwent a combined en bloc liver and pancreas transplant following complications of WRS. WRS is characterized clinically through infantile insulin-dependent diabetes mellitus, neutropenia, recurrent infections, propensity for liver failure following viral infections, bone dysplasia, and developmental delay. Usually, death occurs from fulminant liver and concomitant kidney failure. Few cases with WRS are reported in the literature, mostly from consanguineous parents. To the best of our knowledge, combined en bloc liver and pancreas transplant has not been performed in small children.
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Affiliation(s)
- Ahmed M. Elsabbagh
- MedStar Georgetown Transplant Institute; Georgetown University Hospital; Washington DC USA
| | - Jason Hawksworth
- MedStar Georgetown Transplant Institute; Georgetown University Hospital; Washington DC USA
| | - Khalid M. Khan
- MedStar Georgetown Transplant Institute; Georgetown University Hospital; Washington DC USA
| | - Nada Yazigi
- MedStar Georgetown Transplant Institute; Georgetown University Hospital; Washington DC USA
| | - Cal S. Matsumoto
- MedStar Georgetown Transplant Institute; Georgetown University Hospital; Washington DC USA
| | - Thomas M. Fishbein
- MedStar Georgetown Transplant Institute; Georgetown University Hospital; Washington DC USA
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24
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Al-Aama JY, Al-Zahrani HS, Jelani M, Sabir HS, Al-Saeedi SA, Ahmed S. Novel splice site mutation in EIF2AK3 gene causes Wolcott-Rallison syndrome in a consanguineous family from Saudi Arabia. Congenit Anom (Kyoto) 2018; 58:39-40. [PMID: 28220546 DOI: 10.1111/cga.12217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/14/2017] [Accepted: 02/14/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Jumana Yousuf Al-Aama
- Princess Al-Jawhara Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hams Saeed Al-Zahrani
- Princess Al-Jawhara Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Musharraf Jelani
- Princess Al-Jawhara Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hesham Salih Sabir
- Pediatric Radiology Unit, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Saad Abdullah Al-Saeedi
- Pediatric Department, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Saleem Ahmed
- Princess Al-Jawhara Center of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Genetic Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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25
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Deeb A, Al-Zidgali F, Ofoegbu BN. Multicystic dysplastic kidney: a new association of Wolcott-Rallison syndrome. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM-17-0090. [PMID: 28955442 PMCID: PMC5610347 DOI: 10.1530/edm-17-0090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 08/18/2017] [Indexed: 11/08/2022] Open
Abstract
Wolcott-Rallison syndrome (WRS) is a rare autosomal recessive disorder due to mutations in the EIF2AK3 gene. It is characterized by permanent neonatal diabetes mellitus, skeletal dysplasia, liver impairment, neutropenia and renal dysfunction. Liver is the most commonly affected organ and liver failure is the commonest cause of death in this syndrome. The EIF2AK3 gene encodes a transmembrane protein PERK, which is important for the cellular response to endoplasmic reticulum (ER) stress. The absence of PERK activity reduces the ER's abilities to deal with stress, leading to cell death by apoptosis. On acquiring febrile illness, affected patients suffer from liver injury, which may progress into liver failure and death. Renal involvement is less common and is mainly in the form of functional renal impairment at the advanced stage of the disease. Structural renal anomalies have not been reported in WRS. We report a 6-month-old girl who presented with neonatal diabetes on day 1 of life. Her genetic testing confirmed WRS due to missense mutation in the EIF2AK3 gene (c.2867G > A, p.Gly956Glu). Parents are first-degree cousins and both are heterozygous carriers to the mutation. 2 paternal uncles had the same mutation and died of liver disease at 1 and 14 years of age. Neither had a renal disease. She presented with hematuria during a febrile illness at the age of 5 months. Ultrasound scan showed right ectopic multicystic dysplastic kidney (MCDK). To the best of our knowledge, this is the first patient with WRS who is reported to have an MCDK disease. LEARNING POINTS Neonatal diabetes should be considered in babies presenting with early hyperglycemia particularly if there is a family history.Genetic diagnosis in neonatal diabetes enables disease confirmation, genetic counseling and anticipation of potential complications during concomitant situations such as acute illness, trauma or major surgery.There is lack of phenotype-genotype correlation in Wolcott-Rallison syndrome.Structural kidney abnormality, in our case MCDK, can be seen in WRS.
