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Francisco A, Goler AMY, Navarro CDC, Onder A, Yildiz M, Kendir Demirkol Y, Karademir Yilmaz B, Seven Menevse T, Güran T, Castilho RF. Lack of NAD(P)+ transhydrogenase activity in patients with primary adrenal insufficiency due to NNT variants. Eur J Endocrinol 2024; 190:130-138. [PMID: 38261461 DOI: 10.1093/ejendo/lvae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/10/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Pathogenic variants in the nicotinamide nucleotide transhydrogenase gene (NNT) are a rare cause of primary adrenal insufficiency (PAI), as well as functional impairment of the gonads. OBJECTIVE Despite the description of different homozygous and compound heterozygous NNT variants in PAI patients, the extent to which the function and expression of the mature protein are compromised remains to be clarified. DESIGN The activity and expression of mitochondrial NAD(P)+ transhydrogenase (NNT) were analyzed in blood samples obtained from patients diagnosed with PAI due to genetically confirmed variants of the NNT gene (n = 5), heterozygous carriers as their parents (n = 8), and healthy controls (n = 26). METHODS NNT activity was assessed by a reverse reaction assay standardized for digitonin-permeabilized peripheral blood mononuclear cells (PBMCs). The enzymatic assay was validated in PBMC samples from a mouse model of NNT absence. Additionally, the PBMC samples were evaluated for NNT expression by western blotting and reverse transcription quantitative polymerase chain reaction and for mitochondrial oxygen consumption. RESULTS NNT activity was undetectable (<4% of that of healthy controls) in PBMC samples from patients, independent of the pathogenic genetic variant. In patients' parents, NNT activity was approximately half that of the healthy controls. Mature NNT protein expression was lower in patients than in the control groups, while mRNA levels varied widely among genotypes. Moreover, pathogenic NNT variants did not impair mitochondrial bioenergetic function in PBMCs. CONCLUSIONS The manifestation of PAI in NNT-mutated patients is associated with a complete lack of NNT activity. Evaluation of NNT activity can be useful to characterize disease-causing NNT variants.
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Affiliation(s)
- Annelise Francisco
- Department of Pathology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP 13083-888, Brazil
- Department of Biochemistry, Faculty of Medicine, Genetic and Metabolic Diseases Research Center, Marmara University Faculty of Medicine, Istanbul 34854, Turkey
| | - Ayse Mine Yilmaz Goler
- Department of Biochemistry, Faculty of Medicine, Genetic and Metabolic Diseases Research Center, Marmara University Faculty of Medicine, Istanbul 34854, Turkey
| | | | - Asan Onder
- Department of Pediatric Endocrinology and Diabetes, Medeniyet University Goztepe Training and Research Hospital, Istanbul 34722, Turkey
| | - Melek Yildiz
- Pediatric Genetic Diseases, Umraniye Training and Research Hospital, Istanbul 34764, Turkey
| | - Yasemin Kendir Demirkol
- Department of Pediatric Genetics, Umraniye Research and Training Hospital, University of Health Sciences, Istanbul 34764, Turkey
| | - Betul Karademir Yilmaz
- Department of Biochemistry, Faculty of Medicine, Genetic and Metabolic Diseases Research Center, Marmara University Faculty of Medicine, Istanbul 34854, Turkey
| | - Tuba Seven Menevse
- Department of Pediatric Endocrinology and Diabetes, Marmara University Faculty of Medicine, Istanbul 34854, Turkey
| | - Tülay Güran
- Department of Pediatric Endocrinology and Diabetes, Marmara University Faculty of Medicine, Istanbul 34854, Turkey
| | - Roger Frigério Castilho
- Department of Pathology, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP 13083-888, Brazil
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Carsote M, Nistor C. Addison's Disease: Diagnosis and Management Strategies. Int J Gen Med 2023; 16:2187-2210. [PMID: 37287503 PMCID: PMC10243343 DOI: 10.2147/ijgm.s390793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/29/2023] [Indexed: 06/09/2023] Open
Abstract
We aim to overview Addison's disease (AD) with regard to current diagnosis and management. This is a narrative review of full-length articles published in English between January 2022 and December 2022 (including online ahead of print versions) in PubMed-indexed journals. We included original studies in living humans regardless of the level of statistical significance starting from the key search terms "Addison's disease" or "primary adrenal insufficiency" in title or abstract. We excluded articles with secondary adrenal insufficiency. Briefly, 199 and 355 papers, respectively were identified; we manually checked each of them, excluded the duplicates, and then selected 129 based on their clinical relevance in order to address our 1-year analysis. We organized the data in different subsections covering all published aspects on the subject of AD. To our knowledge, this is the largest AD retrospective from 2022 on published data. A massive role of genetic diagnosis especially in pediatric cases is highlighted; the importance of both pediatric and adult awareness remains since unusual presentations continue to be described. COVID-19 infection is a strong player amid this third year of pandemic although we still not do have large cohorts in this particular matter as seen, for instance, in thyroid anomalies. In our opinion, the most important topic for research is immune checkpoint inhibitors, which cause a large panel of endocrine side effects, AD being one of them.
