1
|
Yildirim Simsir I, Tuysuz B, Ozbek MN, Tanrikulu S, Celik Guler M, Karhan AN, Denkboy Ongen Y, Gunes N, Soyaltin UE, Altay C, Nur B, Ozalkak S, Akgun Dogan O, Dursun F, Pekkolay Z, Eren MA, Usta Y, Ozisik S, Ozgen Saydam B, Adiyaman SC, Unal MC, Gungor Semiz G, Turan I, Eren E, Kayserili H, Jeru I, Vigouroux C, Atik T, Onay H, Ozen S, Arioglu Oral E, Akinci B. Clinical features of generalized lipodystrophy in Turkey: A cohort analysis. Diabetes Obes Metab 2023; 25:1950-1963. [PMID: 36946378 DOI: 10.1111/dom.15061] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/09/2023] [Accepted: 03/19/2023] [Indexed: 03/23/2023]
Abstract
AIM To describe the Turkish generalized lipodystrophy (GL) cohort with the frequency of each complication and the death rate during the period of the follow-up. METHODS This study reports on 72 patients with GL (47 families) registered at different centres in Turkey that cover all regions of the country. The mean ± SD follow-up was 86 ± 78 months. RESULTS The Kaplan-Meier estimate of the median time to diagnosis of diabetes and/or prediabetes was 16 years. Hyperglycaemia was not controlled in 37 of 45 patients (82.2%) with diabetes. Hypertriglyceridaemia developed in 65 patients (90.3%). The Kaplan-Meier estimate of the median time to diagnosis of hypertriglyceridaemia was 14 years. Hypertriglyceridaemia was severe (≥ 500 mg/dl) in 38 patients (52.8%). Seven (9.7%) patients suffered from pancreatitis. The Kaplan-Meier estimate of the median time to diagnosis of hepatic steatosis was 15 years. Liver disease progressed to cirrhosis in nine patients (12.5%). Liver disease was more severe in congenital lipodystrophy type 2 (CGL2). Proteinuric chronic kidney disease (CKD) developed in 32 patients (44.4%) and cardiac disease in 23 patients (31.9%). Kaplan-Meier estimates of the median time to diagnosis of CKD and cardiac disease were 25 and 45 years, respectively. Females appeared to have a more severe metabolic disease, with an earlier onset of metabolic abnormalities. Ten patients died during the follow-up period. Causes of death were end-stage renal disease, sepsis (because of recurrent intestinal perforations, coronavirus disease, diabetic foot infection and following coronary artery bypass graft surgery), myocardial infarction, heart failure because of dilated cardiomyopathy, stroke, liver complications and angiosarcoma. CONCLUSIONS Standard treatment approaches have only a limited impact and do not prevent the development of severe metabolic abnormalities and early onset of organ complications in GL.
Collapse
Affiliation(s)
- Ilgin Yildirim Simsir
- Division of Endocrinology, Department of Internal Medicine, Ege University School of Medicine, Izmir, Turkey
| | - Beyhan Tuysuz
- Department of Genetics, Istanbul Cerrahpasa University, Istanbul, Turkey
| | - Mehmet Nuri Ozbek
- Division of Pediatric Endocrinology, Mardin Artuklu University, Mardin, Turkey
| | - Seher Tanrikulu
- Division of Endocrinology, Department of Internal Medicine, Acibadem Hospital, Istanbul, Turkey
| | - Merve Celik Guler
- Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Asuman Nur Karhan
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Yasemin Denkboy Ongen
- Division of Pediatric Endocrinology, Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Nilay Gunes
- Department of Genetics, Istanbul Cerrahpasa University, Istanbul, Turkey
| | - Utku Erdem Soyaltin
- Division of Endocrinology, Department of Internal Medicine, Ege University School of Medicine, Izmir, Turkey
| | - Canan Altay
- Department of Radiology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Banu Nur
- Division of Pediatric Genetics, Akdeniz University, Antalya, Turkey
| | - Servan Ozalkak
- Division of Pediatric Endocrinology, Diyarbakir Children's Hospital, Diyarbakir, Turkey
| | - Ozlem Akgun Dogan
- Department of Pediatric Genetics, Faculty of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Fatma Dursun
- Department of Pediatric Endocrinology and Diabetes, Istanbul University of Health Science, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Zafer Pekkolay
