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Bocchi MB, Giuli C, Farine F, Ravaioli C, Martellini S, Farsetti P, Palmacci O. Pathological Fractures in Patients Affected by Pycnodysostosis: A Case Series. J Clin Med 2024; 13:2522. [PMID: 38731051 PMCID: PMC11084355 DOI: 10.3390/jcm13092522] [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: 03/11/2024] [Revised: 04/16/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: Pycnodysostosis is a rare genetic disorder causing skeletal dysplasia. It is determined by a gene mutation leading to cathepsin K deficiency and predisposes a patient to osteosclerosis, resulting in increased bone fragility. The altered bone quality typical of this disease is responsible for an increased risk of fractures. The purpose of our study was to evaluate the orthopedic manifestations and potential pitfalls in the surgical treatments of pathological fractures in a series of patients treated in our institution who were affected by pycnodysostosis. Methods: We retrospectively evaluated clinical and radiographic characteristics of five patients with pycnodysostosis treated for pathological fractures at our hospital in the past 5 years. Results: Two male and three female patients were included in this study. Four patients had a family history of pycnodysostosis. All the patients were of short stature, but only two underwent growth hormone treatment. All the patients experienced fractures, mostly in their lower limbs and occurring as a result of low-energy trauma. Most of the patients experienced either consolidation delay or nonunion. Conclusions: The orthopedic management of fractures in patients with pycnodysostosis poses an ongoing challenge for orthopedic surgeons. The fact that the bone is simultaneously sclerotic and brittle makes any orthopedic surgical treatment challenging and at a high risk of nonunion in any case.
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Affiliation(s)
- Maria Beatrice Bocchi
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.B.B.); (F.F.); (S.M.); (O.P.)
- Scuola di Specializzazione in Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Cristina Giuli
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.B.B.); (F.F.); (S.M.); (O.P.)
- Scuola di Specializzazione in Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Farine
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.B.B.); (F.F.); (S.M.); (O.P.)
- Scuola di Specializzazione in Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Camilla Ravaioli
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.B.B.); (F.F.); (S.M.); (O.P.)
- Scuola di Specializzazione in Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Sara Martellini
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.B.B.); (F.F.); (S.M.); (O.P.)
- Scuola di Specializzazione in Ortopedia e Traumatologia, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Pasquale Farsetti
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Osvaldo Palmacci
- Department of Orthopaedics, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.B.B.); (F.F.); (S.M.); (O.P.)
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Moroni A, Brizola E, Di Cecco A, Tremosini M, Sergiampietri M, Bianchi A, Tappino B, Piana M, Gnoli M. Pathological mandibular fracture complicated by osteonecrosis in an adult patient with pycnodysostosis: clinical report and review of the literature. Eur J Med Genet 2024; 67:104904. [PMID: 38141876 DOI: 10.1016/j.ejmg.2023.104904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/22/2023] [Accepted: 12/17/2023] [Indexed: 12/25/2023]
Abstract
Pycnodysostosis is an ultra-rare osteosclerotic skeletal disorder characterized by short stature, susceptibly to fractures, acroosteolysis of the distal phalanges, and craniofacial features (frontal bossing, prominent nose, obtuse mandibular angle, micrognathia). Dental abnormalities (delayed eruption of teeth, hypodontia, malocclusion, dental crowding, persistence of deciduous teeth, enamel hypoplasia, and increased caries) are also frequent; due to bone metabolism alteration, the patients have an increased risk for jaw osteomyelitis, especially after tooth extraction or mandible fracture. Other complications are obstructive sleep apnea, endocrine alterations and cytopenia. Pycnodysostosis is caused by biallelic loss of function variants in CTSK gene, coding the lysosomal protease cathepsin K. CTSK is involved in the degradation of bone matrix proteins, such as type I and type II collagen. In pycnodysostosis, this degradation is decreased, leading to increased bone density and bone fragility with pathological fractures and poor healing. We present a clinical report of a female adult patient with typical pycnodysostosis phenotype. At the age of 52 years, she had a pathological spontaneous fracture of the right mandible complicated by osteonecrosis, treated with load bearing osteosynthesis. The direct sequencing of CTSK gene revealed the presence of the pathogenic homozygous variant c.746T>A, (p.Ile249Asn), that confirmed the diagnosis of pycnodysostosis. We also review the literature case series published to date, that suggest to always consider the diagnosis of pycnodysostosis in case of osteosclerosis, even in the absence of brachydactyly or short stature. This report details the natural history of the disease in this patient, from childhood to adulthood, and highlights the importance of a quality of life assessment. In addition, we describe a case of mandibular osteonecrosis and spontaneous fracture in pycnodysostosis, drawing attention on the maxillofacial complications in these patients and on the importance of a personalized follow-up.
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Affiliation(s)
- Alice Moroni
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Evelise Brizola
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Alessia Di Cecco
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Morena Tremosini
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
| | - Marta Sergiampietri
- Maxillo Facial Surgery Unit, CHIRMED Department, University of Catania, AOU Policlinico San Marco, Catania, Italy.
| | - Alberto Bianchi
- Maxillo Facial Surgery Unit, CHIRMED Department, University of Catania, AOU Policlinico San Marco, Catania, Italy; Department of General Surgery and Medical-Surgical Specialties, University of Catania, 95124 Catania, Italy.
| | - Barbara Tappino
- LABSIEM (Laboratory for the Study of Inborn Errors of Metabolism), IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy.
| | - Maria Piana
- U.O.C. Anatomia Patologica II, Dipartimento di Diagnostica delle Immagini e di Laboratorio, A.O.U. Policlinico - San Marco, Catania, Italy.
| | - Maria Gnoli
- Department of Rare Skeletal Disorders, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
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Persiani P, Martini L, Calogero V, Formica VM, Giannini E, Speziale Varsamis T, Celli M, Zambrano A, De Meo D, Villani C. Challenges in surgical orthopaedic treatment in a rare case of pycnodysostosis: Sometimes you win, sometimes you learn. J Orthop Sci 2023; 28:1412-1417. [PMID: 34083087 DOI: 10.1016/j.jos.2021.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Pietro Persiani
- Department of Orthopaedic and Traumatology, "Sapienza" University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy
| | - Lorena Martini
- Department of Orthopaedic and Traumatology, "Sapienza" University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy
| | - Valeria Calogero
- Department of Orthopaedic and Traumatology, "Sapienza" University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy.
| | - Virginia Maria Formica
- Department of Orthopaedic and Traumatology, "Sapienza" University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy
| | - Elettra Giannini
- Department of Orthopaedic and Traumatology, "Sapienza" University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy
| | - Tommaso Speziale Varsamis
- Department of Orthopaedic and Traumatology, "Sapienza" University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy
| | - Mauro Celli
- Department of Pediatrics, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Anna Zambrano
- Department of Pediatrics, "Sapienza" University of Rome, Viale Regina Elena, 324, 00161, Rome, Italy
| | - Daniele De Meo
- Department of Orthopaedic and Traumatology, "Sapienza" University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy
| | - Ciro Villani
- Department of Orthopaedic and Traumatology, "Sapienza" University of Rome, Piazzale A. Moro, 3, 00185 Rome, Italy
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Markova TV, Kenis V, Melchenko E, Guseva D, Osipova D, Galeeva N, Nagornova T, Dadali EL. Clinical and genetic characterization of three Russian patients with pycnodysostosis due to pathogenic variants in the CTSK gene. Mol Genet Genomic Med 2022; 10:e1904. [PMID: 35315254 PMCID: PMC9034671 DOI: 10.1002/mgg3.1904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 01/22/2022] [Accepted: 01/31/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Pycnodysostosis (PD, OMIM # 265800) is a rare variant of skeletal dysplasia with an autosomal recessive type of inheritance, characterized by a combination of specific features such as disproportionate nanism, generalized osteosclerosis, and distinct craniofacial dysmorphism. Radiographic features include acro-osteolysis of the distal phalanges in association with sclerosing bone lesions with multiple fractures. The polymorphism of the clinical manifestations of pycnodysostosis and low prevalence of the disorder lead to the difficulties with early. METHODS The following tests were used for diagnostics: genealogical analysis, clinical examination, neurological examination according to the standard method with an assessment of the psychoemotional sphere, radiological analysis, searching for pathogenic variants in the CTSK gene by the automated Sanger sequencing. RESULTS We describe first clinical and genetic characteristics of three Russian patients with pycnodysostosis from unrelated families. Two patients have a novel homozygous nucleotide substitution c.746T>A (p. Ile249Asn), and one has a previously described homozygous pathogenic variant c.746T>C (p.Ile249Thr) in the CTSK gene. In all three cases, a transition or transversion was found at nucleotide position 746 in exon 6 of the CTSK gene, leading to two different amino acid substitutions in the polypeptide chain. The obtained results may indicate the presence of a major pathogenic variant in the CTSK gene, leading to the typical manifestation of the disease. CONCLUSION The data presented in the study enlarge the clinical, radiological, and mutational spectrum of pycnodysostosis. Typical clinical manifestations and the small size of the CTSK gene make the automated Sanger sequencing the optimal method for diagnosis of pycnodysostosis.
