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Ali DS, Marini F, Alsarraf F, Alalwani H, Alamri A, Khan AA, Brandi ML. Case Report: Calcium sensing receptor gene gain of function mutations: a case series and report of 2 novel mutations. Front Endocrinol (Lausanne) 2023; 14:1215036. [PMID: 37654565 PMCID: PMC10466028 DOI: 10.3389/fendo.2023.1215036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/20/2023] [Indexed: 09/02/2023] Open
Abstract
Autosomal dominant hypocalcemia (ADH1) is a genetic disorder characterized by low serum calcium and low or inappropriately normal levels of parathyroid hormone. The disease is caused by a heterozygous activating mutation of the calcium-sensing receptor (CaSR) gene, encoding a G-Protein-coupled cell membrane sensor of extracellular calcium concentration mainly expressed by parathyroid glands, renal tubules, and the brain. ADH1 has been linked to 113 unique germline mutations, of which nearly 96% are missense mutations. There is often a lack of a clear genotype/phenotype correlation in the reported literature. Here, we described a case series of 6 unrelated ADH1 probands, each one bearing a gain-of-function CaSR mutation, and two children of one of these cases, matching our identified mutations to the same ones previously reported in the literature, and comparing the clinical and biochemical characteristics, as well as the complication profile. As a result of these genetic and clinical comparisons, we propose that a genotype/phenotype correlation may exist because our cases showed similar presentation, characteristics, and severity, with respect to published cases with the same or similar mutations. We also contend that the severity of the presentation is highly influenced by the specific CaSR variant. These findings, however, require further evaluation and assessment with a systematic review.
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Affiliation(s)
- Dalal S. Ali
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, ON, Canada
| | - Francesca Marini
- Fondazione Italiana Ricerca sulle Malattie dell'Osso (FIRMO) Onlus, Italian Foundation for the Research on Bone Diseases, Florence, Italy
| | - Farah Alsarraf
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, ON, Canada
| | - Hatim Alalwani
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, ON, Canada
| | - Abdulrahman Alamri
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, ON, Canada
| | - Aliya A. Khan
- Division of Endocrinology and Metabolism, McMaster University, Hamilton, ON, Canada
| | - Maria Luisa Brandi
- Fondazione Italiana Ricerca sulle Malattie dell'Osso (FIRMO) Onlus, Italian Foundation for the Research on Bone Diseases, Florence, Italy
- Donatello Bone Clinic, Villa Donatello Hospital, Sesto Fiorentino, Italy
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Teleanu RI, Sarman MA, Epure DA, Matei M, Roşca I, Roza E. Autosomal Dominant Hypocalcemia Type 1 and Neonatal Focal Seizures. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1011. [PMID: 37371242 DOI: 10.3390/children10061011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
Autosomal dominant hypocalcemia type 1 (ADH1) is a rare form of hypoparathyroidism that is characterized by gain-of-function mutations in the CASR gene, which provides instructions for producing the protein called calcium-sensing receptor (CaSR). Hypocalcemia in the neonatal period has a wide differential diagnosis. We present the case of a female newborn with genetic hypoparathyroidism (L125P mutation of CASR gene), hypocalcemia, and neonatal seizures due to the potential correlation between refractory neonatal seizures and ADH1. Neonatal seizures were previously described in patients with ADH1 but not in association with the L125P mutation of the CASR gene. Prompt diagnosis and management by a multidisciplinary and an appropriate therapeutic approach can prevent neurological and renal complications.