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Affiliation(s)
- Asma Deeb
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Faisal Al-Zidgali
- Neonatology Department, Corniche Hospital, Abu Dhabi, United Arab Emirates
| | - Bibian N Ofoegbu
- Neonatology Department, Corniche Hospital, Abu Dhabi, United Arab Emirates
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Rivera E, Gupta S, Chavers B, Quinones L, Berger MR, Schwarzenberg SJ, Pruett T, Verghese P, Chinnakotla S. En bloc multiorgan transplant (liver, pancreas, and kidney) for acute liver and renal failure in a patient with Wolcott-Rallison syndrome. Liver Transpl 2016; 22:371-4. [PMID: 26784269 DOI: 10.1002/lt.24402] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/16/2015] [Accepted: 12/28/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Erilia Rivera
- Departments of Pediatrics Division of Transplantation Masonic Children's Hospital, University of Minnesota, Minneapolis, MN
| | - Sameer Gupta
- Departments of Pediatrics Division of Transplantation Masonic Children's Hospital, University of Minnesota, Minneapolis, MN
| | - Blanche Chavers
- Departments of Pediatrics Division of Transplantation Masonic Children's Hospital, University of Minnesota, Minneapolis, MN
| | - Laura Quinones
- Departments of Pediatrics Division of Transplantation Masonic Children's Hospital, University of Minnesota, Minneapolis, MN
| | - Megan Rooney Berger
- Departments of Surgery Division of Transplantation Masonic Children's Hospital, University of Minnesota, Minneapolis, MN
| | - Sarah Jane Schwarzenberg
- Departments of Pediatrics Division of Transplantation Masonic Children's Hospital, University of Minnesota, Minneapolis, MN
| | - Timothy Pruett
- Departments of Surgery Division of Transplantation Masonic Children's Hospital, University of Minnesota, Minneapolis, MN
| | - Priya Verghese
- Departments of Pediatrics Division of Transplantation Masonic Children's Hospital, University of Minnesota, Minneapolis, MN
| | - Srinath Chinnakotla
- Departments of Surgery Division of Transplantation Masonic Children's Hospital, University of Minnesota, Minneapolis, MN
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Deeb A, Habeb A, Kaplan W, Attia S, Hadi S, Osman A, Al-Jubeh J, Flanagan S, DeFranco E, Ellard S. Genetic characteristics, clinical spectrum, and incidence of neonatal diabetes in the Emirate of AbuDhabi, United Arab Emirates. Am J Med Genet A 2015; 170:602-9. [PMID: 26463504 DOI: 10.1002/ajmg.a.37419] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/21/2015] [Indexed: 11/08/2022]
Abstract
Neonatal diabetes mellitus (NDM) can be transient (TNDM) or permanent (PNDM). Data on NDM from the Gulf region are limited to few studies on PNDM.The objective of this study was to describe the genetic and clinical spectrum of NDM and estimate its incidence in AbuDhabi, capital of the United Arab Emirate (UAE). Patients were identified from the pediatric diabetes clinics and sequencing of known NDM genes was conducted in all families. Twenty-five patients were identified. Incidence during 1985-2013 was 1:29,241 Live births. Twenty-three out of twenty-five had PNDM (incidence 1:31,900) and 2/25 had TNDM (incidence 1:350,903). Eleven out of twenty-five had extra-pancreatic features and three had pancreatic aplasia. The genetic cause was detected in 21/25 (84%). Of the PNDM patients, nine had recessive EIF2AK3 mutations, six had homozygous INS mutations, two with deletion of the PTF1A enhancer, one was heterozygous for KCNJ11 mutation, one harboured a novel ABCC8 variant, and 4/21 without mutations in all known PNDM genes. One TNDM patient had a 6q24 methylation defect and another was homozygous for the INS c-331C>G mutation. This mutation also caused permanent diabetes with variable age of onset from birth to 18 years. The parents of a child with Wolcott-Rallison syndrome had a healthy girl following pre-implantation genetic diagnosis. The child with KCNJ11 mutation was successfully switched from insulin to oral sulphonylurea. The incidence of PNDM in Abu Dhabi is among the highest in the world and its spectrum is different from Europe and USA. In our cohort, genetic testing has significant implications for the clinical management.
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Affiliation(s)
- Asma Deeb
- Department of Pediatric Endocrinology, Mafraq Hospital, AbuDhabi, United Arab Emirates
| | - Abdelhadi Habeb
- Department of Pediatric, Prince Mohamed bin Abdulaziz Hospital, Madinah, Saudi Arabia
| | - Walid Kaplan
- Department of Endocrine, Tawam Hospital, Al Ain, United Arab Emirates
| | - Salima Attia
- Department of Pediatric Endocrinology, Mafraq Hospital, AbuDhabi, United Arab Emirates
| | - Suha Hadi
- Department of Endocrine, Tawam Hospital, Al Ain, United Arab Emirates
| | - Amani Osman
- Imperial College London Diabetes Center, Al Ain, United Arab Emirates
| | - Jamal Al-Jubeh
- Department of Pediatric Endocrinology, Shaikh Khalifa Medical Center, AbuDhabi, United Arab Emirates
| | - Sarah Flanagan
- Department of Molecular Genetics, Institute of Biomedical and Clinical Science, Peninsula Medical School, University of Exeter, Exeter, United Kingdom
| | - Elisa DeFranco
- Department of Molecular Genetics, Institute of Biomedical and Clinical Science, Peninsula Medical School, University of Exeter, Exeter, United Kingdom
| | - Sian Ellard
- Department of Molecular Genetics, Institute of Biomedical and Clinical Science, Peninsula Medical School, University of Exeter, Exeter, United Kingdom
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