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Lee NK, Uhler KM, Yoon PJ, Santos-Cortez RLP. Clinical Genetic Testing for Hearing Loss: Implications for Genetic Counseling and Gene-Based Therapies. Biomedicines 2024; 12:1427. [PMID: 39062005 PMCID: PMC11274279 DOI: 10.3390/biomedicines12071427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/13/2024] [Accepted: 06/13/2024] [Indexed: 07/28/2024] Open
Abstract
Genetic factors contribute significantly to congenital hearing loss, with non-syndromic cases being more prevalent and genetically heterogeneous. Currently, 150 genes have been associated with non-syndromic hearing loss, and their identification has improved our understanding of auditory physiology and potential therapeutic targets. Hearing loss gene panels offer comprehensive genetic testing for hereditary hearing loss, and advancements in sequencing technology have made genetic testing more accessible and affordable. Currently, genetic panel tests available at a relatively lower cost are offered to patients who face financial barriers. In this study, clinical and audiometric data were collected from six pediatric patients who underwent genetic panel testing. Known pathogenic variants in MYO15A, GJB2, and USH2A were most likely to be causal of hearing loss. Novel pathogenic variants in the MYO7A and TECTA genes were also identified. Variable hearing phenotypes and inheritance patterns were observed amongst individuals with different pathogenic variants. The identification of these variants contributes to the continually expanding knowledge base on genetic hearing loss and lays the groundwork for personalized treatment options in the future.
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Affiliation(s)
- Nam K. Lee
- Department of Otolaryngology—Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Kristin M. Uhler
- Department of Physical Medicine and Rehabilitation, Children’s Hospital Colorado, Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA
- Department of Pediatric Otolaryngology, Children’s Hospital Colorado, Aurora, CO 80045, USA
| | - Patricia J. Yoon
- Department of Otolaryngology—Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- Department of Pediatric Otolaryngology, Children’s Hospital Colorado, Aurora, CO 80045, USA
| | - Regie Lyn P. Santos-Cortez
- Department of Otolaryngology—Head and Neck Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
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Lujinschi ȘN, Sorohan BM, Obrișcă B, Vrabie A, Lupușoru G, Achim C, Andronesi AG, Covic A, Ismail G. Genotype-Phenotype Correlations in Alport Syndrome-A Single-Center Experience. Genes (Basel) 2024; 15:593. [PMID: 38790222 PMCID: PMC11121304 DOI: 10.3390/genes15050593] [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: 04/14/2024] [Revised: 05/02/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Alport syndrome (AS) is a common and heterogeneous genetic kidney disease, that often leads to end-stage kidney disease (ESKD). METHODS This is a single-center, retrospective study that included 36 adults with type IV collagen (COL4) mutations. Our main scope was to describe how genetic features influence renal survival. RESULTS A total of 24 different mutations were identified, of which eight had not been previously described. Mutations affecting each of the type IV collagen α chains were equally prevalent (33.3%). Most of the patients had pathogenic variants (61.1%). Most patients had a family history of kidney disease (71%). The most prevalent clinical picture was nephritic syndrome (64%). One-third of the subjects had extrarenal manifestations, 41.6% of patients had ESKD at referral, and another 8.3% developed ESKD during follow-up. The median renal survival was 42 years (95% CI, 29.98-54.01). The COL4A4 group displayed better renal survival than the COL4A3 group (p = 0.027). Patients with missense variants had higher renal survival (p = 0.023). Hearing loss was associated with lower renal survival (p < 0.001). CONCLUSIONS Patients with COL4A4 variants and those with missense mutations had significantly better renal survival, whereas those with COL4A3 variants and those with hearing loss had worse prognoses.
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Affiliation(s)
- Ștefan Nicolaie Lujinschi
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.M.S.); (B.O.); (A.V.); (G.L.); (C.A.); (A.G.A.); (G.I.)
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Bogdan Marian Sorohan
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.M.S.); (B.O.); (A.V.); (G.L.); (C.A.); (A.G.A.); (G.I.)
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Bogdan Obrișcă
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.M.S.); (B.O.); (A.V.); (G.L.); (C.A.); (A.G.A.); (G.I.)
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Alexandra Vrabie
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.M.S.); (B.O.); (A.V.); (G.L.); (C.A.); (A.G.A.); (G.I.)
