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Kantaputra P, Daroontum T, Kitiyamas K, Piyakhunakorn P, Kawasaki K, Sathienkijkanchai A, Wasant P, Vatanavicharn N, Yasanga T, Kaewgahya M, Tongsima S, Cox TC, Arold ST, Ohazama A, Ngamphiw C. Homozygosity for a Rare Plec Variant Suggests a Contributory Role in Congenital Insensitivity to Pain. Int J Mol Sci 2024; 25:6358. [PMID: 38928066 PMCID: PMC11203604 DOI: 10.3390/ijms25126358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
Congenital insensitivity to pain is a rare human condition in which affected individuals do not experience pain throughout their lives. This study aimed to identify the molecular etiology of congenital insensitivity to pain in two Thai patients. Clinical, radiographic, histopathologic, immunohistochemical, and molecular studies were performed. Patients were found to have congenital insensitivity to pain, self-mutilation, acro-osteolysis, cornea scars, reduced temperature sensation, tooth agenesis, root maldevelopment, and underdeveloped maxilla and mandible. The skin biopsies revealed fewer axons, decreased vimentin expression, and absent neurofilament expression, indicating lack of dermal nerves. Whole exome and Sanger sequencing identified a rare homozygous variant c.4039C>T; p.Arg1347Cys in the plakin domain of Plec, a cytolinker protein. This p.Arg1347Cys variant is in the spectrin repeat 9 region of the plakin domain, a region not previously found to harbor pathogenic missense variants in other plectinopathies. The substitution with a cysteine is expected to decrease the stability of the spectrin repeat 9 unit of the plakin domain. Whole mount in situ hybridization and an immunohistochemical study suggested that Plec is important for the development of maxilla and mandible, cornea, and distal phalanges. Additionally, the presence of dental anomalies in these patients further supports the potential involvement of Plec in tooth development. This is the first report showing the association between the Plec variant and congenital insensitivity to pain in humans.
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Affiliation(s)
- Piranit Kantaputra
- Center of Excellence in Medical Genetics Research, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand; (K.K.); (M.K.)
- Division of Pediatric Dentistry, Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Teerada Daroontum
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Kantapong Kitiyamas
- Center of Excellence in Medical Genetics Research, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand; (K.K.); (M.K.)
- Division of Pediatric Dentistry, Department of Orthodontics and Pediatric Dentistry, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Panat Piyakhunakorn
- Panare Hospital, Dental Public Health Division, Panare District, Surat Thani 94130, Thailand;
| | - Katsushige Kawasaki
- Division of Oral Anatomy, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata 950-2181, Japan; (K.K.); (A.O.)
| | - Achara Sathienkijkanchai
- Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 73170, Thailand; (A.S.); (P.W.); (N.V.)
| | - Pornswan Wasant
- Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 73170, Thailand; (A.S.); (P.W.); (N.V.)
| | - Nithiwat Vatanavicharn
- Division of Medical Genetics, Department of Pediatrics, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 73170, Thailand; (A.S.); (P.W.); (N.V.)
| | - Thippawan Yasanga
- Medical Science Research Equipment Center, Research Administration Section, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Massupa Kaewgahya
- Center of Excellence in Medical Genetics Research, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand; (K.K.); (M.K.)
| | - Sissades Tongsima
- National Biobank of Thailand, National Center for Genetic Engineering and Biotechnology (BIOTEC), Pathum Thani 12120, Thailand; (S.T.); (C.N.)
| | - Timothy C. Cox
- Departments of Oral & Craniofacial Sciences, School of Dentistry, and Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA;
| | - Stefan T. Arold
- Biological and Environmental Science and Engineering Division, Computational Bioscience Research Center, King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia;
| | - Atsushi Ohazama
- Division of Oral Anatomy, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, Niigata 950-2181, Japan; (K.K.); (A.O.)
| | - Chumpol Ngamphiw
- National Biobank of Thailand, National Center for Genetic Engineering and Biotechnology (BIOTEC), Pathum Thani 12120, Thailand; (S.T.); (C.N.)
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Rodríguez-Blanque R, Nielsen LM, Piqueras-Sola B, Sánchez-García JC, Cortés-Martín C, Reinoso-Cobo A, Cortés-Martín J. A Systematic Review of Congenital Insensitivity to Pain, a Rare Disease. J Pers Med 2024; 14:570. [PMID: 38929791 PMCID: PMC11204641 DOI: 10.3390/jpm14060570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Pain perception, far from being a pathological mechanism, is a crucial protective stimulus to prevent additional injuries. Any disturbance in this complex system poses significant risks to individuals, affecting their quality of life and even their survival. OBJECTIVE This review aims to explore congenital insensitivity to pain, an extremely rare genetic disorder with an autosomal recessive pattern that results in the inability to perceive pain. We will focus on the well-known subtype, congenital insensitivity to pain with anhidrosis (CIPA). Our research seeks to update existing knowledge through a comprehensive literature review. METHODOLOGY The review employs a systematic literature review, analyzing various sources and scientific documents, primarily emphasizing CIPA. The review follows the PROSPERO protocol, registered under CRD42023394489. The literature search was performed on the Scopus, PubMed, and Cinahl databases. RESULTS Our review reveals secondary complications associated with CIPA, such as recurrent bone fractures, temperature insensitivity, self-mutilation, and, occasionally, intellectual disabilities. The limited available information underscores the need for expanding our knowledge. CONCLUSIONS In summary, CIPA, particularly, presents a significant medical challenge with adverse impacts on quality of life. Early diagnosis, education for families and healthcare professionals, and appropriate nursing care are essential for effective management. This review highlights the necessity of further research and awareness to enhance support for those affected.