- Division of Endocrinology and Metabolism, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | - Mehmet Ali Eren
- Department of Endocrinology and Metabolism, Harran University, Faculty of Medicine, Sanliurfa, Turkey
| | - Yusuf Usta
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Secil Ozisik
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Basak Ozgen Saydam
- Division of Endocrinology and Metabolism, Yildirim Beyazit University, Yenimahalle Training Hospital, Ankara, Turkey
| | - Suleyman Cem Adiyaman
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Mehmet Cagri Unal
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Gokcen Gungor Semiz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ihsan Turan
- Division of Pediatric Endocrinology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Erdal Eren
- Division of Pediatric Endocrinology, Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Hulya Kayserili
- Department of Medical Genetics, Koc University School of Medicine, Istanbul, Turkey
| | - Isabelle Jeru
- Department of Medical Genetics, DMU BioGeM, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris, France
| | - Corinne Vigouroux
- Assistance Publique-Hôpitaux de Paris, Saint-Antoine University Hospital, National Reference Center for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Department of Endocrinology, Diabetology and Reproductive Endocrinology and Department of Molecular Biology and Genetics, and Sorbonne University, Inserm U938, Saint-Antoine Research Centre, Institute of Cardiometabolism and Nutrition, Paris, France
| | - Tahir Atik
- Division of Pediatric Genetics, Ege University School of Medicine, Izmir, Turkey
| | - Huseyin Onay
- Department of Medical Genetics, Ege University, Izmir, Turkey
| | - Samim Ozen
- Division of Pediatric Endocrinology and Diabetes, Ege University School of Medicine, Izmir, Turkey
| | - Elif Arioglu Oral
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | |
Collapse
|
2
|
Biancalana E, Ceccarini G, Magno S, Ortenzi V, Giannese D, Santini F, Solini A. Canagliflozin on top of dual renin-angiotensin system blockade in a woman with partial acquired lipodystrophy, type 2 diabetes and severely proteinuric chronic kidney disease: a case report. Front Endocrinol (Lausanne) 2023; 14:1172468. [PMID: 37274321 PMCID: PMC10237351 DOI: 10.3389/fendo.2023.1172468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 04/26/2023] [Indexed: 06/06/2023] Open
Abstract
Sodium glucose cotransporter 2 inhibitors have proven strong efficacy in reducing end-stage renal disease in patients with type 2 diabetes. We are presenting here the case of a 40-year-old woman with acquired partial lipodystrophy, type 2 diabetes and essential hypertension complicated by chronic kidney disease and proteinuria in the nephrotic range. She first came to our attention in 2012; estimated glomerular filtration rate (eGFR) was 41.5 ml/min/1.73 m2 and total proteinuria was 375 mg/24h; she was treated with dual renin angiotensin system blocking. Proteinuria significantly increased during the following years, reaching a nephrotic range (>5 g/day). A kidney biopsy revealed a tubule-interstitial involvement compatible with type 2 diabetes. Leptin replacement therapy, started in 2018, improved glycaemic control and lipid profile, also determining a reduction in insulin total daily dose. In 2019, after the publication of the CREDENCE study, canagliflozin was started on top of losartan and ramipril. After an initial, expected eGFR drop, kidney function stabilized, and albuminuria significantly reduced (from 4120 to 984 mg/24h), while serum potassium showed only minimal increase. At last follow-up (2022) total proteinuria was still reducing (510 mg/24h), while kidney function was substantially unchanged (eGFR 40 ml/min/1.73 m2). This case report suggests that, despite not recommended in international guidelines, the use of SGLT2i in combination with dual renin angiotensin system blockade should be considered in specific conditions and under close clinical monitoring.