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Gabriela Lupușoru
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.M.S.); (B.O.); (A.V.); (G.L.); (C.A.); (A.G.A.); (G.I.)
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Camelia Achim
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.M.S.); (B.O.); (A.V.); (G.L.); (C.A.); (A.G.A.); (G.I.)
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Andreea Gabriella Andronesi
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.M.S.); (B.O.); (A.V.); (G.L.); (C.A.); (A.G.A.); (G.I.)
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Andreea Covic
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Nephrology Depatment, Dialysis and Renal Transplant Center, “Dr. C. I. Parhon” Clinical Hospital, 700503 Iasi, Romania
| | - Gener Ismail
- Department of Nephrology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (B.M.S.); (B.O.); (A.V.); (G.L.); (C.A.); (A.G.A.); (G.I.)
- Department of Nephrology, Fundeni Clinical Institute, 022328 Bucharest, Romania
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Chavez E, Goncalves S, Rheault MN, Fornoni A. Alport Syndrome. ADVANCES IN KIDNEY DISEASE AND HEALTH 2024; 31:170-179. [PMID: 39004457 DOI: 10.1053/j.akdh.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 02/10/2024] [Accepted: 02/28/2024] [Indexed: 07/16/2024]
Abstract
Alport syndrome (AS) is characterized by progressive kidney failure, hematuria, sensorineural hearing loss, and ocular abnormalities. Pathogenic variants in the COL4A3-5 genes result in a defective deposition of the collagen IV α3α4α5 protomers in the basement membranes of the glomerulus in the kidney, the cochlea in the ear and the cornea, lens capsule and retina in the eye. The presence of a large variety of COL4A3-5 gene(s) pathogenetic variants irrespective of the mode of inheritance (X-linked, autosomal recessive, autosomal dominant, or digenic) with and without syndromic features is better defined as the "Alport spectrum disorder", and represents the most common cause of genetic kidney disease and the second most common cause of genetic kidney failure. The clinical course and prognosis of individuals with AS is highly variable. It is influenced by gender, mode of inheritance, affected gene(s), type of genetic mutation, and genetic modifiers. This review article will discuss the epidemiology, classification, pathogenesis, diagnosis, clinical course with genotype-phenotype correlations, and current and upcoming treatment of patients with AS. It will also review current recommendations with respect to when to evaluate for hearing loss or ophthalmologic abnormalities.
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Affiliation(s)
- Efren Chavez
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL.
| | - Stefania Goncalves
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, University of Miami Ear Institute, Miami, FL
| | - Michelle N Rheault
- Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Alessia Fornoni
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL; Peggy and Harold Katz Family Drug Discovery Center, University of Miami Miller School of Medicine, Miami, FL.
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4
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Greenberg D, Rosenblum ND, Tonelli M. The multifaceted links between hearing loss and chronic kidney disease. Nat Rev Nephrol 2024; 20:295-312. [PMID: 38287134 DOI: 10.1038/s41581-024-00808-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2024] [Indexed: 01/31/2024]
Abstract
Hearing loss affects nearly 1.6 billion people and is the third-leading cause of disability worldwide. Chronic kidney disease (CKD) is also a common condition that is associated with adverse clinical outcomes and high health-care costs. From a developmental perspective, the structures responsible for hearing have a common morphogenetic origin with the kidney, and genetic abnormalities that cause familial forms of hearing loss can also lead to kidney disease. On a cellular level, normal kidney and cochlea function both depend on cilial activities at the apical surface, and kidney tubular cells and sensory epithelial cells of the inner ear use similar transport mechanisms to modify luminal fluid. The two organs also share the same collagen IV basement membrane network. Thus, strong developmental and physiological links exist between hearing and kidney function. These theoretical considerations are supported by epidemiological data demonstrating that CKD is associated with a graded and independent excess risk of sensorineural hearing loss. In addition to developmental and physiological links between kidney and cochlear function, hearing loss in patients with CKD may be driven by specific medications or treatments, including haemodialysis. The associations between these two common conditions are not commonly appreciated, yet have important implications for research and clinical practice.