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Affiliation(s)
- Raluca Ioana Teleanu
- Faculty of Medicine, Clinical Neurosciences Department, Peadiatric Neurology, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Pediatric Neurology Department-"Dr. Victor Gomoiu" Children's Hospital, 022102 Bucharest, Romania
| | - Marlene Alexandra Sarman
- Faculty of Medicine, Clinical Neurosciences Department, Peadiatric Neurology, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Pediatric Neurology Department-"Dr. Victor Gomoiu" Children's Hospital, 022102 Bucharest, Romania
| | - Diana Anamaria Epure
- Pediatric Neurology Department-"Dr. Victor Gomoiu" Children's Hospital, 022102 Bucharest, Romania
| | - Margarita Matei
- Endocrinology Department-"Dr. Victor Gomoiu" Children's Hospital, 022102 Bucharest, Romania
| | - Ioana Roşca
- Faculty of Medicine, Clinical Neurosciences Department, Peadiatric Neurology, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- "Prof. Panait Sarbu" Clinical Hospital, 060251 Bucharest, Romania
| | - Eugenia Roza
- Faculty of Medicine, Clinical Neurosciences Department, Peadiatric Neurology, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Pediatric Neurology Department-"Dr. Victor Gomoiu" Children's Hospital, 022102 Bucharest, Romania
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Wang H, Chen R, Zhang F, Yu Z, Wang Y, Tang Z, Yang L, Tang X, Xiong B. Superhydrophobic Paper-Based Microfluidic Field-Effect Transistor Biosensor Functionalized with Semiconducting Single-Walled Carbon Nanotube and DNAzyme for Hypocalcemia Diagnosis. Int J Mol Sci 2022; 23:ijms23147799. [PMID: 35887147 PMCID: PMC9318675 DOI: 10.3390/ijms23147799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 02/06/2023] Open
Abstract
Hypocalcemia is caused by a sharp decline in blood calcium concentration after dairy cow calving, which can lead to various diseases or even death. It is necessary to develop an inexpensive, easy-to-operate, reliable sensor to diagnose hypocalcemia. The cellulose-paper-based microfluidic field-effect biosensor is promising for point-of-care, but it has poor mechanical strength and a short service life after exposure to an aqueous solution. Octadecyltrichlorosilane (OTS), as a popular organosilane derivative, can improve the hydrophobicity of cellulose paper to overcome the shortage of cellulose paper. In this work, OTS was used to produce the superhydrophobic cellulose paper that enhances the mechanical strength and short service life of MFB, and a microfluidic field-effect biosensor (MFB) with semiconducting single-walled carbon nanotubes (SWNTs) and DNAzyme was then developed for the Ca2+ determination. Pyrene carboxylic acid (PCA) attached to SWNTs through a non-covalent π-π stacking interaction provided a carboxyl group that can bond with an amino group of DNAzyme. Two DNAzymes with different sensitivities were designed by changing the sequence length and cleavage site, which were functionalized with SPFET/SWNTs-PCA to form Dual-MFB, decreasing the interference of impurities in cow blood. After optimizing the detecting parameters, Dual-MFB could determine the Ca2+ concentration in the range of 25 μM to 5 mM, with a detection limit of 10.7 μM. The proposed Dual-MFB was applied to measure Ca2+ concentration in cow blood, which provided a new method to diagnose hypocalcemia after dairy cow calving.
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Affiliation(s)
- Hui Wang
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing 100193, China; (H.W.); (R.C.); (F.Z.); (Z.Y.); (Y.W.); (Z.T.); (L.Y.)
| | - Ruipeng Chen
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing 100193, China; (H.W.); (R.C.); (F.Z.); (Z.Y.); (Y.W.); (Z.T.); (L.Y.)
| | - Fan Zhang
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing 100193, China; (H.W.); (R.C.); (F.Z.); (Z.Y.); (Y.W.); (Z.T.); (L.Y.)
- State Key Laboratory of Animal Nutrition, College of Animal Science and Technology, China Agricultural University, Beijing 100193, China
| | - Zhixue Yu
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing 100193, China; (H.W.); (R.C.); (F.Z.); (Z.Y.); (Y.W.); (Z.T.); (L.Y.)
| | - Yue Wang
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing 100193, China; (H.W.); (R.C.); (F.Z.); (Z.Y.); (Y.W.); (Z.T.); (L.Y.)
| | - Zhonglin Tang
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing 100193, China; (H.W.); (R.C.); (F.Z.); (Z.Y.); (Y.W.); (Z.T.); (L.Y.)
| | - Liang Yang
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing 100193, China; (H.W.); (R.C.); (F.Z.); (Z.Y.); (Y.W.); (Z.T.); (L.Y.)
| | - Xiangfang Tang
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing 100193, China; (H.W.); (R.C.); (F.Z.); (Z.Y.); (Y.W.); (Z.T.); (L.Y.)
- Correspondence: (X.T.); (B.X.)
| | - Benhai Xiong
- State Key Laboratory of Animal Nutrition, Institute of Animal Science, Chinese Academy of Agricultural Sciences, Beijing 100193, China; (H.W.); (R.C.); (F.Z.); (Z.Y.); (Y.W.); (Z.T.); (L.Y.)
- Correspondence: (X.T.); (B.X.)