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Affiliation(s)
| | - Vladimir Kenis
- H.Turner National Medical Research Center for Сhildren's Orthopedics and Trauma SurgeryPushkinRussia
| | - Evgeniy Melchenko
- H.Turner National Medical Research Center for Сhildren's Orthopedics and Trauma SurgeryPushkinRussia
| | - Darya Guseva
- Research Centre for Medical GeneticsMoscowRussia
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Gurbanov A, Kiper PÖŞ, Tekşam Ö. Recurrent fractures and an unusual diagnosis: Pycnodysostosis. J Natl Med Assoc 2022; 114:295-297. [PMID: 35272848 DOI: 10.1016/j.jnma.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/22/2022] [Accepted: 02/14/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Anar Gurbanov
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
| | | | - Özlem Tekşam
- Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Sayed Amr K, El-Bassyouni HT, Abdel Hady S, Mostafa MI, Mehrez MI, Coviello D, El-Kamah GY. Genetic and Molecular Evaluation: Reporting Three Novel Mutations and Creating Awareness of Pycnodysostosis Disease. Genes (Basel) 2021; 12:genes12101552. [PMID: 34680947 PMCID: PMC8535549 DOI: 10.3390/genes12101552] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/11/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022] Open
Abstract
Pycnodysostosis is a rare autosomal recessive disorder with characteristic diagnostic manifestations. This study aims to phenotype and provide molecular characterization of Egyptian patients, with emphasis on identifying unusual phenotypes and raising awareness about pycnodysostosis with different presentations to avoid a mis- or under-diagnosis and consequent mismanagement. We report on 22 Egyptian pycnodysostosis patients, including 9 new participants, all descending from consanguineous families and their ages ranging from 6 to 15 years. In addition, prenatal diagnosis was performed in one family with affected siblings. They all presented with short stature, except for one patient who presented with pancytopenia as her primary complaint. Moreover, 41.2% of patients had sleep apnea, 14% presented with craniosynostosis, and 44.4% had failure of tooth development. Molecular analysis via direct exome sequencing of the cathepsin K gene revealed three novel mutations ((NM_000396.3) c.761_763delCCT, c.864_865delAA, and c.509G>T) as well as two previously reported mutations among nine new cases. The following is our conclusion: This study expands the molecular spectrum of pycnodysostosis by identifying three novel mutations and adds to the clinical and orodental aspects of the disease. The link between the CTSK gene mutations and the failure of tooth development has not been established, and further studies could help to improve our understanding of the molecular pathology.
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Affiliation(s)
- Khalda Sayed Amr
- Molecular Genetics Department, National Research Centre, Cairo 12622, Egypt;
| | | | | | - Mostafa I. Mostafa
- Oro-Dental Genetics Department, National Research Centre, Cairo 12622, Egypt;
| | - Mennat I. Mehrez
- Oro-Dental Genetics Department, National Research Centre, Cairo 12622, Egypt;
- Correspondence: (M.I.M.); (G.Y.E.-K.)
| | - Domenico Coviello
- Laboratorio di Genetica Umana, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Ghada Y. El-Kamah
- Clinical Genetics Department, National Research Centre, Cairo 12622, Egypt;
- Correspondence: (M.I.M.); (G.Y.E.-K.)
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Mushiba AM, Faqeih E, Saleh MA, Ramzan K, Imtiaz F, Al-Owain M, Alhashem AM, Alswaid A. The genotypic and phenotypic spectrum of pycnodysostosis in Saudi Arabia: Novel variants and clinical findings. Am J Med Genet A 2021; 185:2455-2463. [PMID: 33963797 DOI: 10.1002/ajmg.a.62230] [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: 11/03/2020] [Revised: 02/14/2021] [Accepted: 03/28/2021] [Indexed: 11/10/2022]
Abstract
Pycnodysostosis is characterized by short stature, osteosclerosis, acro-osteolysis, increased tendency of fractures, and distinctive dysmorphic features. It is a rare autosomal recessive disease caused by biallelic CTSK mutations. The clinical details of 18 patients from Saudi Arabia were reviewed. Short stature, osteopetrosis, acro-osteolysis, and distinctive facial dysmorphism were documented in all cases. Our results highlight the significant complications associated with this disease. The large anterior fontanelle is one of the cardinal signs of this disease; however, half of our patients had small fontanelles and a quarter had craniosynostosis, which caused optic nerve compression. Sleep apnea was of the major complications in three patients. Bone fracture can be a presenting symptom, and in our patients it mainly occurred after the age of 3 years. Bone marrow suppression was seen in a single patient of our cohort who was misdiagnosed initially with malignant osteopetrosis. In this study, we also describe two novel (c.5G > A [p.Trp2Ter], c.538G > A [p.Gly180Ser]) and two reported (c.244-29 A > G, c.830C > T [p.Ala277Val]) CTSK mutations. Our results indicate that the recurrent intronic variant, c.244-29 A > G is likely to be a founder mutation, as it was found in 78% (14/18 patients) of our cohort belonging to the same tribe.
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Affiliation(s)
- Aziza M Mushiba
- Section of Medical Genetics, Department of Pediatrics, Children's Specialist Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Eissa Faqeih
- Section of Medical Genetics, Department of Pediatrics, Children's Specialist Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed A Saleh
- Section of Medical Genetics, Department of Pediatrics, Children's Specialist Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Khushnooda Ramzan
- Centre for Genomic Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Faiqa Imtiaz
- Centre for Genomic Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed Al-Owain
- Department of Medical Genetics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Amal M Alhashem
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.,Division of Genetics, Department of Pediatrics Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Alswaid
- Division of Genetics, Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Sait H, Srivastava P, Gupta N, Kabra M, Kapoor S, Ranganath P, Rungsung I, Mandal K, Saxena D, Dalal A, Roy A, Pabbati J, Phadke SR. Phenotypic and genotypic spectrum of CTSK variants in a cohort of twenty-five Indian patients with pycnodysostosis. Eur J Med Genet 2021; 64:104235. [PMID: 33945887 DOI: 10.1016/j.ejmg.2021.104235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 03/28/2021] [Accepted: 04/26/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pycnodysostosis is an autosomal recessive skeletal dysplasia with easily recognizable clinical features and marked molecular heterogeneity. In this study, we explored the clinical and molecular spectrum of 25 Indian patients with pycnodysostosis from 20 families. METHODS Clinical information was collected on a predesigned clinical proforma. Sanger method was employed to sequence all the exons and exon/intron boundaries of the CTSK gene. Novel variants were systematically assessed by prediction softwares and protein modelling. The pathogenicity of variant was established based on ACMG-AMP criteria. An attempt was also made to establish a genotype-phenotype correlation and devise a diagnostic scoring system based on clinical and radiological findings. RESULTS Consanguinity and positive family history were present in 65% (13/20) and 45% (9/20) of the families respectively. Short stature and fractures were the predominant presenting complaints and was evident in 96% (24/25) and 32% (8/25) of affected individuals respectively. Gestalt facial phenotype and acro-osteolysis were present in 76% (19/25) and 82.6% (19/23) of the individuals respectively. Hepatosplenomegaly was present in 15% (3/20) of the individuals with one of them having severe anaemia. Causative sequence variations were identified in all of them. A total of 19 variants were identified from 20 families amongst which 10 were novel. Homozygous variants were identified in 90% (18/20) families. Amongst the novel variants, there was a considerable proportion (40%) of frameshift variants (4/10). No significant genotype-phenotype correlation was noted. Scoring based on clinical and radiological findings led to the proposal that a minimum of 2 scores in each category is required in addition to high bone density to diagnose pycnodysostosis with certainty. CONCLUSION This study delineated the genotypic and phenotypic characterisation of Indian patients with pycnodysostosis with identification of 10 novel variants. We also attempted to develop a clinically useful diagnostic scoring system which requires further validation.