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Affiliation(s)
- Raquel Rodríguez-Blanque
- San Cecilio University Hospital, 18071 Granada, Spain;
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (C.C.-M.); (J.C.-M.)
| | - Laura Maria Nielsen
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga—Teatinos, Arquitecto Francisco Peñalosa 3, 29071 Malaga, Spain; (L.M.N.); (A.R.-C.)
| | | | - Juan Carlos Sánchez-García
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (C.C.-M.); (J.C.-M.)
| | - Celia Cortés-Martín
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (C.C.-M.); (J.C.-M.)
| | - Andrés Reinoso-Cobo
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga—Teatinos, Arquitecto Francisco Peñalosa 3, 29071 Malaga, Spain; (L.M.N.); (A.R.-C.)
| | - Jonathan Cortés-Martín
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain; (C.C.-M.); (J.C.-M.)
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Sun L, Dai J, Zhang Y, Zhou L, Ren Y, Wang H. A novel NTRK1 splice site variant causing congenital insensitivity to pain with anhidrosis in a Chinese family. Front Genet 2024; 15:1345081. [PMID: 38798698 PMCID: PMC11116696 DOI: 10.3389/fgene.2024.1345081] [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] [Received: 01/31/2024] [Accepted: 04/17/2024] [Indexed: 05/29/2024] Open
Abstract
Background Congenital insensitivity to pain with anhidrosis (CIPA, OMIM #256800), also known as hereditary sensory and autonomic neuropathy type Ⅳ (HSAN-IV), is a rare autosomal recessive disorder characterized by recurrent episodic fevers, anhidrosis, insensitivity to noxious stimuli, self-mutilating behavior and intellectual disability. CIPA can be caused by the variants in NTRK1 gene, which encodes a high-affinity tyrosine kinase receptor for nerve growth factor. To ascertain the hereditary cause of a patient with CIPA accompanied by the additional symptoms of mild growth retardation, prone to fracture, underdeveloped nails of fingers and toes, irregular tooth alignment, enamel hypoplasia, postoperative wound healing difficulty, hand and limb deformity, and dislocation of hip joint, whole exome sequencing was used and revealed a compound heterozygous variant in NTRK1. Methods DNA was extracted from peripheral blood samples of pediatric patients and their parents, and subjected to comprehensive analysis using whole-exome sequencing (WES), followed by verification of variant sites in the NTRK1 gene through Sanger sequencing. To elucidate the functional impact of the newly discovered variants, an in vitro experimental system was established. Splicing analysis was conducted using PCR and Sanger sequencing, while expression levels were assessed through qPCR and Western blot techniques. Results One hotspot variant c.851-33T>A(ClinVar ID: 21308) and a novel variant c.850 + 5G>A(ClinVar ID:3069176) was inherited from her father and mother, respectively, identified in the affected individuals. The c.850 + 5G>A variant in NTRK1 resulted in two forms of aberrant mRNA splicing: 13bp deletion (c.838_850del13, p. Val280Ser fs180) and 25bp deletion (826_850del25, p. Val276Ser fs180) in exon 7, both leading to a translational termination at a premature stop codon and forming a C-terminal truncated protein. The expression of two abnormal splicing isoforms was decreased both in the level of mRNA and protein. Conclusion In conclusion, this study elucidated the genetic cause of a patient with CIPA and identified a novel variant c.850 + 5G>A in NTRK1, which broadened the and enriched the NTRK1 mutation spectrum.
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Affiliation(s)
- Ling Sun
- Department of Cardiology, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jin Dai
- Department of Orthopaedics, Suzhou, Jiangsu, China
| | - Yuan Zhang
- Department of Clinical Laboratory, Suzhou, Jiangsu, China
- Laboratory of Pediatric Research, Suzhou, Jiangsu, China
| | - Lijun Zhou
- Department of Clinical Laboratory, Suzhou, Jiangsu, China
- Laboratory of Pediatric Research, Suzhou, Jiangsu, China
| | - Yaqiong Ren
- Department of Clinical Laboratory, Suzhou, Jiangsu, China
- Laboratory of Pediatric Research, Suzhou, Jiangsu, China
| | - Hongying Wang
- Department of Clinical Laboratory, Suzhou, Jiangsu, China
- Laboratory of Pediatric Research, Suzhou, Jiangsu, China
- Institute of Pediatric Research, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
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Sreenivasan V, Karunakar P, Madhileti S, Govindaswamy Ramamoorthy J, Gulati R. A rare case of congenital insensitivity to pain with anhidrosis. Paediatr Int Child Health 2024:1-4. [PMID: 38659257 DOI: 10.1080/20469047.2024.2344879] [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: 09/24/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
A 22-month-old girl of consanguineous parents was admitted with a high-grade fever. She was found to have insensitivity to painful stimuli and an absence of perspiration. She also displayed self-mutilating behaviour and was insensitive to cold/hot water on her body. On examination, there was loss of the tip of the tongue, missing teeth, generalised xerosis, and several ulcers at sites of minor trauma. She also had dysplastic nails and digital ulcers. Sensory examination demonstrated a complete lack of awareness of pain and temperature, vibration and fine touch were intact and lacrimation was normal. Differential diagnoses of hereditary sensory and autonomic neuropathy (HSAN), Lesch-Nyhan syndrome, hypohidrotic ectodermal dysplasia and leprosy were considered. Results of routine blood investigations including serum uric acid were normal. On performing clinical exome sequencing, the diagnosis of congenital insensitivity to pain with anhidrosis (CIPA) of autosomal recessive inheritance was confirmed. A novel, predicted to be pathogenic variant detected at exon 16 of the NTRK1 gene resulting in congenital insensitivity to pain with anhidrosis is reported.Abbreviations: CIPA: congenital Insensitivity to pain with anhidrosis; HSAN: hereditary sensory and autonomic neuropathy; NGF: nerve growth factor; NTRK1: neurotrophic tyrosine kinase receptor 1 gene; TrKA: tropomyosin receptor kinase A.