Collapse
Affiliation(s)
- Edoardo Biancalana
- Department of Clinical and Experimental Medicine University of Pisa, Pisa, Italy
| | - Giovanni Ceccarini
- Obesity and Lipodistrophy Center, University Hospital of Pisa, Pisa, Italy
| | - Silvia Magno
- Obesity and Lipodistrophy Center, University Hospital of Pisa, Pisa, Italy
| | - Valerio Ortenzi
- Section of Pathology, University Hospital of Pisa, Pisa, Italy
| | | | - Ferruccio Santini
- Obesity and Lipodistrophy Center, University Hospital of Pisa, Pisa, Italy
| | - Anna Solini
- Department of Surgical, Medical, Molecular and Critical Area Pathology, University of Pisa, Pisa, Italy
| |
Collapse
|
3
|
Mosbah H, Vantyghem M, Nobécourt E, Andreelli F, Archambeaud F, Bismuth E, Briet C, Cartigny M, Chevalier B, Donadille B, Daguenel A, Fichet M, Gautier J, Janmaat S, Jéru I, Legagneur C, Leguier L, Maitre J, Mongeois E, Poitou C, Renard E, Reznik Y, Spiteri A, Travert F, Vergès B, Zammouri J, Vigouroux C, Vatier C. Therapeutic indications and metabolic effects of metreleptin in patients with lipodystrophy syndromes: Real-life experience from a national reference network. Diabetes Obes Metab 2022; 24:1565-1577. [PMID: 35445532 PMCID: PMC9541305 DOI: 10.1111/dom.14726] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/05/2022] [Accepted: 04/18/2022] [Indexed: 12/01/2022]
Abstract
AIM To describe baseline characteristics and follow-up data in patients with lipodystrophy syndromes treated with metreleptin in a national reference network, in a real-life setting. PATIENTS AND METHODS Clinical and metabolic data from patients receiving metreleptin in France were retrospectively collected, at baseline, at 1 year and at the latest follow-up during treatment. RESULTS Forty-seven patients with lipodystrophy including generalized lipodystrophy (GLD; n = 28) and partial lipodystrophy (PLD; n = 19) received metreleptin over the last decade. At baseline, the median (interquartile range [IQR]) patient age was 29.3 (16.6-47.6) years, body mass index was 23.8 (21.2-25.7) kg/m2 and serum leptin was 3.2 (1.0-4.9) ng/mL, 94% of patients had diabetes (66% insulin-treated), 53% had hypertension and 87% had dyslipidaemia. Metreleptin therapy, administered for a median (IQR) of 31.7 (14.2-76.0) months, was ongoing in 77% of patients at the latest follow-up. In patients with GLD, glycated haemoglobin (HbA1c) and fasting triglyceride levels significantly decreased from baseline to 1 year of metreleptin treatment, from 8.4 (6.5-9.9)% [68 (48-85) mmol/mol] to 6.8 (5.6-7.4)% [51(38-57) mmol/mol], and 3.6 (1.7-8.5) mmol/L to 2.2 (1.1-3.7) mmol/L, respectively (P < 0.001), with sustained efficacy thereafter. In patients with PLD, HbA1c was not significantly modified (7.7 [7.1-9.1]% [61 (54-76) mmol/mol] at baseline vs. 7.7 [7.4-9.5]% [61(57-80) mmol/mol] at 1 year), and the decrease in fasting triglycerides (from 3.3 [1.9-9.9] mmol/L to 2.5 [1.6-5.3] mmol/L; P < 0.01) was not confirmed at the latest assessment (5.2 [2.2-11.3] mmol/L). However, among PLD patients, at 1 year, 61% were responders regarding glucose homeostasis, with lower baseline leptin levels compared to nonresponders, and 61% were responders regarding triglyceridaemia. Liver enzymes significantly decreased only in the GLD group. CONCLUSIONS In this real-life setting study, metabolic outcomes are improved by metreleptin therapy in patients with GLD. The therapeutic indication for metreleptin needs to be clarified in patients with PLD.