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Affiliation(s)
- Haseena Sait
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Priyanka Srivastava
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Neerja Gupta
- Division of Genetics, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Madhulika Kabra
- Division of Genetics, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Kapoor
- Division of Genetics & Metabolism, Department of Pediatrics, LokNayak Hospital and Maulana Azad Medical College, New Delhi, India
| | - Prajnya Ranganath
- Department of Medical Genetics,Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Ikrormi Rungsung
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - Kausik Mandal
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Deepti Saxena
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ashwin Dalal
- Diagnostics Division, Centre for DNA Fingerprinting and Diagnostics, Hyderabad, India
| | - Ajitesh Roy
- Department of Endocrinology, Vivekananda Institute of Medical Sciences, Ramakrishna Mission Seva Pratishthan, Kolkata, India
| | - Jayalakshmi Pabbati
- Department of Pediatrics, Gandhi Medical College and Hospital, Secunderabad, India
| | - Shubha R Phadke
- Department of Medical Genetics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Chen Y, Wei B, Xu P, Tang H, Yang L, Wang Y, Fu Y, Yang X, Mao Y. Schistosoma japonicum cystatin suppresses osteoclastogenesis via manipulating the NF‑κB signaling pathway. Mol Med Rep 2021; 23:273. [PMID: 33576450 PMCID: PMC7893784 DOI: 10.3892/mmr.2021.11912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 01/22/2021] [Indexed: 11/06/2022] Open
Abstract
Abnormal osteoclastic activation and secretion of cysteine proteinases result in excessive bone resorption, which is one of the primary factors in the development of bone metabolic disorders, such as rheumatoid arthritis and osteoporosis. Mammalian cystatins have been demonstrated to restrain osteoclastic bone resorption and to alleviate severe osteolytic destruction via blocking the activity of cysteine proteinases. However, the specific effects of parasite cystatins on the formation and function of osteoclasts remain unclear. The purpose of the current study was to explore the effects of cystatins from Schistosoma japonicum (Sj‑Cys) on macrophage colony‑stimulating factor (M‑CSF) and receptor activator of NF‑κB ligand (RANKL)‑induced osteoclast differentiation, as well as the underlying molecular mechanisms. Recombinant Sj‑Cys (rSj‑Cys) dose‑dependently restrained osteoclast formation, with a half‑maximal inhibitory concentration (IC50) value of 0.3 µM, and suppressed osteoclastic bone resorptive capability in vitro. The findings were based on tartrate resistant acid phosphatase (TRAP) staining and bone resorption assays, respectively. However, the cell viability assay showed that the repression of rSj‑Cys on osteoclast formation did not depend on effects on cell viability or apoptosis. Based on the results of reverse transcription‑quantitative PCR and western blot analysis, it was found that rSj‑Cys downregulated the expression levels of osteoclastogenesis‑related genes and proteins, by interfering with M‑CSF and RANKL‑induced NF‑κB signaling and downstream transcription factors during early‑phase osteoclastogenesis. Overall, the results of the present study revealed that rSj‑Cys exerted an inhibitory role in osteoclast differentiation and could be a prospective biotherapeutic candidate for the treatment and prevention of bone metabolic disorders.
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Affiliation(s)
- Yu Chen
- School of Life Sciences, Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
| | - Bangguo Wei
- Key Laboratory of Anhui Province for Tissue Transplantation, Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
| | - Panpan Xu
- Key Laboratory of Anhui Province for Tissue Transplantation, Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
| | - Huadong Tang
- School of Life Sciences, Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
| | - Langlang Yang
- Department of Microbiology and Parasitology, Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
| | - Yuhang Wang
- Department of Microbiology and Parasitology, Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
| | - Yingxiao Fu
- School of Life Sciences, Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
| | - Xiaodi Yang
- Department of Microbiology and Parasitology, Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
| | - Yingji Mao
- School of Life Sciences, Bengbu Medical College, Bengbu, Anhui 233000, P.R. China
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Doherty MA, Langdahl BL, Vogel I, Haagerup A. Clinical and genetic evaluation of Danish patients with pycnodysostosis. Eur J Med Genet 2021; 64:104135. [PMID: 33429075 DOI: 10.1016/j.ejmg.2021.104135] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 09/02/2020] [Accepted: 01/03/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Pycnodysostosis is a rare autosomal recessive osteosclerotic skeletal dysplasia caused by variants in the cathepsin K gene (CTSK). Clinical features include short stature, bone fragility, characteristic facial features and acro-osteolysis of the distal phalanges. Usually, patients suffer from multiple bone fractures. The purpose of this study was to describe the Danish population of pycnodysostosis patients with respect to genotype, phenotype and the prevalence of complications. We collected medical history, performed clinical examination, collected blood- and urine samples, performed dual-energy x-ray absorptiometry scan (DXA) and high-resolution peripheral quantitative computed tomography scan (HRpQCT) and obtained clinical photos. Information about complications, bone mineral density and bone markers in the blood were collected and analysed. RESULTS Ten patients with a median age of 32 years ranging from five to 51 years participated. The pycnodysostosis phenotype varied with respect to the number of bone fractures and degree of complications. DXA and HRpQCT showed high bone mineral density. A tendency of growth hormone treatment escalating growth and increasing final height was seen. A marker of bone resorption measured in blood was within normal range in nine patients and elevated in one patient. A novel pathogenic variant in CSTK causing pycnodysostosis was detected in two related patients. Moreover information about the patients' own health perception was reported. An example being they rated their mental health to be good despite multiple bone fractures. CONCLUSION This study provides information about genotypes and phenotypes in a Danish pycnodysostosis population. It reports new data about the complications such as bone fractures and it elucidates the levels of bone turnover markers as well as the density of the bones in one of the biggest cohort of pycnodysostosis patients ever published. An individualised approach to treatment in this patient group is necessary as the phenotype including complications varies between patients. Additional studies are needed to further understand genotype-phenotype correlations.
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Affiliation(s)
| | - Bente L Langdahl
- Department of Endocrinology, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark; Department of Biomedicine, Aarhus University, Denmark.
| | - Ida Vogel
- Department of Clinical Genetics, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark; Department of Biomedicine, Aarhus University, Denmark.
| | - Annette Haagerup
- NIDO∣danmark, Gødstrup, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
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11
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Schmidt GS, Schacht JP, Knee TS, Shakir MKM, Hoang TD. PYKNODYSOSTOSIS (OSTEOPETROSIS ACRO-OSTEOLYTICA). AACE Clin Case Rep 2020; 6:e257-e261. [PMID: 32984533 DOI: 10.4158/accr-2020-0169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/21/2020] [Indexed: 11/15/2022] Open
Abstract
Objective To present a case of pyknodysostosis (PKND), a rare genetic cause of skeletal dysplasia that often goes undiagnosed even in patients with classic features. Methods We report a case of PKND that went undiagnosed over many years despite classic features. We performed physical examination, imaging studies, and genetic testing on the patient. Results A 21-year-old female presented to endocrinology to establish care. On evaluation, she was noted to have disproportionate short stature and a past medical history notable for bilateral blindness due to optic atrophy secondary to bone enlargement and thickening of the optic nerve canal before age 7 years. She also had a history of foot fractures occurring with ambulation. Her family history was significant for consanguineous parents and relatives with similar clinical features. Physical examination revealed a short, 128-cm tall female with open anterior and mastoid fontanels, mild frontal bossing and micrognathia, evidence of double rows of teeth, and digits of varied length in both hands and feet. Plain radiographs demonstrated diffuse sclerosis and marked cortical thickening of the pelvis, femurs, metacarpals, proximal phalanges, and metatarsals as well as decreased phalangeal length and acro-osteolysis of the hands and feet. Dual energy X-ray absorptiometry demonstrated increased bone mineral density (z scores +2.5 lumbar spine, +3.7 femoral neck, +4.5 total hip). Genetic testing revealed a exon 5-homozygous mutation in the cathepsin K (CTSK) gene consistent with PKND. Conclusion Patients with PKND come to medical attention for a variety of reasons but often go undiagnosed even when presenting with classic features due to the rarity of the condition and the overlap with other skeletal dysplasias.