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Affiliation(s)
- Mara Carsote
- Department of Endocrinology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Gonads and Infertility, “C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania
| | - Claudiu Nistor
- Department 4 – Cardio -Thoracic Pathology, Thoracic Surgery II Discipline, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Thoracic Surgery Department, “Dr. Carol Davila” Central Emergency University Military Hospital, Bucharest, Romania
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Dursun F, Genc HM, Mine Yılmaz A, Tas I, Eser M, Pehlivanoglu C, Yilmaz BK, Guran T. Primary adrenal insufficiency in a patient with biallelic QRSL1 mutations. Eur J Endocrinol 2022; 187:K27-K32. [PMID: 35894854 DOI: 10.1530/eje-22-0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/27/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Biallelic QRSL1 mutations cause mitochondrial 'combined oxidative phosphorylation deficiency-40' (COXPD40). COXPD40 has been reported to be invariably lethal in infancy. Adrenal insufficiency was weakly reported and investigated among seven previously reported patients with COXPD40. OBJECTIVE We report the clinical, biochemical, molecular, and functional characteristics of a patient with adrenal insufficiency due to COXPD40. METHODS The medical history and adrenal function tests were examined. Genetic analysis was performed using whole-exome sequencing. Mitochondrial function was tested using mitochondrial membrane potential (MMP) and superoxide dismutase (SOD) enzyme assays. RESULTS An 8-year-old boy was investigated for adrenal insufficiency. He also had mild developmental delay, sensorineural hearing loss, hypertrophic cardiomyopathy, nephrocalcinosis, elevated parathyroid hormone and creatine kinase, and lactic acidosis. Biallelic novel QRSL1 variants (c.300T>A;Y100* and c.610G>A;G204R) were identified. Oxidative damage in mitochondria was shown by reduced MMP and SOD assays in the patient compared to controls (P < 0.0001). Adrenal function tests revealed a 'primary adrenal insufficiency other than congenital adrenal hyperplasia' (non-CAH PAI) with an isolated glucocorticoid deficiency. In the 8-year follow-up, having the longest survival of reported COXPD40 patients, he had preserved mineralocorticoid functions and gonadal steroidogenesis. CONCLUSION Biallelic QRSL1 mutations can cause non-CAH PAI. Adrenal functions should be monitored in mitochondrial disorders to improve clinical outcomes.