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Affiliation(s)
- Dina Greenberg
- Program in Developmental and Stem Cell Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Norman D Rosenblum
- Program in Developmental and Stem Cell Biology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
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郭 丽, 刘 薇, 陈 敏, 徐 佳, 马 宁, 张 晓, 段 清, 刘 珊, 王 晓, 甄 俊, 倪 鑫, 张 杰. [Long-term auditory monitoring in children with Alport syndrome based on different degrees of renal injury]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2024; 38:44-49. [PMID: 38297848 PMCID: PMC11116163 DOI: 10.13201/j.issn.2096-7993.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Indexed: 02/02/2024]
Abstract
Objective:To investigate long-term auditory changes and characteristics of Alport syndrome(AS) patients with different degrees of renal injury. Methods:Retrospectively analyzing clinical data of patients diagnosed AS from January 2007 to September 2022, including renal pathology, genetic detection and hearing examination. A long-term follow-up focusing on hearing and renal function was conducted. Results:This study included 70 AS patients, of which 33(25 males, 8 females, aged 3.4-27.8 years) were followed up, resulting in a loss rate of 52.9%.The follow-up period ranged from 1.1to 15.8 years, with 16 patients followed-up for over 10 years. During the follow-up, 10 patients presenting with hearing abnormalities at the time of diagnosis of AS had progressive hearing loss, and 3 patients with new hearing abnormalities were followed up, which appeared at 5-6 years of disease course. All of which were sensorineural deafness. While only 3 patients with hearing abnormalities among 13 patients received hearing aid intervention. Of these patients,7 developed end-stage renal disease(ESRD), predominantly males (6/7). The rate of long-term hearing loss was significantly different between ESRD group and non-ESRD group(P=0.013). There was no correlation between the progression of renal disease and long-term hearing level(P>0.05). kidney biopsies from 28 patients revealed varying degrees of podocyte lesion and uneven thickness of basement membrane. The severity of podocyte lesion was correlated with the rate of long-term hearing loss(P=0.048), and there was no correlation with the severity of hearing loss(P>0.05). Among 11 cases, theCOL4A5mutationwas most common (8 out of 11), but there was no significant correlation between the mutation type and hearing phenotype(P>0.05). Conclusion:AS patients exhibit progressive hearing loss with significant heterogeneity over the long-term.. THearing loss is more likely to occur 5-6 years into the disease course. Hearing abnormalities are closely related to renal disease status, kidney tissue pathology, and gene mutations, emphasizing the need for vigilant long-term hearing follow-up and early intervention.
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Affiliation(s)
- 丽宁 郭
- 国家儿童医学中心 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
- 儿童耳鼻咽喉头颈外科疾病北京市重点实验室Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery
| | - 薇 刘
- 国家儿童医学中心 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
- 儿童耳鼻咽喉头颈外科疾病北京市重点实验室Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery
| | - 敏 陈
- 国家儿童医学中心 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
- 儿童耳鼻咽喉头颈外科疾病北京市重点实验室Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery
| | - 佳童 徐
- 首都医科大学附属北京儿童医院病理科Department of Pathology, Beijing Children′s Hospital, Capital Medical University
| | - 宁 马
- 国家儿童医学中心 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
- 儿童耳鼻咽喉头颈外科疾病北京市重点实验室Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery
| | - 晓 张
- 国家儿童医学中心 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
- 儿童耳鼻咽喉头颈外科疾病北京市重点实验室Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery
| | - 清川 段
- 国家儿童医学中心 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
- 儿童耳鼻咽喉头颈外科疾病北京市重点实验室Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery
| | - 珊珊 刘
- 国家儿童医学中心 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
- 儿童耳鼻咽喉头颈外科疾病北京市重点实验室Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery
| | - 晓旭 王
- 国家儿童医学中心 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
- 儿童耳鼻咽喉头颈外科疾病北京市重点实验室Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery
| | - 俊淞 甄
- 国家儿童医学中心 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
- 儿童耳鼻咽喉头颈外科疾病北京市重点实验室Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery
| | - 鑫 倪
- 国家儿童医学中心 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
- 儿童耳鼻咽喉头颈外科疾病北京市重点实验室Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery
| | - 杰 张
- 国家儿童医学中心 首都医科大学附属北京儿童医院耳鼻咽喉头颈外科(北京,100045)Department of Otorhinolaryngology Head and Neck Surgery, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health, Beijing 100045, China
- 儿童耳鼻咽喉头颈外科疾病北京市重点实验室Beijing Key Laboratory for Pediatric Diseases of Otolaryngology Head and Neck Surgery
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Podury A, Jiam NT, Kim M, Donnenfield JI, Dhand A. Hearing and sociality: the implications of hearing loss on social life. Front Neurosci 2023; 17:1245434. [PMID: 37854291 PMCID: PMC10579609 DOI: 10.3389/fnins.2023.1245434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/18/2023] [Indexed: 10/20/2023] Open
Abstract
Hearing is essential to the formation of social relationships and is the principal afferent of social life. Yet hearing loss, which is one of the most prevalent forms of sensory disability worldwide and is critical for social development, has received little attention from the social interventionalist perspective. The purpose of this mini-review is to describe the basic neurobiological principles of hearing and to explore the reciprocal relationships between social support, hearing loss, and its psychosocial comorbidities. We also discuss the role of social enrichment in sensorineural recovery and identify open questions within the fields of hearing physiology and social networks.