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Affiliation(s)
- Gregory S Schmidt
- Division of Endocrinology, Department of Medicine, Bethesda, Maryland
| | - John P Schacht
- Department of Genetics, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Treyce S Knee
- Division of Endocrinology, Department of Medicine, Bethesda, Maryland
| | | | - Thanh D Hoang
- Division of Endocrinology, Department of Medicine, Bethesda, Maryland
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12
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Al-Araimi M, Al-Hosni A, Maimani AA. A First-Case Report of Pycnodysostosis in an Omani Boy. J Pediatr Genet 2020; 11:42-46. [PMID: 35186389 DOI: 10.1055/s-0040-1714364] [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: 04/15/2020] [Accepted: 06/08/2020] [Indexed: 10/23/2022]
Abstract
Here we reported on the genetic findings of a 9-year-old Omani boy with a rare inherited bone disorder. The patient's clinical features include dysmorphic facial features, short stature, and skeletal abnormalities. Exome sequence of the patient's deoxyribonucleic acid revealed a variant in the cathepsin K gene, which was confirmed by Sanger sequencing. These findings established the diagnosis of pycnodysostosis (PKND). To the best of the authors' knowledge, this case is the first case to be reported in the Gulf Cooperative Region of the novel PKND with molecular confirmation.
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Affiliation(s)
- Musallam Al-Araimi
- National Genetic Centre, Royal Hospital, Ministry of Health, Muscat, Oman
| | - Aliya Al-Hosni
- National Genetic Centre, Royal Hospital, Ministry of Health, Muscat, Oman
| | - Ashwaq Al Maimani
- National Genetic Centre, Royal Hospital, Ministry of Health, Muscat, Oman
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13
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Overexpression of cathepsin K and vascular endothelial growth factor in chronic venous ulcerations. Postepy Dermatol Alergol 2020; 37:234-239. [PMID: 32489360 PMCID: PMC7262799 DOI: 10.5114/ada.2020.94840] [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: 07/02/2018] [Accepted: 10/18/2018] [Indexed: 12/03/2022] Open
Abstract
Introduction Chronic venous disease (CVD) is a disabling condition affecting about 1% to 3% of the general population. Besides varicose veins, CVD can result also in the formation of severe skin lesions, especially venous ulcerations (VU). The exact mechanism of VU is still unknown. Aim To evaluate immunoexpression of vascular endothelial growth factor (VEGF) and cathepsin K in healthy individuals and patients with VU. Material and methods The study included 12 patients with venous ulcers and 10 healthy individuals who served as controls; both groups were sex- and age-matched. Biopsy samples were obtained from lower leg areas and submitted to histochemical analysis. Results There was a significant difference between the study group and the control group in cathepsin K expression (1.007 ±0.3 vs. 0.22 ±0.2, respectively, p < 0.001) and VEGF expression (1.17 ±0.59 vs. 0.27 ±0.19, respectively, p < 0.001). Additionally, the microvessel density (per mm2) differed significantly between the study group and the control group (97.6 ±28.81 vs. 59.32 ±12.71, respectively, p < 0.001). We found no correlation between cathepsin K and microvessel density, and cathepsin K and VEGF in both groups, but there was a significant correlation between microvessel density and VEGF immunoexpression in the study group (r = 0.82, p = 0.002). Conclusions Increased immunoexpression of VEGF and cathepsin K suggests that both of these proteins may play a role in VU development.
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14
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Reassessing enzyme kinetics: Considering protease-as-substrate interactions in proteolytic networks. Proc Natl Acad Sci U S A 2020; 117:3307-3318. [PMID: 31980525 DOI: 10.1073/pnas.1912207117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Enzymes are catalysts in biochemical reactions that, by definition, increase rates of reactions without being altered or destroyed. However, when that enzyme is a protease, a subclass of enzymes that hydrolyze other proteins, and that protease is in a multiprotease system, protease-as-substrate dynamics must be included, challenging assumptions of enzyme inertness, shifting kinetic predictions of that system. Protease-on-protease inactivating hydrolysis can alter predicted protease concentrations used to determine pharmaceutical dosing strategies. Cysteine cathepsins are proteases capable of cathepsin cannibalism, where one cathepsin hydrolyzes another with substrate present, and misunderstanding of these dynamics may cause miscalculations of multiple proteases working in one proteolytic network of interactions occurring in a defined compartment. Once rates for individual protease-on-protease binding and catalysis are determined, proteolytic network dynamics can be explored using computational models of cooperative/competitive degradation by multiple proteases in one system, while simultaneously incorporating substrate cleavage. During parameter optimization, it was revealed that additional distraction reactions, where inactivated proteases become competitive inhibitors to remaining, active proteases, occurred, introducing another network reaction node. Taken together, improved predictions of substrate degradation in a multiple protease network were achieved after including reaction terms of autodigestion, inactivation, cannibalism, and distraction, altering kinetic considerations from other enzymatic systems, since enzyme can be lost to proteolytic degradation. We compiled and encoded these dynamics into an online platform (https://plattlab.shinyapps.io/catKLS/) for individual users to test hypotheses of specific perturbations to multiple cathepsins, substrates, and inhibitors, and predict shifts in proteolytic network reactions and system dynamics.
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15
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Pathak JL, Bravenboer N, Klein-Nulend J. The Osteocyte as the New Discovery of Therapeutic Options in Rare Bone Diseases. Front Endocrinol (Lausanne) 2020; 11:405. [PMID: 32733380 PMCID: PMC7360678 DOI: 10.3389/fendo.2020.00405] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/20/2020] [Indexed: 01/18/2023] Open
Abstract
Osteocytes are the most abundant (~95%) cells in bone with the longest half-life (~25 years) in humans. In the past osteocytes have been regarded as vestigial cells in bone, since they are buried inside the tough bone matrix. However, during the last 30 years it has become clear that osteocytes are as important as bone forming osteoblasts and bone resorbing osteoclasts in maintaining bone homeostasis. The osteocyte cell body and dendritic processes reside in bone in a complex lacuno-canalicular system, which allows the direct networking of osteocytes to their neighboring osteocytes, osteoblasts, osteoclasts, bone marrow, blood vessels, and nerves. Mechanosensing of osteocytes translates the applied mechanical force on bone to cellular signaling and regulation of bone adaptation. The osteocyte lacuno-canalicular system is highly efficient in transferring external mechanical force on bone to the osteocyte cell body and dendritic processes via displacement of fluid in the lacuno-canalicular space. Osteocyte mechanotransduction regulates the formation and function of the osteoblasts and osteoclasts to maintain bone homeostasis. Osteocytes produce a variety of proteins and signaling molecules such as sclerostin, cathepsin K, Wnts, DKK1, DMP1, IGF1, and RANKL/OPG to regulate osteoblast and osteoclast activity. Various genetic abnormality-associated rare bone diseases are related to disrupted osteocyte functions, including sclerosteosis, van Buchem disease, hypophosphatemic rickets, and WNT1 and plastin3 mutation-related disorders. Meticulous studies during the last 15 years on disrupted osteocyte function in rare bone diseases guided for the development of various novel therapeutic agents to treat bone diseases. Studies on genetic, molecular, and cellular mechanisms of sclerosteosis and van Buchem disease revealed a role for sclerostin in bone homeostasis, which led to the development of the sclerostin antibody to treat osteoporosis and other bone degenerative diseases. The mechanism of many other rare bone diseases and the role of the osteocyte in the development of such conditions still needs to be investigated. In this review, we mainly discuss the knowledge obtained during the last 30 years on the role of the osteocyte in rare bone diseases. We speculate about future research directions to develop novel therapeutic drugs targeting osteocyte functions to treat both common and rare bone diseases.