Collapse
Affiliation(s)
- Héléna Mosbah
- Endocrinology DepartmentAssistance Publique–Hôpitaux de Paris (AP‐HP), Saint–Antoine University Hospital, National Reference Centre for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS)ParisFrance
- Sorbonne University, Inserm UMR_S 938, Saint–Antoine Research CentreCardiometabolism and Nutrition University Hospital Institute (ICAN)ParisFrance
| | - Marie‐Christine Vantyghem
- Department of Endocrinology, Diabetology and Metabolism, Lille University Hospital; University of Lille, INSERM U1190European Genomic Institute for DiabetesLilleFrance
| | - Estelle Nobécourt
- Department of Endocrinology, Diabetology and MetabolismLa Réunion University HospitalSaint Pierre de la RéunionFrance
| | - Fabrizio Andreelli
- AP‐HP, Pitié‐Salpêtrière University Hospital, Department of Diabetology; Sorbonne University, INSERMNutrition and Obesity: systemic approaches « NutriOmics »ParisFrance
| | - Francoise Archambeaud
- Department of Endocrinology, Diabetology and MetabolismDupuytren University HospitalLimogesFrance
| | - Elise Bismuth
- AP‐HP, Robert‐Debré University Hospital, Department of Paediatric Endocrinology, Diabetology and MetabolismUniversity of ParisParisFrance
| | - Claire Briet
- Department of EndocrinologyDiabetology and Metabolism, Angers University Hospital, Laboratory MITOVASC, UMR CNRS 6015, INSERM 1083AngersFrance
| | - Maryse Cartigny
- Reference Centre for Rare Diseases of Genital Development DEVGEN, Endocrinology Unit, Diabetology and Paediatric Gynecology DepartmentLille University HospitalLilleFrance
| | - Benjamin Chevalier
- Department of Endocrinology, Diabetology and Metabolism, Lille University Hospital; University of Lille, INSERM U1190European Genomic Institute for DiabetesLilleFrance
| | - Bruno Donadille
- Endocrinology DepartmentAssistance Publique–Hôpitaux de Paris (AP‐HP), Saint–Antoine University Hospital, National Reference Centre for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS)ParisFrance
- Sorbonne University, Inserm UMR_S 938, Saint–Antoine Research CentreCardiometabolism and Nutrition University Hospital Institute (ICAN)ParisFrance
| | - Anne Daguenel
- Department of PharmacyAP‐HP, Saint–Antoine University HospitalParisFrance
| | - Mathilde Fichet
- Department of Endocrinology, Diabetology and MetabolismRennes University HospitalRennesFrance
| | - Jean‐François Gautier
- Department of Endocrinology, Diabetology and MetabolismAP‐HP, Lariboisière University HospitalParisFrance
| | - Sonja Janmaat
- Endocrinology DepartmentAssistance Publique–Hôpitaux de Paris (AP‐HP), Saint–Antoine University Hospital, National Reference Centre for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS)ParisFrance
- Sorbonne University, Inserm UMR_S 938, Saint–Antoine Research CentreCardiometabolism and Nutrition University Hospital Institute (ICAN)ParisFrance
| | - Isabelle Jéru
- Endocrinology DepartmentAssistance Publique–Hôpitaux de Paris (AP‐HP), Saint–Antoine University Hospital, National Reference Centre for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS)ParisFrance
- Sorbonne University, Inserm UMR_S 938, Saint–Antoine Research CentreCardiometabolism and Nutrition University Hospital Institute (ICAN)ParisFrance
| | - Carole Legagneur
- Department of Paediatric Endocrinology, Diabetology and MetabolismUniversity Hospital Brabois‐Vandoeuvre lès NancyVandoeuvre lès NancyFrance
| | - Lysiane Leguier
- Department of Endocrinology, Diabetology and Metabolism, Lille University Hospital; University of Lille, INSERM U1190European Genomic Institute for DiabetesLilleFrance
| | - Julie Maitre
- Department of Paediatrics and Endocrinology, Diabetology and MetabolismOrléans HospitalOrléansFrance
| | - Elise Mongeois
- Department of Paediatrics and Endocrinology, Diabetology and MetabolismOrléans HospitalOrléansFrance
| | - Christine Poitou
- Nutrition Department, Sorbonne University/INSERM, Research Unit: Nutrition and Obesity; Systemic Approaches (NutriOmics)AP‐HP, Pitié‐Salpêtrière University Hospital, Reference Centre for Rare Diseases PRADORT (PRADer‐Willi Syndrome and other Rare Obesities with Eating Disorders)ParisFrance
| | - Eric Renard
- Department of Endocrinology, Diabetes and Nutrition, Montpellier University Hospital; Clinical Investigation Centre INSERM1411; Institute of Functional Genomics, CNRS, INSERMUniversity of MontpellierMontpellierFrance
| | - Yves Reznik
- Department of Endocrinology, Diabetology and MetabolismCôte de Nacre University HospitalCaenFrance