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Wu Y, Zhang C, Huang X, Cao L, Liu S, Zhong P. Autosomal dominant hypocalcemia with a novel CASR mutation: a case study and literature review. J Int Med Res 2022; 50:3000605221110489. [PMID: 35818129 PMCID: PMC9280832 DOI: 10.1177/03000605221110489] [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] [Indexed: 11/15/2022] Open
Abstract
Autosomal dominant hypocalcemia type 1 (ADH1) is a rare inherited disorder characterized by hypocalcemia with low parathyroid hormone (PTH) levels and high urinary calcium. Its clinical presentation varies from mild asymptomatic to severe hypocalcemia. It is caused by gain-of-function mutations in the calcium-sensing receptor gene (CASR) which affect PTH secretion from the parathyroid gland and calcium resorption in the kidney. Here, we describe a case who presented with symptoms of recurrent seizure caused by hypocalcemia with a novel CASR variant. We comprehensively analyzed the phenotypic features of this presentation and reviewed the current literature to better understand clinical manifestations and the genetic spectrum.
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Affiliation(s)
- Yingying Wu
- Department of Neurology, Suzhou Hospital of Anhui Medical University, Suzhou, China.,Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chao Zhang
- Department of Neurology, Suzhou Hospital of Anhui Medical University, Suzhou, China
| | - Xiaojun Huang
- Department of Neurology and Instituted of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Cao
- Department of Neurology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shihua Liu
- Department of Neurology, Suzhou Hospital of Anhui Medical University, Suzhou, China
| | - Ping Zhong
- Department of Neurology, Suzhou Hospital of Anhui Medical University, Suzhou, China
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Elston MS, Elajnaf T, Hannan FM, Thakker RV. Autosomal dominant hypocalcemia type 1 (ADH1) associated with myoclonus and intracerebral calcifications. J Endocr Soc 2022; 6:bvac042. [PMID: 35402765 PMCID: PMC8989155 DOI: 10.1210/jendso/bvac042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Indexed: 11/19/2022] Open
Abstract
Abstract
Autosomal dominant hypocalcemia type 1 (ADH1) is a disorder of extracellular calcium homeostasis caused by germline gain-of-function mutations of the calcium-sensing receptor (CaSR). Over 35% of ADH1 patients have intracerebral calcifications predominantly affecting the basal ganglia. The clinical consequences of such calcifications remain to be fully characterized, although the majority of patients with these calcifications are considered to be asymptomatic. We report a 20-year-old female proband with a severe form of ADH1 associated with recurrent hypocalcemic and hypercalcemic episodes, persistent childhood hyperphosphatemia, and a low calcium/phosphate ratio. From the age of 18 years, she had experienced recurrent myoclonic jerks affecting the upper limbs that were not associated with epileptic seizures, extra-pyramidal features, cognitive impairment, or alterations in serum calcium concentrations. Computerised tomography (CT) scans revealed calcifications of the globus pallidus regions of the basal ganglia bilaterally, and also the frontal lobes at the grey-white matter junction, and posterior horn choroid plexuses. The patient’s myoclonus resolved following treatment with levetiracetam. CASR mutational analysis identified a reported germline gain-of-function heterozygous missense mutation, c.2363T>G; p.(Phe788Cys), which affects an evolutionarily conserved phenylalanine residue located in transmembrane domain helix 5 of the CaSR protein. Analysis of the cryo-electron microscopy CaSR structure predicted the wild-type Phe788 residue to form interactions with neighbouring phenylalanine residues, which likely maintain the CaSR in an inactive state. The p.(Phe788Cys) mutation was predicted to disrupt these interactions, thereby leading to CaSR activation. These findings reveal myoclonus as a novel finding in an ADH1 patient with intracerebral calcifications.
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Affiliation(s)
- Marianne S Elston
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
| | - Taha Elajnaf
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, UK
| | - Fadil M Hannan
- Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford, UK
| | - Rajesh V Thakker
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
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Gomes V, Silvestre C, Ferreira F, Bugalho MJGM. Autosomal dominant hypocalcaemia: identification of two novel variants of CASR gene. BMJ Case Rep 2020; 13:13/6/e234391. [PMID: 32513763 DOI: 10.1136/bcr-2020-234391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Autosomal dominant hypocalcaemia is a rare aetiology of hypocalcaemia, caused by gain-of-function mutations of the calcium-sensing receptor (CASR) gene. We present two cases of two asymptomatic women (50-year-old-case 1 and 25-year-old-case 2), referred to our endocrinology department for investigation of hypocalcaemia, hyperphosphatemia and inappropriately low parathormone. Both patients had relatives with the same laboratorial findings. At diagnosis, both patients presented basal ganglia calcifications. Genetic analysis was performed, identifying two novel heterozygous CASR variants: c.2269G>A (p.Glu757Lys) and c.2086C>G (p.Leu696Val), respectively, for case 1 and case 2. Affected individuals started oral calcium and vitamin D analogues, aiming to a low-normal calcium level. They remain under observation and are asymptomatic.