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Affiliation(s)
- Janak L. Pathak
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nathalie Bravenboer
- Department of Clinical Chemistry, Amsterdam University Medical Centers, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jenneke Klein-Nulend
- Key Laboratory of Oral Medicine, Guangzhou Institute of Oral Disease, Affiliated Stomatology Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Oral Cell Biology, Academic Centre for Dentistry Amsterdam, Amsterdam Movement Sciences, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- *Correspondence: Jenneke Klein-Nulend
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16
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Bizaoui V, Michot C, Baujat G, Amouroux C, Baron S, Capri Y, Cohen-Solal M, Collet C, Dieux A, Geneviève D, Isidor B, Monnot S, Rossi M, Rothenbuhler A, Schaefer E, Cormier-Daire V. Pycnodysostosis: Natural history and management guidelines from 27 French cases and a literature review. Clin Genet 2019; 96:309-316. [PMID: 31237352 DOI: 10.1111/cge.13591] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 01/25/2023]
Abstract
Pycnodysostosis is a lysosomal autosomal recessive skeletal dysplasia characterized by osteosclerosis, short stature, acro-osteolysis, facial features and an increased risk of fractures. The clinical heterogeneity of the disease and its rarity make it difficult to provide patients an accurate prognosis, as well as appropriate care and follow-up. French physicians from the OSCAR network have been asked to fill out questionnaires collecting molecular and clinical data for 27 patients issued from 17 unrelated families. All patients showed short stature (mean = -3.5 SD) which was more severe in females (P = .006). The mean fracture rate was moderate (0.21 per year), with four fractures in total average. About 75% underwent at least one surgery, with an average number of 2.1 interventions per patient. About 50% required non-invasive assisted ventilation due to sleep apnea (67%). About 29% showed psychomotor difficulties and 33% needed a school assistant or adapted schooling. No patient had any psychological evaluation or follow-up. Molecular data were available for 14 families. Growth hormone administration was efficient on linear growth in 40% of cases. We propose several axis of management, such as systematic cerebral MRI for Chiari malformation screening at diagnosis and regular psychological follow-up.
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Affiliation(s)
- Varoona Bizaoui
- Department of Medical Genetics, Reference Center for Skeletal Dysplasia and OSCAR Network, Paris Descartes-Sorbonne Paris Cité University, INSERM UMR 1163, Instititut Imagine, Hôpital Necker Enfants Malades, Paris, France
| | - Caroline Michot
- Department of Medical Genetics, Reference Center for Skeletal Dysplasia and OSCAR Network, Paris Descartes-Sorbonne Paris Cité University, INSERM UMR 1163, Instititut Imagine, Hôpital Necker Enfants Malades, Paris, France
| | - Geneviève Baujat
- Department of Medical Genetics, Reference Center for Skeletal Dysplasia and OSCAR Network, Paris Descartes-Sorbonne Paris Cité University, INSERM UMR 1163, Instititut Imagine, Hôpital Necker Enfants Malades, Paris, France
| | - Cyril Amouroux
- Department of Paediatric Endocrinology, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Sabine Baron
- Service de Génétique Médicale, CHU de Nantes, Nantes, France
| | - Yline Capri
- Genetics Department, AP-HP, Robert-Debré University Hospital, Paris, France
| | - Martine Cohen-Solal
- Department of Rheumatology, Lariboisière Hospital, INSERM U1132 and University Paris-Diderot, Paris, France
| | - Corinne Collet
- Department of Biochemistry, APHP, Saint-Louis Lariboisière Hospitals, Paris, France
| | - Anne Dieux
- Centre de Référence CLAD NdF, Service de Génétique Clinique, Hôpital Jeanne de Flandre, CHU Lille, France
| | - David Geneviève
- Service de Génétique Clinique et du Département de Génétique Médicale, Maladies Rares et Médecine Personnalisée, Centre de Compétence Maladies Osseuses Constitutionnelles, Inserm U1183, Université Montpellier, Montpellier, France
| | - Bertrand Isidor
- Service de Génétique Médicale, CHU de Nantes, Nantes, France
| | - Sophie Monnot
- Department of Medical Genetics, Reference Center for Skeletal Dysplasia and OSCAR Network, Paris Descartes-Sorbonne Paris Cité University, INSERM UMR 1163, Instititut Imagine, Hôpital Necker Enfants Malades, Paris, France
| | - Massimiliano Rossi
- Hospices Civils de Lyon, Service de Génétique, Centre de Référence Anomalies du Développement, Bron, France.,Centre de Recherche en Neurosciences de Lyon, INSERM U1028, CNRS UMR5292, UCB Lyon 1, Lyon, France
| | - Anya Rothenbuhler
- Department of Paediatric Endocrinology, Bicêtre Hospital, Paris, France
| | - Elise Schaefer
- Service de Génétique Médicale, Institut de Génétique Médicale d'Alsace, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Valérie Cormier-Daire
- Department of Medical Genetics, Reference Center for Skeletal Dysplasia and OSCAR Network, Paris Descartes-Sorbonne Paris Cité University, INSERM UMR 1163, Instititut Imagine, Hôpital Necker Enfants Malades, Paris, France
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17
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Grewal S, Kilic Ö, Savci-Heijink CD, Kloen P. Disturbed remodeling and delayed fracture healing in pediatric pycnodysostosis patients. J Orthop 2019; 16:373-377. [PMID: 31048950 DOI: 10.1016/j.jor.2019.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/31/2019] [Indexed: 11/18/2022] Open
Abstract
Pycnodysostosis is an autosomal recessive disease caused by a gene mutation leading cathepsin K deficiency. Pathological fractures of the long bones are common, but guidelines on fracture treatment in these patients are still lacking. We have treated 5 fractures in 2 pediatric pycnodysostosis patients. We hypothesize that pycnodysostosis patients have an incomplete remodeling process in fracture healing because of cathepsin K deficiency. Therefore, to minimize the role of endochondral bone formation (indirect) after a fracture, it seems prudent to strive for direct bone healing (intramembranous) instead of indirect bone healing. Open reduction with internal fixation should be the goal.
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Affiliation(s)
- Simran Grewal
- Department of Orthopaedic Surgery, Amsterdam University Medical Centers, Amsterdam Movement Sciences, the Netherlands
| | - Özgür Kilic
- Department of Orthopaedic Surgery, Amsterdam University Medical Centers, Amsterdam Movement Sciences, the Netherlands
| | | | - Peter Kloen
- Department of Orthopaedic Surgery, Amsterdam University Medical Centers, Amsterdam Movement Sciences, the Netherlands
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18
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Kochar IPS, Sethi A, Ahamad A. A Novel Variant c.847T>C in CTSK Gene Leading to Pycnodysostosis: A Case Report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2019; 12:1179547619837234. [PMID: 30967749 PMCID: PMC6444763 DOI: 10.1177/1179547619837234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 12/03/2022]
Abstract
Pycnodysostosis is a rare genetic disorder with a prevalence of 1.7 per million
births; it usually presents with short stature, osteosclerosis, increased bone
fragility, and acro-osteolysis of distal phalanges. There are less than 200
cases reported worldwide and very few from South-East Asia. We present a case of
pycnodysostosis who presented with short stature, acro-osteolysis of distal
phalanges, and on genetic testing revealing a variant c.847T>C, p.Y283H, in
exon 7 of the CTSK in homozygous state: not reported till date
to the best of our knowledge.