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Affiliation(s)
- Vaishnavi Sreenivasan
- Department of Paediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Pediredla Karunakar
- Department of Paediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sravani Madhileti
- Department of Paediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Reena Gulati
- Department of Paediatrics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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5
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Cho JH, Hwang S, Kwak YH, Yum M, Seo GH, Koh J, Ju YS, Yoon J, Kang M, Do H, Kim S, Kim G, Bae H, Lee BH. Clinical and genetic characteristics of three patients with congenital insensitivity to pain with anhidrosis: Case reports and a review of the literature. Mol Genet Genomic Med 2024; 12:e2430. [PMID: 38581121 PMCID: PMC10997844 DOI: 10.1002/mgg3.2430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Congenital insensitivity to pain with anhidrosis (CIPA) is an extremely rare autosomal recessive disorder caused by loss-of-function mutations of the NTRK1 gene, affecting the autonomic and sensory nervous system. Clinical manifestation is varied and includes recurrent fever, pain insensitivity, anhidrosis, self-mutilating behavior, and intellectual disability. METHODS Clinical and genetic features were assessed in two males and one female with genetically confirmed CIPA using exome or genome sequencing. RESULTS CIPA symptoms including recurrent fever, pain insensitivity, and anhidrosis manifested at the age of 1 year (age range: 0.3-8 years). Two patients exhibited self-mutilation tendencies, intellectual disability, and developmental delay. Four NTRK1 (NM_002529.3) mutations, c.851-33T>A (p.?), c.2020G>T (p.Asp674Tyr), c.2303C>T (p.Pro768Leu), and c.574-156_850+1113del (exons 5-7 del) were identified. Two patients exhibited early onset and severe phenotype, being homozygous for c.851-33T>A (p.?) mutations and compound heterozygous for c.851-33T>A (p.?) and c.2020G>T (p.Asp674Tyr) mutation of NTRK1. The third patient with compound heterozygous mutations of c.2303C>T (p.Pro768Leu) and c.574-156_850+1113del (exons 5-7 del) displayed a late onset and milder clinical manifestation. CONCLUSION All three patients exhibited variable phenotypes and disease severity. This research enriches our understanding of clinical and genetic aspects of CIPA, highlighting variable phenotypes and disease severity.
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Affiliation(s)
- Jun Hee Cho
- Medical Genetics Center, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
- Department of Pediatrics, Asan Medical Center Children's HospitalUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Soojin Hwang
- Medical Genetics Center, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
- Department of Pediatrics, Asan Medical Center Children's HospitalUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Yoon Hae Kwak
- Department of Orthopedic Surgery, Asan Medical Center Children's HospitalUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Mi‐Sun Yum
- Department of Pediatric NeurologyAsan Medical Center, University of Ulsan College of MedicineSeoulRepublic of Korea
| | - Go Hun Seo
- Division of Medical Genetics, 3billion, Inc.SeoulRepublic of Korea
| | | | | | - Ji‐Hee Yoon
- Medical Genetics Center, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
- Department of Pediatrics, Asan Medical Center Children's HospitalUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Minji Kang
- Asan Medical CenterAsan Institute for Life SciencesSeoulRepublic of Korea
| | - Hyo‐Sang Do
- Asan Medical CenterAsan Institute for Life SciencesSeoulRepublic of Korea
| | - Soyoung Kim
- Asan Medical CenterAsan Institute for Life SciencesSeoulRepublic of Korea
| | - Gu‐Hwan Kim
- Medical Genetics Center, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Hyunwoo Bae
- Medical Genetics Center, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
- Department of Pediatrics, Asan Medical Center Children's HospitalUniversity of Ulsan College of MedicineSeoulRepublic of Korea
| | - Beom Hee Lee
- Medical Genetics Center, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
- Department of Pediatrics, Asan Medical Center Children's HospitalUniversity of Ulsan College of MedicineSeoulRepublic of Korea
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6
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Pacifico P, Testa G, Amodeo R, Mainardi M, Tiberi A, Convertino D, Arevalo JC, Marchetti L, Costa M, Cattaneo A, Capsoni S. Human TrkAR649W mutation impairs nociception, sweating and cognitive abilities: a mouse model of HSAN IV. Hum Mol Genet 2023; 32:1380-1400. [PMID: 36537577 PMCID: PMC10077510 DOI: 10.1093/hmg/ddac295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/11/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
A functional nerve growth factor NGF-Tropomyosin Receptor kinase A (TrkA) system is an essential requisite for the generation and maintenance of long-lasting thermal and mechanical hyperalgesia in adult mammals. Indeed, mutations in the gene encoding for TrkA are responsible for a rare condition, named Hereditary Sensory and Autonomic Neuropathy type IV (HSAN IV), characterized by the loss of response to noxious stimuli, anhidrosis and cognitive impairment. However, to date, there is no available mouse model to properly understand how the NGF-TrkA system can lead to pathological phenotypes that are distinctive of HSAN IV. Here, we report the generation of a knock-in mouse line carrying the HSAN IV TrkAR649W mutation. First, by in vitro biochemical and biophysical analyses, we show that the pathological R649W mutation leads to kinase-inactive TrkA also affecting its membrane dynamics and trafficking. In agreement with the HSAN IV human phenotype, TrkAR649W/m mice display a lower response to thermal and chemical noxious stimuli, correlating with reduced skin innervation, in addition to decreased sweating in comparison to TrkAh/m controls. Moreover, the R649W mutation decreases anxiety-like behavior and compromises cognitive abilities, by impairing spatial-working and social memory. Our results further uncover unexplored roles of TrkA in thermoregulation and sociability. In addition to accurately recapitulating the clinical manifestations of HSAN IV patients, our findings contribute to clarifying the involvement of the NGF-TrkA system in pain sensation.