| | - Anne Spiteri
- Department of Endocrinology, Diabetology and MetabolismGrenoble University HospitalGrenobleFrance
| | - Florence Travert
- Department of Diabetology and MetabolismAP‐HP, Bichat University HospitalParisFrance
| | - Bruno Vergès
- Department of Endocrinology, Diabetology and MetabolismBocage University HospitalDijonFrance
| | - Jamila Zammouri
- Sorbonne University, Inserm UMR_S 938, Saint–Antoine Research CentreCardiometabolism and Nutrition University Hospital Institute (ICAN)ParisFrance
- AP‐HP, Robert‐Debré University Hospital, Department of Paediatric Endocrinology, Diabetology and MetabolismUniversity of ParisParisFrance
| | - Corinne Vigouroux
- Endocrinology DepartmentAssistance Publique–Hôpitaux de Paris (AP‐HP), Saint–Antoine University Hospital, National Reference Centre for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS)ParisFrance
- Sorbonne University, Inserm UMR_S 938, Saint–Antoine Research CentreCardiometabolism and Nutrition University Hospital Institute (ICAN)ParisFrance
| | - Camille Vatier
- Endocrinology DepartmentAssistance Publique–Hôpitaux de Paris (AP‐HP), Saint–Antoine University Hospital, National Reference Centre for Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS)ParisFrance
- Sorbonne University, Inserm UMR_S 938, Saint–Antoine Research CentreCardiometabolism and Nutrition University Hospital Institute (ICAN)ParisFrance
| |
Collapse
|
4
|
Fernández-Pombo A, Sánchez-Iglesias S, Cobelo-Gómez S, Hermida-Ameijeiras Á, Araújo-Vilar D. Familial partial lipodystrophy syndromes. Presse Med 2021; 50:104071. [PMID: 34610417 DOI: 10.1016/j.lpm.2021.104071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/18/2021] [Indexed: 12/14/2022] Open
Abstract
Lipodystrophies are a heterogeneous group of rare conditions characterised by the loss of adipose tissue. The most common forms are the familial partial lipodystrophy (FPLD) syndromes, which include a set of disorders, usually autosomal dominant, due to different pathogenetic mechanisms leading to improper fat distribution (loss of fat in the limbs and gluteal region and variable regional fat accumulation). Affected patients are prone to suffering serious morbidity via the development of metabolic complications associated to insulin resistance and an inability to properly store lipids. Although no well-defined diagnostic criteria have been established for lipodystrophy, there are certain clues related to medical history, physical examination and body composition evaluation that may suggest FPLD prior to confirmatory genetic analysis. Its treatment must be fundamentally oriented towards the control of the metabolic abnormalities. In this sense, metreleptin therapy, the newer classes of hypoglycaemic agents and other investigational drugs are showing promising results. This review aims to summarise the current knowledge of FPLD syndromes and to describe their clinical and molecular picture, diagnostic approaches and recent treatment modalities.
Collapse
Affiliation(s)
- Antía Fernández-Pombo
- UETeM-Molecular Pathology of Rare Diseases Group, Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, IDIS-CiMUS, University of Santiago de Compostela, Santiago de Compostela 15782, Spain; Division of Endocrinology and Nutrition, University Clinical Hospital of Santiago de Compostela, 15706, Spain
| | - Sofía Sánchez-Iglesias
- UETeM-Molecular Pathology of Rare Diseases Group, Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, IDIS-CiMUS, University of Santiago de Compostela, Santiago de Compostela 15782, Spain
| | - Silvia Cobelo-Gómez
- UETeM-Molecular Pathology of Rare Diseases Group, Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, IDIS-CiMUS, University of Santiago de Compostela, Santiago de Compostela 15782, Spain
| | - Álvaro Hermida-Ameijeiras
- UETeM-Molecular Pathology of Rare Diseases Group, Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, IDIS-CiMUS, University of Santiago de Compostela, Santiago de Compostela 15782, Spain; Division of Internal Medicine, University Clinical Hospital of Santiago de Compostela, 15706, Spain
| | - David Araújo-Vilar
- UETeM-Molecular Pathology of Rare Diseases Group, Department of Psychiatry, Radiology, Public Health, Nursing and Medicine, IDIS-CiMUS, University of Santiago de Compostela, Santiago de Compostela 15782, Spain; Division of Endocrinology and Nutrition, University Clinical Hospital of Santiago de Compostela, 15706, Spain.