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Affiliation(s)
- Archana Podury
- Harvard Medical School, Boston, MA, United States
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Diego, San Diego, CA, United States
| | - Nicole T. Jiam
- Harvard Medical School, Boston, MA, United States
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States
| | - Minsu Kim
- Department of Molecular and Cellular Biology, Harvard University, Cambridge, MA, United States
| | | | - Amar Dhand
- Harvard Medical School, Boston, MA, United States
- Department of Neurology, Brigham and Women’s Hospital, Boston, MA, United States
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Cosgrove D, Gratton MA, Madison J, Vosik D, Samuelson G, Meehan D, Delimont D, Phillips G, Smyth B, Pramparo T, Jarocki D, Nguyen M, Komers R, Jenkinson C. Dual inhibition of the endothelin and angiotensin receptor ameliorates renal and inner ear pathologies in Alport mice. J Pathol 2023; 260:353-364. [PMID: 37256677 PMCID: PMC10330771 DOI: 10.1002/path.6087] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/08/2023] [Accepted: 04/04/2023] [Indexed: 06/01/2023]
Abstract
Alport syndrome (AS), a type IV collagen disorder, leads to glomerular disease and, in some patients, hearing loss. AS is treated with inhibitors of the renin-angiotensin system; however, a need exists for novel therapies, especially those addressing both major pathologies. Sparsentan is a single-molecule dual endothelin type-A and angiotensin II type 1 receptor antagonist (DEARA) under clinical development for focal segmental glomerulosclerosis and IgA nephropathy. We report the ability of sparsentan to ameliorate both renal and inner ear pathologies in an autosomal-recessive Alport mouse model. Sparsentan significantly delayed onset of glomerulosclerosis, interstitial fibrosis, proteinuria, and glomerular filtration rate decline. Sparsentan attenuated glomerular basement membrane defects, blunted mesangial filopodial invasion into the glomerular capillaries, increased lifespan more than losartan, and lessened changes in profibrotic/pro-inflammatory gene pathways in both the glomerular and the renal cortical compartments. Notably, treatment with sparsentan, but not losartan, prevented accumulation of extracellular matrix in the strial capillary basement membranes in the inner ear and reduced susceptibility to hearing loss. Improvements in lifespan and in renal and strial pathology were observed even when sparsentan was initiated after development of renal pathologies. These findings suggest that sparsentan may address both renal and hearing pathologies in Alport syndrome patients. © 2023 Travere Therapeutics, Inc and The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Dominic Cosgrove
- Center for Sensory Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Michael Anne Gratton
- Department of Otolaryngology, Washington University in St. Louis, St. Louis, MO, USA
| | - Jacob Madison
- Center for Sensory Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Denise Vosik
- Center for Sensory Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Gina Samuelson
- Center for Sensory Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Daniel Meehan
- Center for Sensory Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Duane Delimont
- Center for Sensory Neuroscience, Boys Town National Research Hospital, Omaha, NE, USA
| | - Grady Phillips
- Department of Otolaryngology, Washington University in St. Louis, St. Louis, MO, USA
| | - Brendan Smyth
- Department of Otolaryngology, Washington University in St. Louis, St. Louis, MO, USA
| | | | - Diana Jarocki
- Department of Otolaryngology, Washington University in St. Louis, St. Louis, MO, USA
| | - Mai Nguyen
- Travere Therapeutics, San Diego, CA, USA
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8