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Affiliation(s)
- Paola Pacifico
- Bio@SNS Laboratory, Scuola Normale Superiore, Pisa 56124, Italy
| | - Giovanna Testa
- Bio@SNS Laboratory, Scuola Normale Superiore, Pisa 56124, Italy
| | - Rosy Amodeo
- Center for Nanotechnology Innovation @NEST, Istituto Italiano di Tecnologia, Pisa 56127, Italy
- NEST, Scuola Normale Superiore, Pisa 56127, Italy
| | - Marco Mainardi
- Bio@SNS Laboratory, Scuola Normale Superiore, Pisa 56124, Italy
- Neuroscience Institute, National Research Council (IN-CNR), Pisa 56124, Italy
| | - Alexia Tiberi
- Bio@SNS Laboratory, Scuola Normale Superiore, Pisa 56124, Italy
| | - Domenica Convertino
- Center for Nanotechnology Innovation @NEST, Istituto Italiano di Tecnologia, Pisa 56127, Italy
- NEST, Scuola Normale Superiore, Pisa 56127, Italy
| | - Juan Carlos Arevalo
- Departmento de Biología Celular y Patología, Instituto de Neurociencias de Castilla y León, University of Salamanca, Salamanca 37007, Spain
- Institute of Biomedical Research of Salamanca, Salamanca 37007, Spain
| | - Laura Marchetti
- Center for Nanotechnology Innovation @NEST, Istituto Italiano di Tecnologia, Pisa 56127, Italy
- Department of Pharmacy, University of Pisa, Pisa 56126, Italy
| | - Mario Costa
- Neuroscience Institute, National Research Council (IN-CNR), Pisa 56124, Italy
- Pisa Center for Research and Clinical Implementation Flash Radiotherapy (CPFR@CISUP), Pisa 56126, Italy
| | - Antonino Cattaneo
- Bio@SNS Laboratory, Scuola Normale Superiore, Pisa 56124, Italy
- Rita Levi-Montalcini European Brain Research Institute (EBRI), Rome 00161, Italy
| | - Simona Capsoni
- Bio@SNS Laboratory, Scuola Normale Superiore, Pisa 56124, Italy
- Department of Neuroscience and Rehabilitation, Institute of Physiology, University of Ferrara, Ferrara 44121, Italy
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Moraes BC, Ribeiro-Filho HV, Roldão AP, Toniolo EF, Carretero GPB, Sgro GG, Batista FAH, Berardi DE, Oliveira VRS, Tomasin R, Vieceli FM, Pramio DT, Cardoso AB, Figueira ACM, Farah SC, Devi LA, Dale CS, de Oliveira PSL, Schechtman D. Structural analysis of TrkA mutations in patients with congenital insensitivity to pain reveals PLCγ as an analgesic drug target. Sci Signal 2022; 15:eabm6046. [PMID: 35471943 DOI: 10.1126/scisignal.abm6046] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Chronic pain is a major health issue, and the search for new analgesics has become increasingly important because of the addictive properties and unwanted side effects of opioids. To explore potentially new drug targets, we investigated mutations in the NTRK1 gene found in individuals with congenital insensitivity to pain with anhidrosis (CIPA). NTRK1 encodes tropomyosin receptor kinase A (TrkA), the receptor for nerve growth factor (NGF) and that contributes to nociception. Molecular modeling and biochemical analysis identified mutations that decreased the interaction between TrkA and one of its substrates and signaling effectors, phospholipase Cγ (PLCγ). We developed a cell-permeable phosphopeptide derived from TrkA (TAT-pQYP) that bound the Src homology domain 2 (SH2) of PLCγ. In HEK-293T cells, TAT-pQYP inhibited the binding of heterologously expressed TrkA to PLCγ and decreased NGF-induced, TrkA-mediated PLCγ activation and signaling. In mice, intraplantar administration of TAT-pQYP decreased mechanical sensitivity in an inflammatory pain model, suggesting that targeting this interaction may be analgesic. The findings demonstrate a strategy to identify new targets for pain relief by analyzing the signaling pathways that are perturbed in CIPA.