| |
Collapse
|
5
|
Abstract
Lipodystrophy syndromes (LS) constitute a group of rare diseases of the adipose tissue, characterized by a complete or selective deficiency of the fat mass. These disorders are associated with important insulin resistance, cardiovascular and metabolic comorbidities that impact patient's survival and quality of life. Management is challenging and includes diet, physical activity, and specific pharmacological treatment of LS-associated comorbidities. Because of a common pathophysiology involving decreased concentration of the adipokine leptin, efforts have been made to develop therapeutic strategies with leptin replacement therapy. Metreleptin, a recombinant human leptin analogue, has been proposed in hypoleptinemic patients since the beginning of 2000's. The treatment leads to an improvement in metabolic parameters, more important in generalized than in partial LS forms. In this review, the current knowledge about the development of the drug, its outcomes in the treatment of lipodystrophic patients as well as the peculiarities of its use will be presented.
Collapse
|
6
|
Atalaia A, Ben Yaou R, Wahbi K, De Sandre-Giovannoli A, Vigouroux C, Bonne G. Laminopathies' Treatments Systematic Review: A Contribution Towards a 'Treatabolome'. J Neuromuscul Dis 2021; 8:419-439. [PMID: 33682723 PMCID: PMC8203247 DOI: 10.3233/jnd-200596] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Variants in the LMNA gene, encoding lamins A/C, are responsible for a growing number of diseases, all of which complying with the definition of rare diseases. LMNA-related disorders have a varied phenotypic expression with more than 15 syndromes described, belonging to five phenotypic groups: Muscular Dystrophies, Neuropathies, Cardiomyopathies, Lipodystrophies and Progeroid Syndromes. Overlapping phenotypes are also reported. Linking gene and variants with phenotypic expression, disease mechanisms, and corresponding treatments is particularly challenging in laminopathies. Treatment recommendations are limited, and very few are variant-based. OBJECTIVE The Treatabolome initiative aims to provide a shareable dataset of existing variant-specific treatment for rare diseases within the Solve-RD EU project. As part of this project, we gathered evidence of specific treatments for laminopathies via a systematic literature review adopting the FAIR (Findable, Accessible, Interoperable, and Reusable) guidelines for scientific data production. METHODS Treatments for LMNA-related conditions were systematically collected from MEDLINE and Embase bibliographic databases and clinical trial registries (Cochrane Central Registry of Controlled Trials, clinicaltrial.gov and EudraCT). Two investigators extracted and analyzed the literature data independently. The included papers were assessed using the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. RESULTS From the 4783 selected articles by a systematic approach, we identified 78 papers for our final analysis that corresponded to the profile of data defined in the inclusion and exclusion criteria. These papers include 2 guidelines/consensus papers, 4 meta-analyses, 14 single-arm trials, 15 case series, 13 cohort studies, 21 case reports, 8 expert reviews and 1 expert opinion. The treatments were summarized electronically according to significant phenome-genome associations. The specificity of treatments according to the different laminopathic phenotypical presentations is variable. CONCLUSIONS We have extracted Treatabolome-worthy treatment recommendations for patients with different forms of laminopathies based on significant phenome-genome parings. This dataset will be available on the Treatabolome website and, through interoperability, on genetic diagnosis and treatment support tools like the RD-Connect's Genome Phenome Analysis Platform.
