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Alfalasi M, ElGhazali G, Fathalla W, Khawaja K. Anti-U1RNP-70kD-positive case of neonatal lupus presenting with seizure and incomplete heart block: a case report and literature review. Front Pediatr 2023; 11:1239327. [PMID: 37681197 PMCID: PMC10482031 DOI: 10.3389/fped.2023.1239327] [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: 06/13/2023] [Accepted: 08/04/2023] [Indexed: 09/09/2023] Open
Abstract
Neonatal lupus erythematosus (NLE) is an autoimmune disease caused by the transplacental passage of anti-Ro/SS-A and anti-La/SS-B. This can be less commonly seen with U1-ribonucleoprotein (U1RNP). Our patient is a 7-day-old male, who first presented with seizures. In addition, during an electroencephalogram, he was found to have an irregular heart rhythm. Looking further into the history, we found that the mother was aware that she had systemic lupus erythematosus (SLE). However, she had not been followed up with a rheumatologist. The workup for NLE found a negative anti-Ro/SS-A and anti-La/SS-B, with a positive U1RNP-70kD. U1RNP-70kD is a diagnostic test for mixed connective tissue disease in adults, but no research has been done on its significance in NLE. Despite having SLE, the infant's mother did not receive surveillance during her pregnancy, as the current guidelines are tailored for mothers with anti-Ro/SS-A and anti-La/SS-B. As a result, this calls for the extension of these guidelines to include the U1RNP-70kD antibody. In this case, the 70kD subtype of U1RNP was positive, which may have had a role to play in this unusual presentation. However, further research is needed to improve the care of mothers and babies with U1RNP-70kD.
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Affiliation(s)
- Maryam Alfalasi
- Education Institute, Sheikh Khalifa Medical City (SKMC), Abu Dhabi, United Arab Emirates
| | - Gehad ElGhazali
- Sheikh Khalifa Medical City(SKMC), Purelab-Purehealth, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Waseem Fathalla
- Department of Pediatric Neurology, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, United Arab Emirates
| | - Khulood Khawaja
- Department of Pediatric Rheumatology, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, United Arab Emirates
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Mitra S, Harvey-Jones K, Kraev I, Verma V, Meehan C, Mintoft A, Norris G, Campbell E, Tucker K, Robertson NJ, Hristova M, Lange S. The Extracellular Vesicle Citrullinome and Signature in a Piglet Model of Neonatal Seizures. Int J Mol Sci 2023; 24:11529. [PMID: 37511288 PMCID: PMC10380774 DOI: 10.3390/ijms241411529] [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: 06/11/2023] [Revised: 07/09/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Neonatal seizures are commonly associated with acute perinatal brain injury, while understanding regarding the downstream molecular pathways related to seizures remains unclear. Furthermore, effective treatment and reliable biomarkers are still lacking. Post-translational modifications can contribute to changes in protein function, and post-translational citrullination, which is caused by modification of arginine to citrulline via the calcium-mediated activation of the peptidylarginine deiminase (PAD) enzyme family, is being increasingly linked to neurological injury. Extracellular vesicles (EVs) are lipid-bilayer structures released from cells; they can be isolated from most body fluids and act as potential liquid biomarkers for disease conditions and response to treatment. As EVs carry a range of genetic and protein cargo that can be characteristic of pathological processes, the current study assessed modified citrullinated protein cargo in EVs isolated from plasma and CSF in a piglet neonatal seizure model, also following phenobarbitone treatment. Our findings provide novel insights into roles for PAD-mediated changes on EV signatures in neonatal seizures and highlight the potential of plasma- and CSF-EVs to monitor responses to treatment.
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Affiliation(s)
- Subhabrata Mitra
- Department of Neonatology, Institute for Women’s Health, University College London, London WC1E 6BT, UK; (K.H.-J.); (V.V.); (C.M.); (A.M.); (G.N.); (E.C.); (K.T.); (N.J.R.)
| | - Kelly Harvey-Jones
- Department of Neonatology, Institute for Women’s Health, University College London, London WC1E 6BT, UK; (K.H.-J.); (V.V.); (C.M.); (A.M.); (G.N.); (E.C.); (K.T.); (N.J.R.)
| | - Igor Kraev
- Electron Microscopy Suite, Faculty of Science, Technology, Engineering and Mathematics, Open University, Milton Keynes MK7 6AA, UK;
| | - Vinita Verma
- Department of Neonatology, Institute for Women’s Health, University College London, London WC1E 6BT, UK; (K.H.-J.); (V.V.); (C.M.); (A.M.); (G.N.); (E.C.); (K.T.); (N.J.R.)
| | - Christopher Meehan
- Department of Neonatology, Institute for Women’s Health, University College London, London WC1E 6BT, UK; (K.H.-J.); (V.V.); (C.M.); (A.M.); (G.N.); (E.C.); (K.T.); (N.J.R.)