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Affiliation(s)
- Beatriz C Moraes
- Department of Biochemistry, Chemistry Institute, University of São Paulo, SP 05508-000, Brazil
| | - Helder V Ribeiro-Filho
- Brazilian Center for Research in Energy and Materials (CNPEM), Brazilian Biosciences National Laboratory (LNBio) Campinas, SP 13083-100, Brazil
| | - Allan P Roldão
- Department of Biochemistry, Chemistry Institute, University of São Paulo, SP 05508-000, Brazil
| | - Elaine F Toniolo
- Laboratory of Neuromodulation of Experimental Pain (LaNed), Department of Anatomy, Institute of Biomedical Sciences, University of Sao Paulo, SP 05508-000, Brazil
| | - Gustavo P B Carretero
- Department of Biochemistry, Chemistry Institute, University of São Paulo, SP 05508-000, Brazil
| | - Germán G Sgro
- Department of Biochemistry, Chemistry Institute, University of São Paulo, SP 05508-000, Brazil.,Department of Biomolecular Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP 14040903, Brazil
| | - Fernanda A H Batista
- Brazilian Center for Research in Energy and Materials (CNPEM), Brazilian Biosciences National Laboratory (LNBio) Campinas, SP 13083-100, Brazil
| | - Damian E Berardi
- Department of Biochemistry, Chemistry Institute, University of São Paulo, SP 05508-000, Brazil
| | - Victoria R S Oliveira
- Laboratory of Neuromodulation of Experimental Pain (LaNed), Department of Anatomy, Institute of Biomedical Sciences, University of Sao Paulo, SP 05508-000, Brazil
| | - Rebeka Tomasin
- Department of Biochemistry, Chemistry Institute, University of São Paulo, SP 05508-000, Brazil
| | - Felipe M Vieceli
- Department of Biochemistry, Chemistry Institute, University of São Paulo, SP 05508-000, Brazil
| | - Dimitrius T Pramio
- Department of Biochemistry, Chemistry Institute, University of São Paulo, SP 05508-000, Brazil
| | - Alexandre B Cardoso
- Department of Biochemistry, Chemistry Institute, University of São Paulo, SP 05508-000, Brazil
| | - Ana C M Figueira
- Brazilian Center for Research in Energy and Materials (CNPEM), Brazilian Biosciences National Laboratory (LNBio) Campinas, SP 13083-100, Brazil
| | - Shaker C Farah
- Department of Biochemistry, Chemistry Institute, University of São Paulo, SP 05508-000, Brazil
| | - Lakshmi A Devi
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Camila S Dale
- Laboratory of Neuromodulation of Experimental Pain (LaNed), Department of Anatomy, Institute of Biomedical Sciences, University of Sao Paulo, SP 05508-000, Brazil
| | - Paulo S L de Oliveira
- Brazilian Center for Research in Energy and Materials (CNPEM), Brazilian Biosciences National Laboratory (LNBio) Campinas, SP 13083-100, Brazil
| | - Deborah Schechtman
- Department of Biochemistry, Chemistry Institute, University of São Paulo, SP 05508-000, Brazil
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8
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Zhang M, Cao X, Li N, Duan G, Zhang X. Autism spectrum disorder in a boy with congenital insensitivity to pain with anhidrosis: a case report. BMC Pediatr 2022; 22:126. [PMID: 35277138 PMCID: PMC8915475 DOI: 10.1186/s12887-022-03196-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/07/2022] [Indexed: 11/12/2022] Open
Abstract
Background In this case report, we described the past history, clinical manifestations, genetic characteristics and cognitive evaluation of a boy with congenital insensitivity to pain with anhidrosis (CIPA) who developed autism spectrum disorder (ASD). Case presentation The boy had an early onset of CIPA at the age of 48 months, and was later diagnosed with ASD at 5 years old. Developmental delays in communication, social skills and the presence of maladaptive behaviors were observed in the patient. Professional treatments significantly improved the developmental delays. Conclusions This case demonstrated that ASD may develop in children with CIPA, and pediatricians should be aware that if they suspect or identify a child with CIPA that they should also be screened for ASD using similar examination and diagnostic tools as shown in the present report. Moreover, therapeutic interventions for ASD was helpful for the remission of both diseases.