Collapse
Affiliation(s)
- Antonio Atalaia
- Sorbonne Université, Inserm, Center of Research in Myology, G.H. Pitié-Salpêtrière, Paris, France
| | - Rabah Ben Yaou
- Sorbonne Université, Inserm, Center of Research in Myology, G.H. Pitié-Salpêtrière, Paris, France
- AP-HP Sorbonne Université, Neuromyology Department, Centre de référence maladies neuromusculaires Nord/Est/Ile-de-France (FILNEMUS network), Institut de Myologie, G.H. Pitié-Salpêtrière, Paris, France
| | - Karim Wahbi
- APHP, Cochin Hospital, Cardiology Department, FILNEMUS, Centre de Référence de Pathologie Neuromusculaire Nord/Est/Ile de France, Université de Paris, Paris, France
| | - Annachiara De Sandre-Giovannoli
- AP-HM, Department of Medical Genetics, and CRB-TAC (CRB AP-HM), Children’s Hospital La Timone, Marseille, France
- Aix Marseille University, Inserm, Marseille Medical Genetics Marseille, France
| | - Corinne Vigouroux
- AP-HP Saint-Antoine Hospital, Reference Centre of Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Departments of Molecular Biology and Genetics and of Endocrinology, 75012 Paris, France
- Sorbonne Université, Inserm, Saint-Antoine Research Center, Paris, France
| | - Gisèle Bonne
- Sorbonne Université, Inserm, Center of Research in Myology, G.H. Pitié-Salpêtrière, Paris, France
| |
Collapse
|
7
|
Bagias C, Xiarchou A, Bargiota A, Tigas S. Familial Partial Lipodystrophy (FPLD): Recent Insights. Diabetes Metab Syndr Obes 2020; 13:1531-1544. [PMID: 32440182 PMCID: PMC7224169 DOI: 10.2147/dmso.s206053] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/31/2020] [Indexed: 12/16/2022] Open
Abstract
Lipodystrophies are a heterogeneous group of congenital or acquired disorders, characterized by partial or generalized loss of adipose tissue. Familial partial lipodystrophy (FPLD) presents with genetic and phenotypic variability with insulin resistance, hypertriglyceridemia and hepatic steatosis being the cardinal metabolic features. The severity of the metabolic derangements is in proportion with the degree of lipoatrophy. The underpinning pathogenetic mechanism is the limited capacity of adipose tissue to store lipids leading to lipotoxicity, low-grade inflammation, altered adipokine secretion and ectopic fat tissue accumulation. Advances in molecular genetics have led to the discovery of new genes and improved our knowledge of the regulation of adipose tissue biology. Diagnosis relies predominantly on clinical findings, such as abnormal fat tissue topography and signs of insulin resistance and is confirmed by genetic analysis. In addition to anthropometry and conventional imaging, new techniques such as color-coded imaging of fat depots allow more accurate assessment of the regional fat distribution and differentiation of lipodystrophic syndromes from common metabolic syndrome phenotype. The treatment of patients with lipodystrophy has proven to be challenging. The use of a human leptin analogue, metreleptin, has recently been approved in the management of FPLD with evidence suggesting improved metabolic profile, satiety, reproductive function and self-perception. Preliminary data on the use of glucagon-like peptide 1 receptor agonists (GLP1 Ras) and sodium-glucose co-transporter 2 (SGLT2) inhibitors in cases of FPLD have shown promising results with reduction in total insulin requirements and improvement in glycemic control. Finally, investigational trials for new therapeutic agents in the management of FPLD are underway.
Collapse
Affiliation(s)
- Christos Bagias
- Department of Endocrinology, University of Ioannina, Ioannina, Greece
| | - Angeliki Xiarchou
- Department of Endocrinology, University of Ioannina, Ioannina, Greece
| | | | - Stelios Tigas
- Department of Endocrinology, University of Ioannina, Ioannina, Greece
- Correspondence: Stelios Tigas Department of Endocrinology, University of Ioannina, Ioannina45110, GreeceTel +30 2651007800 Email
| |
Collapse
|
8
|
Selting K, Hansen NJ, Harrison W. Massive labial lipomatous hypertrophy in familial partial lipodystrophy seen on computed tomographic angiography. Radiol Case Rep 2019; 14:1311-1313. [PMID: 31516643 PMCID: PMC6727031 DOI: 10.1016/j.radcr.2019.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/02/2019] [Accepted: 08/03/2019] [Indexed: 11/02/2022] Open
Abstract
We present a 28-year-old female with a rare familial partial lipodystrophy. Originally presenting at the age of 14, she began experiencing hypertrophy of the fat in the mons pubis and labia majora regions. By the age of 24 she had disfiguring hypertrophy of these areas with severe fatty overgrowth, similar in nature to that experienced by her father and paternal grandmother. During her workup and planning for suction lipectomy, she underwent computed tomography angiography with the imaging manifestation of severe massive subcutaneous fat hypertrophy; the imaging appearance was only able to be explained after a thorough review of the patient's history and medical literature.