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Affiliation(s)
| | - Aashish Sethi
- Department of Paediatric Endocrinology, Indraprastha Apollo Hospital, Delhi, India
| | - Ayesha Ahamad
- Department of Pediatrics, Aligarh Muslim University, Aligarh, India
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19
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Roy S, Das Chakraborty S, Biswas S. Not all pycnodysostosis-related mutants of human cathepsin K are inactive - crystal structure and biochemical studies of an active mutant I249T. FEBS J 2018; 285:4265-4280. [PMID: 30199612 DOI: 10.1111/febs.14655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 12/18/2022]
Abstract
Human cathepsin K (CTSK) is a collagenolytic lysosomal cysteine protease that plays an important role in bone turnover. Mutation in CTSK gene is associated with loss of collagenolytic activity of CTSK leading to an autosomal recessive bone disorder called pycnodysostosis. Although a number of pycnodysostotic missense mutations have been reported, underlying mechanism of the disease is not clear. In this study, we investigated in vitro six recombinant pycnodysostosis-related mutants of human CTSK (G79E, I249T, G243E, G303E, G319C and Q187P). While all the mutants, like wild-type, show similar high levels of expression in Escherichia coli, four of them (G79E, G303E, G319C and Q187P) are inactive, unstable and spontaneously degrade during purification process. In contrast, proteolytic/collagenolytic activity, zymogen activation kinetics and stability of G243E and I249T mutants are nominally affected. Crystal structure of I249T at 1.92 Å resolution shows that the mutation in R-domain causes conformational changes of a surface loop in the L-domain although the catalytic cleft remains unaltered. Molecular simulation, normal mode analysis and fluorescence lifetime measurement eliminated the possibility that the change in L-domain surface loop orientation is a crystallization artefact. CD-based thermal melting profile indicates that stability of I249T is significantly higher than wild-type. Our studies first time reports that pycnodysostosis-related mutations do not always lead to complete loss of general proteolytic activity or specific collagenolytic activity of CTSK. The first crystal structure of a pycnodysostotic mutant (I249T) provides critical information that may pave new avenues towards understanding the disease at molecular level. DATABASE: The atomic co-ordinates and structure factors for I249T mutant of human CTSK (codes 5Z5O) have been deposited in the Protein Data Bank (http://wwpdb.org/).
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Affiliation(s)
- Sumana Roy
- Crystallography and Molecular Biology Division, Saha Institute of Nuclear Physics, Kolkata, India
| | | | - Sampa Biswas
- Crystallography and Molecular Biology Division, Saha Institute of Nuclear Physics, Kolkata, India.,Homi Bhaba National Institute, Mumbai, India
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20
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Otaify GA, Abdel-Hamid MS, Mehrez MI, Aboul-Ezz E, Zaki MS, Aglan MS, Temtamy SA. Genetic study of eight Egyptian patients with pycnodysostosis: identification of novel CTSK mutations and founder effect. Osteoporos Int 2018; 29:1833-1841. [PMID: 29796728 DOI: 10.1007/s00198-018-4555-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/27/2018] [Indexed: 12/13/2022]
Abstract
UNLABELLED This is the first Egyptian study with detailed clinical and orodental evaluation of eight patients with pycnodysostosis and identification of four mutations in CTSK gene with two novel ones and a founder effect. INTRODUCTION Pycnodysostosis is a rare autosomal recessive skeletal dysplasia due to mutations in the CTSK gene encoding for cathepsin K, a lysosomal cysteine protease. METHODS We report on the clinical, orodental, radiological, and molecular findings of eight patients, from seven unrelated Egyptian families with pycnodysostosis. RESULTS All patients were offspring of consanguineous parents and presented with the typical clinical picture of the disorder including short stature, delayed closure of fontanels, hypoplastic premaxilla, obtuse mandibular angle, and drum stick terminal phalanges with dysplastic nails. Their radiological findings showed increased bone density, acro-osteolysis, and open cranial sutures. Mutational analysis of CTSK gene revealed four distinct homozygous missense mutations including two novel ones, c.164A>C (p. K55T) and c.433G>A (p.V145M). The c.164A>C (p. K55T) mutation was recurrent in three unrelated patients who also shared similar haplotype, suggesting a founder effect. CONCLUSION Our findings expand the mutational spectrum of CTSK gene and emphasize the importance of full clinical examination of all body systems including thorough orodental evaluation in patients with pycnodysostosis.
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Affiliation(s)
- G A Otaify
- Clinical Genetics Department, Human Genetics and Genome Research Division, Center of Excellence for Human Genetics, National Research Centre, Cairo, Egypt.
| | - M S Abdel-Hamid
- Medical Molecular Genetics Department, Human Genetics and Genome Research Division, National Research Centre, Cairo, Egypt
| | - M I Mehrez
- Orodental Genetics Department, Human Genetics and Genome Research Division, Center of Excellence for Human Genetics, National Research Centre, Cairo, Egypt
| | - E Aboul-Ezz
- Dental Basic Science Department, Dental and Oral Research Division, National Research Centre, Cairo, Egypt
| | - M S Zaki
- Clinical Genetics Department, Human Genetics and Genome Research Division, Center of Excellence for Human Genetics, National Research Centre, Cairo, Egypt
| | - M S Aglan
- Clinical Genetics Department, Human Genetics and Genome Research Division, Center of Excellence for Human Genetics, National Research Centre, Cairo, Egypt
| | - S A Temtamy
- Clinical Genetics Department, Human Genetics and Genome Research Division, Center of Excellence for Human Genetics, National Research Centre, Cairo, Egypt
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Abstract
Inborn errors of metabolism encompass a wide spectrum of disorders, frequently affecting bone. The most important metabolic disorders that primarily influence calcium or phosphate balance, resulting in skeletal pathology, are hypophosphatemic rickets and hypophosphatasia. Conditions involving bone marrow or affecting skeletal growth and development are mainly the lysosomal storage disorders, in particular the mucopolysaccharidoses. In these disorders skeletal abnormalities are often the presenting symptom and early recognition and intervention improves outcome in many of these diseases. Many disorders of intermediary metabolism may impact bone health as well, resulting in higher frequencies of osteopenia and osteoporosis. In these conditions factors contributing to the reduced bone mineralization can be the disorder itself, the strict dietary treatment, reduced physical activity or sunlight exposure and/or early ovarian failure. Awareness of these primary or secondary bone problems amongst physicians treating patients with inborn errors of metabolism is of importance for optimization bone health and recognition of skeletal complications.
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Affiliation(s)
- M Langeveld
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - C E M Hollak
- Department of Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
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22
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Drake MT, Clarke BL, Oursler MJ, Khosla S. Cathepsin K Inhibitors for Osteoporosis: Biology, Potential Clinical Utility, and Lessons Learned. Endocr Rev 2017; 38:325-350. [PMID: 28651365 PMCID: PMC5546879 DOI: 10.1210/er.2015-1114] [Citation(s) in RCA: 162] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 06/20/2017] [Indexed: 12/24/2022]
Abstract
Cathepsin K is a cysteine protease member of the cathepsin lysosomal protease family. Although cathepsin K is highly expressed in osteoclasts, lower levels of cathepsin K are also found in a variety of other tissues. Secretion of cathepsin K from the osteoclast into the sealed osteoclast-bone cell interface results in efficient degradation of type I collagen. The absence of cathepsin K activity in humans results in pycnodysostosis, characterized by increased bone mineral density and fractures. Pharmacologic cathepsin K inhibition leads to continuous increases in bone mineral density for ≤5 years of treatment and improves bone strength at the spine and hip. Compared with other antiresorptive agents, cathepsin K inhibition is nearly equally efficacious for reducing biochemical markers of bone resorption but comparatively less active for reducing bone formation markers. Despite multiple efforts to develop cathepsin K inhibitors, potential concerns related to off-target effects of the inhibitors against other cathepsins and cathepsin K inhibition at nonbone sites, including skin and perhaps cardiovascular and cerebrovascular sites, prolonged the regulatory approval process. A large multinational randomized, double-blind phase III study of odanacatib in postmenopausal women with osteoporosis was recently completed. Although that study demonstrated clinically relevant reductions in fractures at multiple sites, odanacatib was ultimately withdrawn from the regulatory approval process after it was found to be associated with an increased risk of cerebrovascular accidents. Nonetheless, the underlying biology and clinical effects of cathepsin K inhibition remain of considerable interest and could guide future therapeutic approaches for osteoporosis.