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Yang K, Xu YC, Hu HY, Li YZ, Li Q, Luan YY, Liu Y, Sun YQ, Feng ZK, Yan YS, Yin CH. Investigation of a Novel NTRK1 Variation Causing Congenital Insensitivity to Pain With Anhidrosis. Front Genet 2021; 12:763467. [PMID: 34938316 PMCID: PMC8686761 DOI: 10.3389/fgene.2021.763467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Congenital insensitivity to pain with anhidrosis (CIPA), a rare autosomal recessive sensory neuropathy, was caused mainly by biallelic mutations in the NTRK1 gene. The pathogenesis of CIPA still needs further elucidation. Methods: Here, we recruited a CIPA case and introduced whole-exome sequencing (WES) to identify the causative variation. Subsequently, an in silico molecular dynamic (MD) analysis was performed to explore the intramolecular impact of the novel missense variant. Meanwhile, in vitro functional study on the novel variant from a metabolomic perspective was conducted via the liquid chromatography–mass spectrometry (LC-MS) approach, of which the result was verified by quantitative real-time PCR (qRT-PCR). Results: A novel compound heterozygous variation in NTRK1 gene was detected, consisting of the c.851–33T > A and c.2242C > T (p.Arg748Trp) variants. MD result suggested that p.Arg748Trp could affect the intramolecular structure stability. The results of the LC-MS and metabolic pathway clustering indicated that the NTRK1Arg748Trp variant would significantly affect the purine metabolism in vitro. Further analysis showed that it induced the elevation of NT5C2 mRNA level. Conclusion: The findings in this study extended the variation spectrum of NTRK1, provided evidence for counseling to the affected family, and offered potential clues and biomarkers to the pathogenesis of CIPA.
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Affiliation(s)
- Kai Yang
- Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yi-Cheng Xu
- Department of Neurology, Aerospace Center Hospital, Beijing, China
| | - Hua-Ying Hu
- Jiaen Genetics Laboratory, Beijing Jiaen Hospital, Beijing, China
| | - Ya-Zhou Li
- Department of Pediatric Orthopaedic, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qian Li
- National Research Institute for Family Planning, Beijing, China
| | - Ying-Yi Luan
- Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yan Liu
- Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Yong-Qing Sun
- Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Zhan-Ke Feng
- Jiaen Genetics Laboratory, Beijing Jiaen Hospital, Beijing, China
| | - You-Sheng Yan
- Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Cheng-Hong Yin
- Prenatal Diagnosis Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China
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10
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Baghdadi S, Saberi S, Baghdadi T. Guided growth in the correction of knee deformity in patients with congenital insensitivity to pain. J Orthop Surg Res 2021; 16:184. [PMID: 33706758 PMCID: PMC7948364 DOI: 10.1186/s13018-021-02304-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background Orthopedic manifestations of congenital insensitivity to pain (CIP) can be devastating if left untreated. Knee deformities are common in patients with CIP and might lead to joint destruction and loss of walking ability. The purpose of the present study was to report the results and complications of guided growth procedures around the knee in patients with CIP. Methods In a retrospective review, all patients with CIP who underwent guided growth procedures around the knee from 2009 to 2017 at a tertiary referral hospital were evaluated. Patients with secondary insensitivity to pain (e.g., syringomyelia), as well as patients with incomplete records, were excluded. Demographic data, clinical findings, correction rate, and complications were recorded. Results Ten knees in six patients fulfilled the inclusion criteria. The median age was 10 (range, 5–12), with a mean follow-up of 31 months (range, 16–56). Distal femoral tension-band hemiepiphysiodesis was the most common procedure, followed by proximal tibial hemiepiphysiodesis. The mean correction rate was 0.28°/month for femoral deformity. Staples were removed prematurely in one patient due to extrusion. No cases of infection or skin dehiscence were observed. None of the patients needed a reconstructive knee procedure during the study period. Conclusions The findings of this study suggest that guided growth procedures might have a role in the correction of knee deformities in patients with CIP. However, the correction rate is lower than that of typically developing children, patients should be closely followed to prevent complications, and stringent patient selection criteria should be followed to ensure success.
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Affiliation(s)
- Soroush Baghdadi
- Joint Reconstruction Research Center, Department of Orthopedics, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, 1419733141, Iran
| | - Sadegh Saberi
- Joint Reconstruction Research Center, Department of Orthopedics, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, 1419733141, Iran
| | - Taghi Baghdadi
- Joint Reconstruction Research Center, Department of Orthopedics, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, 1419733141, Iran.
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11
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Li L, Jia C, Tang Y, Kong Y, Xia Y, Ma L. Novel Gross Deletion Mutations in NTRK1 Gene Associated With Congenital Insensitivity to Pain With Anhidrosis. Front Pediatr 2021; 9:638190. [PMID: 33748046 PMCID: PMC7969531 DOI: 10.3389/fped.2021.638190] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Congenital insensitivity to pain with anhidrosis (CIPA) is a rare inherited autosomal recessive disorder characterized by insensitivity to noxious stimuli, anhidrosis, recurrent fever, and intellectual disability. CIPA is mainly caused by mutations in the neurotrophic tyrosine kinase receptor type 1 gene (NTRK1). This study aims to identify pathogenic mutations underlying CIPA in two unrelated Chinese families. Methods: DNA was extracted from blood samples of patients and their available family members and subjected to whole exome sequencing (WES). Real-time PCR (qPCR), Gap-PCR, and Sanger sequencing were applied to verify the identified variants. Result: We found novel compound gross deletion mutations [exon1-6 del (g.1-1258_10169del); exon5-7 del (g.6995_11999del)] of NTRK1 (MIM 191315) gene in family 1 and the compound heterozygous mutations [c.851-33T>A; exon5-7 del (g.6995_11999del)] in family 2. Interestingly, we discovered the intragenic novel gross deletion [exon5-7 del (g.6995_11999del)] mediated by recombination between Alu elements. Conclusions: The present study highlights two rare gross deletion mutations in the NTRK1 gene associated with CIPA in two unrelated Chinese families. The deletion of exon1-6 (g.1-1258_10169del) is thought to be the largest NTRK1 deletion reported to date. Our findings expand the mutation spectrum of NTRK1 mutations in the Chinese and could be useful for prenatal interventions and more precise pharmacological treatments to patients. WES conducted in our study is a convenient and useful tool for clinical diagnosis of CIPA and other associated disorders.