| | - Alison Mintoft
- Department of Neonatology, Institute for Women’s Health, University College London, London WC1E 6BT, UK; (K.H.-J.); (V.V.); (C.M.); (A.M.); (G.N.); (E.C.); (K.T.); (N.J.R.)
| | - Georgina Norris
- Department of Neonatology, Institute for Women’s Health, University College London, London WC1E 6BT, UK; (K.H.-J.); (V.V.); (C.M.); (A.M.); (G.N.); (E.C.); (K.T.); (N.J.R.)
| | - Ellie Campbell
- Department of Neonatology, Institute for Women’s Health, University College London, London WC1E 6BT, UK; (K.H.-J.); (V.V.); (C.M.); (A.M.); (G.N.); (E.C.); (K.T.); (N.J.R.)
| | - Katie Tucker
- Department of Neonatology, Institute for Women’s Health, University College London, London WC1E 6BT, UK; (K.H.-J.); (V.V.); (C.M.); (A.M.); (G.N.); (E.C.); (K.T.); (N.J.R.)
| | - Nicola J. Robertson
- Department of Neonatology, Institute for Women’s Health, University College London, London WC1E 6BT, UK; (K.H.-J.); (V.V.); (C.M.); (A.M.); (G.N.); (E.C.); (K.T.); (N.J.R.)
| | - Mariya Hristova
- Perinatal Brain Repair Group, Department of Neonatology, UCL Institute for Women’s Health, London WC1E 6HU, UK;
| | - Sigrun Lange
- Perinatal Brain Repair Group, Department of Neonatology, UCL Institute for Women’s Health, London WC1E 6HU, UK;
- Tissue Architecture and Regeneration Research Group, School of Life Sciences, University of Westminster, London W1W 6UW, UK
- Pathobiology and Extracellular Vesicle Research Group, School of Life Sciences, University of Westminster, London W1W 6UW, UK
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Lim MS, Shin JE, Lee SM, Eun HS, Park MS, Park KI, Namgung R, Lee KA, Lee JS. Diagnosis of Severe Protein C Deficiency Confirmed by Presence of Rare PROCGene Mutation. NEONATAL MEDICINE 2016. [DOI: 10.5385/nm.2016.23.4.233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Myung Seop Lim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Eun Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Soon Min Lee
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Ho Sun Eun
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Min Soo Park
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Kook In Park
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Ran Namgung
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung A Lee
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sung Lee
- Department of Clinical Genetics, Yonsei University College of Medicine, Seoul, Korea
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Yun D, Stein SL. Review of the cutaneous manifestations of autoimmune connective tissue diseases in pediatric patients. World J Dermatol 2015; 4:80-94. [DOI: 10.5314/wjd.v4.i2.80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 02/25/2015] [Accepted: 04/07/2015] [Indexed: 02/06/2023] Open
Abstract
Autoimmune connective tissue diseases are chronic inflammatory disorders associated with complex genetic and environmental interplay resulting in a variety of cutaneous and systemic manifestations. Pediatric onset of these disorders carries a unique diagnostic pressure for the clinician due to the potential years of disease burden and complications. Mortality and morbidity from these disorders has fallen dramatically over the past fifty years due to increasing awareness of these disease sequelae and utilization of systemic treatment modalities when necessary. This review highlights the clinical features that are unique to pediatric presentations of lupus erythematosus, juvenile idiopathic arthritis, juvenile dermatomyositis, juvenile onset systemic sclerosis and morphea. Each of these disorders has a distinct appearance corresponding to a particular cutaneous and systemic clinical course and prognosis. Awareness of the associated potential systemic complications can also alert the clinician to make astute management decisions when confronted with a probable rheumatologic case. Cutaneous symptoms may predate onset of systemic symptoms and by keeping the rheumatologic differential diagnoses in mind, the dermatologist can play a key role in potentially offsetting autoimmune disease burden in children.
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Padilla-España L, Díaz Cabrera R, Del Boz J, Lozano Calero C. Congenital lupus with multiorgan involvement: a case report and review of literature. Pediatr Dermatol 2015; 32:401-4. [PMID: 25660236 DOI: 10.1111/pde.12450] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Neonatal lupus erythematosus (NLE) is an autoimmune disease caused by transplacental antibodies that can damage fetal tissue and cause various findings. With the exception of congenital heart block, which can be easily recognized at birth because of neonatal cardiac monitoring during the delivery and immediately after birth, most cases of NLE are recognized within days to weeks of life, but fewer than 10 cases with findings present at birth have been reported. We report the case of a newborn with extensive cutaneous eruption at the time of birth and multisystemic involvement, including hematologic, respiratory, hepatic, and neurologic involvement.
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Affiliation(s)
| | - Rocio Díaz Cabrera
- Department of Pediatrics, Hospital Costa del Sol, Marbella, Málaga, Spain
| | - Javier Del Boz
- Department of Dermatology, Hospital Costa del Sol, Marbella, Málaga, Spain
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