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Boeckhaus J, Mohr L, Dihazi H, Tönshoff B, Weber LT, Pape L, Latta K, Fehrenbach H, Lange-Sperandio B, Kettwig M, Staude H, König S, John-Kroegel U, Gellermann J, Hoppe B, Galiano M, Haffner D, Rhode H, Gross O. Ratio of Urinary Proteins to Albumin Excretion Shifts Substantially during Progression of the Podocytopathy Alport Syndrome, and Spot Urine Is a Reliable Method to Detect These Pathologic Changes. Cells 2023; 12:cells12091333. [PMID: 37174733 PMCID: PMC10177071 DOI: 10.3390/cells12091333] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/12/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023] Open
Abstract
The urinary albumin- and protein-to-creatinine ratios (UACR and UPCR, respectively) are key endpoints in most clinical trials assessing risk of progression of chronic kidney disease (CKD). For the first time, the current study compares the UACR versus the UPCR head-to-head at early stages of CKD, taking use of the hereditary podocytopathy Alport syndrome (AS) as a model disease for any CKD. Urine samples originated from the prospective randomized, controlled EARLY PRO-TECT Alport trial (NCT01485978). Urine samples from 47 children with confirmed diagnoses of AS at very early stages of CKD were divided according to the current stage of AS: stage 0 (UACR < 30 mg/g), stage 1 (30-300 mg/g) or stage 2 (>300 mg/g). The range of estimated glomerular filtration rate was 75-187.6 mL/min. The mean age was 10.4 ± 4.5 years. In children at stage 0, proteinuria in spot urine, confirmed in 24 h urine, was almost ten times higher than albuminuria (106.4 ± 42.2 vs. 12.5 ± 9.7; p < 0.05); it was "only" about three times higher in stage 1 (328.5 ± 210.1 vs. 132.3 ± 80.5; p < 0.05) and almost equal in stage 2 (1481.9 ± 983.4 vs. 1109.7 ± 873.6; p = 0.36). In 17 children, UACRs and UPCRs were measured simultaneously in 24 h urine and spot urine in the same study visit. Interestingly, the UACR (and UPCR) in 24 h urine vs. in spot urine varied by less than 10% (266.8 ± 426.4 vs. 291.2 ± 530.2). In conclusion, our study provides the first evidence that in patients with normal glomerular filtration rate (GFR) and low amounts of albuminuria, especially in children with podocytopathies such as AS, measuring the UACR and UPCR in spot urine is a reliable and convenient alternative to 24 h urine collection. Our study advocates both the UACR and the UPCR as relevant diagnostic biomarkers in future clinical trials in children with glomerular diseases because the UPCR seems to be a very significant parameter at very early stages of podocytopathies. The German Federal Ministry of Education and Research funded this trial (01KG1104).
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Affiliation(s)
- Jan Boeckhaus
- Clinic for Nephrology and Rheumatology, University Medical Center Goettingen, 37075 Goettingen, Germany
| | - Lea Mohr
- Clinic for Nephrology and Rheumatology, University Medical Center Goettingen, 37075 Goettingen, Germany
| | - Hassan Dihazi
- Clinic for Nephrology and Rheumatology, University Medical Center Goettingen, 37075 Goettingen, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, University Children's Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Lutz T Weber
- Pediatric Nephrology, Children's and Adolescents' Hospital, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - Lars Pape
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany
- Department of Pediatrics II, University Childrens' Hospital, University of Duisburg-Essen, 45147 Essen, Germany
| | - Kay Latta
- Clementine Kinderhospital Frankfurt, 60316 Frankfurt, Germany
| | - Henry Fehrenbach
- Pediatric Nephrology, Children's Hospital, 87700 Memmingen, Germany
| | | | - Matthias Kettwig
- Clinic of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Hagen Staude
- Pediatric Nephrology, University Children's Hospital Rostock, 18057 Rostock, Germany
| | - Sabine König
- University Children's Hospital Münster, 48149 Münster, Germany
| | - Ulrike John-Kroegel
- Division of Pediatric Nephrology, University Children's Hospital, 07743 Jena, Germany
| | - Jutta Gellermann
- Pediatric Nephrology, Charité Children's Hospital, 10117 Berlin, Germany
| | - Bernd Hoppe
- Division of Pediatric Nephrology, Department of Pediatrics, University of Bonn, 53121 Bonn, Germany