Collapse
|
9
|
Abstract
The discovery of leptin changed the view of adipose tissue from that of a passive vessel that stores fat to that of a dynamic endocrine organ that actively regulates behaviour and metabolism. Secreted by adipose tissue, leptin functions as an afferent signal in a negative feedback loop, acting primarily on neurons in the hypothalamus and regulating feeding and many other functions. The leptin endocrine system serves a critical evolutionary function by maintaining the relative constancy of adipose tissue mass, thereby protecting individuals from the risks associated with being too thin (starvation and infertility) or too obese (predation). In this Review, the biology of leptin is summarized, and a conceptual framework is established for studying the pathogenesis of obesity, which, analogously to diabetes, can result from either leptin hyposecretion or leptin resistance. Herein, these two states are distinguished with the terms 'type 1 obesity' and 'type 2 obesity': type 1 obesity describes a subset of obese individuals with low endogenous plasma leptin levels who respond to leptin therapy, whereas type 2 obesity describes most obese individuals, who are leptin resistant but might respond to leptin therapy in combination with other drugs, such as leptin sensitizers.
Collapse
Affiliation(s)
- Jeffrey M Friedman
- Howard Hughes Medical Institute, The Rockefeller University, New York, NY, USA.
| |
Collapse
|
10
|
Corvillo F, Akinci B. An overview of lipodystrophy and the role of the complement system. Mol Immunol 2019; 112:223-232. [PMID: 31177059 DOI: 10.1016/j.molimm.2019.05.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 12/19/2022]
Abstract
The complement system is a major component of innate immunity playing essential roles in the destruction of pathogens, the clearance of apoptotic cells and immune complexes, the enhancement of phagocytosis, inflammation, and the modulation of adaptive immune responses. During the last decades, numerous studies have shown that the complement system has key functions in the biology of certain tissues. For example, complement contributes to normal brain and embryonic development and to the homeostasis of lipid metabolism. However, the complement system is subjected to the effective balance between activation-inactivation to maintain complement homeostasis and to prevent self-injury to cells or tissues. When this control is disrupted, serious pathologies eventually develop, such as C3 glomerulopathy, autoimmune conditions and infections. Another heterogeneous group of ultra-rare diseases in which complement abnormalities have been described are the lipodystrophy syndromes. These diseases are characterized by the loss of adipose tissue throughout the entire body or partially. Complement over-activation has been reported in most of the patients with acquired partial lipodystrophy (also called Barraquer-Simons Syndrome) and in some cases of the generalized variety of the disease (Lawrence Syndrome). Even so, the mechanism through which the complement system induces adipose tissue abnormalities remains unclear. This review focuses on describing the link between the complement system and certain forms of lipodystrophy. In addition, we present an overview regarding the clinical presentation, differential diagnosis, classification, and management of patients with lipodystrophy associated with complement abnormalities.
Collapse
Affiliation(s)
- F Corvillo
- Complement Research Group, La Paz University Hospital Research Institute (IdiPAZ), La Paz University Hospital, Madrid, Spain; Center for Biomedical Network Research on Rare Diseases (CIBERER U754), Madrid, Spain.
| | - B Akinci
- Division of Endocrinology, Department of Internal Medicine, Dokuz Eylul University, Izmir, Turkey; Brehm Center for Diabetes Research, Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, 1000 Wall Street, Room 5313, Ann Arbor, MI, 48105, USA
| |
Collapse
|