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Affiliation(s)
- Vânia Gomes
- Endocrinology, Diabetes and Metabolism Department, Hospital de Santa Maria, Lisboa, Portugal
| | - Catarina Silvestre
- Endocrinology, Diabetes and Metabolism Department, Hospital de Santa Maria, Lisboa, Portugal
| | - Florbela Ferreira
- Endocrinology, Diabetes and Metabolism Department, Hospital de Santa Maria, Lisboa, Portugal
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Ferreira KS, Teixeira ADO, Brito ED, Arbiza BCC, Puntel GO, Silva AMVD, Paulitsch FDS, Signori LU. ELECTROLYTE CHANGES RELATED TO MUSCLE PAIN AFTER RESISTANCE EXERCISES. REV BRAS MED ESPORTE 2020. [DOI: 10.1590/1517-869220202603217420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction Resistance exercises (RE) performed at high intensity cause an inflammatory response and electrolyte abnormalities in blood plasma. Objectives To study the plasma electrolyte changes resulting from a high-intensity session of RE in untrained volunteers, and to correlate these with delayed onset muscle soreness (DOMS). Methods Twenty volunteers, aged 26.9 (±4.4) years, underwent an RE session. The workout (leg extension, squat and leg press) consisted of four sets of 10 maximum repetitions. Electrolytes (Na+, K+, Ca2+ e Mg2+) were evaluated before the training (baseline), immediately (0 min), and 30 minutes after the RE. The DOMS was assessed 24 hours after the sessions. Results The Na+ increased immediately after the RE and returned to normal after 30 min (p<0.001). After 30 min, K+ increased compared to baseline levels and immediately after the RE (p<0.001). Ca2+ and Mg2+ levels did not change throughout the study. Changes in Na+ and K+ levels were correlated immediately (r=-0.511; p=0.021) and 30 min (r=-0.455; p=0.049) after RE. Plasma concentrations of Na+ 0 min were correlated (r=-0.520; p=0.018) with the DOMS. Conclusion High-intensity RE in untrained volunteers leads to changes in plasma concentrations of Na+ and K+. Na+ concentrations immediately after RE were related to DOMS; individuals that presented smaller alterations in this electrolyte reported more muscular pain. Level of evidence II; Diagnostic Studies - Development of diagnostic criteria on consecutive patients (with universally applied reference “gold” standard).
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Chen Y, Gao Y, Tao Y, Lin D, An S. Identification of a Calcium-sensing Receptor in Human Dental Pulp Cells That Regulates Mineral Trioxide Aggregate–induced Mineralization. J Endod 2019; 45:907-916. [DOI: 10.1016/j.joen.2019.03.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 02/28/2019] [Accepted: 03/28/2019] [Indexed: 12/23/2022]
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A Novel Mutation of the Calcium-Sensing Receptor Gene Causing Familial Hypocalciuric Hypercalcemia Complicates Medical Followup after Roux-en-Y Gastric Bypass: A Case Report and a Summary of Mutations Found in the Same Hospital Laboratory. Case Rep Endocrinol 2019; 2019:9468252. [PMID: 30895164 PMCID: PMC6393866 DOI: 10.1155/2019/9468252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/05/2019] [Indexed: 12/22/2022] Open
Abstract
Heterozygous inactivating mutations in the calcium-sensing receptor (CaSR) gene are known to cause familial hypocalciuric hypercalcemia (FHH), usually a benign form of hypercalcemia without symptoms of a disrupted calcium homeostasis. FHH can be mistaken for the more common primary hyperparathyroidism (PHPT), for which surgical treatment may be needed. We describe a case of a 36-year-old woman with hypercalcemia and elevated PTH, initially suspected of having PHPT. Sequencing of the CaSR-gene revealed a mutation in nucleotide 437, changing the amino acid in position 146 from Glycine to Aspartate. The mutation was previously undescribed in the literature, but a very low calcium:creatinine clearance ratio supported the diagnosis FHH. A few years later, the patient's two daughters were tested and the association between mutation and hypercalcemia could be confirmed. The patient was gastric bypass-operated and therefore, due to malabsorption and increased risk of fracture, was in need of adequate calcium supplementation. The chronically elevated calcium levels challenged medical followup, as calcium sufficiency could not be monitored in a traditional manner. Eventually the patient developed elevated alkaline phosphatase, a further increased PTH and a decreased DXA T-score indicating calcium deficiency and bone resorption. As a supplement, all CaSR-mutations found at our hospital, 2005-2018.
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