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Affiliation(s)
- Matthew T. Drake
- Division of Endocrinology and Kogod Center on Aging, Mayo Clinic College of Medicine, Rochester, Minnesota 55905
| | - Bart L. Clarke
- Division of Endocrinology and Kogod Center on Aging, Mayo Clinic College of Medicine, Rochester, Minnesota 55905
| | - Merry Jo Oursler
- Division of Endocrinology and Kogod Center on Aging, Mayo Clinic College of Medicine, Rochester, Minnesota 55905
| | - Sundeep Khosla
- Division of Endocrinology and Kogod Center on Aging, Mayo Clinic College of Medicine, Rochester, Minnesota 55905
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Shambhavi A, Salian S, Shah H, Nair M, Sharan K, Jin DK, Cho SY, Mathew M, Shukla A, Girisha KM. Pycnodysostosis: Novel Variants in CTSK and Occurrence of Giant Cell Tumor. J Pediatr Genet 2017; 7:9-13. [PMID: 29441215 DOI: 10.1055/s-0037-1604100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 06/01/2017] [Indexed: 12/17/2022]
Abstract
Pycnodysostosis is an autosomal recessive skeletal dysplasia caused by pathogenic variants in the cathepsin K ( CTSK ) gene. We report seven patients from four unrelated families with this condition in whom we have identified three novel pathogenic variants, c.120 + 1G > T in intron 2, c.399 + 1G > A in intron 4, and c.148T > G (p.W50G) in exon 2, and a known variant, c.568C > T (p.Q190*) in exon 5 of CTSK . We present the clinical, radiographic, and molecular findings of all individuals with molecularly proven pycnodysostosis from the present cohort. We also report the occurrence of giant cell tumor in the skull of a patient with this condition.
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Affiliation(s)
- Arya Shambhavi
- Department of Medical Genetics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Smrithi Salian
- Department of Medical Genetics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Hitesh Shah
- Department of Orthopaedics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Mohandas Nair
- Department of Pediatrics, Government Medical College, Kozhikode, India
| | - Krishna Sharan
- Department of Radiotherapy, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Dong-Kyu Jin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung Yoon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Mary Mathew
- Department of Pathology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Anju Shukla
- Department of Medical Genetics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Katta M Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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24
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Durmaz CD, Taş V, Kocaay P, Fitöz ÖS, Onay H, Beton S, Özkınay F, Ilgın Ruhi H. Bilateral choanal atresia in an adult woman with pycnodysostosis. Congenit Anom (Kyoto) 2017; 57:91-92. [PMID: 27933642 DOI: 10.1111/cga.12204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 11/22/2016] [Accepted: 11/27/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Ceren Damla Durmaz
- Department of Medical Genetics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Vedat Taş
- Department of Otolaryngology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Pınar Kocaay
- Department of Pediatric Endocrinology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ömer Suat Fitöz
- Department of Radiology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Hüseyin Onay
- Department of Medical Genetics, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Süha Beton
- Department of Otolaryngology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ferda Özkınay
- Department of Medical Genetics, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Hatice Ilgın Ruhi
- Department of Medical Genetics, Faculty of Medicine, Ankara University, Ankara, Turkey
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25
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26
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Araujo TF, Ribeiro EM, Arruda AP, Moreno CA, de Medeiros PFV, Minillo RM, Melo DG, Kim CA, Doriqui MJR, Felix TM, Fock RA, Cavalcanti DP. Molecular analysis of the CTSK gene in a cohort of 33 Brazilian families with pycnodysostosis from a cluster in a Brazilian Northeast region. Eur J Med Res 2016; 21:33. [PMID: 27558267 PMCID: PMC4997772 DOI: 10.1186/s40001-016-0228-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/18/2016] [Indexed: 12/29/2022] Open
Abstract
Background Pycnodysostosis is an autosomal recessive skeletal dysplasia, the prevalence of which is estimated to be low (1 per million). Nevertheless, in recent years we have found 27 affected individuals from 22 families in Ceará State, a region of the Brazilian Northeast, giving a local prevalence of 3 per million. This local prevalence associated with a high parental consanguinity, suggesting a possible founder effect, prompted us to perform a molecular investigation of these families to test this hypothesis. Methods The CTSK gene was sequenced by the Sanger method in the patients and their parents. In addition to 18 families from Ceará, this study also included 15 families from other Brazilian regions. We also investigated the origin of each family from the birthplace of the parents and/or grandparents. Results We have studied 39 patients, including 33 probands and 6 sibs, from 33 families with pycnodysostosis and identified six mutations, five previously described (c.436G>C, c.580G>A, c.721C>T, c.830C>T and c.953G>A) and one novel frameshift (c.83dupT). This frameshift variant seems to have a single origin in Ceará State, since the haplotype study using the polymorphic markers D1S2344, D1S442, D1S498 and D1S2715 suggested a common origin. Most of the mutations were found in homozygosity in the patients from Ceará (83.3 %) while in other states the mutations were found in homozygosity in half of patients. We have also shown that most of the families currently living outside of Ceará have northeastern ancestors, suggesting a dispersion of these mutations from the Brazilian Northeast. Conclusions The high frequency of pycnodysostosis in Ceará State is the consequence of the high inbreeding in that region. Several mutations, probably introduced a long time ago in Ceará, must have spread due to consanguineous marriages and internal population migration. However, the novel mutation seems to have a single origin in Ceará, suggestive of a founder effect. Electronic supplementary material The online version of this article (doi:10.1186/s40001-016-0228-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thaís Fenz Araujo
- Skeletal Dysplasia Group, Department of Medical Genetics, Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
| | - Erlane Marques Ribeiro
- Children's Hospital Albert Sabin, Fortaleza, CE, Brazil.,Medical Sciences Faculty of Juazeiro do Norte (FMJ), Juazeiro do Norte, CE, Brazil
| | | | - Carolina Araujo Moreno
- Skeletal Dysplasia Group, Department of Medical Genetics, Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil.,Perinatal Genetics Program, Department of Medical Genetics, Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil
| | | | | | - Débora Gusmão Melo
- Medical Department, Federal University of de São Carlos (UFSCAR), São Carlos, SP, Brazil
| | - Chong Ae Kim
- Medical Genetics Unit, Children's Institute, Medical Sciences Faculty, University of São Paulo (FCMUSP), São Paulo, SP, Brazil
| | | | - Têmis Maria Felix
- Medical Genetics Service, Clinical Hospital of Porto Alegre, Porto Alegre, RS, Brazil
| | - Rodrigo Ambrosio Fock
- Centro de Genética Médica da Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Denise Pontes Cavalcanti
- Skeletal Dysplasia Group, Department of Medical Genetics, Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil. .,Perinatal Genetics Program, Department of Medical Genetics, Faculty of Medical Sciences, State University of Campinas, Campinas, SP, Brazil.
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27
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Appelman-Dijkstra NM, Papapoulos SE. From disease to treatment: from rare skeletal disorders to treatments for osteoporosis. Endocrine 2016; 52:414-26. [PMID: 26892377 PMCID: PMC4879160 DOI: 10.1007/s12020-016-0888-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/02/2016] [Indexed: 12/18/2022]
Abstract
During the past 15 years there has been an expansion of our knowledge of the cellular and molecular mechanisms regulating bone remodeling that identified new signaling pathways fundamental for bone renewal as well as previously unknown interactions between bone cells. Central for these developments have been studies of rare bone disorders. These findings, in turn, have led to new treatment paradigms for osteoporosis some of which are at late stages of clinical development. In this article, we review three rare skeletal disorders with case descriptions, pycnodysostosis and the craniotubular hyperostoses sclerosteosis and van Buchem disease that led to the development of cathepsin K and sclerostin inhibitors, respectively, for the treatment of osteoporosis.