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Affiliation(s)
- Lulu Li
- Department of Newborn Screening Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Chao Jia
- Department of Neonatology, Hebei Provincial Children's Hospital, Shijiazhuang, China
| | - Yue Tang
- Department of Newborn Screening Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yuanyuan Kong
- Department of Newborn Screening Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yaofang Xia
- Department of Neonatology, Hebei Provincial Children's Hospital, Shijiazhuang, China
| | - Li Ma
- Department of Neonatology, Hebei Provincial Children's Hospital, Shijiazhuang, China
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12
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Zhu Z, Chen B, Na R, Fang W, Zhang W, Zhou Q, Zhou S, Lei H, Huang A, Chen T, Ni D, Gu Y, Liu J, Rao Y, Fang F. A genome-wide association study reveals a substantial genetic basis underlying the Ebbinghaus illusion. J Hum Genet 2020; 66:261-271. [PMID: 32939015 DOI: 10.1038/s10038-020-00827-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/03/2020] [Accepted: 08/04/2020] [Indexed: 11/09/2022]
Abstract
The Ebbinghaus illusion (EI) is an optical illusion of relative size perception that reflects the contextual integration ability in the visual modality. The current study investigated the genetic basis of two subtypes of EI, EI overestimation, and EI underestimation in humans, using quantitative genomic analyses. A total of 2825 Chinese adults were tested on their magnitudes of EI overestimation and underestimation using the method of adjustment, a standard psychophysical protocol. Heritability estimation based on common single nucleotide polymorphisms (SNPs) revealed a moderate heritability (34.3%) of EI overestimation but a nonsignificant heritability of EI underestimation. A meta-analysis of two phases (phase 1: n = 1986, phase 2: n = 839) of genome-wide association study (GWAS) discovered 1969 and 58 SNPs reaching genome-wide significance for EI overestimation and EI underestimation, respectively. Among these SNPs, 55 linkage-disequilibrium-independent SNPs were associated with EI overestimation in phase 1 with genome-wide significance and their associations could be confirmed in phase 2 cohort. Gene-based analyses found seven genes to be associated with EI overestimation at the genome-wide level, two from meta-analysis, and five from classical two-stage analysis. Overall, this study provided consistent evidence for a substantial genetic basis of the Ebbinghaus illusion.
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Affiliation(s)
- Zijian Zhu
- School of Psychology, Shaanxi Normal University, 710062, Xi'an, China
| | - Biqing Chen
- PKU-IDG/McGovern Institute for Brain Research, and Peking-Tsinghua Center for Life Sciences, Peking University, 100871, Beijing, China.,Central Laboratory, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, 210029, Nanjing, China
| | - Ren Na
- PKU-IDG/McGovern Institute for Brain Research, and Peking-Tsinghua Center for Life Sciences, Peking University, 100871, Beijing, China
| | - Wan Fang
- PKU-IDG/McGovern Institute for Brain Research, and Peking-Tsinghua Center for Life Sciences, Peking University, 100871, Beijing, China.,Beijing Innovative Center for Genomics, Peking University School of Life Sciences, and National Institute of Biological Sciences, 102206, Beijing, China
| | - Wenxia Zhang
- PKU-IDG/McGovern Institute for Brain Research, and Peking-Tsinghua Center for Life Sciences, Peking University, 100871, Beijing, China
| | - Qin Zhou
- College of Laboratory Medicine, Chongqing Medical University, 400016, Chongqing, China
| | - Shanbi Zhou
- University-Town Hospital of Chongqing Medical University, 401331, Chongqing, China
| | - Han Lei
- College of Laboratory Medicine, Chongqing Medical University, 400016, Chongqing, China
| | - Ailong Huang
- College of Laboratory Medicine, Chongqing Medical University, 400016, Chongqing, China
| | - Tingmei Chen
- College of Laboratory Medicine, Chongqing Medical University, 400016, Chongqing, China
| | - Dongsheng Ni
- Division of Molecular Nephrology and Creative Training Center for Undergraduates, M.O.E. Key Laboratory of Medical Diagnostics, College of Laboratory Medicine, Chongqing Medical University, 400016, Chongqing, China
| | - Yuping Gu
- Division of Molecular Nephrology and Creative Training Center for Undergraduates, M.O.E. Key Laboratory of Medical Diagnostics, College of Laboratory Medicine, Chongqing Medical University, 400016, Chongqing, China
| | - Jianing Liu
- Division of Molecular Nephrology and Creative Training Center for Undergraduates, M.O.E. Key Laboratory of Medical Diagnostics, College of Laboratory Medicine, Chongqing Medical University, 400016, Chongqing, China
| | - Yi Rao
- PKU-IDG/McGovern Institute for Brain Research, and Peking-Tsinghua Center for Life Sciences, Peking University, 100871, Beijing, China. .,Beijing Innovative Center for Genomics, Peking University School of Life Sciences, and National Institute of Biological Sciences, 102206, Beijing, China.
| | - Fang Fang
- PKU-IDG/McGovern Institute for Brain Research, and Peking-Tsinghua Center for Life Sciences, Peking University, 100871, Beijing, China. .,School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, 100871, Beijing, China.