| | - Matthias Galiano
- Department of Pediatrics and Adolescent Medicine, University Hospital, Friedrich-Alexander-University Erlangen, 91054 Erlangen, Germany
| | - Dieter Haffner
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany
| | - Heidrun Rhode
- Department of Internal Medicine I, Cardiology, Angiology, Intensive Medical Care, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Oliver Gross
- Clinic for Nephrology and Rheumatology, University Medical Center Goettingen, 37075 Goettingen, Germany
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9
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An Update on Women and Girls with Alport Syndrome. CURRENT PEDIATRICS REPORTS 2022. [DOI: 10.1007/s40124-022-00279-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Martínez-Pulleiro R, García-Murias M, Fidalgo-Díaz M, García-González MÁ. Molecular Basis, Diagnostic Challenges and Therapeutic Approaches of Alport Syndrome: A Primer for Clinicians. Int J Mol Sci 2021; 22:ijms222011063. [PMID: 34681722 PMCID: PMC8541626 DOI: 10.3390/ijms222011063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 12/20/2022] Open
Abstract
Alport syndrome is a genetic and hereditary disease, caused by mutations in the type IV collagen genes COL4A3, COL4A4 and COL4A5, that affects the glomerular basement membrane of the kidney. It is a rare disease with an underestimated prevalence. Genetic analysis of population cohorts has revealed that it is the second most common inherited kidney disease after polycystic kidney disease. Renal involvement is the main manifestation, although it may have associated extrarenal manifestations such as hearing loss or ocular problems. The degree of expression of the disease changes according to the gene affected and other factors, known or yet to be known. The pathophysiology is not yet fully understood, although some receptors, pathways or molecules are known to be linked to the disease. There is also no specific treatment for Alport syndrome; the most commonly used are renin–angiotensin–aldosterone system inhibitors. In recent years, diagnosis has come a long way, thanks to advances in DNA sequencing technologies such as next-generation sequencing (NGS). Further research at the genetic and molecular levels in the future will complete the partial vision of the pathophysiological mechanism that we have, and will allow us to better understand what is happening and how to solve it.
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Affiliation(s)
- Raquel Martínez-Pulleiro
- Grupo de Xenética e Bioloxía do Desenvolvemento das Enfermidades Renais, Laboratorio de Nefroloxía (No. 11), Instituto de Investigación Sanitaria de Santiago (IDIS), Complexo Hospitalario de Santiago de Compostela (CHUS), 15706 Santiago de Compostela, Spain; (R.M.-P.); (M.G.-M.)
- Grupo de Medicina Xenómica (GMX), 15706 Santiago de Compostela, Spain
| | - María García-Murias
- Grupo de Xenética e Bioloxía do Desenvolvemento das Enfermidades Renais, Laboratorio de Nefroloxía (No. 11), Instituto de Investigación Sanitaria de Santiago (IDIS), Complexo Hospitalario de Santiago de Compostela (CHUS), 15706 Santiago de Compostela, Spain; (R.M.-P.); (M.G.-M.)
- Grupo de Medicina Xenómica (GMX), 15706 Santiago de Compostela, Spain
| | - Manuel Fidalgo-Díaz
- Departamento de Nefrología, Complexo Hospitalario Universitario de Santiago (CHUS), 15706 Santiago de Compostela, Spain;
| | - Miguel Ángel García-González
- Grupo de Xenética e Bioloxía do Desenvolvemento das Enfermidades Renais, Laboratorio de Nefroloxía (No. 11), Instituto de Investigación Sanitaria de Santiago (IDIS), Complexo Hospitalario de Santiago de Compostela (CHUS), 15706 Santiago de Compostela, Spain; (R.M.-P.); (M.G.-M.)
- Grupo de Medicina Xenómica (GMX), 15706 Santiago de Compostela, Spain
- Fundación Pública Galega de Medicina Xenómica-SERGAS, Complexo Hospitalario de Santiago de Compostela (CHUS), 15706 Santiago de Compostela, Spain
- Correspondence: ; Tel.: +34-981-555-197
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