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Affiliation(s)
- Natasha M Appelman-Dijkstra
- Center for Bone Quality, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Socrates E Papapoulos
- Center for Bone Quality, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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28
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Wen X, Yi LZ, Liu F, Wei JH, Xue Y. The role of cathepsin K in oral and maxillofacial disorders. Oral Dis 2015; 22:109-15. [PMID: 26458004 DOI: 10.1111/odi.12378] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 09/30/2015] [Indexed: 01/05/2023]
Abstract
Cathepsin K (CTSK) was thought to be a collagenase, specifically expressed by osteoclasts, and played an important role in bone resorption. However, more and more research found that CTSK was expressed in more extensive cells, tissues, and organs. It may not only participate in regulating human physiological activity, but also be closely related to a variety of disease. In this review, we highlight the relationship between CTSK and oral and maxillofacial disorders on the following three aspects: oral and maxillofacial abnormities in patients with pycnodysostosis caused by CTSK mutations, oral and maxillofacial abnormities in Ctsk(-/-) mice, and the role of CTSK in oral and maxillofacial diseases, including periodontitis, peri-implantitis, tooth movement, oral and maxillofacial tumor, root resorption, and periapical disease.
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Affiliation(s)
- X Wen
- State Key Laboratory of Military Stomatology, Department of Prosthodontics, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - L-z Yi
- State Key Laboratory of Military Stomatology, Department of Oral Biology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - F Liu
- Department of Stomatology, Northwest Women's and Children's Hospital, Xi'an, China
| | - J-h Wei
- State Key Laboratory of Military Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Y Xue
- State Key Laboratory of Military Stomatology, Department of Oral Biology, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China.,Clinic of Oral Rare and Genetic Diseases, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, China
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29
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Nassar K, Janani S, Rachidi W, Mkinsi O. [Pycnodysostosis, a case report]. Presse Med 2015; 44:1193-6. [PMID: 26456945 DOI: 10.1016/j.lpm.2015.09.003] [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: 07/30/2015] [Revised: 08/27/2015] [Accepted: 09/03/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kawtar Nassar
- Centre hospitalier universitaire, service de rhumatologie, Casablanca, Maroc.
| | - Saadia Janani
- Centre hospitalier universitaire, service de rhumatologie, Casablanca, Maroc
| | - Wafae Rachidi
- Centre hospitalier universitaire, service de rhumatologie, Casablanca, Maroc
| | - Ouafa Mkinsi
- Centre hospitalier universitaire, service de rhumatologie, Casablanca, Maroc
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30
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Xue Y, Wang L, Xia D, Li Q, Gao S, Dong M, Cai T, Shi S, He L, Hu K, Mao T, Duan X. Dental Abnormalities Caused by Novel Compound Heterozygous CTSK Mutations. J Dent Res 2015; 94:674-81. [PMID: 25731711 DOI: 10.1177/0022034515573964] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cathepsin K (CTSK) is an important protease responsible for degrading type I collagen, osteopontin, and other bone matrix proteins. The mutations in the CTSK gene can cause pycnodysostosis (OMIM 265800), a rare autosomal recessive bone dysplasia. Patients with pycnodysostosis have been reported to present specific dental abnormalities; however, whether these dental abnormalities are related to dysfunctional CTSK has never been reported. Here we investigated the histologic changes of cementum and alveolar bone in a pycnodysostosis patient, caused by novel compound heterozygous mutations in the CTSK gene (c.87 G>A p.W29X and c.848 A>G p.Y283C). The most impressive manifestations in tooth were extensive periradicular high-density clumps with unclear periodontal space by orthopantomography examination and micro-computed tomography scanning analysis. Hematoxylin/eosin and toluidine blue staining and atomic force microscopy analysis showed that the cementum became significantly thickened, softened, and full of cementocytes. The disorganized bone structure was the main character of alveolar bone. The p.W29X mutation may represent the loss-of-function allele with an earlier termination codon in the precursor CTSK polypeptide. Residue Y283 is highly conserved among papain-like cysteine proteases. Three-dimensional structure modeling analysis found that the loss of the hydroxybenzene residue in the Y283C mutation would interrupt the hydrogen network and possibly affect the self-cleavage of the CTSK enzyme. Furthermore, p.Y283C mutation did not affect the mRNA and protein levels of overexpressed CTSK in COS-7 system but did reduce CTSK enzyme activity. In conclusion, the histologic and ultrastructural changes of cementum and alveolar bone might be affected by CTSK mutation via reduction of its enzyme activity (clinical trial registration: ChiCTR-TNC-10000876).
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Affiliation(s)
- Y Xue
- State Key Laboratory of Military Stomatology, Department of Oral Biology, Clinic of Oral Rare and Genetic Diseases, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, P. R. China
| | - L Wang
- Department of Molecular Biology, Fourth Military Medical University, Xi'an, Shaanxi, P. R. China
| | - D Xia
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, Aarhus C, Denmark
| | - Q Li
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, Aarhus C, Denmark
| | - S Gao
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, Aarhus C, Denmark
| | - M Dong
- Interdisciplinary Nanoscience Center (iNANO), Aarhus University, Aarhus C, Denmark
| | - T Cai
- Oral Infection and Immunity Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD, USA
| | - S Shi
- Center for Craniofacial Molecular Biology, University of Southern California School of Dentistry, Los Angeles, CA, USA
| | - L He
- State Key Laboratory of Military Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, P. R. China
| | - K Hu
- State Key Laboratory of Military Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, P. R. China
| | - T Mao
- State Key Laboratory of Military Stomatology, Department of Oral and Maxillofacial Surgery, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, P. R. China
| | - X Duan
- State Key Laboratory of Military Stomatology, Department of Oral Biology, Clinic of Oral Rare and Genetic Diseases, School of Stomatology, Fourth Military Medical University, Xi'an, Shaanxi, P. R. China
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31
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Matar HE, James LA. A challenging paediatric pathological femur fracture in pyknodysostosis (osteopetrosis acro-osteolytica): lessons learnt. BMJ Case Rep 2014; 2014:bcr-2014-207730. [PMID: 25414231 DOI: 10.1136/bcr-2014-207730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Hosam E Matar
- Department of Trauma & Orthopaedics, Alder Hey Children's Hospital, Liverpool, Merseyside, UK
| | - Leroy A James
- Department of Trauma & Orthopaedics, Alder Hey Children's Hospital, Liverpool, Merseyside, UK
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32
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Abstract
Pycnodysostosis is a rare autosomal recessive disorder caused by an inactivating mutation in cathepsin K (CTSK) and characterized by dysmorphic facial features, a short stature, acroosteolysis, osteosclerosis with increased bone fragility, and delayed closure of cranial sutures. Patients usually present with short stature or dysmorphic features the Pediatric Endocrinology or Genetics clinics, with atypical fractures to the orthopedics clinics or hematological abnormalities to the hematology clinics. However, under-diagnosis or misdiagnosis of this condition is a major issue. Pycnodysostosis is not a life threatening condition, but craniosynostosis, frequent fractures, respiratory-sleep problems, and dental problems may cause significant morbidity. Although no specific treatment for this disorder has been described, patients should be followed for complications and treated accordingly. A specific treatment for the disorder must be established in the future to prevent complications and improve quality of life for patients in the current era of advanced molecular research.
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Affiliation(s)
- Serap Turan
- Department of Pediatric Endocrinology, Marmara University, Istanbul, Turkey
- Address correspondence to: Dr. Serap Turan, Department of Pediatric Endocrinology and Diabetes, Marmara University Hospital, Fevzi Cakmak Mh. Mimar Sinan Cd. No 41. Istanbul 34899, Turkey. E-mail:
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