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Affiliation(s)
- Fatma Dursun
- Umraniye Training and Research Hospital, Department of Pediatric Endocrinology and Diabetes
| | - Hulya Maras Genc
- Umraniye Training and Research Hospital, Department of Pediatric Neurology, University of Health Sciences, Istanbul, Turkey
| | - Ayşe Mine Yılmaz
- School of Medicine, Department of Biochemistry, Genetic and Metabolic Diseases Research and Investigation Center, Marmara University, Istanbul, Turkey
| | - Ibrahim Tas
- Umraniye Training and Research Hospital, Department of Pediatric Nutrition and Metabolism
| | - Metin Eser
- Umraniye Training and Research Hospital, Department of Medical Genetics
| | - Cemile Pehlivanoglu
- Umraniye Training and Research Hospital, Department of Pediatric Nephrology, University of Health Sciences, Istanbul, Turkey
| | - Betul Karademir Yilmaz
- School of Medicine, Department of Biochemistry, Genetic and Metabolic Diseases Research and Investigation Center, Marmara University, Istanbul, Turkey
| | - Tulay Guran
- School of Medicine, Department of Pediatric Endocrinology and Diabetes, Marmara University, Istanbul, Turkey
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Maharaj A, Kwong R, Williams J, Smith C, Storr H, Krone R, Braslavsky D, Clemente M, Ram N, Banerjee I, Çetinkaya S, Buonocore F, Güran T, Achermann JC, Metherell L, Prasad R. A retrospective analysis of endocrine disease in sphingosine-1-phosphate lyase insufficiency: case series and literature review. Endocr Connect 2022; 11:e220250. [PMID: 35904228 PMCID: PMC9346324 DOI: 10.1530/ec-22-0250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/28/2022] [Indexed: 11/14/2022]
Abstract
Sphingosine-1-phosphate lyase (SGPL1) insufficiency syndrome (SPLIS) is an autosomal recessive multi-system disorder, which mainly incorporates steroid-resistant nephrotic syndrome and primary adrenal insufficiency. Other variable endocrine manifestations are described. In this study, we aimed to comprehensively annotate the endocrinopathies associated with pathogenic SGPL1 variants and assess for genotype-phenotype correlations by retrospectively reviewing the reports of endocrine disease within our patient cohort and all published cases in the wider literature up to February 2022. Glucocorticoid insufficiency in early childhood is the most common endocrine manifestation affecting 64% of the 50 patients reported with SPLIS, and a third of these individuals have additional mineralocorticoid deficiency. While most individuals also have nephrotic syndrome, SGPL1 variants also account for isolated adrenal insufficiency at presentation. Primary gonadal insufficiency, manifesting with microphallus and cryptorchidism, is reported in less than one-third of affected boys, all with concomitant adrenal disease. Mild primary hypothyroidism affects approximately a third of patients. There is paucity of data on the impact of SGPL1 deficiency on growth, and pubertal development, limited by the early and high mortality rate (approximately 50%). There is no clear genotype-phenotype correlation overall in the syndrome, with variable disease penetrance within individual kindreds. However, with regards to endocrine phenotype, the most prevalent disease variant p.R222Q (affecting 22%) is most consistently associated with isolated glucocorticoid deficiency. To conclude, SPLIS is associated with significant multiple endocrine disorders. While endocrinopathy in the syndrome generally presents in infancy, late-onset disease also occurs. Screening for these is therefore warranted both at diagnosis and through follow-up.
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Affiliation(s)
- Avinaash Maharaj
- Centre for Endocrinology, John Vane Science Centre, Queen Mary University of London, London, UK
| | - Ruth Kwong
- Centre for Endocrinology, John Vane Science Centre, Queen Mary University of London, London, UK
| | - Jack Williams
- Centre for Endocrinology, John Vane Science Centre, Queen Mary University of London, London, UK
| | - Christopher Smith
- Centre for Endocrinology, John Vane Science Centre, Queen Mary University of London, London, UK
| | - Helen Storr
- Centre for Endocrinology, John Vane Science Centre, Queen Mary University of London, London, UK
| | - Ruth Krone
- Birmingham Children’s Hospital, Birmingham, UK
| | - Debora Braslavsky
- Centro de Investigaciones Endocrinológicas ‘Dr. Cesar Bergadá’ (CEDIE) – CONICET – FEI – División de Endocrinología, Hospital de Niños ‘Ricardo Gutiérrez’, Buenos Aires, Argentina
| | - Maria Clemente
- Paediatric Endocrinology, Growth and Development Research Unit, Vall d’Hebron Research Institute (VHIR), Hospital Vall d’Hebron, CIBERER, Instituto de Salud Carlos III, Barcelona, Spain
| | - Nanik Ram
- Department of Endocrinology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Indraneel Banerjee
- Department of Paediatric Endocrinology, Royal Manchester Children’s Hospital, Manchester, UK
| | - Semra Çetinkaya
- Health Sciences University, Dr. Sami Ulus Obstetrics and Gynaecology, Children’s Health and Disease Education and Research Hospital, Ankara, Turkey
| | - Federica Buonocore
- Genetics and Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Tülay Güran
- Department of Paediatric Endocrinology and Diabetes, Marmara University, School of Medicine, Istanbul, Turkey
| | - John C Achermann
- Genetics and Genomic Medicine Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Louise Metherell
- Centre for Endocrinology, John Vane Science Centre, Queen Mary University of London, London, UK
| | - Rathi Prasad
- Centre for Endocrinology, John Vane Science Centre, Queen Mary University of London, London, UK
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