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13
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Gucev Z, Tasic V, Bogevska I, Laban N, Saveski A, Polenakovic M, Plaseska-Karanfilska D, Komlosi K, Winter J, Schweiger S, Nishimura G, Spranger J, Bartsch O. Heterotopic ossifications and Charcot joints: Congenital insensitivity to pain with anhidrosis (CIPA) and a novel NTRK1 gene mutation. Eur J Med Genet 2019; 63:103613. [PMID: 30677517 DOI: 10.1016/j.ejmg.2019.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 01/11/2019] [Accepted: 01/12/2019] [Indexed: 10/27/2022]
Abstract
Congenital insensitivity to pain with anhidrosis (CIPA), also known as hereditary sensory and autonomic neuropathy type IV (HSAN-IV), is a rare and severe autosomal recessive disorder. We report on an adult female patient whose clinical findings during childhood were not recognized as CIPA. There was neither complete anhidrosis nor a recognizable sensitivity to heat. Tumorlike swellings of many joints and skeletal signs of Charcot neuropathy developed in adolescence which, together with a history of self-mutilation, led to a clinical suspicion of CIPA confirmed by identification of a novel homozygous variant c.1795G > T in the NTRK1 gene in blood lymphocytes. Both parents were heterozygous for the mutation. The variant predicts a premature stop codon (p.Gly599Ter) and thus represents a pathogenic variant; the first reported in the Southeastern European population.
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Affiliation(s)
| | | | | | | | | | | | | | - Katalin Komlosi
- Institute of Human Genetics, Medical Center of the Johannes Gutenberg University Mainz, University of Mainz, Germany
| | - Jennifer Winter
- Institute of Human Genetics, Medical Center of the Johannes Gutenberg University Mainz, University of Mainz, Germany
| | - Susann Schweiger
- Institute of Human Genetics, Medical Center of the Johannes Gutenberg University Mainz, University of Mainz, Germany
| | - Gen Nishimura
- Intractable Disease Center, Saitama Medical University Hospital, Saitama, Japan
| | | | - Oliver Bartsch
- Institute of Human Genetics, Medical Center of the Johannes Gutenberg University Mainz, University of Mainz, Germany
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14
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Wang R, Liu Y, Zhou YY, Wang JY, Xu ZJ, Chen SY, Wang QQ, Yuan P. Postoperative redislocation of the hip in a patient with congenital insensitivity to pain with anhidrosis: A case report and review of literature. World J Clin Cases 2018; 6:836-841. [PMID: 30510952 PMCID: PMC6264989 DOI: 10.12998/wjcc.v6.i14.836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 02/05/2023] Open
Abstract
Pelvic osteotomy is commonly used to adjust acetabula dysplasia for congenital dislocation of the hip, whereas congenital insensitivity to pain with anhidrosis (CIPA) is a rare hereditary disease that often has the characteristics of joint development deformity and easy fracture. This article reports the case involving a CIPA patient who was surgically treated by Chiari pelvic osteotomy and proximal femoral rotation osteotomy for congenital dislocation of the left hip joint and was provided long-term follow-up for redislocation and bilateral femoral head absorption.
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Affiliation(s)
- Rui Wang
- The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Yi Liu
- The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Yi-Yi Zhou
- The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Jia-Ying Wang
- The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Zhu-Jie Xu
- The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Sha-Yang Chen
- The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Qi-Qi Wang
- The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
| | - Peng Yuan
- The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi 214000, Jiangsu Province, China
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15
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Li N, Sun J, Guo S, Liu Y, Wang C, Zhu C, Zhang X. Phenotypic and genotypic features of a pair of Chinese identical twins with congenital insensitivity to pain and anhidrosis: A case report. Medicine (Baltimore) 2018; 97:e13209. [PMID: 30461622 PMCID: PMC6392968 DOI: 10.1097/md.0000000000013209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Congenital insensitivity to pain with anhidrosis (CIPA) is a rare autosomal recessive genetic disorder characterized by insensitivity to noxious stimulus and the absence of sweating. Fractures and joint destruction are common complications, but detailed studies on mineral and skeletal homeostasis are not available. Mental retardation is often reported, but detailed observations during childhood are lacking. PATIENT CONCERNS A pair of 46-month-old Chinese identical twin brothers was presented at our hospital. The brothers had the typical manifestations of insensitivity to noxious stimulus, inability to sweat, and recurrent episodes of unexplained fever. Fortunately, they did not present common complications such as self-mutilation, trauma, bruise, and repeated bone fractures. DIAGNOSES Two novel compound heterozygous variants of NTRK1 (c.632T > A and c.1253_1254delTC) were identified. INTERVENTIONS The patients were subjected to routine and specialist clinical examinations. Daily care and symptomatic treatment were given. OUTCOME X-ray films of proband 2 showed a fracture in the first metatarsal. Decreased bone mineral density (BMD) and mild-to-moderate retardation of the Gesell developmental schedules (GDS), especially language and adaptability, were observed. Evaluation results for BMD and GDS in proband 2 were worse than those in his brother. LESSONS The current findings expand our knowledge about the spectrum of phenotypic and genotypic features of CIPA, which will help facilitate future genotype-phenotype association studies. Daily care by parents promotes favorable outcomes in patients.
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